World Bank must define life expectancy, say international public health experts

Oct 25 2013

The World Bank must define life expectancy, its key poverty indicator, as starting at the time of conception and not at the time of birth if millions of lives are to be saved from injury or death. International public health experts, writing in the Journal of the Royal Society of Medicine, said that definitional oversight, in which the life of the child is inadvertently cut into two, ‘inside’ and ‘outside’ the womb, covers up risks to the fetus and is particularly unfair to children born in areas increasingly at risk to disasters and already disadvantaged by poverty, hunger and social deprivation. This segmented definition, said the authors, should be replaced by a new inclusive way of thinking about ‘the unborn child’.

The World Health Organisation has estimated that there are 200 million plus conceptions globally each year, mostly among disadvantaged groups in disadvantaged areas. The first nine months of life are vulnerable to risks, not just medical but employment, agricultural, security, energy and climate risks. Lead author, Dr Bruce Currey, of the Institute of Social and Preventative Medicine, University of Geneva, said: “Social and environmental risks and hazards affecting mother and baby during pregnancy may reduce the resilience of the child in the next stages of life’s journey.” He continued: “Until now, the nine months between conception and birth are being ignored in the UN disaster and climate change discourse.”

Risks to the unborn infant have a potentially massive global impact. The consequent mortality and disability-adjusted life year burden resulting from mishaps to the estimated 200 million plus pregnancies each year is so large that it cannot be comprehended. In contrast the circa 30,000 people who die globally from natural disasters represent only a very small proportion of the unnecessary deaths of unborn children in the world.

Dr Currey said: “To prevent this global toll and to begin to reduce the reality of risks to the unborn infant, the medical, health and midwifery professions must together advocate concerted action to fill the nine month gap – ignored by so many organisations and policy makers.” He added: “This challenges us to accept a very broad concept of integrated health, drawing from expertise far outside the traditional medical specialties. On the one hand, medicine’s wider role must reach out to embrace economists, engineers and climatologists. On the other hand economists, engineers and climatologists have to be persuaded by gynaecologists and obstetricians to see risk reduction for the unborn child and thus improved pregnancy outcomes as measurable performance indicators of their endeavours.”