Tanya Doherty, Asha George and Mark Tomlinson

This article reviews the state of well-being of South Africa’s children across a number of indices, including heath, education and preparedness for the impact of global warming. Despite South Africa being a signatory to the UN’s Sustainable Development Goals we are failing when it comes to our children.

Some say that this is the best time to be alive given the remarkable progress made in health and well-being since 1990. However, we face new challenges that threaten the progress of the past two decades: The Covid-19 pandemic, the unprecedented dangers from climate disruption and unregulated commercial actors. The WHO-UNICEF-Lancet Commission “A Future for the World’s Children”[1] (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32540-1/fulltext#seccestitle60) is an urgent clarion call to redefine how we think and advocate for children and young people.

The Commission places children and young people at the centre of the Sustainable Development Goals (SDGs) as a strategic opportunity to catalyse progress across multiple fronts. After all, healthy children living in an enabling environment that allows them to meet their developmental potential is the greatest resource a country has.

In galvanizing action to secure a better future for children and young people, the Commission co-chaired by Helen Clark, former Prime Minister of New Zealand and former Administrator of the UN Development Programme, and Dr Awa Coll-Seck, Minister of State in Senegal, calls attention to several critical areas with suggested actions for countries. As commissioners from South Africa, we provide some examples of how South Africa performed.

The commission developed a new “flourishing index” (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32540-1/fulltext#figures) which assessed children’s health, education, growth and experiences of violence. It also created a sustainability index which ranked countries based on their excess greenhouse gas emissions. Strikingly, no country did well on sustainability, flourishing and the absence of inequity (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32540-1/fulltext#seccestitle590).

All three are essential for securing the future of children and young people.  The interactive map in the report (https://www.thelancet.com/infographics/child-health) shows that the poorest countries have a long way to go towards enabling children to live healthy lives, but wealthier countries threaten the future of all children through carbon pollution, which does not adhere to country borders,  and is on course to cause runaway climate change and environmental disaster.

 Measuring child flourishing and future environmental threats: If we revert to business as usual post-Covid-19 there is a 93% chance that global warming will exceed 4 degrees Celsius by 2100, with catastrophic consequences. Stopping greenhouse gas emissions as quickly as possible is essential to ensure a liveable planet for generations to come. South Africa stands out as a unique example of a country that performed poorly across both metrics (child flourishing and sustainability), ranking 127th in the world for child flourishing measures– while being a large emitter of CO2 (ranking 150th out of 180 countries) – on track to exceed its 2030 CO2 target by 197%.

The elements driving the low flourishing index score include persistently high levels of poverty, food insecurity and lack of access to basic services, all of which have worsened during the Covid-19 lockdown. Despite being an upper middle-income country, 59% of children in SA live in households with a monthly income below the national poverty line (monthly per capita income less than R1 183 in 2018 rands) and 31% of households still do not have access to safe sanitation facilities. Although school attendance is high (90% of children aged 7-16 years), quality of education is poor with only 34% of lower secondary school children having a minimum proficiency in Maths, and 78% of children at the end of Grade 4 not being able to read for meaning. Added to this is a completely disrupted 2020 academic year which has created enormous gaps in learning for the majority of children in the country. South Africa also has an intractably high stunting rate of 27% of children under 5, contributing to learning challenges and consequent poor earning potential. Young women and girls also experience extremely high levels of gender-based and intimate partner violence which have escalated over the past several months. These indicators captured in the flourishing index highlight the enormous gaps that remain for children and young people in South Africa.

On the environmental side, South Africa’s high carbon emissions are driven by the heavy reliance on coal for energy and heavy industry and the country is already experiencing the impact of climate change through severe drought conditions. Halting further emission increases will require proactive implementation of new policies allowing for renewable energy sources to contribute to national energy production. Improving the health and wellbeing of children in South Africa today should not come at the expense of eroding the environment for future generations of children.

Harmful commercial marketing: Corporations have massive power and are often richer than governments (69 of the 100 richest entities on earth are corporations, not governments).  On this continent, children face increasing exposure to commercial advertising and social media promoting inappropriate foods, alcohol, tobacco and gambling. The increase of harmful marketing directed at children is contributing to an 11-fold increase in childhood obesity. Corporate self-regulation has failed miserably and we require new global frameworks to control harmful marketing targeted to children and protection of their digital data. Large companies that dominate the food and beverage environment have become more widespread in low and middle income settings such as South Africa and have been implicated in rising obesity (https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001253) – with 13% (https://www.unicef.org/southafrica/media_22345.html) of children under five being overweight. Companies manufacturing breast milk substitutes contravene the government’s regulations routinely (http://blogs.sun.ac.za/iplaw/files/2013/12/ZAF-2012-Regulations-relating-to-foodstuffs-for-infants-and-young-children-R.-No.-991-of-2012_0.pdf) with inappropriate marketing and sponsorship(http://www.samj.org.za/index.php/samj/article/view/12787). Marketing of breast milk substitutes is one of the reasons for the low breastfeeding rates. In South Africa, 41% (https://www.unicef.org/southafrica/media_22345.html) of infants six to eight months of age aren’t being breastfed and this is likely to have worsened due to maternal-newborn separation in hospitals related to Covid-19 transmission fears. The government needs to be more stringent about enforcing existing legislation and addressing inadequate maternity protection which makes it hard for working women to continue breastfeeding. More efforts are required to create enabling environments to make it easier to follow healthy diets. Stronger regulation of big food companies is also needed.

Involvement of children: The oft repeated phrase ‘Nothing for us without us’ is central for children and young people. Their contributions lead to improved social cohesion and more egalitarian communities. It is their future and they must have their voices heard and hold adults accountable for the state of the planet bequeathed to them.

Benefit costs from the SDGs: Intervening early not only is cost-effective but also reaps high development rewards for future generations and society as a whole. The Commission report estimates a funding gap of $195 per person to unlock economic, development and health benefits. This is affordable and trivial compared to other expenditures made by governments and corporations.

Multi-sectoral action: No one sector is going to solve the problem. Sectors beyond health and education must be involved to catalyse progress. Municipalities also need to be strengthened, as it is robust local governments that connect households and communities to national initiatives. The report recommends the creation of a cross-cutting government ministry to co-ordinate actions across sectors (such as transport, housing, social services, education, agriculture and trade) and a greater focus on ‘pro-child’ policies in all sectors.

Leadership: Courageous leadership is called for at all levels. Child well-being is often delegated to smaller departments, bundled with disability and women’s issues.  This must change.

Data gaps:  No country reported on more than 70% of child related SDG indicators, while many reported on less than half.  If progress is to be made, good data allowing the accurate tracking of child and country progress is essential. South Africa has reported on 48% of the child-related SDG indicators since 2015 resulting in large data gaps hampering the ability to monitor progress and hold stakeholders to account.

Focussing on what is needed for children now is not enough, we urgently need to be forward thinking and make changes to protect the planet for future generations of children. The health and rights of children and adolescents – particularly the most marginalised and vulnerable – are under immediate threat from the indirect effects of Covid-19, climate change, commercial actors, and growing inequities. This Commission makes a robust case for a better future, by constructing a common future in a polarising world, by confronting corporate actors, and by calling for the more effective participation of young people.  A new global movement that calls for strong, unified action today is the only way to promote children’s healthy growth and development and ensure their rights are protected.

Written by: Prof Tanya Doherty (1,2), Prof Asha George (2) and Prof Mark Tomlinson (3)

  • Health Systems Research Unit, South African Medical Research Council and School of Public Health, University of the Western Cape
  • School of Public Health, University of the Western Cape
  • Institute for Life Course Health Research, Department of Global Health, Stellenbosch University
  1. Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, et al. A future for the world’s children? A WHO-UNICEF-Lancet Commission. The Lancet 2020; 395(10224).