Child Health

Background and Challenges

Domestic and International Situation

The importance of protecting and improving the health of children goes without saying. Over the past few decades, child health has improved and mortality rates for young children have declined [ 1]. However, much remains to be done to further improve the health status of children. More than half of all child deaths are due to conditions that could be easily treated and prevented if access to health care and quality of life were guaranteed.

There are large disparities in child survival rates around the world, with low- and middle-income countries being the most affected. The sub-Saharan region of Africa has the highest child mortality rate in the world, in some places 15 times higher than in high-income countries. Most child deaths are preventable through immunization, proper home care, access to health services, increased breastfeeding rates, and improved nutrition. However, many life-saving interventions do not reach the world’s poorest people.

Improving survival rates is only one of many issues related to child health, and health status improvement, growth and development cannot be ignored. In 2016, 250 million children did not enjoy full physical and psychological development, which is an alarming 43% of the world’s children. Violence against children is also rampant, and by 2019, one billion children will have been affected by abuse and neglect. Children must be provided with the stable environment they need to learn and grow, including health and nutrition, protection from threats, and guaranteed opportunities. Society needs to recognize that investing in children is one of the most important things we can do to create a better future.

The following information from the World Health Organization (WHO) fact sheet provides an overview of the WHO’s policy trends.

First, let’s look at survival rates and health outcomes [2]. In 2019, 5.2 million children under the age of five died of preventable and treatable diseases, including 1.5 million in the first 11 months of life and 1.3 million in the first four years of life, with the rest being newborns born less than 28 days after birth. The most common causes of death among children under 5 years of age are premature birth-related complications, birth-related respiratory disorders/trauma, pneumonia, congenital anomalies, diarrhea, and malaria.

Second, undernutrition is associated with 45% of child deaths [3]. In 2019, 144 million children under the age of five worldwide were underdeveloped, 47 million are frail (too thin for their height), while 38.3 million are estimated to be overweight or obese. Approximately 44% of infants between 0–6 months of age are exclusively breastfed. Few children receive safe and nutritionally appropriate supplemental foods, and in most countries, less than a quarter of infants aged 6–23 months meet age-appropriate standards for dietary diversity and frequency. If all children between the ages of 0–23 months received optimal breastfeeding, it is estimated that more than 820,000 children under the age of 5 could be saved each year. Breastfeeding is associated with higher intelligence quotient (IQ), higher school attendance, and higher earnings in adulthood. If breastfeeding can improve child development and reduce health care costs, it can contribute to economic benefits not only for individual families but also at the national level.

Third, this is a focus on improving survival and health in newborns. Although neonatal deaths have declined from 5 million in 1990 to 2.4 million in 2019, children face the greatest risk of death in the first 28 days of life [4]. In 2019, 47% of under-five deaths will occur in the neonatal period, with about 1/3 of these deaths occurring on the day of birth and 3/4 occurring within the first week of life. Children who die within 28 days of birth suffer from conditions and diseases related to lack of quality care at birth and skilled care and treatment immediately after birth and in the first few days of life. Premature birth, birth complications (birth asphyxia and lack of breathing), infections, and congenital anomalies are the most common causes of neonatal deaths. Women who receive midwife-led continuity of care (MLCC), provided by internationally trained professional midwives, are 16% less likely to lose their child and 24% less likely to experience preterm birth.

The fourth is violence. Violence against children includes any form of violence against a person under the age of 18, whether by a parent or other caregiver, peer, romantic partner, or stranger. It is estimated that one billion children between the ages of 2 and 17 experience physical, sexual, or emotional violence or neglect in a single year [5]. Childhood experiences of violence are lifelong. Experiences of violence in childhood can affect lifelong health and well-being, but evidence from around the world shows that violence against children is preventable.

The fifth topic is children’s cancer. Four hundred thousand children and adolescents between the ages of 0 and 19 are diagnosed with cancer each year [6]. The most common childhood cancers are leukemia, brain tumors, lymphoma, and solid tumors such as neuroblastomas and Wilms tumors. In high-income countries, where comprehensive treatment is available, more than 80% of children will survive cancer, while in low- and middle-income countries (LMICs), cures are estimated at 15–45%. Most childhood cancers are curable with generic drugs and other treatments such as surgery and radiation therapy. Treatment of childhood cancer is cost-effective in all income settings. Avoidable deaths from childhood cancer in LMICs are due to lack of diagnosis, misdiagnosis or delayed diagnosis, barriers to receiving treatment, treatment abandonment, death from toxicity, and high recurrence rates.

Sixth, let’s look at child abuse: among children aged 2–4, three out of every four children or 3 million children suffer physical punishment or psychological violence on a daily basis [7]. Among children aged 0–17 years, 1 in 5 girls and 1 in 13 boys are victims of sexual violence.

Finally, there are various new threats including climate change, air pollution, obesity, and traffic accidents. Greenhouse gas emissions, which lead to climate change and ecosystem destruction, threaten the lives of all children. Children are vulnerable to the health effects of indoor and outdoor air pollution, which according to a 2016 report is responsible for about 7 million deaths annually. More than 250 million children are at risk of not enjoying their developmental potential. One hundred and twenty-four million children and adolescents are affected by obesity. Children are frequently exposed to commercial marketing that promotes addictive substances and unhealthy products. Road traffic accidents are the leading cause of death among children and adolescents, putting more than one billion children at risk each year.

Domestic child health issues have some similarities and some differences with global issues. Japan’s child health indicators have been compared with the OCED average, which shows a mix of relatively good and not-so-good indicators. The following is a detailed look at each of these indicators.

In terms of neonatal mortality and health status, the neonatal mortality rate in Japan is 2.1 per 1,000 live births, which is even lower than the OECD average (3.9 per 1,000 live births) [8]. On the other hand, the percentage of underweight babies is higher than the OECD average, at 9.5% compared to the OCED average of 6.5% for all births.

A survey on eating habits and physical activity shows that 8% of 15-year-olds do not eat breakfast or dinner, the lowest rate among OECD countries. In terms of exercise habits, 47% of 15-year-olds engage in regular physical activity of at least a certain intensity, which is slightly lower than the OCED average.

In terms of poverty, the child poverty rate in Japan is higher than the OCED average, reported at 13.9% in 2015 [9]. This figure has been on the rise since the 1980s. The poverty rate for single-parent families is 50.8%, which is the worst among high-income countries.

In terms of abuse, the number of child abuse cases handled by child consultations centers has been on the rise, reaching 193,780 in 2019, the highest number ever recorded [10]. The number of deaths due to abuse has been on a gradual increase since 2015, with 50 cases per year. Half of the deaths due to abuse occur in the age group of 0–1 years. The most common perpetrators are biological mothers, followed by biological fathers, multiple parents, and adoptive mothers. Regarding anxiety about school life and bullying, the percentage of students who are anxious about school life, bullying, school exam results (62% in Japan vs. 55% in the OCED average), and of those who report being a victim of bullying (22% in Japan vs. 19% in the OECD average) is slightly higher than the OECD average.

In addition, interest in mental health is increasing, and the total number of patients with mental disorders under 20 years of age rose from 117,000 in 1999 to 276,000, showing a remarkable increase in the number of patients. Schizophrenia, schizotypal disorder, and delusional disorder account for the majority of cases. In addition to the increased interest in developmental disorders such as Attention-Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder, it has also been pointed out that there has been recognition of disorders specific to childhood such as severe mood dysregulation and oppositional provocation disorder.

Finally, we will focus on medical care. As mentioned above, children who require medical care such as ventilators, gastric banding (tube feeding), and suctioning of sputum after long-term hospitalization in the NICU, etc., are called children requiring constant medical care. The number of such children doubled in 10 years to 19,712 in Japan in 2018 [11]. According to a survey conducted in 2016, 72% of the children in medical care received tube feeding at home, 62% received suction, and 20% received ventilator management.

Characteristics and Challenges

The majority of child deaths in the world occur in newborns and children aged 1–12 months, and many of these deaths are preventable by improving access to medical care and quality of life, such as premature birth, complications during childbirth (suffocation and lack of breathing during childbirth), and infectious diseases. The high percentage of low-birth-weight babies is recognized as a challenge. The number of children in medical care is also increasing due to the increase in the percentage of low-birth-weight babies and the improvement of survival rates through the advancement of medical technology, and there is a need to improve the coordination and support system for medical care, health care, welfare, etc., so that children can smoothly receive support that corresponds to their development and growth.

It has been reported that one billion children are affected by abuse and violence. It is recognized as a global problem that affects development and learning, and is believed to have a negative impact on normal development and learning. In Japan, the number of consultations on child abuse continues to increase, and the number of deaths is also increasing, making it an important issue in child health. Compared to OECD countries, the child poverty rate in Japan is comparable to the poverty rate in the U.S., especially in single-parent families, where about half of the children live in poverty.

Policy Trends

International Policy Trends

Development In the declaration of the 2030 Agenda for Sustainable Development [12], it is clearly stated that the goal is to achieve a world where all children are free from violence and exploitation. Efforts have been made to help children learn about the Sustainable Development Goals (SDGs) and acquire the knowledge necessary to realize sustainable development, including human rights, gender equality, peace and non-violence, and the concept of global citizenship. The SDGs include eliminating inequality and disparity, protecting against violence and abuse, and maintaining a sustainable environment.

Policy Trends in Japan

In response to the suggestion that social measures to ensure the sound upbringing of children are inadequate [12], the government has been strengthening measures for maternal and child health, infant health, and adolescent health through the implementation of the first phase of a national campaign called, “Healthy Parents and Children 21” in 2001, and second phase of the same campaign in 2015 [13] [14].

In December 2019, the Basic Law for Child and Maternal Health and Child Development was enacted [15]. Medical care for child rearing refers to medical care and health care that comprehensively addresses problems related to physical and mental health that arise from birth, through neonatal, infant, school age, and adolescent stages, all the way until to adulthood, and provides services related to education and welfare that are closely related to these stages [16] [17].

In February 2021, based on the provisions of the Basic Law for Child and Maternal Health and Child Development, the Cabinet approved the Basic Policy on Child and Maternal Health and Child Development [18]. In this policy, it is clearly stated that consultation and support for childbirth and childcare should be provided to both parents in order to deal with mental health of expectant and nursing mothers, including postpartum depression, and postpartum depression of fathers. As for children’s mental health, the increase in the number of patients with mental disorders among minors under 20 years old was reported in April 2019. Recommendations have been made regarding policies focusing on children’s mental health, while concrete moves will be formulated in the future.

As for children requiring medical care, support systems are being developed in local communities. The “Act on the Comprehensive Support for the Daily Life and Social Life of Persons with Disabilities and Partial Amendment of the Child Welfare Act” enacted in May 2016 stipulates that local governments are obligated to make efforts to establish a system for liaison and coordination with organizations that provide support in fields such as health, medical care, and welfare so that children requiring medical care can receive necessary support smoothly [20]. In June of the same year, the Government of Japan issued a notice to local governments on the “Further Promotion of Cooperation among Health, Medical Care, Welfare, Education, and Other Organizations in Relation to Support for Children Requiring Medical Care” to promote the establishment of a cooperative system [21].

HGPI's Initiatives

HGPI’s Activities

HGPI has positioned child health as one of the agenda items for health care policy since FY2020, and has started activities such as writing columns and holding lectures. In the first year, we wrote two columns to set the agenda. The first traced the process leading up to the enactment of the Basic Law for Child and Maternal Health and Child Development. The second column identified issues related to children’s health, focusing on the Child Death Review (CDR), a system for verifying child deaths. To date, there have been two HGPI Seminar’s on child health. In the first seminar, Dr. Masaki Sonoda introduced his efforts to promote child support for sick children. The second seminar focused on child health issues around the world.

HGPI’s Focus Areas and Mission

The Convention on the Rights of the Child, which was adopted by the United Nations in 1989 and ratified by Japan in 1994, states that four main rights should be guaranteed: the right to life, the right to education, the right to protection, and the right to participation. We would like to contribute to these rights by ensuring that children’s lives are protected, that they have access to medical care and education, that they grow up to be who they are, and that they are protected from violence and exploitation. With regard to the right to participate, we place importance on the “realization of citizen-centered health care policies,” which is also HGPI’s mission, and we would like to build policies to improve children’s health by carefully listening to the voices of the children concerned.

In addition, we would like to make effective use of our experience, knowledge, and domestic and international networks in fields that are closely related to children’s health such as mental health, reproductive health, and non-communicable diseases.

Upcoming Activities

Establishing a system that supports the physical and mental health of children, pregnant and nursing mothers, and their guardians throughout society is an urgent task for the future of Japan. As mentioned above, there are many other issues that need to be considered, such as reproduction, perinatal and newborn care, adolescent mental health, support for children in medical care, abuse, child poverty, and nutrition. In light of these social conditions, HGPI will continue to conduct research, disseminate information, and stimulate discussion among stakeholders in industry, government, academia, and the private sector in Japan and abroad in order to contribute to the healthy growth of children.

In particular, mental health is a pressing issue for children’s health in Japan, so in FY2021, we will establish an educational program to improve children’s mental health and measure the effectiveness of the educational program based on children’s voices. According to a September 2020 UNICEF (United Nations Children’s Fund) report [22], the mental well-being of children in Japan is the lowest among developed countries, and one in five children in Japan is said to have a mental health problem. However, there are limited educational opportunities for children to gain specific knowledge and skills related to mental health, and a nationwide educational program needs to be established and implemented as soon as possible. We will build and distribute education to help children increase their self-esteem, recognize their difficulties in life, recognize that it is okay to ask for help, and connect them to appropriate support. In addition, we will examine concrete measures to enable adults in the community to work together to take children’s voices seriously as children’s rights and implement mental health prevention measures.


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Last Modified: May 2021