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Pandemic impact ‘tip of the iceberg’ after years of neglecting child mental health

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A seven-year-old child looks out the window in Istanbul, Turkey, during the COVID-19 emergency. Closure of schools, disruption of health services and suspension of nutrition programmes, due to the coronavirus pandemic, have affected hundreds of millions of children globally. Photo: UNICEF

COVID-19 has taken a toll on the mental health of children and young people, and impacts could be felt for many years to come, UN children’s agency, UNICEF, warned on Tuesday.

Even before the crisis, children and youth were already carrying the burden of mental health conditions and without significant investment in addressing them, according to the latest edition of its flagship report, the State of the World’s Children.

Globally, more than one in seven adolescents aged 10–19 is estimated to live with a diagnosed mental disorder, while almost 46,000 die annually from suicide, which is among the top five causes of death for this demographic.

Yet wide gaps persist between mental health needs and mental health funding, with only around two per cent of government health budgets going to mental health spending.

‘Tip of the iceberg’

The past 18 months have been hard on children, said Henrietta Fore, the UNICEF Executive Director.

“With nationwide lockdowns and pandemic-related movement restrictions, children have spent indelible years of their lives away from family, friends, classrooms, play – key elements of childhood itself,” she said.  

“The impact is significant, and it is just the tip of the iceberg. Even before the pandemic, far too many children were burdened under the weight of unaddressed mental health issues.”

Ms. Fore regretted that too little government investment is being allocated to address these critical needs. “Not enough importance is being placed on the relationship between mental health and future life outcomes,” she said.

Lockdowns and losses

Preliminary findings from a UNICEF-backed study of children and adults in 21 countries, reveal the extent of the pandemic’s toll.  On average. one in five young people said they often feel depressed or have little interest in doing things.

As the pandemic enters a third year, the impact on children and young people’s mental health and well-being continues to weigh heavily, the agency stated.

Worldwide, at least one in seven children has been directly affected by lockdowns, and some 1.6 children have suffered some loss of education, according to latest data.

Angry and afraid

Many children said they feel afraid, angry and worried about the future, due to the disruptions in their routines, education and recreation, as well as concern surrounding family income and health.

An online study in China in early 2020, cited in the report, revealed that one-third of respondents reported feeling scared or anxious.  

Diagnosed mental disorders can significantly harm the health, education, life outcomes and earning capacity of children and young people.

While the impact on their lives cannot be calculated, UNICEF said new analysis from the London School of Economics estimates that mental disorders are costing countries nearly $390 billion a year in lost contribution to their economics.

Invest in change  

The State of the World’s Children report calls for governments and their partners to promote mental health for all children, adolescents and caregivers, and also to protect those in need of help while caring for the most vulnerable.

“Mental health is a part of physical health – we cannot afford to continue to view it as otherwise,” said Ms. Fore. “For far too long, in rich and poor countries alike, we have seen too little understanding and too little investment in a critical element of maximizing every child’s potential. This needs to change.”

Recommendations include urgent investment in all sectors, not just health, and scaling up evidence-based interventions, including parenting programmes that promote responsive and nurturing caregiving. Schools also should support mental health through quality services and positive relationships.

UNICEF also advocates for breaking the silence surrounding mental illness by addressing stigma, promoting better understanding of the issues, and taking the experiences of children and young people seriously.

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Health & Wellness

COVID-19 deaths at lowest level in nearly a year

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A thermometer gun is used to take a boy's temperature in Sri Lanka. © UNICEF/Chameera Laknath

Although COVID-19 deaths continue to decline, vaccine inequity persists, the head of the World Health Organization (WHO) said on Wednesday, again calling for greater support for developing countries.

Agency chief Tedros Adhanom Ghebreyesus reported that the death toll from the disease is now at its lowest level in almost a year. 

“But it’s still an unacceptably high level – almost 50,000 deaths a week, and the real number is certainly higher,” he said, speaking during the regular WHO briefing from Geneva. 

“Deaths are declining in every region except Europe, where several countries are facing fresh waves of cases and deaths.  And of course, deaths are highest in the countries and populations with the least access to vaccines.” 

Tedros appealed for global cooperation. “Countries that continue to roll out boosters now are effectively preventing other countries from vaccinating their most at-risk populations,” he said. 

Missing the mark 

As of Wednesday, there were more than 238 million COVID-19 cases worldwide, and more than 4.8 million deaths. 

WHO had previously pushed governments to vaccinate 10 per cent of their populations by the end of September, a target which 56 nations missed, most of them in Africa. 

Tedros said even more countries are at risk of missing the 40 per cent target to be achieved by the end of the year.  Three countries – Burundi, Eritrea and the Democratic People’s Republic of Korea – have yet to start vaccinations. 

 “About half of the remaining countries are constrained by supply. They have a vaccination programme underway, but don’t have enough supply to accelerate enough to reach the target,” he said. 

Tedros urged countries and companies that control global vaccine supply to prioritize distribution to the COVAX solidarity initiative and the African Vaccine Acquisition Trust (AVAT). 

Meanwhile, WHO and partners are working with other countries, such as those affected by fragility or conflict, to strengthen technical and logistical capacity for vaccine rollout. 

“With aggressive and ambitious action, most of these countries can still reach the 40% target by the end of this year, or be on a clear pathway to reaching it.” 

Crisis in Tigray 

Tedros also addressed the escalating crisis in northern Ethiopia, where a nearly year-long war in the Tigray region has left up to seven million people in urgent need for food and other assistance. 

The conflict has spilled over into neighbouring Afar and Amhara, further increasing needs and complicating response efforts. Aid is not reaching the area “at anywhere close to the levels needed”, he said, and communications, electricity, other basis services remain cut off. 

WHO and partners are calling for unfettered access to the affected regions, as the lives of millions of people are at stake, Tedros told journalists. 

“People with chronic illnesses are dying due to lack of both food and medicine. Nearly 200,000 children have gone without critical vaccinations,” he said   

“When people do not have enough food, they are more susceptible to deadly diseases, as well as the threat of starvation, and that’s what we’re now seeing in Tigray.”

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Global health community prescribes climate action for COVID recovery

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Street scene in India. © UNICEF/Vinay Panjwani

Ambitious national climate commitments are crucial for States to sustain a healthy, green recovery from the COVID-19 pandemic, according to a new UN health agency report launched on Monday in the lead-up to the COP26 climate change conference in Glasgow, Scotland.

Based on a growing body of research confirming numerous and inseparable links between climate and health, the World Health Organization’s (WHO) COP26 Special Report on Climate Change and Health spells out that transformational action in every sector, from energy, transport and nature to food systems and finance is needed to protect people.

The COVID-19 pandemic has shone a light on the intimate and delicate links between humans, animals and our environment”, said WHO chief Tedros Adhanom Ghebreyesus. “The same unsustainable choices that are killing our planet are killing people”.

An urgent call

WHO’s report was launched at the same time as an open letter, signed by over two thirds of the global health workforce – 300 organizations representing at least 45 million doctors and health professionals worldwide – calling for national leaders and COP26 country delegations to step up climate action. 

“Wherever we deliver care, in our hospitals, clinics and communities around the world, we are already responding to the health harms caused by climate change”, the letter from the health professionals reads.

“We call on the leaders of every country and their representatives at COP26 to avert the impending health catastrophe by limiting global warming to 1.5°C, and to make human health and equity central to all climate change mitigation and adaptation actions”.

Fossil fuels ‘killing us’

Both the report and open letter come as unprecedented extreme weather events and other climate impacts are taking a rising toll on everyone.

Heatwaves, storms and floods have taken thousands of lives and disrupted millions of others while also threatening healthcare systems and facilities when they are needed most, according to WHO.

Changes in weather and climate are threatening food security and driving up food-, water- and vector-borne diseases, such as malaria, while climate impacts are also negatively affecting mental health.  

“The burning of fossil fuels is killing us. Climate change is the single biggest health threat facing humanity”, states the WHO report. And while no one is safe from the health impacts of climate change, “they are disproportionately felt by the most vulnerable and disadvantaged”.

Climate actions far outweigh costs

Meanwhile, air pollution, primarily the result of burning fossil fuels, which also drives climate change, causes 13 deaths per minute worldwide, according to WHO. 

The report states clearly that the public health benefits from implementing ambitious climate actions far outweigh the costs. 

“It has never been clearer that the climate crisis is one of the most urgent health emergencies we all face”, said Maria Neira, WHO Director of Environment, Climate Change and Health.

“Bringing down air pollution…would reduce the total number of global deaths from air pollution by 80 per cent while dramatically reducing the greenhouse gas emissions that fuel climate change”, she pointed out.

Dr. Neira added that a shift to more nutritious, plant-based diets “could reduce global emissions significantly, ensure more resilient food systems, and avoid up to 5.1 million diet-related deaths a year by 2050”.  

Call to action

Although achieving the Paris Agreement on climate change would improve air quality, diet and physical activity – saving millions of lives a year – most climate decision-making processes currently do not account for these health co-benefits and their economic valuation.  

Tedros underscored WHO’s call for all countries to “commit to decisive action at COP26 to limit global warming to 1.5°C – not just because it’s the right thing to do, but because it’s in our own interests”, and highlighted 10 priorities in the report to safeguard “the health of people and the planet that sustains us.”

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Health & Wellness

World misses most 2020 mental health targets

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At a time when the COVID-19 pandemic is highlighting a growing need for mental health support, there has been a worldwide failure to provide people with the services they need, a report by the World Health Organization (WHO) has concluded.

Released on Friday, the latest edition of the Mental Health Atlas ‘paints a disappointing picture, which shows that increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that are aligned with needs.

‘Extremely concerning’

“It is extremely concerning that…good intentions are not being met with investment,” Tedros Adhanom Ghebreyesus, Director-General of the WHO said.

“We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health because there is no health without mental health.”

 “Investments in mental health data and in strengthening services are needed so countries can build back better post COVID-19,” Dr. Tarun Dua, WHO Unit Head, Department of Mental Health and Substance Use, said at the release of the report in Geneva.

The cost of low investment in community-based health services is too high, she added, stating that mental, neurological and substance abuse services were the most disrupted health services during the pandemic.

“COVID-19 has provided us with a new opportunity to reflect on services, their equitable distribution and prevention programmes, so it’s an opportunity to build back better…Lost productivity costs a trillion dollars a year, so we should be investing, as for every dollar invested the return is five dollars”, added Dr. Fahmy Hanna, from WHO’s Department of Mental Health and Substance Use.

2020 targets missed

According to the report, which includes data from 171 countries, none of the targets for effective leadership and governance for mental health, provision of mental health services in communities, mental health promotion and prevention, or targets for strengthening of information systems, were close to being achieved.

In 2020, just 51 per cent of WHO’s 194 Member States reported that their mental health policy or plan was in line with international and regional human rights instruments, way short of the 80 per cent target.

And only 52 per cent of countries met the target relating to mental health promotion and prevention programmes, also well below the 80 per cent target.

The only 2020 target met was a reduction in the rate of suicide by 10 per cent, but even then, only 35 countries said they had a stand-alone prevention strategy, policy or plan, the report stated.

Massive inequalities 

Although gaps exist globally, there has been steady progress seen in the adoption of policies, plans and laws, as well as improvements in capacity to report regularly across years on a set of core mental health indicators, the report found.

Despite this, the  percentage of government health budgets spent on mental health has scarcely changed during the last years, still hovering around two per cent.

The Mental Health Atlas 2020 also shows massive inequalities in the availability of mental health resources and their allocation between high- and low-income countries and across regions.

More encouraging was the increase in countries reporting mental health promotion and prevention programmes, from 41 per cent of Member States in 2014 to 52 per cent in 2020.

Decentralized care is slow

The decentralization of mental health care to community settings has long been recommended by WHO.

However the report found that more than 70 per cent of total government expenditure on mental health was allocated to mental hospitals in middle-income countries, compared with 35 per cent in high-income countries.

This indicates that centralized mental hospitals and institutional inpatient care still receive more funds than services provided in general hospitals and primary health-care centres in many countries, the report said.

New targets for 2030

The global targets reported on in the Mental Health Atlas are from WHO’s Comprehensive Mental Health Action Plan, which contained targets for 2020.

This plan has now been extended to 2030 and includes new targets for the inclusion of mental health and psychosocial support in emergency preparedness plans, the integration of mental health into primary health care, and research on mental health.

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