Addressing inequalities in health outcomes especially for women and children is, perhaps, the most important challenge towards achieving sustainable health gains. Despite impressive improvements in overall indicators of health over recent decades, health inequalities within and between countries persist and, in many cases, have widened and continue to widen. At the global level, the survival gap between poor and rich children has been growing. For example, a child born in Sub-Saharan Africa in 1970 faced a risk of dying before his or her fifth birthday that was nine times greater than a child born in an industrialized country. In 1990, the base year of the Millennium Development Goals (MDGs), the same risk was 19 times greater; in 2006, it was 27 times greater. A new global movement called A Promise Renewed aims to work with countries to end all preventable child deaths and reduce the widening inequalities between countries.
Inequalities between poor and rich children within developing countries are responsible for half or more of the global under-5 mortality gap. On average, children in the poorest 20% of a developing country population are about twice as likely to die or to be malnourished as those in the better-off 20%. If the death rates of all children in developing countries could be reduced to the level currently prevailing in the best-off child population of those countries, the number of under-5 deaths could be reduced by half or more. (author introduction)