Why are children and adolescents not at the centre of everything we do?

One of the things about a pandemic is that suddenly there is a seemingly endless array of experts telling us about mask wearing, nutrition, infection, behaviour change, the differences between physical and social distancing, and how to preserve our mental well-being during lockdown. We have infectious disease experts, education experts, public health experts, commerce and industry experts – not to mention the social media and communication experts among them. 

One of the things about experts, however, is that for the most part what they do best is push their own agendas – and often very narrow ones. In public health, we would call this a siloed approach. You are an HIV expert, and your task is to get as much funding for HIV research and treatment as possible, and for you this is the number one health priority that you advocate for. Whether obesity and non-communicable diseases kill as many or more people every year is only peripherally your concern. Mostly this is fine because knowledge and expertise are useful and pushing an agenda has its place. 

But what happens in a pandemic, when seeing the bigger picture – and not simply your own narrow agenda – is of paramount importance. 

Having said this, pushing an agenda is normal and inevitable, and those doing it should continue doing so. But in the context of a seemingly endless array of priorities and a catastrophic lockdown, is there one thing we could perhaps use to better guide our responses – to the pandemic now, but also into the post-Covid-19 world? Is there a single issue, a single group that can be placed centre stage and whose interests be considered as primary? 

As a thought exercise, what would happen if South Africa were to place the interests of children front and centre of all policy and responses? 

Earlier this year I was part of a World Health Organisation-Unicef-Lancet Commission called A future for the world’s children? In the report, we showed how the health and rights of children and adolescents – particularly the most marginalised and vulnerable – are under immediate threat from climate change, commercial marketing of harmful products, and growing inequities. We made the case for countries putting children and adolescents at the core of their plans, their budgets and their programming, and called for a global movement for change, and one that invited children and adolescents to meaningfully engage as key stakeholders. 

In the context of the current pandemic, might focusing on children help us get our priorities right and prevent short-sighted responses to Covid-19, make government and societal response more rational and reasoned, and minimise the influence of both narrow groupings within government and corporate interests from defining the current Covid-19 response? 

What would such an approach look like? 

Six years ago, Michael Komape was at his school in Limpopo. The run-down and dilapidated pit latrine he was using was not strong enough to hold his five-year-old body and he fell into the pit of human excrement and drowned. I have reflected often on the utter horror of his last minutes of life as he screamed for help. When we put Michael right at the centre of all that we do, then we will address the horrific state of so many schools and we will not pour R57-billion into an inefficient and dying airline. 

When a provincial government plans new roads, but with children and communities at the heart of it, and explicitly sees roads primarily as connectors of communities to each other, and links to employment and health facilities, then everybody wins – even industry and the trucking industry. When we put children at the centre, effective policies and the policing of alcohol, cigarette sales and gambling advertising becomes part and parcel of our everyday actions – not just when we have a pandemic. 

When children are the lens through which we approach decisions, we would have immediately understood that lockdown meant that 9.1 million children were no longer receiving school meals. It would have meant that a coherent contingency plan would have been developed, or at the very least – as the months dragged by and we were confronted with the sheer horror of the impact of the lockdown on child hunger – it would not have taken a court case for the government to be compelled to ensure that children get a nutritious meal a day.  

This is my plaintive cry to President Cyril Ramaphosa: the most vulnerable in our society are suffering and it is getting worse. We have to put children at the centre of all that we do. Opening casinos is not as important as feeding children. Protecting teachers cannot come at any cost to children. Teachers are vital, and I am not suggesting they be sacrificed at the altar of children’s education. But currently, children are being sacrificed at the altar of teacher safety. 

This does not have to be a zero-sum game. 

The thing about children (to quote a very cliched song) is that they are our future. When we put them first, we are forced to think a little further than only the next peak in our infection. We are compelled to think of the lifetime effects of stunting, years of lost education, the school dropout rate, and entire industries being wiped out that we may never get back. And we will by definition protect teachers from infection because they are so important to our children.  

President Ramaphosa, if you were to think like this, it might presage a shift to a more decisive and authoritative leadership where you are prepared to consider the bigger picture, to make announcements that are more coherent and that perhaps appear less arbitrary, and even provide you with the steeliness to resist the pressures from those with narrow agendas (be they corporate interests or unions from without, or cabinet ministers from within). 

If you are not able to do this, our children (and by extension all of us) will be carrying the most unbearable burden across the next generation. DM/MC

Professor Mark Tomlinson is co-director of the Institute for Life Course Health Research in the Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University.