WMA Declaration of Ottawa on Child Health

Adopted by the 50^th World Medical Assembly, Ottawa, Canada, October 1998,
revised by the 60^th WMA General Assembly, New Delhi, India, October 2009
and by the 71^st WMA General Assembly (online), Cordoba, Spain, October 2020

PREAMBLE

Science has now proven that to reach their potential, children need to grow up in an environment where they can thrive – spiritually, emotionally, mentally, physically and intellectually. That place must be characterized by four fundamental elements: 

• A healthy, safe and sustainable physical and emotional environment.
• the opportunity for optimal growth and development;
• adequate health services for healthy child development; and
• monitoring and research for evidence-based continual improvement into the future

Physicians know that the future of our world depends on our children. Early childhood experiences strongly influence future development, including basic learning, school success, economic participation, social citizenry, and health. In most situations, parents and caregivers are only able to provide nurturing environments with help from local, regional, national and international organizations.

The principles of this Declaration apply to all children in the world from birth to 18 years of age, regardless of race, age, ethnicity, nationality, political affiliation, creed, language, gender, sex, disease or disability, physical ability, mental ability, sexual orientation, cultural history, life experience or the socioeconomic status of the child or her/his parents or legal guardian. In all countries of the world, regardless of resources, meeting these principles should be a priority for parents, communities and governments. The United Nations Convention on the Rights of Children (1989) and National Children’s rights Charters, set out the broader rights of all children and young people, but those rights cannot exist without health. Furthermore, the United Nations Sustainable and Development Goals, especially SDG3, SDG4, SDG5, and SDG6, apply directly to the health of children and the social determinants of health. Responsibility for giving effect to the principles herein lies with the government of the region where the child is primarily domiciled. 

All children should be treated with dignity, tolerance and respect and be taught the same.

All children have the right to the highest attainable standard of physical and mental health and wellbeing.

Addressing the social determinants of health is essential to achieving equity in health and healthcare in children.

While children are generally regarded as the vulnerable groups, the most vulnerable groups of children include children with special needs, orphans, the homeless, refugees and asylum seekers, disabled, children from low-income homes and conflict zones. These groups require special consideration in all areas.

1. A healthy, safe and sustainable physical and emotional environment comprises the following elements:

• A safe and sustainable physical environment with minimum climate change, optimum ecosystem free from water, air and soil pollution and degradation;
• Urgent implementation of climate change adaptation and mitigation strategies, and age-appropriate education on climate change to achieve a better and more sustainable environment for all children;
• A safe home, a family setting, available parental care and a community that cares;
• Healthy, safe and stable families, homes, schools and communities;
• Protection from bullying and an environment that promotes positive mental health;
• Protection from discrimination based on age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor;
• Access to a safe infrastructure, including safe sanitation, transportation, and places to play;
• Protection from natural and man-made disasters;
• Protection from physical, sexual, emotional and verbal abuse and neglect;
• Prevention of exploitation in the form of child labour;
• Protection from harmful traditional practices;
• Freedom from witnessing and participating in violence and armed conflict including forced recruitment as child soldiers or into gangs;
• Protection from the harms associated with alcohol, tobacco and substance abuse, including the right to age-appropriate information.

All infants should be officially registered within one month of birth or as soon as possible to enable them to have an official identity, access to health care, social security and any other resources where identification is mandatory.

Asylum seeking children, whether accompanied or unaccompanied, should not be detained, separated from the parents and families sent back to a place where they are at risk of human rights violations.

2. The opportunity for optimal growth and development entails:

• Access to adequate healthy and nutritious food to promote long-term health development. This includes the promotion of exclusive breastfeeding, where possible, for the first six months of life as long as the mother and baby are comfortable, access to adequate safe food that satisfies dietary diversity, and protection from obesogenic environments through regulation of unhealthy and processed food and beverages;
• Promotion and encouragement of nutritional literacy, physical activity and physical education from an early age;
• Access to education from early childhood through secondary education with provisions for those without access;
• Access to age-appropriate information as it pertains to health, including the provision of evidence-based comprehensive sexuality education;
• Access to social assistance.

3. Access to the full range or appropriate and high-quality healthcare services for all stages of childhood development entails:

The best interests of the child shall be the primary consideration in the provision of health care.  The following principles of child health care must be ensured:

• Appropriate preventive, curative, rehabilitative and emergency care for mother and child;
• Prenatal and maternal care for the best possible health at birth and good postnatal care to ensure the best possible outcomes for mother and child;
• Respect for the privacy of children;
• Medical care for all children of asylum seekers and refugees;
• Specialized training necessary to enable caregivers to respond appropriately to the specific medical, physical, emotional and developmental needs of children & their families;
• Basic health care including developmental assessment, health promotion, recommended immunization, early detection of disease, access to medicines, oral and eye-health;
• Multidisciplinary (i.e. consisting of physicians, social workers, psychologists, therapists, occupational therapists, education specialists and others) and community-based mental health prevention, care and prompt referral for intervention when problems are identified;
• Priority access to emergency medical care for life-threatening conditions;
• Hospitalization when appropriate. Hospitals should provide access to parental facilities and policies for continuous parental care;
• Specialist diagnosis, care and treatment when needed;
• Rehabilitation services and supports within the community;
• Pain management and care and prevention (or minimization) of suffering;
• End of life care / Palliative care;
• Informed consent is necessary before initiating any diagnostic, therapeutic, rehabilitative, or research procedure on a child.  In the majority of cases, the consent shall be obtained from the parent(s) or legal guardian, or, in some cases, by extended family, although the wishes of a competent child should be taken into account before consent is given.  Where a child lacks competence and is able to express a view, his/her wishes should still be taken into account before consent is given. Where appropriate (e.g. reproductive health services), competent children should be allowed to consent to treatment without parental consent. In case of a life-threatening, and when competent children cannot give consent and parents/caregivers are not accessible, for treatment, consent should be presumed for life-saving treatment;
• The full range of sexual and reproductive health services for adolescents including access to abortion according to national legislation;
• Respect for the sexual and gender identity of the child. Harmful practices like genital mutilation or so-called conversion therapies must be forbidden;
• Social assistance and mechanisms to provide for universal access to health care are ensured for all particularly vulnerable children;
• The homeless, orphaned, asylum seeker, refugees and children from conflict zones should be provided with essential and emergency medical care without discrimination.

4. Monitoring & and research for evidence-based continual improvement into the future includes:

• The principles of the Declaration of Helsinki must be observed in any research study involving children as research subjects.