Some Strategies to Reduce Risk in Chapter 4. The same organizing format followed in that chapter is followed here. The question of how to decide what combination of those risk factors should be given priority for any given level of resource availability is considered on page 139 CHILDHOOD UNDERNUTRITION The strategy of primary health care was adopted by the World Health Assembly in 1977 and outlined further in the 1978 Declaration of Alma-Ata on Health for All ( 24). The dec laration encouraged governments to strive toward attaining Health for All by ensuring, at a minimum, the following activities: education concerning prevailing health problems, their prevention and control; promotion of food supply and good nutrition; safe water and basic sanitation; maternal and child health care which included family planning immunization against major infectious diseases; prevention and treatment of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs Primary health care emphasized programmatic areas rather than diseases, and encouraged community and individual self-reliance and participation, an emphasis on prevention, and a multisectoral approach. Subsequently, the concept of"selective primary health care"was proposed to allow for the scarcity of resources available to achieve health for all. It involved defining strategies focusing on priority health problems(including infant and child mortality), using interven- tions that were feasible toimplement, of low cost, and with proven efficacy(25, 26). UNICEF's GOBI strategy of 1982 emerged from this. At its foundation were four child health inter- ventions which met the above criteria and which were considered to be synergistic-growth monitoring(G), oral rehydration therapy for diarrhoea(O), the promotion of breastfeeding (B)and childhood immunizations( D). Birth spacing/family planning(F), food supplemen tation(F)and the promotion of female literacy(F)were added subsequently( GOBl-FFF) There has been subsequent analysis and discussion of the extent to which the specific interventions can be integrated into primary health care, and whether strategies should be nodified in view of new knowledge and changing circumstances. However, concern with ensuring that child health strategies are based on feasible and affordable interventions that are synergistic and of proven effectiveness -has remained. This chapter builds on that tradition by providing information on the costs and effects of selected interventions target ing key risk factors affecting the health of children. The results not only identify a group of interventions that are very cost-effective, but also illustrate how information on the costs and effectiveness of selected interventions can provide useful insights that can be used to re-assess, from time to time, the need to modify current approaches in view of changing The focus is on interventions aimed primarily at the risk factors identified in Chapter 4 rather than all possible child health interventions. We have selected some interventions that can be delivered on a population-wide basis and some that focus on individuals, to illustrate how the two approaches interact. Childhood immunizations have not been in- cluded because they do not respond to one of the major risk factors of Chapter 4, and because it is already widely accepted that they are cost-effective(28).The fact that interven- tions are not included here, therefore, should not be taken to imply that they are not cost ettectiveSome Strategies to Reduce Risk 109 in Chapter 4. The same organizing format followed in that chapter is followed here. The question of how to decide what combination of those risk factors should be given priority for any given level of resource availability is considered on page 139. CHILDHOOD UNDERNUTRITION The strategy of primary health care was adopted by the World Health Assembly in 1977 and outlined further in the 1978 Declaration of Alma-Ata on Health for All (24). The Dec￾laration encouraged governments to strive toward attaining Health for All by ensuring, at a minimum, the following activities: education concerning prevailing health problems, their prevention and control; promotion of food supply and good nutrition; safe water and basic sanitation; maternal and child health care which included family planning; immunization against major infectious diseases; prevention and treatment of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs. Primary health care emphasized programmatic areas rather than diseases, and encouraged community and individual self-reliance and participation, an emphasis on prevention, and a multisectoral approach. Subsequently, the concept of “selective primary health care” was proposed to allow for the scarcity of resources available to achieve health for all. It involved defining strategies focusing on priority health problems (including infant and child mortality), using interven￾tions that were feasible to implement, of low cost, and with proven efficacy (25, 26). UNICEF’s GOBI strategy of 1982 emerged from this. At its foundation were four child health inter￾ventions which met the above criteria and which were considered to be synergistic – growth monitoring (G), oral rehydration therapy for diarrhoea (O), the promotion of breastfeeding (B) and childhood immunizations (I). Birth spacing/family planning (F), food supplemen￾tation (F) and the promotion of female literacy (F) were added subsequently (GOBI-FFF) (27). There has been subsequent analysis and discussion of the extent to which the specific interventions can be integrated into primary health care, and whether strategies should be modified in view of new knowledge and changing circumstances. However, concern with ensuring that child health strategies are based on feasible and affordable interventions – that are synergistic and of proven effectiveness – has remained. This chapter builds on that tradition by providing information on the costs and effects of selected interventions target￾ing key risk factors affecting the health of children. The results not only identify a group of interventions that are very cost-effective, but also illustrate how information on the costs and effectiveness of selected interventions can provide useful insights that can be used to re-assess, from time to time, the need to modify current approaches in view of changing knowledge and circumstances. The focus is on interventions aimed primarily at the risk factors identified in Chapter 4 rather than all possible child health interventions. We have selected some interventions that can be delivered on a population-wide basis and some that focus on individuals, to illustrate how the two approaches interact. Childhood immunizations have not been in￾cluded because they do not respond to one of the major risk factors of Chapter 4, and because it is already widely accepted that they are cost-effective (28). The fact that interven￾tions are not included here, therefore, should not be taken to imply that they are not cost￾effective