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Handbook of WMA Policies
World Medical Association D-1998-01-2009
WMA DECLARATION OF OTTAWA
ON
CHILD HEALTH
Adopted by the 50th
World Medical Assembly, Ottawa, Canada, October 1998
and amended by the 60th
WMA General Assembly, New Delhi, India, October 2009
PREAMBLE
Science has now proven that to reach their potential, children need to grow up in a place
where they can thrive – spiritually, emotionally, mentally, physically and intellectually1
. That
place must have four fundamental elements:
• a safe and secure environment;
• the opportunity for optimal growth and development;
• health services when needed; and
• monitoring & research for evidence-based continual improvement into the future2
.
Physicians know that the future of our world depends on our children: their education,
their employability, their productivity, their innovation, and their love and care for one
another and for this planet. Early childhood experiences strongly influence future
development including basic learning, school success, economic participation, social
citizenry, and health3
. In most situations, parents and caregivers alone cannot provide
strong nurturing environments without help from local, regional, national and international
organi-zations1
. Physicians therefore join with parents, and with world leaders to advocate
for healthy children.
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, disease or disability, physical ability, mental ability, sexual orientation, cultural
history, life experience or the social standing of the child or her/his parents or legal guard-
ian. 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) sets out the wider rights of all children and young people,
but those rights cannot exist without health.
GENERAL PRINCIPLES
1. A place with a safe and secure environment includes:
a. Clean water, air and soil;
b. Protection from injury, exploitation, discrimination and from traditional practices
prejudicial to the health of the child, and
D-1998-01-2009 New Delhi
Child Health (Ottawa)
c. Healthy families, homes and communities
2. A place where a child can have good health and development offers:
a. Prenatal and maternal care for the best possible health at birth
b. Nutrition for proper growth, development and long-term health
c. Early learning opportunities and high quality care at home and in the community
d. Opportunities and encouragement for physical activity
e. Affordable & accessible high quality primary & secondary education
3. A full range of health resources available to all means:
a. The best interests of the child shall be the primary consideration in the provision of
health care;
b. Those caring for children shall have the special training and skills necessary to
enable them to respond appropriately to the medical, physical, emotional and
developmental needs of children & their families
c. Basic health care including health promotion, recommended immunization, drugs
& dental health
d. Mental health care and prompt referral to intervention when problems identified
e. Priority access to drugs for life- or limb-threatening conditions for all mothers and
children
f. Hospitalization only if the care and treatment required cannot be provided at home,
in the community or on an outpatient basis
g. Access to specialty diagnostic and treatment services when needed
h. Rehabilitation services and supports within community
i. Pain management and care and prevention (or minimization) of suffering
j. Informed consent is necessary before initiating any diagnostic, therapeutic, re-
habilitative, 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 ex-
tended family, although the wishes of a competent child should be taken into ac-
count before consent is given.
4. Research4 & monitoring for continual improvement includes:
a. All infants will be officially registered within one month of birth
b. All children will be treated with dignity and respect
c. Quality care is ensured through on-going monitoring of services, including
collection of data, and evaluation of outcomes
d. Children will share in the benefits from scientific research relevant to their needs
e. The privacy of a child patient will be respected
Handbook of WMA Policies
World Medical Association D-1998-01-2009
1
Irwin LG, Siddiqi A, Hertzman C. “Early Child Development: A Powerful Equalizer. Final Re-
port”. World Health Organization Commission on the Social Determinants of Health June 2007
2
WHO Commission on Social Determinants of Health (Closing the Gap in a Generation) 2008
3
Canadian Charter for Child and Youth Health
4
Proposed WMA statement on ethical principles for medical research on child subjects
* Please refer the background document for specific principles.