The development of a United Nations sponsored Millennium Development Goal (MDG) relating to childhood survival contributed significantly to reducing mortality among children under 5 years old in many countries in the first years of the twenty-first century.1 The development of an independent authoritative mechanism, the Countdown to 2015 Collaboration contributed significantly to global progress towards the goals. While childhood mortality in the UK has also decreased over the past 40 years, the UK's child mortality trends and excess deaths figures compare unfavourably with many European countries.1 ,2 It is increasingly clear that the UK could do better in ensuring the best possible conditions for children to survive and thrive. Several recent publications have highlighted the extent of the problem, and stimulated responses from government and non-governmental sectors.3-7 We propose now that an independent cross-sector mechanism be set up to agree targets for reduction of UK excess child and adolescent mortality, identify gaps in knowledge, monitor progress in reaching goals and make recommendations that contribute towards improving UK child survival. In this paper, we first review the UK's performance on child and adolescent mortality compared with other wealthy countries in order to establish a baseline for future monitoring. We examine why the UK has higher child and adolescent mortality compared with some other European countries, by describing main causes and social determinants of death. Finally we explore what can be done to reduce mortality, and make recommendations to improve UK child and adolescent survival. Trends in UK and European child mortality We used data from the Organisation for Economic Cooperation and Development (OECD) for infant mortality8 and the WHO World Mortality Database for 1-19-year-olds9 to calculate centiles of child and adolescent mortality for a group of comparable wealthy countries identified as appropriate comparators for UK mortality.1 ,10 These countries are the …