A Mighty Purpose
Page 33
The child survival revolution continues today, even without a galvanizing leader. There are many organizations and individuals—including the staff of UNICEF and its vast network of national committees and on-the-ground NGO and community partners—who work assiduously to save and protect the youngest inhabitants of our planet. Donors and volunteers and governments across the globe steadfastly support this critical effort. In recent years, the rate of decline for child mortality has, in fact, accelerated. UNICEF has recently made the issue more of a priority, and donor and partner interest has been somewhat reignited. Amid copious stories of waste and scandal and corruption in the UN system and a miasma of skepticism about foreign aid and development, the campaign against child mortality stands out as one of the world body’s most striking successes.
The most important people in all this, of course, are children and their parents. A lesson Grant’s father, John Black Grant, instilled in many of his medical students and in his own son: any effort to help people must grow out of their community and involve their participation—or it will not work. Jim Grant was erroneously accused of being “top-down” and of callously telling parents what they should do and how they should do it. But his ultimate aim was not to impose his or anyone else’s will on mothers and fathers in the developing world—it was, quite simply, to empower them to save their own sons and daughters. Regardless of “top-down” or “bottom-up,” all parents—no matter where they live—want the same thing: for their children to survive and grow up and have a decent shot at life. Why should this be denied to any parent? Such an assurance doesn’t seem like too much to ask, yet for millions of families beyond the reach of vaccines, clean water, education, and the most basic health care, it still is.
The road toward human progress runs through a clamoring gauntlet of skeptics. Some will say that international development is a flawed process, riddled with failure and conflicting agendas. Many past efforts have done more harm than good. Aid fosters dependency. Top-down prescriptions risk unseen perils (especially without local buy-in). Poverty cannot be fixed or solved. It is not like putting a man on the moon. All of that, to some extent, is true. But complexity can also be a cop-out. As Peter Adamson points out, the child survival revolution is really about “taking up the slack.” There is no good reason that any child anywhere should die of a preventable disease or grow up illiterate or be physically and mentally stunted for lack of proper nourishment. There are ills in this world that can be stamped out, that can be fixed—Jim Grant proved it. His grasp of international aid and poverty was extensive, but his most basic belief—the belief that fueled nearly everything he did—was a simple one: the benefits of science and society should be made available to the many, not just the few.
One question that quivers on the lips of several former UNICEF staff: What if Jim Grant had lived another ten or fifteen years? He was in the midst of his crusade when cancer took him—he had many other plans. What else would have been achieved had he been allowed to carry on? A few have suggested that polio would now be eradicated, measles consigned to history books, child mortality reduced to an even lower rate than it is now. Maybe the world would have already met the fourth Millennium Development Goal—to reduce child mortality by two-thirds, based on 1990 levels (we are currently not on track to reach the target, despite recent gains). All speculation, of course, but it’s impossible not to wonder about the what-ifs. Another question that has been bandied about: What would Jim Grant say now?
Jon Rohde attempted to answer this during a lecture he gave at George Washington University in March 2010. Somewhat indignant, his speech was also defiantly optimistic. He told the audience who Grant was, what he had done, and what lessons we could all learn from him—among them: bureaucracies can’t replace visionary leaders; precise, “doable,” time-bound goals are essential; be persistent—don’t abandon a valid program at the first sign of donor fatigue; good governance is key—Grant made children the “proof” of good governance. Then the brusque, insistent doctor told everyone what he thought Grant would be doing today. He would, said Rohde, “focus on those most left behind in the progress of the last decades … transform UNICEF back into the agency it was when he joined—known for field presence … defend the right to child survival with the same intensity we defend civil and political rights … strengthen UNICEF support for education, especially of girls.”
He would also “forge an alliance among partners” and would make “children the integrating catalyst.” Then with a jolt of incredulity, Rohde added: “What political leader today consistently stands high to speak for children—their needs, rights and futures?… Where do we see that today? Why have they forgotten such a basic lesson? Jim would put children back on the political agenda.”
Indeed, were he here, Jim Grant would likely be decrying the continuing global scandal that still takes place every single day—17,000 children under age five dying needlessly today, tomorrow, and the day after that. Dying even though the vaccines and medicines and other means to protect them readily exist. That number is less than half of what it was when Grant took the helm of UNICEF in 1980. But in the twenty-first century, that’s not good enough. It’s a statistic of shame. We should no longer be keeping tabs on the number of children who die each day because we have not bothered to save them.
“Jim was a phenomenon,” says Dr. Bill Foege. “Now we take it for granted that the number of child deaths under age five has come down dramatically—it’s still far too high, and it’s still obscene, but it’s come down so much in the last few decades. Who thanks Jim Grant for that? But they should.”
Acknowledgments
This book would not have happened without the generosity and commitment of a large number of people.
My wife, Kathy, urged me to pursue this idea and has steadfastly supported me from the beginning. For several years, she put up with my ridiculous schedule and took care of our young kids on countless nights and weekends to give me time (and on some weekends took our son and daughter to her father’s place). I certainly would not have seen it through without her. I am also grateful for the warm encouragement provided by my parents and father-in-law.
My agents, Larry Weissman and Sascha Alper, believed in this book, and they believed in me. They guided me as I wrote my proposal and stuck with me throughout the entire process. I could not have asked for better or more devoted advocates.
Judith Gurewich, of Other Press, immediately understood the importance of this book and put her publishing house firmly behind it. Her passion and vision—and incisive editing—have made the book stronger and more nuanced. I feel deeply fortunate to have a publisher who is so personally invested in my project. I have also been lucky to work with a top-notch staff at Other Press, including Marjorie DeWitt, Lauren Shekari, Jessica Greer, Terrie Akers, and Yvonne Cárdenas.
I interviewed eighty-six people in the course of my reporting, many of whom proved pivotal. I am particularly grateful for the time and attention of Mary Cahill, Jon Rohde, Peter Adamson, Kul Gautam, Richard Reid, Cole Dodge, Alan Court, Abdul Mohammed, Dr. Nyi Nyi, Richard Jolly, Sheila Barry, Fouad Kronfol, Manou Assadi, John and Mehr Kahn Williams, Yohannes Tsadik, Agop Kayayan, David Haxton, Ulf Kristoffersson, and not least, Jamie and Bill Grant. The assistance offered by Ted Thomas, Marea Hatziolos, Warren Unna, and Melissa and Sarah Young was also extremely helpful.
Mary Cahill truly went above and beyond, time and again providing me with important information and connecting me with dozens of Jim Grant’s colleagues and friends; probably a third of the people I interviewed were referred by Mary. She was also a wonderful source, who helped me understand her extraordinary and indefatigable former boss. Jon Rohde, Peter Adamson, and Grant’s sons, Bill and Jamie, were all very gracious, indulging numerous interview requests and e-mails; each also read a draft of the book and provided useful and meaningful feedback.
Many other sources were hugely helpful as well, and I apologize for not mentioning them all here.
It was a great privilege to tell this story. Thank you to everyone who enabled me to do so.
A Note on Sources
Most of the information in this book is based on interviews I conducted with Jim Grant’s colleagues, friends, family members, and others. Altogether I interviewed eighty-six people, many of them multiple times. I also relied upon a wide array of original material: internal and external UNICEF reports on numerous topics; official UNICEF board records; UN and UNICEF audits; memos; schedules; trip logs; press releases; Jim Grant’s oral history; John Black Grant’s oral history; UNICEF staff oral histories; UNICEF historical accounts; speeches; correspondence; Telexes; video footage; photos; Grant’s academic, military, and citizenship documents; and his personal letters, files, and notebooks. I acquired these items from a range of sources, including the UNICEF archives, the UNICEF Web site, the UN’s online document system, and Grant’s family members (John Black Grant’s oral history was obtained from the Columbia University Center for Oral History).
UNICEF’s annual flagship publication, The State of the World’s Children (which Grant launched with Peter Adamson), was a significant source of information, particularly for the early years of Grant’s tenure. I also relied upon facts, figures, and additional information from many other UNICEF publications, including 1946–2006: Sixty Years for Children; America’s Partnership with UNICEF: A Report to the United States on the Impact of Its Contribution to UNICEF from 1985 to 1995; Promises Kept: James Grant in South Asia; the UNICEF Annual Report (numerous years); and UNICEF Staff News (the organization’s regular internal newsletter). Immunization coverage figures were provided by the World Health Organization.
Selected Bibliography
I found many books, scholarly works, news articles, and other published accounts useful in researching this book, and I have listed here those that were especially helpful. Published works that I quote directly are attributed in the body of the text. Three books were especially important: Jim Grant: UNICEF Visionary, edited by Richard Jolly and published by UNICEF; and Maggie Black’s two volumes on UNICEF history (titles provided below). I would encourage anyone who wants to learn more about UNICEF and/or aspects of the Jim Grant period not covered in these pages to read them.
BOOKS
Anderson, G. Norman. Sudan in Crisis: The Failure of Democracy. Gainesville: University Press of Florida, 1999.
Balinska, Marta A. For the Good of Humanity: Ludwik Rajchman, Medical Statesman. Budapest: Central European University Press, 1995.
Becker, Jasper. City of Heavenly Tranquility: Beijing in the History of China. Oxford, UK: Oxford University Press, 2008.
Black, Maggie. The Children and the Nations: The Story of Unicef. New York: UNICEF, 1984.
——. Children First: The Story of Unicef, Past and Present. New York: Oxford University Press, 1996.
——. The No-Nonsense Guide to International Development.
Oxford, UK: New Internationalist Publications, 2007.
Bornstein, David. How to Change the World: Social Entrepreneurs and the Power of New Ideas. New York: Oxford University Press, 2004.
Broz, Svetlana. Good People in an Evil Time: Portraits of Complicity and Resistance in the Bosnian War. New York: Other Press, 2005.
Bullock, Mary Brown. An American Transplant: The Rockefeller Foundation & Peking Union Medical College. Berkeley: University of California Press, 1980.
Cash, Richard, Gerald T. Keusch, and Joel Lamstein. Child Health & Survival: The UNICEF GOBI-FFF Program. London: Croom Helm, 1987.
Chang, Iris. The Rape of Nanking: The Forgotten Holocaust of World War II. New York: Basic Books, 1997.
Cornia, Giovanni Andrea, Richard Jolly, and Frances Stewart. Adjustment with a Human Face. Vol. 1, Protecting the Vulnerable and Promoting Growth. Oxford, UK: Clarendon Press, 1987.
Dodge, Cole P., and Magne Raundalen. Reaching Children in War: Sudan, Uganda and Mozambique. Sweden: Sigma Forlag, with the Scandinavian Institute of African Studies, 1991.
Dodge, Marilyn S. The Way It Was: Connections with Hope. Lexington, KY: CreateSpace Independent Publishing Platform, 2013.
Duarte, José Napoleón, with Diana Page. Duarte: My Story. New York: Putnam, 1986.
Farmer, Paul, Jim Yong Kim, Arthur Kleinman, and Matthew Basilico. Reimagining Global Health: An Introduction. Berkeley: University of California Press, 2013.
Fisher, Roger, and William Ury. Getting to Yes: Negotiating Agreement without Giving In. Boston: Houghton Mifflin, 1981.
Goodfield, June. The Planned Miracle. London: Cardinal, 1991.
Grant, John B. Health Care for the Community: Selected Papers of Dr. John B. Grant, edited by Conrad Seipp. Baltimore: Johns Hopkins University Press, 1963.
Huq, Mujibul. Near Miracle in Bangladesh. Bangladesh: University Press Limited, 1991.
Jolly, Richard. UNICEF (United Nations Children’s Fund): Global Governance That Works. London: Routledge, 2014.
——, ed. Jim Grant: UNICEF Visionary. Florence, Italy: UNICEF Innocenti Research Centre, 2001.
Kamm, Henry. Cambodia: Report from a Stricken Land. New York: Arcade Publishing, 1998.
Knowles, Elizabeth M. Oxford Dictionary of Quotations. Oxford, UK: Oxford University Press, 1999.
Koivusalo, Meri, and Eeva Ollila. Making a Healthy World: Agencies, Actors and Policies in International Health. London: Zed Books, 1997.
Minear, Larry. Humanitarianism Under Siege: A Critical Review of Operation Lifeline Sudan. Trenton, NJ: Red Sea Press, 1991.
Mukerjee, Madhusree. Churchill’s Secret War: The British Empire and the Ravaging of India During World War II. New York: Basic Books, 2010.
Offit, Paul A. The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis. New Haven: Yale University Press, 2005.
Oshinsky, David M. Polio: An American Story. Oxford, UK: Oxford University Press, 2005.
Rieff, David. Slaughterhouse: Bosnia and the Failure of the West. New York: Touchstone, 1995.
Sen, Amartya. Development as Freedom. New York: Anchor Books, 1995.
Shawcross, William. The Quality of Mercy: Cambodia, Holocaust and Modern Conscience. Glasgow: Fontana/Collins, 1985.
Shirer, William L. The Rise and Fall of the Third Reich: A History of Nazi Germany. New York: Fawcett Crest, 1962.
Spence, John D. The Search for Modern China. New York: Norton, 1990.
Vianello-Chiodo, Marco. Under-Soldier. Bloomington, IN: Author-House, 2012.
JOURNAL ARTICLES AND LECTURES
Bellagio Study Group on Child Survival, “Knowledge into Action on Child Survival,” Lancet 362, no. 9380 (July 26, 2003): 323–27.
Black, Robert E., Jennifer Bryce, and Saul S. Morris. “Where and Why Are 10 Million Children Dying Every Year?” Lancet 361, no. 9376 (June 28, 2003): 2226–34.
Cueto, Marcos. “The Origins of Primary Health Care and Selective Primary Health Care.” American Journal of Public Health 94 (November 2004): 1864–74.
Duffy, Jim. “John Black Grant: A Revolutionary in China.” Johns Hopkins Public Health, Spring 2005, 14–17.
Grant, James P. “A Fresh Approach to Meeting the Basic Needs of the World’s Poorest Billion.” Internationales Asienforum 9 (1978): 7–25.
——. “Jumpstarting Development.” Foreign Policy, no. 91 (June 22, 1993): 124.
Gwatkin, Davidson R. “Why Bother? GOBI-FF, Population Growth, and Human Well-Being.” Washington, DC: Overseas Development Council, 1983.
Horton, Richard. “UNICEF Leadership 2005–2015: A Call for Strategic Change.” Lancet 364, no. 9451 (December 11, 2004): 2071–74.
Hulme, David. “Lessons from the Making of the MDGs: Human Development Meets Results-Based Management in an Unfair World.” IDS Bulletin 41, no. 1 (January 2010): 15–25.
Litsios, Socrates. “John Black Grant—a 20th Century Public Health Giant.” Perspectives in Biology and Medicine 54, no. 4 (2011): 532–49.
Newell, Kenneth. “Selective Primary Health Care: The Counter Revolution
.” Social Science and Medicine 26, no. 9 (1988): 903–6.
Pincock, Stephen. “Rajanikant Arole.” Lancet, 378, no. 9785 (July 2, 2011): 24.
Quinley, John C., and Timothy D. Baker. “Lobbying for International Health: The Link between Good Ideas and Funded Programs: Bread for the World and the Agency for International Development.” American Journal of Public Health 76, no. 7 (July 1986): 793–96.
Rohde, Jon E. “Why the Other Half Dies: The Science and Politics of Child Mortality in the Third World.” Leonard Parsons Memorial Lecture. Birmingham, UK, March 15, 1982.
Sartorius, Rolf H., and Vernon W. Ruttan. “The Sources of the Basic Human Needs Mandate.” Journal of Developing Areas 23 (April 1989): 331–62.
Sen, Amartya. “Mortality as an Indicator of Economic Success and Failure.” Innocenti Lecture. Florence, Italy, March 3, 1995.
Snyder, Alison. “Carl E. Taylor.” Lancet, 375, no. 9722 (April 10, 2010): 1248.
Wisner, Ben. “GOBI Versus PHC? Some Dangers of Selective Primary Health Care.” Social Science and Medicine 26, no. 9 (1988): 963–69.