package arrived in the mail. It was from Dr. Rohde. Inside was a copy of a lecture hehad recently delivered in Birmingham, England, entitled “Why the Other Half Dies: The Science and Politics of Child Mortality in the Third World.” The majority of deaths of young children, Rohde wrote, were due to a small “handful of conditions”—diarrhea, malnutrition, pneumonia, measles. Fully half of these deaths, he estimated, could be easily prevented—not with advanced medical technology and expensive hospitals—but with a few cheap, basic, and readily available interventions. Chief among these were immunization, oral rehydration salts, and a “colorful weight card” that could help mothers chart their children’s growth and, therefore, identify and halt malnutrition. To put these remedies to use on a large scale, Rohde suggested, you have to “demedicalize” health care—put the means and power and training in the hands not of doctors, but of community health workers and parents. This was because the medical establishment was, in some cases, an obstacle. “Professionalism, international health bureaucracies and social power structures all combine in a strange mélange to ignore or even impede progress towards child health,” he argued.
He recounted in the report how a professor of pediatrics had once told him that gastroenteritis is the “bread and butter” of the pediatrician in the developing world, “and that he could not afford to eliminate so radically his basic source of income by allowing oral rehydration technology to be disseminated.”
Rohde’s opinions were greatly influenced by his friend David Morley, a British pediatrician and expert on child epidemiology who had long supported simple and preventive treatments to tackle child mortality.
Rohde made his main message clear. “The road to health, I believe, does have short cuts,” he wrote. In order to exploit those shortcuts, you have to home in on that “handful of conditions.” And in order for the shortcuts to work, the consumer (in most cases, the mother) has to be involved, and “decision makers” (heads of state, officials, and donors) have to be engaged. This argument was classic John Grant: Jim Grant’s father believed that health care could not be improved without social outreach and the buy-in of the local community. Finally, Rohde insisted, the message must be simple and easily conveyed.
The main problem, the biggest obstacle, Rohde claimed, was the absence of one key ingredient: political will.
Not all of this was news to Grant. He already knew about oral rehydration salts and immunization. And he knew, of course, that the majority of child deaths in the developing world were preventable—he had been bludgeoning people with this fact since he had started at UNICEF. But unlike Rohde or his father, Grant was not a doctor; he was a lawyer. He did not know the specifics. Though well versed in the labyrinthine annals of international aid and development, he did not understand the challenges of halting or staving off disease and malnutrition in impoverished communities. Despite his repeated exhortations to stop the “silent emergency,” he did not have a workable blueprint for doing so. Rohde’s paper provided one. It also gave shape and substance to a notion that had been turning over in his head since the two men spoke on the Yangtze River: Narrow your focus. Instead of trying to do everything, pick a few things, big things, bad things—the worst things. Pickthem carefully, pin targets on them, and then unload on them with everything you’ve got. That was it, that was the quantum leap—marshal all of UNICEF’s resources to launch a direct attack on child mortality. It was a fight that did not need to wait for new technologies or medicines or strategies, but could be waged right now with weapons already in hand.
Grant wanted to know more. Rohde invited him to Haiti, where he was then running a rural health program funded by
He recounted in the report how a professor of pediatrics had once told him that gastroenteritis is the “bread and butter” of the pediatrician in the developing world, “and that he could not afford to eliminate so radically his basic source of income by allowing oral rehydration technology to be disseminated.”
Rohde’s opinions were greatly influenced by his friend David Morley, a British pediatrician and expert on child epidemiology who had long supported simple and preventive treatments to tackle child mortality.
Rohde made his main message clear. “The road to health, I believe, does have short cuts,” he wrote. In order to exploit those shortcuts, you have to home in on that “handful of conditions.” And in order for the shortcuts to work, the consumer (in most cases, the mother) has to be involved, and “decision makers” (heads of state, officials, and donors) have to be engaged. This argument was classic John Grant: Jim Grant’s father believed that health care could not be improved without social outreach and the buy-in of the local community. Finally, Rohde insisted, the message must be simple and easily conveyed.
The main problem, the biggest obstacle, Rohde claimed, was the absence of one key ingredient: political will.
Not all of this was news to Grant. He already knew about oral rehydration salts and immunization. And he knew, of course, that the majority of child deaths in the developing world were preventable—he had been bludgeoning people with this fact since he had started at UNICEF. But unlike Rohde or his father, Grant was not a doctor; he was a lawyer. He did not know the specifics. Though well versed in the labyrinthine annals of international aid and development, he did not understand the challenges of halting or staving off disease and malnutrition in impoverished communities. Despite his repeated exhortations to stop the “silent emergency,” he did not have a workable blueprint for doing so. Rohde’s paper provided one. It also gave shape and substance to a notion that had been turning over in his head since the two men spoke on the Yangtze River: Narrow your focus. Instead of trying to do everything, pick a few things, big things, bad things—the worst things. Pickthem carefully, pin targets on them, and then unload on them with everything you’ve got. That was it, that was the quantum leap—marshal all of UNICEF’s resources to launch a direct attack on child mortality. It was a fight that did not need to wait for new technologies or medicines or strategies, but could be waged right now with weapons already in hand.
Grant wanted to know more. Rohde invited him to Haiti, where he was then running a rural health program funded by
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