Epscot Fitzgerald once said, "It's the mark of a first rate intelligence to be able to keep two contradictory ideas in mind at the same time such as, the situation is hopeless and here is how we will fix it". Jim Grant did this. The world told him this is a hopeless situation and he replied, "Here is what we are going to do to solve it and here is how we will go to scale". Because he did that we are here today to celebrate a better world and to plan for even more improvements. People often ask the question, "How can one replace Jim Grant?" and the answer is, some people cannot be replaced but some people don't need to be replaced because for example once someone has invented the light bulb or the car or the computer chip or a cellular phone it doesn't have to be done again. It takes us all to a new level and we get to reap the benefit. Once Jim showed how to go to scale with child survival we get to reap the benefits and use that information. So enjoy being part of that movement, this interdependent movement, that depends on the role of everyone in this room.
I once heard about a man who went to a fortune teller and he was told you will be very poor and extremely unhappy until you are forty-five. Grasping at this straw he asked what will happen when I am forty-five and the fortune teller said, "You'll get used to it". Well Jim Grant wasn't willing to get used to children suffering when it was avoidable. He took inspiration and so should we from the incredible reductions in infant mortality in past decades and the increases in life expectancy and the decreases in birth rates. These happy trends give evidence of the power of deliberate decisions, of purposeful actions and these advances constitute the single best evidence we have that things can be made even better in the future. These improvements have changed the world for all time. They raised the standard against which future generations will be measured.
So let's look at the future but not in an unthinking, euphoric, rose tinted way. Let's start with the sobering realities. UNICEF published in the state of the world's children and WHO published in its state of the world's health a very encouraging picture. Health has never been better. At the same time they painted a very dark picture which said that the gap between the rich and the poor has never been greater. This is a health problem, but it's more than that, it's a social problem. But it's even more than that. It's an ethical problem because it means that the poor are subsidizing every one of us in this room. Our food is less expensive because people work at minimum wage. Our houses are cheaper, our clothes are cheaper because people work at minimum wage and subsidize the way we live. And as Richard Jolly said, "The market place won't solve every problem, some problems require deliberate action". Small pox vaccine was on the market for 170 years but it took deliberate action to get rid of small pox. Polio vaccine has now been on the market for 40 years but it is only now that there is deliberate action that polio will disappear. And some problems aren't made better by the market place at all, quite the reverse. Our tobacco problem is the result of the market place so that really is a health issue. To change poverty will require our best efforts. But the dark story goes beyond poverty. We've learned that more children than soldiers have died in war in the past ten years and that's startling. Two million children have died in war. This is not the way it used to be and this is not the way it should be. And we've also learned that the worst is as bad as anything we have seen. During the first thirty days of the Rwanda camps last year the death rate was 9%. This is three times as high as during January of 1942 in Leningrad, the worst mortality month of the siege of Leningrad. So we simply can not relax. And then of course there are the new and growing problems, aids, emerging infections, homelessness, street children and drugs, fatalism. And with all the improvements in child survival the gap continues to increase between what we could deliver and what we actually deliver. When you look at what we could deliver with immunizations, diarrheal diseases, acute respiratory infections, with antihelmens, Vitamin A, iodine, it becomes clear what we are not doing. When you look at tobacco how the gap is actually growing so that tobacco is not the single most lethal agent in the world. Then add maternal mortality, malnutrition, malaria, AZT and the transmission of HIV to newborns, treatment for shiftisimyosis, the gap continues to grow between what we could do and what we do. This knowledge belongs to all of us not just to each of us and not just to some of us. Scientific knowledge is not anyone persons possession. It was Ghandi that reminded us that the golden rule is to refuse to enjoy what millions cannot enjoy and yet part of the world enjoys this knowledge but does not give it to the rest of the world. But finally in the face of all this perhaps the most sobering of all is a mindset in the donor community that concludes that we can't a expand our efforts to improve the health of children globally.
At the UNICEF board last week, repeatedly people rejoiced over the fact that the UNICEF budget had now reached one billion dollars per year. But also it was said this is not a time to talk about expansion and I got to thinking that Jim Grant lead for the multitude health with the work and generation of resources. Carol Bellamy the new director of UNICEF now needs that same sort of support. The effort needs to expand because the entire budget of UNICEF and WHO for an entire year, for the entire world now equals twelve hours of the US health care budget and we say we can't expand.
One of my favorite quotes over the years has been....
And of course that's the need to balance these negatives with the positives and come up with a perspective on how do we accentuate the positive. Norman Cousins said, "The single greatest lesson of the last two centuries is that it is possible to plan a rational future". What are some of the positives. Sudan has had a cease-fire that actually worked for the last forty days in order to deliver health to its people. Number two I think it's very positive that every day we get a chance to start again. We get a chance no matter what the mistakes of the past to try again. And I'm always reminded of David Hamber, the president of Carnegie who talked about growing up in Indiana where basketball was so important that they finally had to impose some academic tests on basketball players. He says he remembers the first one. There was the coach and the player and the tester. The tester asked the basketball player what is 7 times 7. He answered forty-nine. The coach jumped up and said give him another chance. And every day we get another chance.
A third positive is the science. It makes things possible but is makes things increasingly affordable. All one needs to do is look at the price of Hepatitis B vaccine for example. It makes things easier. We will see in future decades more antigens given to children in fewer visits. We will see needles and syringes give way to oral vaccine. We will decrease our need for refrigeration. Science will give us new vaccines and new medications. Science is making it possible to track with precision a diminishing number of polio strains. But there are other positives. The ability to measure the disease problems of children is a prerequisite to solving them and as bad as our surveillance systems might be they are getting better when you consider what we now know about polio and measles and guinea worm and nutritional status. Our improving knowledge is improving control.
We are also aided by the communications revolution and by the growth of democracy. It makes a difference when people have the ability to hold their leaders responsible but we are also aided beyond democracy by making child health a political asset and Jim Grant wrote the directions on how to make child health a political asset so that children win, but so do country leaders. I think we are also aided by recent summits. Some people argue we shouldn't be having these, but look at the record. The summit for children set the standard where a meeting dictated later action and held countries responsible to a new level of action.
Summits cause the world to focus and seek solutions and to relate that problem to previous summits. For example the social summit I think was worth every penny just because it focused the world on this problem of poverty and I can't tell you how proud I was to see Mrs. Clinton announce that the United States would increase support for the education of girls. Another positive, our increasing understanding of interrelationships and interdependence. I stop the positives at this point not because there are not more but because we are running out of time, in order to get to a conclusion. My wife teaches four year olds and this is a source of unending stories for me. On the first day of school she gives instruction to the children and one year as she told them if you need to go to the bathroom raise your hand. A very innocent boy asked, "How does that help?"
How will these negative and positives be balanced? It's up to us. That's the reason to study history. To see that everything that now exists has a past history and that it's a cause and effect history and that what we do now does in fact determine the future. That's our challenge. Jim used to talk about famine in India and the fact that when he was younger people accepted it as being inevitable and that the countries of the world did not feel a responsibility to it. That no longer happens. Famine no longer exists any place in the world unless there is human conflict because we know how to prevent it and we feel responsible. The fatalism about faminism is decreasing and the fatalism about child disease and child suffering is decreasing.
But Jim also pointed out that this is the first time in history that basic benefits could be shared with all children, that is basic health, basic education, water and sanitation and he saw what some felt was a future utopia. He saw it to be within our grasp right now. That is a fair start to develop the talents and potential of every child. The critical mass for that future is almost in place. We have the science base, the communications base, the transportation abilities, the intervention techniques and infrastructure but we need a bit more. We need a social norm that wants to see a fair start for all children of the world. We need a social norm that feels a responsibility to share the knowledge and resources that we possess and we need a social norm that understands community to include every child or any place in the world plus any child who will be born in the future. And we need that to happen now. That future can in truth start today with the people in this room to make Jim Grant's dream a reality when he said, "Our task is to insure that death does not follow birth too closely and that life lived long is lived well". If we accept this challenge future generations will know by history only that this loathsome inequity ever existed. Thank you.