This is an archived USAID document retained on this web site as a matter of public record.

Remarks of J. Brian Atwood, USAID Administrator
to the National Council for International Health Silver Anniversary Conference
Arlington, Virginia

June 26, 1998

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Thank you, Jack.

I must congratulate NCIH on the choice of Dr. Nils Daulaire, USAID's senior health advisor and one of the U.S. government's leading authorities on international health, as your new president and CEO.

He has a remarkable ability to make complex technical subjects understandable and important to members of Congress, ordinary citizens and even administrators without advanced scientific training. He will be greatly missed in our Agency, but I have no doubt that his knowledge and skills will be well used at NCIH.

I am especially pleased to be opening this session with young professionals. In the three decades since I was a young foreign service officer, the advancement in international health has been one of great success stories of all time.

It's hard to imagine much more important -- or exciting -- work in our world than what you do, or a more important or exciting time to be doing it. Your generation may well be the one that wipes out -- or gains control of many of the old scourges of mankind.

Knowledge is exploding -- about the human body and brain, about disease, about ways to rationally design new drugs and vaccines. And we are learning that something as simple as getting enough Vitamin A can mean the difference between life and death for millions of children, that getting children adequate iodine and iron can prevent millions from having reduced IQs. There is so much we know how to do and we are learning more every day.

Yet your generation of international health professionals could also face overwhelming new health problems on a scale not yet imagined.

Right now, what we do not know how to do is not the biggest problem in international health -- our bigges problem is being able to reach people in the developing world with what we DO know how to do.

Many of you have experienced firsthand the devastating effect conflict, turmoil and the failure of states has on health. Some of you have seen for yourselves that, as a perceptive New York Times article observed last year, disease was the real winner in Africa's civil wars.

You know the effect of war and chaos has on your ability to save lives and improve health. However, you may not be as aware of your role in preventing the political collapse of countries that often results in deadly chaos.

A variety of prominent organizations ranging from the Central Intelligence Agency to the Carnegie Commission on Violence, to the Congressional Budget Office, have looked at the factors that cause nations to erupt into civil war.

While the methodologies used by these organizations in their studies varied, there was a remarkable confluence in their findings.

The studies all found that those nations at greatest risk were characterized as sharing common dynamics: high infant mortality rates, rapid population growth, high population density, large youth populations, a lack of strong democratic institutions, a history of ethnic disputes, and sharp and severe economic distress. As the Congressional Budget Office study found, there is "A fairly striking correlation between economic malaise on the one hand and domestic unrest on the other."

A study commissioned by the CIA found that over a period of 40 years the highest correlation with the failure of states -- not just a change of government but serious collapse or civil war -- was trade and infant mortality.

Trade reflects economic opportunity. Infant mortality reflects the overall well-being of people. Both represent hope for the future. Where people have no hope, governments are in trouble. The very existence of nations is threatened.

As health professionals, you are not only ministering to the health of human bodies -- you are also ministering to the health of societies. If you cannot heal and save the bodies, then the nations may fall apart around you.

One of the saddest aspects of the civil wars of recent years is that, around the world, civilians make up the majority of the casualties in war, especially civil wars.

Children are not just accidental victims of war -- they are often the deliberate targets. And the conditions of mass migrations invite epidemics, malnourishment and even starvation.

National security is no longer solely a matter of who has the biggest armies, the most bombs, missiles or submarines. It is, in a very real way, about saving babies. It is about giving people the opportunity to provide for their families, to build better lives for their children and themselves.

Around the globe, the ground is extraordinarily fertile for more of the conflicts we have seen since the end of the Cold War. The human, social and economic costs of failed nation states are immense.
Many of these conflicts have been propelled, in part, by populations of disaffected youth. There are clear connections between large populations of young people, a lack of economic opportunity, and the potential for societies to collapse in violence.

There are 1.6 billion young people in the world today between the ages of 10 and 24 -- more than one third of the world's population. At least 84% of these young people live in the developing world.

We need to pay more attention to these young people. They are the world of today -- and the future.

The problem is that a great many people have a hard time thinking about the world as it is, not as it was.

Our critics still consider it mushy-minded to examine development problems like poverty, environmental decay and the youth explosion -- even though it is clear that these phenomena produce war, refugees, terrorists and drug traffickers.

This is true in both the developed and the developing world.

India and Pakistan are pursuing nuclear armaments while more than half the malnourished people in the world live within their borders.

The United States finds it easier to spend
$2 billion on a single Seawolf submarine than to spend $2 billion dollars on a development assistance budget that today may offer more security than a submarine.

Yet we all know that the costs of prevention are minuscule when compared with the costs of deadly conflict.

I am not suggesting that the United States does not need a strong and robust national defense. Far from it. Our military power is an important part of the process of making and keeping peace. But in this post-Cold War period, we have discovered the severe limitations of both military action and economic sanctions in bringing about what we want to happen.

We cannot attack an epidemic with missiles, or avert global warming with submarines. We can't address rapid population growth or poverty with economic sanctions. We cannot attack hunger with armies or smart bombs.

The United States and the other donor nations must make sound investments in helping the poorer nations develop -- because it is the right thing to do, but also because it is in our best interest to do so.

Let's just take one powerful example of what works and why it is so important: education.

The education of girls and young women has been acclaimed as the most important investment countries can make to improve their economies and their societies.

Female education not only supports increased productivity and incomes but also has important social benefits. It improves family health and reduces infant mortality and slows rapid population growth -- all crucial factors in determining the relative stability of a nation.

Research shows that the child of a mother who has even a single year of education, has a
9 percent better chance to live to the age of five. Gains increase substantially with each additional year of schooling.

I highlight education because it is a very important area in which we work, but it is only one issue that must be tackled if we want to achieve lasting development in many countries. Agriculture, the environment, economic reform, promoting democracy -- all of these issues need to be addressed in countries where the basic human needs are so great.

As public health professionals, you understand how all these factors relate.

You know the importance of clean water and sanitation in combatting health problems -- of educating people to wash their hands, boil drinking water, cook and store food properly. You know that climate change could cause diseases now confined to tropical areas to explode into what are now temperate zones. You know what nuclear meltdown did to the children of Chernobyl. You know the dangers of encountering new and dangerous micro-organisms when people push farther and farther into wilderness areas. You know that when more and more people crowd into the slums of megacities, conditions are ideal for disease organisms to mutate into new and dangerous forms.

You must help us get the message to the public and to the decisionmakers.

If the United States and other donor nations want to influence the leaders of developing nations and nations making the transition to democracy and market economies, they will have to do it largely by example.

We must lead by our support of the things we say are important -- And by our refusal to support things we think are wrong or unimportant.

Yet when people look at what our own government is spending on international affairs overall and on development in particular, what does it tell them about what we think is important?

USAID is charged with relief in disasters around the world and dealing with the whole gamut of development issues, from improving agricultural production and preventing environmental damage to economic growth. We are expected to help establish democracy and free market economies-- human rights and property rights -- justice systems and financial markets. Health is also a major part of our portfolio.

Yet to do accomplish all that, we get less than one-half of one percent of the federal budget. Our budgets have been dramatically cut during the 1990s as part of the deficit reduction effort. Meanwhile, natural disasters, mass migrations, civil wars were multiplying the needs in a number of areas around the world.

This decade has also provided special opportunities for helping newly independent nations and nations coming out of long conflicts establish democractic institutions and free market economies. But following up on these opportunities requires resources.

This year there is supposed to be a surplus, yet Secretary of State Madeleine Albright and I were warned by Congress earlier this month that the whole foreign affairs account for diplomacy, disarmament and arms control and development must be cut again.

At a time of new nuclear proliferation, when incidents and instability in several countries threaten to explode into wars, when 12 million children die every year -- most from easily preventable causes -- what is the message we are trying to send the world about what we think is really important?

What is the example we seek to set?

Right now around the world, more than one billion people cannot read or write -- 60 percent of those people are women. More than 180 million children under the age of 14 are working as child laborers with virtually no hope of getting even the most basic education. There are 100 million street children and 800 million people are malnourished.

More than 1.3 billion people live in absolute poverty, subsisting on less than a dollar a day.

Each year, about 15 million women under 20 give birth -- more than 10% of all births worldwide. More than half of those pregnancies in sub-Saharan Africa were unintended, in Latin America, about one third.

Globally, at least half of those with HIV infections are younger than 25. USAID supports the world's largest HIV\AIDS prevention program, but despite these efforts, many young adults worldwide have little accurate knowledge of sexually transmitted diseases and their symptoms.

Our world has got to come to grips with what these statistics mean for the coming generation. In some of the countries hardest hit by HIV\AIDS, up to one-third of the children will be orphaned.

That is an almost unimaginable catastrophe. Their education will be cut short -- and often their lives. They will be vulnerable to sexual and economic exploitation. They are likely to be undereducated, underfed, unhealthy, alienated.

The world cannot simply turn its back on these children and let them fend for themselves.

When we look at the 50 poorest countries, we see that they account for only two percent of global income, and that share is actually decreasing, not increasing.

I travel a great deal to these fifty poorest countries. I visit areas of conflict or post-conflict or potential conflict all the time. What I see is what you see in your work -- abject poverty, child soldiers, kids 13 years old carrying weapons. I see uneducated kids, hungry, sick kids trying to survive.

USAID works in a whole variety of ways to address the specific problems of youth. In Brazil, we have a program to deal with street children.

In Angola, Liberia and elsewhere we are working to help demobilize some of those child soldiers I mentioned -- youth as young as 13 or 14 years old who have fought on the frontlines of their nations' civil conflicts.

We must create new kinds of public-private partnerships. The campaign to eradicate polio worldwide is a striking example of such a partnership. Rotarians around the world have provided leadership, millions of volunteer hours and far more money than they originally pledged. No civic club ever attempted such a thing before.
The point is not to try to copy that unique campaign, but to devise other partnerships, bringing in new allies, new leadership, new resources and support.

We must energize similar armies in the public and private sectors, at local, national and international levels in the battles that need to be waged for those 1.6 billion young people.

People care. Ordinary Americans, and ordinary people all over the world, care a great deal about what happens to young people.

We have to help them understand the scope of the problem, what needs to be done and how we might do it -- together. We have to help them channel that caring into effective action.

And we have to find ways to mobilize segments of that huge generation of young people to help themselves.

Your generation of young health professionals must speak out about both the threats and the opportunities.

Collectively, we have the power to shape the world around us. There is so much we can do. It is within our ability to address problems that might seem impossibly large in scale. If we fail to exercise this leadership, the world will be a far worse place and we will have no one to blame but ourselves.

This is an archived USAID document retained on this web site as a matter of public record.

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