by Peter Adamson
This address, given at the invitation of the Canadian National Committee for UNICEF, Toronto, January 1994, is an attempt to sum up the core messages from the fifteen annual State of the World’s Children reports written by Peter Adamson for UNICEF Executve Director James Grant between 1980 and 1994.
Many of UNICEF’s headquarters and field staff contributed to these reports which were distributed by UNICEF offices in all countries to governments and to national and international media. Each year they carried Jim Grant’s essental message that a revolution in child survival could be achieved by methods that were already available and affordable. And each year they made the arguments, answered the criticisms, and reported the progress.
This sustained effort at global outreach was made possible by the most effective communications division in the United Nations family and by its two outstanding Directors, John Williams and Mehr Khan.
Thank you for inviting me here to speak to you this evening. It is a particular honour because the Canadian Committee for UNICEF is widely known as a star in the UNICEF firmament. I believe the volunteer network represented here tonight is approximately 40,000 strong – five times larger than the next largest National Committee. This is a tremendous tribute both to the great servants of this committee, like Harry Black, and also to the Canadian people as a whole.
The first thing I want to do this evening is to thank you for the job that you do with the two publications that I am involved in – the State of the World’s Children and The Progress of Nations. It gives me more encouragement than I can say.
My first contact with UNICEF was during the International Year of the Child in 1979, when I proposed to the then Executive Director, Harry Labouisse, that UNICEF should issue an annual report called the State of the World’s Children. I did not at the time know what I was talking myself into.
The report I am working on now will be my sixteenth. Fifteen of them with Jim Grant. And my remarks this evening are very much a tribute to that extraordinary man. They are also, in large measure, a summary of what I, and many others, have learnt from him over those years.
So it seemed appropriate tonight to try to draw together what have been the central and constant themes of UNICEF’s advocacy for the world’s children over all of these years.
The silent emergency
The most basic fact about the state of the world’s children is that millions still die every year from disease and malnutrition, and that many millions more live on with ill health and poor growth.
For more than a decade, UNICEF has called this the silent emergency.
No famine, no flood, no drought, no earthquake, has ever killed a quarter of a million children in a single week. Yet the silent emergency of ordinary malnutrition and disease does that every week.
These deaths are not news. But those children are just as dead. And their families are just as grieved. And it is still one of UNICEF’s most important messages that these children of the silent emergency are all individual children – children who had name and a nationality, a personality and a potential, a family and a future.
Not to act for, not to speak up for, these children would be to acquiesce in the verdict of a world which says that they do not matter – simply because they are the sons and daughters of the poorest people on earth.
That is why perhaps the most consistent of all UNICEF’s stands, over the last decade or more, has been the stand it has taken for these children of the silent emergency.
Secondly, UNICEF has made the point consistently over the last decade or so that half to two thirds of all these deaths, and most of the accompanying malnutrition and disease, is caused by just a few common problems that can be prevented or treated relatively cheaply and relatively easily.
And in recent years, we have expanded that same message to include major childhood disabilities whose scale and seriousness is only just beginning to be recognised. We have argued, for example, that it is possible to defeat the iodine and vitamin A deficiencies which leave so many millions of children blinded or brain-damaged.
But deciding the priorities was the easy part. And the great lesson of UNICEF’s advocacy over the years – and the great tribute that must be paid to Jim Grant – is that if you want to achieve anything you not only have to select priorities you have to stick with them as well. You have to be able to take the criticism about being tunnel-visioned and repetitive. You have to be prepared to repeat again and again long after those closest to you have got tired of the same message. You have to be prepared to realise that the world hasn’t heard just because you’ve said it before.
There are many problems that UNICEF could have dealt with over the years. Those problems can be seen as a row of doors in a wall: all of the doors represent problems and opportunities to do something for children. One door might be marked ‘Vaccine-preventable disease’ , another might be marked ‘Street children’, another might be labelled ‘Child labour’ and yet another might say ‘Refugee children’. Sadly there are many, many such doors.
UNICEF made a decision to throw most of its weight at the doors with labels like immunisation and ORT. It did so not because these were the only issues. It did so because of a judgement that these were the doors that might give – that the technology and the capacity were there, that if we hammered hard and long enough at these particular doors then they might just fall right off their hinges.
True, its been at the expense of advocacy and action on other really important problems. True, UNICEF has been sometimes tunnel visioned. True, UNICEF has repeated itself ad infinitum.
But true, also, that the lives of 3 million children are now being saved every year because immunisation has moved from 10% to almost 80%. And true that approximately one million children are being saved each year because ORT has been made available to over a third of the developing world’s families. And true that there are over 3 million children in the world this moment who are walking and running and playing like other kids and who would have been crippled for life by polio were it not for the immunisation efforts of the last 10 years.
And in years to come I believe it will come to be true that millions of children will not be brain-damaged by iodine deficiency or blinded by lack of vitamin A because those doors too will have given way under constant pressure from UNICEF and its many partners.
And I honestly believe that if UNICEF had done as many wished, focusing on the wide range of problems that affect the world’s children, focusing on street children one year, and child labour the next, and refugee children the year after that, pushing once on each of those doors and then moving onto the next, then at the end of ten years we would have knocked at all of the doors – earning much applause and satisfying everybody’s concerns – but all of those doors would still be standing almost as firmly as ever.
Many of you here tonight have faced the criticism over UNICEF’s narrow vision. Many of you here tonight have born the burden of seeming to carry to politicians and public the same message time after time, year after year.
But I want to say to you tonight that it was worth it. And that there are millions of children in the world today who do not know of the Canadian National Committee for UNICEF but who have reason to be grateful for what it and you have done over these years.
Goals and going to scale
I’d like to move on if I may to another of the great lessons of these years.
When Jim Grant first came to UNICEF, I think it’s fair to say the world of working for the better health and nutrition of children, was a world of pilot studies and demonstration projects, full of small scale examples of this or that approach or intervention or piece of medical technology. This was important. From this we learned.
But what Jim Grant saw more clearly than anybody else was that this had to change. Many of the basic solutions to many of the most basic problems were already in place – tried and tested, available and affordable.
What was needed was not more pilot projects, but ways and means of going to scale – of taking existing solutions and putting them into action on the same scale as the problems.
Frankly, this frightened an awful lot of people in UNICEF. For this was unknown territory. This meant getting out into the big bad world. This meant making the advocacy message much cruder and simpler, risking the sneers of many of the development experts.
Above all it meant setting goals and mobilising to achieve them. And this in turn has meant enlisting the support of a great many people and organisations, including Heads of State and senior political figures. UNICEF pioneered this approach, and it culminated in the goals for the year 2000 that were established at the World Summit for Children. It is, at the very least, a very important start that over 150 heads of state – representing 90% of the developing world’s children – have made a formal, public commitment to those goals.
Symptom and cause
For a moment now, I’d like to address one of the most common arguments heard over the years against this whole approach. It has often been said that such goals – such specific, targeted interventions as immunisation and ORT – address only the symptoms of poverty and leave the causes undisturbed.
This argument is not as respectable as it appears at first.
It fails to acknowledge that frequent illness, poor growth and illiteracy are some of the most fundamental causes as well as some of the most severe symptoms of poverty.
It fails to take into account that the pulse of economic development is weakened when millions of children fail to grow to their full mental and physical potential because of frequent illness and malnutrition.
It fails to recognise that the march toward greater equality of opportunity is slowed when the children of the poor drop out of school and into a lifetime of illiteracy.
It fails to grasp that the prospects of finding a job and earning an income are crushed by disabilities such as polio, or that a family’s capacity to save and invest in the future is reduced when a child is born blind or mentally retarded.
In these and many other ways, the worst symptoms of poverty help to crush the potential of the poor, to narrow the choices available to them, and to undermine the long-term process of development.
The struggle for social justice and economic development, both within and between nations, must continue – just as the poor themselves will continue to struggle, as they have always done, to meet most of their own needs by their own efforts.
But it is a tragic mistake not to recognise that those efforts can be enhanced by direct attempts to reduce disease, disability, malnutrition, illiteracy, and drudgery.
The answer to such criticism is therefore very simple. Doing something about the silent emergency is doing something fundamental about poverty and underdevelopment.
Affording the cost
In all of this, UNICEF in its advocacy has also tried to stress at every opportunity that these great advances for the world’s children are affordable.
We have estimated, as you all know, that the additional cost of reaching the year 2000 goals in child survival, health, nutrition, education, water supply, and family planning, would be of the order of $25 billion a year throughout the 1990s.
But we have gone further. We have pointed out, in broad terms, where that money might be found. We have argued that only about 10% of the budgets of the developing world’s governments are allocated to meeting the most obvious needs of the poor majority – primary health care, primary education, better nutrition, family planning, water and sanitation. Less than 10%.
Similarly, we have argued that only about 10% of all international aid for development is used for these basic purposes. Only about 1% of all the rich world’s aid, for example, goes to primary education. And only just over 1% goes to family planning.
It would take 10% of the spending of the developing world’s own governments. It would take 10% of the aid from the rich world. Truly it could be said that the problem today is not that overcoming the worst aspects of world poverty is too vast or too expensive a task; it is that it has not seriously been tried.
Part 2: The constant context
For a moment now I’d like to step back and say that however focused UNICEF is, and however clear and unapologetic in its priorities, we should always try to fully acknowledge some of the most vital constants in the wider context of these efforts.
The economic context – debt
One of those constants is the economic difficulties within which so many of the world’s poor people and poor nations struggle to earn a living. And I hope that for all its limited focus, the State of the World’s Children has borne this in mind over the years, acknowledging the enormous economic difficulties, and the enormous economic injustices, under which the developing world labours.
UNICEF, in its advocacy, should always acknowledge that the task of meeting the basic needs of all children does not depend only on the provision of services by UNICEF or governments or anyone else. Whether a child’s basic needs are met or not depends, more than on anything else, on whether that child’s parents have a job and an income.
And that is a question that is inseparable from the great economic issues of terms of trade and commodity prices, of protectionism and free trade, of debt and adjustment policy, of aid and investment. So it is but a short step to take from concern for children to concern for the great international economic issues of our times.
It has therefore been another constant theme of UNICEF advocacy – and one for which Richard Jolly deserves great honour – that allowing world economic problems to be taken out on the growing minds and bodies of young children is the antithesis of all civilised behaviour.
The war on children
The next element in this wider context is the war and violence that affects a sickening number of the world’s children. While sticking with our priorities, and focusing attention on the silent emergency, we have also tried to speak out with a strong voice on the Convention on the Rights of the Child and especially on the issues of children, war, and military spending.
Wars used to be about soldiers. Civilian deaths were uncommon. Deaths of children even rarer. But no longer.
In the last decade, about 1.5 million children have been killed in wars. About 4 million have been cruelly disabled, have lost their limbs, or their eyesight, or their minds, or their inner peace, confidence and sense of security.
Another 20 million have lost their homes, and five million have also lost their countries – they have become refugees.
But the indirect effects of war and military spending have been even greater.
Total annual world military expenditures have long exceeded the combined annual incomes of the poorest half of humanity. If even a small proportion of such resources had been devoted to meeting minimum human needs, then it is a fair bet that we would today be living in a world in which mass hunger, malnutrition, and preventable disease were things of the past.
UNICEF and women
A third consistent in the context of UNICEF advocacy – discussed in every single one of the State of the World’s Children reports – has been the relationship between progress for children and progress for women.
From UNICEF’s particular viewpoint, nothing is as important to the well-being of the child as the well-being of the mother – her health and nutrition, her income and education, her time and her energy, her status and influence.
But women are women as well as mothers, and not take into account the totality of their lives would be insulting as well as being impractical.
And when you look at that totality, it is truly an extraordinary picture.
Women grow most of the developing world’s food. They market most of its crops. They fetch most of its water. They collect most of its fuel. They feed most of its animals. They weed most of its fields. And when their work outside the home is done, they light the third world’s fires, cook its meals, clean its compounds, wash its clothes, shop for its needs, and look after its old and its ill.
And they bear and care for its children.
In return for this disproportionate contribution, the women of the developing world are generally rewarded with less food, less health care, less education, less training, less leisure, less income, and fewer rights.
In 1992, we made our strongest statement yet on this subject. In that year we suggested that the apartheid of gender should be opposed as vigorously as the apartheid of race.
To some this sounded too strong. But I believe it was and is justified.
The abhorrence with which the whole world has rightly regarded apartheid, is an abhorrence born of the simple but powerful moral proposition that a peoples’ rights and opportunities – where they can live, what education and health care they will receive, what job they can do, what income they can earn, what legal standing they will have – should not depend on whether they are born black or white.
Yet it seems that the world is prepared to accept, with none of the depth and breadth of opposition that has been seen during the apartheid years, that all of these things can depend upon the accident of being born male or female.
In many countries, twice as many boys as girls become literate. In some countries, twice as many boys as girls are brought to health centres for treatment. Employment rights, legal rights, property rights, even civil and political liberties are all likely to depend upon being born boy or girl.
I fail to see the moral difference between this and the apartheid system that we have all deplored so vehemently and for so long.
I come now to the last of these great constants in our advocacy. I am referring to the issue of family planning.
This is a controversial subject which touches on sensitivities and strong convictions whichever way you turn – and it has to be spoken about and acted on with a proper respect for peoples’ religious, moral and cultural positions.
But family planning is also a matter of great principle for its proponents. And I am going to try to say why.
For the real facts about family planning are simply not widely enough known.
Let us set the issue of population growth to one side for a moment. We are talking here, primarily, of the health and well-being of hundreds of millions of women and children.
Fifteen hundred women have died today in childbirth. The same happened yesterday and will happen again tomorrow. Half a million young women every year. And they leave behind as many as a million motherless children each year. Many of those women died in great pain, and after long hours of fear and suffering. And for every woman who has died, many more are left with injuries and disabilities which are often painful, embarrassing, permanent and secret. This is one of the great untold tragedies of our times. And much of it – between a quarter and a third – could be prevented by the well-informed spacing and timing of births. In other words – by family planning.
Second, a major part of this great toll is the toll taken by the estimated 50,000 illegal abortions which are now performed on women every single day. 50,000 illegal abortions every single day. Many of them ending in a ghastly death for the mother. Most of those deaths, most of that suffering, could be prevented by family planning.
Third, family planning can drastically improve the quality of women’s lives – by reducing the burden of having too many children too close together, or at too early or too late an age. It can allow women more time and freedom for education, for income earning, for community activities, for caring for their existing children, and perhaps for a few moments of the rest and leisure that are almost totally denied to hundreds of millions of women in the developing world today.
Let me now turn to the effects for children.
A majority of the 13 million child deaths in the world this last year were the deaths of children who were born within two years of a previous birth, or to mothers who were under 18 or over 35, or into families where there were already three or four or more children. In other words, family planning could save the lives of many millions of children each year – and this, again, is just not widely enough known.
Second family planning can significantly improve the nutritional health of children. Fewer and more widely spaced births help to prevent the low birth weights which are strongly associated with malnutrition not only in infancy but throughout the earliest years of life.
Third, family planning improves the overall quality of life for children – because the quality of child care almost inevitably rises as parents are able to invest their time, energy, and resources in bringing up a smaller number of children.
Given all of this, I believe that UNICEF would simply not be being true to its mandate if it did not speak out on this issue – if it neglected what is arguably the greatest of all opportunities for improving the lives, the health, the nutrition, and the educational opportunities of hundreds of millions of women and children in the developing world.
The demand is there. About one pregnancy in every four in the developing countries is not only unplanned but unwanted. The supply could be there. For, again, we are not talking about anything vastly expensive.
And when you add to all this the fact that there is a severe population problem, that in the lifetime of most people in this room the population of sub-Saharan Africa is projected to almost treble, then I believe the case for giving priority to family planning becomes overwhelming.
We all have our own positions on this issue. Let me conclude on this issue by stating mine. When so much could be done, for so many, and for so little – then the failure to make family planning available to all would, I am sure, come to be seen as one of the most catastrophic mistakes of the twentieth century.
First call for children
Finally, let me turn to one of the ideas which has been central to UNICEF’s advocacy throughout the last ten years and which I hope will be central in the next ten.
It is an idea which goes under the name of ‘first call for children.’
And it is an idea based not just on the sands of sentiment about children but on the bed-rock of practical common sense. It is based on the fact that the great majority of the growth of the human brain and the human body is completed by the age of five. There is only one time for growing; and if growth does not happen at that time then it will not happen at all or it will not happen as it should.
So for the sake of children today, and of society tomorrow, it is essential to protect the growth and normal development of children during those early years. That is why those vital, vulnerable years of childhood should be given a first call on our concerns and capacities.
And what UNICEF has said consistently for the last decade is that this commitment should never be set aside even temporarily because of other problems. It is a commitment that must be maintained in good times and in bad, in normal times and in times of emergency, in times of recession and in times of prosperity, in times of peace and in time of war.
The great ideal at the heart of all that we are struggling for is that whether a child has health care or not, whether a child is immunised or not, whether a child grows normally in mind or body or not, whether a child has a school to go to or not ….. should not have to depend on the mistakes and vicissitudes of the adult world, on whether a particular political party is in power, on whether interest rates have risen or commodity prices have fallen, or on any other trough or crest in the endless and inevitable undulations of political and economic life in the modern nation state.
That is the ethic of first call for children. It does not demand that protection for the lives and the development of the young should be a priority; it demands that it should be an absolute. It does not demand the kind of commitment which can be superseded by other priorities that suddenly seem more urgent. It demands the kind of commitment that will not waver in the winds of change.
There will always be something more immediate. There will never be anything more important.
I would like to end, as I began, by bringing all of this back to the silent emergency to which all of these themes relate.
For as the century nears its end, I believe that this remains the big issue that UNICEF must continue to bring to the world’s attention.
In the years to come, will the children of the silent emergency continue to be forgotten and neglected?
In the years to come, will they continue to silently die in such numbers?
In the years to come, will they continue to silently succumb to preventable disease?
Will they continue to be silently crippled by polio, silently blinded by the lack of vitamin A, silently retarded by the lack of 10 cents worth of iodine?
Will they continue to silently watch as other children go to school?
Will they continue to be silently malnourished, silently failing to grow to the potential with which they were born?
I believe these questions to be a litmus test for our civilisation. For a civilised society is one that protects its vulnerable and protects its future. And children are both the vulnerable and the future.
I believe also that far more responsibility rests with UNICEF in this matter than perhaps we know.
No other organisation has the world-wide mandate to stand up for these ideas. No other organisation has the world-wide name and respect with which to do so. No other organisation has the skills of many tens of thousands of people, professionals and volunteers, working in virtually every country in the world. No other organisation has a network of national committees capable of doing what you here in Canada have achieved and are achieving.
Putting all these together, it is easier to see the very great responsibility that rests with UNICEF in the years ahead.
Jim Grant gives this organisation a leadership on these great issues which is unique in the history of international co-operation and which will never be forgotten. Literally hundreds of thousands of people in just about every country have responded to that leadership and become involved in knowing more, caring more, and doing more about the silent emergency.
And when I ask the questions:
Who will stand up in the years ahead for the children of the silent emergency?
Who will risk repeating itself, risk causing controversy, risk speaking out loudly and clearly and often on their behalf?
Who will act for them in every country, speak for them in every forum, remember them when the world forgets?
Then I am glad to know that they are rhetorical questions.
I know who will. UNICEF will. UNICEF has done, is doing, and will continue to do so.
And none more so than the people here tonight and those whom they represent – the people of UNICEF Canada.
It has been a very great privilege for me to play even a small part in that cause, and to talk to you about it here tonight.