Abstract
I am deeply honored by this recognition. I thank those who organized this event and those on the panel who have been so generous in their support and comments. I also want to acknowledge Robert Muscat for his expert help in writing The Nutrition Factor—and Paul Isenman for comparable help on a later book, Malnourished People: A Policy View, which probably had even a more significant impact at the World Bank. And I am very grateful to Jim Levinson, whose support for 57 years has been instrumental in many things I’ve done.
As someone without an academic background in nutrition—who never had a chemistry or biology course, even in high school—in short, I must confess that I’ve surreptitiously been practicing Nutrition without a license—I could use all my time here just to acknowledge the hundreds of people who have helped me fill that vast gap throughout my career. I do recognize their significant contributions and thank them all.
My assignment on the program is to tell you “What You Didn’t Know About The Nutrition Factor,” the 1973 Brookings book that sets out international nutrition policies and recommendations that I’ve been trying to implement ever since with your help.
I should note straightaway that this book was the product of serendipity, of three-and-a-half incidents of good luck—being in the right place at the right time. Let’s start in the early 1960s when I was a junior guy at the White House, assigned to the Food For Peace program. One morning, my boss, President Kennedy’s and then President Johnson’s Director of that program, rushed by my desk in excruciating dental pain. As he headed to his dentist for a root canal, he asked me to take notes for him at a meeting he had intended to attend at the National Academy of Sciences about “Nutrition of the Young Child.”
You must appreciate what a challenge that was for me. I knew nothing about the subject, and as I sat there, all the strange terminology in the presented papers was like a foreign language to me. But in one of them, by Mexican pediatrician Joaquin Cravioto, I did get the gist. He said that malnutrition affected not only height and weight (and, of course, child mortality) but also irreversibly, mental development. His was, in fact, the first seminal work on that topic. Not only thinner and shorter, but slower and irreversibly duller as well.
As I walked back to my office, Constitution Avenue became my Road to Damascus. I was seized with realizing nutrition’s fundamental importance for people’s quality of life. So much so, I spent much of that night putting my thoughts in a memo for my boss. Not hearing back from him after a few days and recognizing that my memos in the White House generally fell on deaf ears, I sent a copy of my thoughts to The New Republic—which published them. As the Academy’s meeting was in December and that week’s was the Christmas issue, I called the piece “For the Child Who Has Nothing.”
The article was summarized in the batch of daily news clips circulated internally by the White House Press Office. Whether it was the published article, or my memo, or my becoming a pest on the subject, malnutrition had caught a little attention. I was asked to organize and cochair an Interagency “Task Force to Meet Nutritional Needs,” designed to explore what the government might do to address this problem in a consequential way.
Shortly after the Task Force submitted its report in March 1964, President Johnson sent out a press release saying, “The gravest health problem of the world is hunger and malnutrition, and Food For Peace” (which, politically, was then largely perceived as an agriculture surplus disposal program) “will concentrate increasing attention on nutrition, especially for the very young.”
The Task Force made a slew of recommendations—fortifying all Food For Peace foods, for example. However, we didn’t have enough evidence to determine how best to address the basic question. Our thinking was to find a country or two willing to develop and test, with us, some prototype efforts. The report piqued the interest of our Ambassador to India, Chester Bowles, who asked me to move to India to develop a large-scale example of what U.S. Government assistance in nutrition might look like. Had it not been for an emergency root canal, there may not have been the Task Force report that got this ball rolling.
Living in India from 1966 to 1970 immersed me in the consequences of malnutrition on an enormous scale. The Bihar Famine dramatically revealed not only how scrawny malnourished bodies were but also how sluggish in their work and basic reflexes. That experience brought home to me the inevitable linking of 2 meanings of “development”—the human and the economic. That idea became the focus of my article “Malnutrition and National Development,” which appeared in Foreign Affairs in October 1967.
The second bit of luck: A fortunate placement of that article in that specific Foreign Affairs issue. That edition featured an article by Richard Nixon, then the leading Republican candidate for President. The article revealed his startling thoughts about opening communications with China after 25 years of severed diplomatic ties. Nixon’s piece received a lot of press.
My article immediately followed the last page of that bombshell announcement. Obviously, that was long before the days when you could Google an article; you had to get your hands on the printed publication. Anyone who read through Nixon’s article would automatically come upon mine. Readers of Foreign Affairs, who may never have given malnutrition a thought, might have stumbled on the subject accidentally. The article did find some readers at the Council on Foreign Relations and at Brookings, who jointly invited me to Brookings to do further research on the topic. So, had it not been for Richard Nixon’s blockbuster piece about China, my early work on nutrition policy might never have drawn more than the meager attention I otherwise had expected.
The third bit of luck: Some unexpectedly nutritious dinners. Brookings had a tradition of concluding its Board of Trustee meetings with dinner for Board members along with Senior Fellows who could discuss their work. One Brookings Board member was Robert McNamara, then the fairly new President of the World Bank, who indicated an interest in my project. Later in the year, at the Board’s next dinner, he asked, “How’s your book coming along?” and invited me to keep him abreast. As it was going to press, I sent him a copy of the manuscript. About 3 weeks later, his secretary called to set up a meeting. At that session, he asked me to come to the World Bank to add Nutrition there.
Later, McNamara, in his annual address to the World Bank’s Board of Governors, proposed to the finance ministers of member countries that they “must face up to the importance and implications of the nutrition problem…that retards both economic and social development.” Again, without the pure happenstance of being in the same dinners as Robert McNamara, I likely never would have had a career at the World Bank. Nor would I have had the opportunity, by the time I retired, to have persuaded the Bank to spend $2.1 billion dollars on nutrition efforts.
Earlier, I mentioned three-and-a-half strokes of good luck related to The Nutrition Factor. The half stroke of good luck was in avoiding the collateral damage that otherwise might have resulted from somebody else’s very bad luck. That Nixon guy again. Probably the oddest and, perhaps, most titillating part of What You Didn’t Know About The Nutrition Factor is that, thanks to him, The Nutrition Factor almost didn’t exist at all.
First, a little backstory. While at Brookings, I sat in the Foreign Policy Division’s wing with Mort Halperin, Henry Kissinger’s National Security staffer, before Mort turned against the Vietnam policy. After he had a falling out with Kissinger and Nixon, he came to Brookings to write a book.
You all know about Nixon’s “dirty tricks”—some worked, and some didn’t, the most infamous of the latter, of course, being the Watergate break-in that finally nailed him. Another of his cockamamie efforts, a year before Watergate, was related, in a strange way, to The Nutrition Factor.
In our section, our file cabinets were side by side. Nixon ordered Mort’s files to be destroyed, assuming they contained secrets of “insider” private discussions. This is something we learned only in 1996 when the Nixon tapes were released and we heard Nixon talking about Mort with Kissinger (and Halderman and Erlichman, who were in the room). After Kissinger said there shouldn’t be security papers allowed at Brookings, a direct Nixon quote from those tapes—“I want it implemented on a thievery basis. God damn it, get in and get those files. Blow the safe and get it.” The next morning, according to the dishonorable private tapes, Nixon pounded the desk as he again ordered aides, “Get it done! I want it done!”
A few days later 2 suspicious men who attempted to get into the building were stopped and turned away by an alert Brookings security guard, who in 2002 was celebrated for this. Strobe Talbott, the president of Brookings then, said the institution was grateful. Had the burglars gotten in, he noted, history might have known the Nixon White House scandals by a different name. “We would not have wanted it to be called Brookings-gate,” he said.
Had Nixon’s shenanigan been successful, The Nutrition Factor might well have been an unintended fatality. My book was quite far along by then—in paper files—and in those days, we didn’t have digital files, Macs or disks, or The Cloud way to save our files electronically—so Nixon’s “blowing the safe” might well have shredded the prospects for publishing the manuscript. And, today, you would be spending your afternoon differently.…But there was a Nutrition Factor, and we are here today.
I’ve been asked recently what I would say if I were to write a sequel, a kind of Nutrition Factor Revisited. For the first section, I would discuss the 8-year-old girl on the cover, whose picture I snapped in Bihar in 1967. What’s her story? If she survived—and I hope that she did—the little girl would be in her 60s now, one of the lucky ones because, at that time, 1 in 4 children didn’t make it to the age of 5. Today in India, 29 of 30 do make it.
And this little girl and her friends would have had only a 15% chance of not being malnourished using today’s measurements. Today she would have a 70% chance. In the mid-1960s, our cover girl’s life expectancy would not have exceeded age 40. Today, life expectancy is 69. And she would have had kids. Each of her children would have grown 5.2 inches taller than she had been at their ages. And they would be more educable and stronger, and more productive. Her grandkids, even more so—now yet another 2.3 inches taller at their age than their parents were. (Many of these figures are from IFPRI’s current research in Bihar, India’s poorest state.)
Better nutrition would clearly have played an important role in all that, along with added health measures, economic progress, and advances in girls’ education. A lot has happened since then, but surprisingly little public attention has been given to this Minor Miracle.
Another section in my hypothetical update of the book would, of course, document the massive amount of work that remains to be done. We know what needs to be done—and can be done. And it doesn’t always have to be done through large-scale projects. To give just one example, a new study from Calcutta Kids (To be transparent, I long have been on the Board of this gem of a small NGO, whose unique work in slums I encourage you to look up) demonstrated that basic health services, behavioral change, and a related strong commitment to growth monitoring, in only 4 years reduced third-degree malnutrition in 0-to-3-year-old children by 70%.
And we understand now that undernutrition is not the only nutrition problem. Overweight/obesity is increasingly a crisis in a growing number of countries and can and must be dealt with.
But what do we say in the final section? As I wanted to give some marching orders, I solicited the views of a dozen deeply committed nutrition folks who are much more current than I. Their responses to my 3 questions would, in effect, say how they would end the book. Their diversified recommendations, however, underline what a multifaceted subject we are dealing with and the related need for comprehensive, interrelated approaches to address nutrition challenges effectively.
One theme that does come through almost all of them—explicitly or implicitly—is the unmet need for a strong political focal point/sustained leadership, and why that is more particular for nutrition because of its marginal status in how most government ministries are organized and budgeted. This confirms that (1) until now, we haven’t been effective enough in our advocacy and (2) the need for all those working in nutrition who are concerned about the consequentiality of their work should, whenever possible, take on that added “advocacy” dimension as part of their role.
The responses to my survey were interesting, insightful, and potentially useful. I considered it a gift to read them. As time doesn’t permit discussion of their varied conclusions here, I’d like to re-gift them to you. And arrangements have been made for them to appear in the September 30 issue of World Nutrition. Its editor, Ted Greiner, will provide, in the following issues, an opportunity to enter into a dialog about those conclusions and proposals.
In closing, I’m happy to say that we’ve come a long way since that root canal. Much has been accomplished since the days when policymakers viewed nutrition in a welfare/charity context—but much obviously remains to be done. Nutrition is such a fundamental component of so many problems and so many solutions that it must have a place at their table. Nutrition Is Fundamental.
The time you’ve taken for today’s event highlights the increased attention that’s been given to nutrition policy over the past 50 years. That is deeply affirming. I may be getting up in years, but my heart is still in this with you. Thank you for this honor.