Authors: Adam Fifield
During a boat trip on the Yangtze River, Grant and Rohde stood together, taking in the imposing rock gorge walls that towered over them, and discussed Grant’s nascent plans for UNICEF. “Jim was looking for ideas,” Rohde says. “He was looking around for what was possible.” Pulsing in both men’s minds at that moment was a simple phrase that was then echoing in the zeitgeist: “health for all.” Less than a year earlier, UNICEF and the World Health Organization had sponsored a seminal international conference on health in Alma Ata (now Almaty), Kazakhstan, that was attended by government representatives from around the world. The conference had set a daring new goal: “health for all by the year 2000.” The laudable aim—to provide every citizen with comprehensive, quality, locally sensitized, and affordable health care within the next two decades—had excited many in international health. But it had flummoxed others. Whether startlingly utopian or boldly idealistic, there did not seem to be much of a plan to make it a reality.
As the broad Yangtze slid beneath them, Rohde shared his two cents with Grant: instead of trying to solve all the health and social problems of the developing world, focus on a few specific things. At some point, as they spoke, they drifted by an astonishing sight that ultimately reinforced Rohde’s point. It was an old mining town on the riverbank, almost completely coated in black soot.
“Can you even imagine comprehensive health care in this community?” Rohde asked. “Where would you start?”
This small moment on the Yangtze would reverberate with great force over the next few years.
If Jim Grant was depressed or shaken after his drubbing by the board, he did not show it—not to staff, anyway. He projected a visceral enthusiasm; so much so that you’d think he was riding the high of a great victory. His optimism was obdurate, as if Teflon-coated. At a staff meeting shortly after the board showdown, Grant framed the setback not as an inconvenience but as an opportunity. We have six months, he jauntily told those in attendance, to reorient ourselves and refocus our priorities.
“He exuded positivity in that meeting,” recalls Alan Court, a Briton who worked in the Indonesia office but was visiting New York at the time. “I remember other people saying, ‘Oh my God, he’s gone out of his head. He doesn’t understand this board. Things aren’t done that way.’ ”
Grant didn’t let on there were any problems. He also did not have the luxury of wallowing or pausing to take stock.
Drought and civil conflict had spawned new emergencies in several African countries, and Grant began to ramp up assistance. The Cambodia crisis continued, though by the spring of 1981 the worst was definitely over—“that patient is off the critical list,” he had told donors in December. The Cambodia operation, despite the taint of Cold War rivalry and the Khmer Rouge quandary, would be lauded as one of the greatest international aid efforts in history. In spring 1981, it looked as though UNICEF would be able to extricate itself from Cambodia by the end of the year.
The same diplomatic dexterity he had used in Cambodia came in handy as UNICEF was drawn into a controversy involving infant formula. Grant was a vociferous advocate of breast-feeding and would routinely tell anyone who would listen that it could save a million babies’ lives each year. He would explain that breast milk boosts young immune systems and wards off deadly diseases—this was especially critical for babies without decent nutrition or basic medical care. The advertising of infant formula in developing countries was therefore a matter of life and death. Babies in impoverished communities who drank formula were at a double disadvantage: they were denied the protection of breast milk and they were also ingesting powder that was often mixed with contaminated water (which was, in many cases, the only water available). This, in turn, could lead to fatal bouts of diarrhea.
After a major global campaign was launched against the makers of infant formula, including Nestlé, the World Health Assembly (the governing body of the World Health
Organization) passed a measure in late May 1981 banning the advertising of formula to hospitals and health clinics. It was up to individual countries to implement the code on the marketing of infant formula, as it was called. The Reagan administration was dead set against the code, siding with the formula companies; the United States had, in fact, been the lone dissenting vote. UNICEF had backed the code, but Grant was cognizant of the need to appease the American government, UNICEF’s biggest donor.
He was careful not to appear too vigilant. In one instance, while the code was still being negotiated, he had resorted to sleight of hand. Kathleen Cravero, then a young American UNICEF staffer, was asked by Grant to represent the organization at a World Health Assembly meeting where language within the code would be discussed. “We were down to words,” says Cravero, “and these words were either going to give the code teeth or no teeth.” Representatives of the US government would be there, and Grant was worried that if UNICEF came out too strongly against the companies, the consequences would be severe. “UNICEF was getting some pretty direct threats from USAID and the American government,” says Cravero. Nonetheless, Grant instructed Cravero “to do what’s right.”
She went to the meeting with another junior colleague and spoke forcefully in favor of strong restrictions against the companies, taking a position “contrary to what WHO, the corporations, and the US government would have wanted UNICEF to take.” At first, Cravero did not understand why Grant had sent her instead of a more senior person. But after the meeting, when
complaints started tumbling in about her unequivocal comments, she realized why Grant had picked her.
“Jim Grant had a reasonable level of deniability that we were young people who didn’t understand or were out of control,” says Cravero. But at the same time, she adds, he “was able to ensure that UNICEF took the positions UNICEF had to take.”
In so doing, Grant managed to keep the US contribution intact, as well as UNICEF’s integrity. “He handled it masterfully,” says Cravero.
Quietly advising Grant on many of his decisions and serving as his moral cornerstone was his wife of thirty-eight years. Ethel Grant was a thin, unassuming, quietly magnanimous woman with short hair and a quick smile. She would sit in the back of the room during meetings, so she could later give her husband her take on the proceedings. On evenings when Jim worked late, she would sometimes sit quietly in his office, knitting, as he beavered away. One senior staff member told her that Jim was working too hard and wondered if she could get him to slow down. She politely declined. “He’s a spinning top,” she said. “If I slow him down, he’ll fall over.”
Over the last four decades, she had found ways to be there for her husband, even in daunting circumstances; when Jim had served in the Burmese theater of World War II in the US Army, she had sent him fruitcakes with bottles of whiskey baked into the middle. After the war, when he worked in China for the UN Relief and Rehabilitation Administration, she surprised him one day by showing up on his doorstep unannounced. A social worker for the Washington, DC, public
school system and a Democratic Party volunteer, she continued to work in Washington during Jim’s first year at UNICEF. But she would eventually give up her career entirely to bolster his. Their three sons, John, Jamie, and Bill, were all grown when their father took the UNICEF job.
Ethel became his emissary to UNICEF staff, holding cocktail parties and dinners and formal teas. She created a welcoming committee for new hires or those new to New York and made a special effort to get to know employees’ spouses. Even those who found Jim overbearing loved Ethel; she tempered his intensity and pulled him back when he went too far. She was also a pivotal go-between: often the fastest way to get to Jim was through Ethel.
Grant did a lot of entertaining, but almost all of the work—the cooking, baking, inviting, and organizing—fell to Ethel. Celebrities, presidents, ambassadors, high-ranking UN officials—Ethel hosted them all. Her “Hostess Book” for Jim’s first few years at UNICEF is packed with the names of UN luminaries. Jim was perennially last-minute, and he would sometimes call Ethel late in the morning and tell her he had invited an ambassador over for lunch—could she throw together some soup and sandwiches? With a chuckle, Grant’s youngest son Bill recalls his mother’s reaction: “He thinks it’s so simple. You can’t just bring over these senior-level people … You can’t just make soup and a sandwich. You’ve got to set the table! You’ve got to get out the good china!”
As he built alliances and drummed up funds and rallied staff and traveled to Paris and Tokyo and Riyadh and Geneva and
Cairo and dozens of other places, Grant was constantly casting around for his next scheme for remaking UNICEF. This quest became more urgent as the gloom of recession closed in, growing murkier and more foreboding. He needed to find something transformative but not grandiose, something big but not too expensive, something easy to sell, with built-in PR appeal—in essence, something “doable.”
He used every opportunity to spread word of the “silent emergency.” Smoking beneath his buoyant veneer were cinders of moral outrage—never too hot or too obvious, but they were there. On February 14, 1982, he delivered a guest sermon at the Cathedral of St. John the Divine in New York City. “About the seventeen million children who die each year, there is little more to be said,” Grant told the congregants, according to his prepared remarks. “Whoever they once were, whatever religion they were growing up in, whatever language they were beginning to speak, and whatever potential lives they may have held, they were simply abandoned by the world into which they were born.” He went on: “Have we not the obligation—to ourselves as well as to them—to bring an end to the needless waste of lives?” This language was likely a rhetorical alloy of Grant’s ardor and the eloquence of his communications shaman Peter Adamson. Calm and considered, with eyes that could narrow to an intense, discerning squint, he was a respected British writer and expert on international development issues. Adamson would become the architect of Grant’s messaging and one of his closest personal friends.
About a month after this speech, a package arrived in the mail. It was from Dr. Rohde. Inside was a copy of a lecture he
had 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. Pick
them 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 USAID. The two men drove around in an old jeep on rutted roads (Rohde was at the wheel). Rohde thinks it was probably during one of these road trips, as they bounced along, that Grant told his friend what he planned to do. The conversation went something like this.