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And I'd like to introduce Elizabeth Farnsworth, who's going to lead our conversation this evening. As you know, Elizabeth Farnsworth is an outstanding journalist, a well-known journalist throughout the country and throughout the world. She is also an award-winning producer and director, and is currently the senior correspondent for the NewsHour with Jim Lehrer. She concentrates on covering foreign affairs and the arts. I'm very pleased to have her join us tonight. Elizabeth Farnsworth is also a member of the council's advisory boards, so thank you Elizabeth. Thank you, Jane. Welcome, everybody, it's great to see you. I see lots of familiar faces, welcome to Carol Bellamy, it's an honor to be here with you. Carol Bellamy is President and CEO of World Learning, an organization that promotes international understanding, democracy, social justice, and economic development through projects in more than 100 countries on five continents. In May, she completed ten years as executive director of UNICEF: The United Nations Childrens' fund. Carol Bellamy has also served as director of the Peace Corps and was herself a volunteer in 1963 to 1965 in Guatemala. Carol Bellamy has been a New York state senator, and was for seven years president of the New York city council, the first woman to have that job. An attorney, she's also worked in corporate law and finance. I think it's sort of a unique bio, myself. I mean, I really don't know anybody else that quite has this bio. There have been some significant improvements in children's lives in recent decades and I want to say a few of these, and I'm sure that Carol Bellamy will say some more, but really, what we're going to have a conversation about is what she has called the "failed promises" of development work on children in the past decades. The significant improvements include 99 percent reduction in polio since 1988, 40 percent decrease in measles since, I think it's about 1990, 50 percent decrease in diarrhea deaths, 16 percent drop in child mortality rates worldwide since 1990. But according to Carol Bellamy's own 2005 report, which she rolled out for the world last year, on the state of the world's children, one-half of the world's children are suffering extreme deprivations from poverty, war, and HIV/AIDS. Ninety million children are severely food-deprived. 500 million have no access to sanitation, and 140 million have never been to school. Carol, you've been remarkably candid about the failures of the world's development organizations and goals. You said recently, "When one half the world's children are growing up hungry and unhealthy, when whole villages are being emptied by AIDS, we fail to deliver on the promise of childhood." And tonight, we're gonna talk about why. There are a lot of ways to do this; I'm going to start with some personal... going into it personally. Go back to that village, where you were a volunteer in Guatemala, in 1963-65. Tell us what it was you saw, I, I mean, if you're anything like I was in those years, I was in a similar experience, it helped to propel you along this course you've taken. Why? What did you see there? What was wrong there, in the way children. what did they suffer then, what did you want to do about it? And then we're gonna get into what's happening there now. Well in many ways, some of the problems still prevail in many parts of the world, lack of access to clean water, we take water for granted, although perhaps the Katrina situation reminded us when you don't have clean water, how important that is. We take santiation, which is even a bigger problem actually, the fact is, around the world today over the last couple of decades there has been an improvement in access to clean water but it hasn't been matched by sanitations, so I go back to this village in Guatemala, or these villages, 'cause I actually served in an area, and so what I recall the most, I suppose, were, because a couple of children died in my arms, were children dying from dehydration, from diarrhea. When you mention it, it is true that there's been a 50 percent cut in diarrhea deaths over the last decade, and a little bit more than that, but that's still means that there's still that's only a 50 percent cut, that's not a hundred percent cut, and that not one child should die from diarrhea, I mean, we know what should be done, this is not something that we don't know what to do. So the fact that there would be this dehydration from bad water, from contaminated food, there wasn't sanitation, that parents didn't know what to do some of those things haven't changed. I felt also, almost from that time that what, you know, one of the things that followed me my whole life was immunization, because I was involved in some preliminary immunization, even in '63-'65. I became the second-highest elected official in New York City in 1977, taking over in '78, in New York City, and yet there'd just been a Centers for Disease Control study of New York City and it determined that about a third of the children in New York City schools were not immunized in those days and that's because there was such a turnover in those school, so many children coming, as you would expect in a big city, from other countries, and so the assumption was, all children got their shots early on, but they didn't. And then, the time I came back to UNICEF again, I was back at immunization. So many of the things I saw in those days. But also, and I would finish on that, I also saw how our people wanted to do things, teachers, teachers, the local farmacia, the local pharmacist, he wasn't really a pharmacist who was a change agent in the community. So I saw people who could lead in the community and make a difference, even though they weren't necessarily called leaders. Have you been back to that village since? I only went back once, it's a. hm, it's not a good test, frankly, because I was in a part of Guatemala that was the most remote part, there was no way out. I actually didn't get back to Guatemala City during the time, because you could only get in through military airpor. military aircraft. But, it was also an area where, a year before, the University of Pennsylvania had discovered the Tikal ruins, so it's now a tourist area, so it's obviously changed because of tourism. Take what is typical about it, though, or a village that's like it in another part of Guatemala or any of the other places you've been and would it be, would that village be significantly better off, the children in that village, typically, I know it's hard to find a typical village, but give it a try, now than they were, say thirty years ago, let's not even go back to '63. Well, one element is, yes, the answer would be yes and I'm gonna explain why, because it means that most of the villages in Guatemala would not be, because this was called a Ladino, which meant a mixed village, it wasn't an indigenous village, and the reality is, even in those parts of the world, like the Americas, frankly, or like East Asia, I don't include sub-Saharan Africa, where there have been improvements over the last couple decades, the most marginalized tend to be indigenous communities, like the Mayan communities have seen very little change at all. Was that the source, your experience in that village, having children die in your arms, the source of this tremendous commitment you've had through the years to this work? I don't know that, what, I... For me, I'm still, to this very day, I consider myself the Peace Corps poster child, it was an extraordinary experience, and it wasn't that every day was an extraordinary experience, there were clearly those days in the two years where you said, "Whoa, what am I doing here?" But, you learn, your life changes, you learn so much about yourself, that's why I like what I'm doing now at World Learning, that's why I like what I did at UNICEF, that people having an international experience, whether it's as an experiment or as you were, I say that for the people in the audience who I know were experimenters, that's what really made the difference. So I don't want to say that it wasn't the children, but you know, I said this to you... I hate do-gooders who think they can do good without money or management... and it's the same thing. I don't think you just approach trying to make things better out of some... solely a sense of charity. I think you approach trying to make things better because people deserve better. And there has to be some, there has to be some equity and some fairness in it, not just because you're Lady Bountiful or Sir Bountiful. So I think it has to be more than just the children, it has to be that this isn't fair, other people, you know, there needs to be something closer to equity, and people need to do better than they do for children now. They talk too much, particularly political leaders. Pick a key problem, one of the key problems of childhood in developing countries that's laid out in your report last year for UNICEF. Pick hunger, sanitation, water, and describe a program that you really respect, that worked, and one that didn't, and tell me the conclusions you draw from that. Well, I think health is a. health. basic health is a very important area, and yet there are many programs that work that are very simple, low-cost, and low-tech. This isn't very sexy, I realize, but everybody needs a little bit of iodine in their diet, and in fact, the lack of a little bit of iodine in their diet is a major cause of mental retardation, or, at least, slow cognitive development in children in the developing world. And yet, if you look, and you can get iodine in different ways, but the best, and the cheapest, and the most consistent way is to get it through salt. And if you want to look at something that actually worked, if you look at the statistics in 1990, about 12 percent of the salt consumed in the developing world was iodized. By the year 2000, over 70 percent was. So this made a difference, it actually made a difference, and as usual, this was a prevention, so it's not as though it was late-breaking news, but it really made a difference in how those children could grow, because early childhood development is a very important... is very important. Well I mentioned one before, I mean, for all the effort put in trying to improve increased access to water, sanitation hasn't kept pace, and again, for children, particularly, inadequate sanitation just means so many different things. It's everything from the dehydration and diarrhea to dying, to malnutrition, and if you look at the eleven, if you look at the numbers of the eleven million children who die every year from totally, totally preventable causes, it's not just malnutrition, but a center cause of that is malnutrition, to worms, I mean, you know, not enough children go to school booths they go to school but they're sick, because they have worms, they can't study, now if they don't have the availability to go to school, as well, that's a problem. So I would say that in the health area, there've been things like iodide salt, there've been things like the polio campaign although it hit a bump, two years ago because of some things in Nigeria, but it's coming back, that's a success, but I would say one of the big health failures has been the lack of attention to sanitation. Okay, let's stay with that for a bit and then I wanna come back to this seemingly non-sexy but very important really small things that make such a huge difference. Why? What is happening in the work on sanitation, I mean, in all of these organizations that you've worked either in or with know this, and there've been lots of efforts, I know this, I've reported on them, I know these kinds of efforts. Why is sanitation, I mean, we all understand it's not the most... it's very difficult, but why? Why has that not been better worked on? Well, I don't want to sound like an apologist, but frankly, I don't believe the primary responsibility rests on international organizations. I believe the primary responsibility rests on presidents, and prime ministers, and parliamentarians, and leaders in countries. That's not to take the, not to allow do-gooder organizations whether it's the U.N. or not off the hook. In, in both the developed and the underdeveloped countries, yes. Absolutely. And frankly, because there hasn't been adequate investment in these areas, and secondarily, interestingly, we now get into this... it's kind of diagrams, and in most countries, even the poorest countries, there's a minister of health. But that minister very often doesn't have much to talk to the minister of water, and there's no minister of sanitation. So water and health sometimes aren't even seen as related, and sanitation never really, you know, as I always say, the worst thing in the world is the famous blue plastic bag. Travel around the developed world today and you just see blue plastic bags everywhere, because they don't decompose. So, it is that frankly, there's nobody responsible. Mm-hmm. Political problem. All right. We're gonna come back to that. I want to go back, now, for a minute to the small iodine, which of course, isn't so small, but it's really making a difference. But I have been interested that there have been many solutions like that, that seem small. I mean, you said that diarrhea's not that hard to prevent. Talk about that a little bit, that simple mix of salt and water and sucrose, right? Yep. And what do you do, why... What's happening, because I keep reading about other small things that are being discovered, for example, for child... for the child mortality rate as babies, that can be done, that make a huge difference. And I wanna throw in there my most favorite, and I think the most important thing for child mortality, which is girls getting an education, which is in some ways... sounds big, yet it's small, because it. I was a banker once, an investment banker, and people asked me, "How do you get good returns?" There is nothing that the produces a bigger return than a girl getting an education because she's more likely to grow to be a healthy adult, her children absolutely, there's empirical evidence less likely to die because she knows, before the age of five, because she knows how to take care of them. Her family's more likely to be economically secure, and she's less likely to become a victim of HIV and AIDS. But, a couple of other small things. Vitamin A. Vitamin A capsules, which can be distributed in conjunction with any kind of immunization campaign, regular immunizations, not just the campaigns, used to be seen as something that would just prevent blindness, but it actually enhances the nutritional system, if you will, just a very simple type of thing, and even the poorest, poorest parents, you see the women, understand that now the one thing they have, if you go to many developing countries, the one thing you'll find, you'll find the immunization card. And so you combine things in conjunction with that one time they might come to get the immunization. For example, another possible thing, because there's not a prevention right now, but more children still to this very day are dying in Africa of malaria even more than HIV and AIDS right now. And so, combining the potential of providing, and perhaps I happen to believe, a very low cost, I actually believe, because when people have to buy it, even at the lowest cost, they'll take more care of it. Again, and that one visit, or that one time when the health clinic is out there that does the Vitamin A and the jab, or the drops, and that treated bed net until they've secured these, and particularly for, it just requires a little education. Mothers love their children, even the poorest mothers, or the mothers who are not educated, they love their children, they don't want their children to die. Get pregnant women and young children under a treated bed net, you really can make a difference in terms of malaria. The politics of all this, that it's not just good will and it really has to be political, and people have to make decisions to do this... You said, you've been so candid about, I mean, while many other people have recognized the fine work you've done, you've been very candid about what even happened during your ten years at UNICEF, you were quoted in an interview as saying, "I wish that after ten years, the world were a better place for children, and I'm not sure it is. What was the lack of political will that you witnessed, that you couldn't, you know, change, that would have helped you? Well, I'll start with... the pandemic of HIV and AIDS. You know, the urgency about HIV and AIDS, and I'm thinking to myself I always wear my ribbon, and I didn't wear it tonight, but I still have too many people in this country who say, "Now, what's that red one for again?" That the urgency of AIDS has left what I would call what I would call the developed world for a couple reasons. One, because there is treatment in some ways, and generally those people, the great majority of the people who need treatment are able to get treatment, and so in the developed world, it's falling on the poorest, or the most marginalized immigrants and minorities, and we don't care as much about those folks. But we've lost the urgency, whereas HIV/AIDS is still growing globally. It isn't just an Africa problem. I mean, there are countries in Africa with a 30 to 35 percent prevalence rate, but if you look at India and China, even with the recently announced reduced rates in China with a lower than one percent, but a lower than one percent in a billion person population is more than a 35 percent in a one million population. And fast growing, and almost a hundred percent in places like Russia and Estonia. The numbers aren't huge, but if you have a hundred percent increase somewhere... It's a different pandemic in different places. In Asia, it's still more, more but getting into the mainstream, more sex workers, and blood, and intravenous drug, whereas the more heterosexual issue in Africa. But it is falling enormously harshly on children. Not just children who have been orphaned as a result of AIDS, but still, it's already estimated that there are fourteen million children that are, of whom because the numbers are in Africa right now because the majority are in Africa, but that will grow to other places in the world, but you have child-headed households, you have girls who if they are going to school, are dropping out of school. And having gone through all that, the failure of leadership to confront HIV and AIDS and what little breakthroughs over the last few years, it's been, I believe a lot of it is still public pronouncements to the public and less so the willingness to get in there and really try to get families, and communities, and church people to talk to their parishoners, and. You're talking about now in the countries which are real problems. Right. I mean, I think that the richer countries have solidarity and provide resources as well. But... so the failure of leadership on HIV for so long, and only starting to crack through. The failure of leadership in terms of the amount of instability in the world today and the use of children as, in conjunction with war, as child soldiers, as sex slaves, as carriers of ammunition... the older boys actually are the soldiers, the younger boys carry ammunition, and the girls have the babies. And it's just happening over and over and over and over again, and a failure to really face up to that. So those are. those, and the continued impact of poverty on the world today. I wanna say one more thing about war. In the mid 20th century, World War II, about 60 percent of casualties, or 60-70 percent were military. I mean, I'm not for any casualties, but they were military. But, in the 21st century, 90 percent plus of casualties in conflict are civilian. Women or children, usually. Wars have changed, they are not two armies fighting each other, they are battles within countries, and it's how do I most hurt the people I hate the most, and you wanna hurt them, the children, and the women. And so, the impact on children, there, and then the failure, frankly, to make these modest investments in simple health systems, and simple education systems. It is down a little bit from 140 million children not in schools, but it's still estimated that there are over a hundred million children in the world who ought to be in primary school who are not in school, and about 60 percent of those are girls. So you don't need some scientific breakthrough, you don't need to read a textbook. You know what needs to be done, but instead of investing in a child at school arms are invested in. Instead of, instead of parking HIV/AIDS with the health commissioner take it on yourself. Make your vice-president of the country your AIDS coordinator, reporting to you every day. And these are the things, again, maybe we as international organizations could have done more, but these are the things that just continue every day to put barriers in terms of creating a world that is really more fit for children. Thinking of organizations that work on issues of health, and let's take HIV/AIDS as an example, and tell me if this is an example that's not good for you to talk about, because I just happen to know about it because I reported from there, but you may have a better example. I'm thinking about a country like Botswana, in Africa, southern Africa, which has one of the highest rates of HIV/AIDS in the world and where there is a real effort to do something about it. And I understand Botswana's a little different, because there is welfare in the form of diamonds, but it's also had a government which I think has made this very important political decision you're talking about, and I haven't followed it closely the past year or two, so I may be out of date here. But I'd be curious to hear from you, what... it's a place where there's a real, it's a strong public/private partnership in working on this issue, and I'd be curious to know from you more about that public/private partnership, how the politics work there, and whether, in fact, getting the retroviral medication to people is really helping, 'cause that was the goal. Well, Botswana's a very interesting country, it was a country that was one of the countries in southern Africa that was not at war, it is a country that had generally economic viability, diamonds, but also some relative stability. But if you talk to the political leadership of Botswana and the president now is just obsessed with these issues and thank goodness is a great leader, but he himself will admit this is a country that was in denial much too long, and basically let it get out of hand. But that being said, I think they are a very good model for, not for what went on in the past, but for publicprivate partnerships, and this is both internally, through the mining companies who have acted as well as external partners, everything from the Gates Foundation to the Elizabeth Glaser folks to the U.N. as well. They had good ministers, they had a really tough health minister, I love her, she's great, she's now a, she's now a senior senior undersecretary undersecretary general, or assistant secretary general, I don't know what her title is, but senior poobah in the World Health Organization. But she was tough, she was tough, and she would tell U.N. agencies you know, you're not, you're not, you know, this is really great, two little diddly pilot projects on mother to child transmission, what, you know, what good is that going to do? So it is, I think there's a lot to learn from Botswana, first to learn what shouldn't have been done, which was denial, denial, denial, denial, but secondly to see what can be done now. I think a lot can be learned in terms of the Botswana story and I hope that other countries will look at that. How about resources for orphans, work for orphans, private, public, U.N.? Well I will offer a view on this. I do not believe the answer on this is orphanages. First of all, there are too many orphans. There would never be the resources, and certainly not the resources to maintain. And so I think you have to do, I think you do several things. First of all, I think you try and keep the parents alive as long as possible. So even if the mother's infected, if through some of the treatment... mother and father, but in this case I particularly focus on... the longer you can keep one of the parents alive, even though they are infected, the shorter the period that child will be an orphan. So start first with prevention, but assuming you've missed that part, keep the parent, one or more parents alive. Two, look to the extended family, but there are so many complications in the extended family, there clearly are great traditions of extended family but there can also be enormous violence and you become subjugated, you almost become a slave in the extended family, so this idea of extended family, there needs to be... Three, I mean, some of the laws need to be changed. For example, there is no law that says you can't have inheritance, but there's tradition in some ways. So some of the laws around property, property is very important and inheritance is critically important. Four, in no particular order, girls, girls, girls, women, women, women. They are the ones, I mean, girls and women are being infected in sub-Saharan Africa at twice the rate of men and boys. Largely because of violence, partly because of this idea that you can cure yourself if you are infected by having sex with a virgin, and so it's younger and younger and younger. Girls... so do more protection there. Do more education there to try and prevent. And then finally, build, support community based organizations. Outside organizations can help, but outside organizations coming in top down aren't going to work. Help build small capacities within local NTOs through churches, through other organizations to at least help provide the food. Pay for their school fees. First of all, you might even do away with the school fees in the first place, but if not, help pay for the school fees. So there's a gradation in my view of... you can't make the orphan situation go away, you try and make it stop growing as large by doing prevention but keep the family alive, support the extended family but beware of terrible possibilities there, change some of the laws for protection purposes, make sure the girls get to go to school, and build community strength to provide very simple services. Is this happening? Are resources going into this? Some of it's happening, not enough, it's not, I've used this word too often, but its probably the least sexy area, more interesting was straight-out prevention and I'm delighted to say that I think the global community's gotten past the prevention versus treatment argument of a couple years ago and everybody realizes you need to do, but a couple years ago, 2001, I guess it was, there was a major global AIDS conference, and there was a commitment to a plan of action. And the area in which there has been the least amount of follow up has been dealing with the issue of children orphaned as the result of AIDS. What would you say was your biggest frustration as the head of UNICEF? Was it dealing with politics, you know, U.S. politics, criticisms of UNICEF and limitations on resources, perhaps because, no funds going to organizations that could be seen as supporting abortion, was it criticisms from other sources, what was your biggest frustration? Well, first of all, UNICEF has absolutely nothing to do with abortion, as I'm reminding people over and over and over again, and in fact, the U.S. is the number 1 supporter of UNICEF, it's the number one supporter of the World Food Program, it's an interesting country if you haven't noticed, and an interesting government, with this kind of love, occasionally not love with the U.N. I mean, in both Republican and Democrat administrations. It kind of has this, "Oh, we're not going to pay our dues," and yet, the U.S. remains, and this has been a Republican and a Democratic administrations, very major supporters of international organizations. Now on a per capita basis, I mean, the Nordics blow the U.S. out of the water, but nevertheless it is important to recognize that the U.S. is a very strong supporter of the World Health organization and the World Food or UNICEF or the refugee agency. So there were occasional difficulties,