Baby Fae, the Ethiopians -- catches our attention. It is a good moment to see what the premier international rescuer of dying children, UNICEF, is doing far from public view.
The United Nations Children's Fund, whose work I have been tracking for a while, is engaged in one of the grand projects of our time: applying cheap, available technologies and services to saving the lives of millions of the children who routinely die of and are stunted by malnutrition, diarrhea and infection in the Third World, year after year.
Yes, there is something arbitrary about plucking out one concern -- health -- of one population group -- children -- from the morass of disabilities summed up in the word "underdeveloped." Such a focus leaves a pitiful amount of work in the world undone. It would be much better if this single concern had been caught up by a rising tide of develop- ment carrying all the cares of all people before it.
No parent, however, will linger long over the necessity of doing what can be done for the most vulnerable members of the human family. A focus on the health of the young, furthermore, takes you quickly to broad matters of nutrition, literacy, family size, jobs and social organization. In the dreadful circumstances, it is good that one U.N. agency -- sticking to its mandate -- is starting to weave an international safety net under the young.
UNICEF promotes a cheap oral rehydration therapy technique to combat diarrhea-caused dehydration, universal child immunization and breast feeding. As I have heard UNICEF's executive director, James Grant, and others talk of the organization's "child survival revolution," however, it becomes evident that these are only the minimum.
It is in the first instance a self-help program, one that requires individual people to take responsibility for maintaining their families' health: to administer cheap salts, to bring the kids for immunization, to breast-feed.
An obvious idea? UNICEF's annual report asks us to think again, observing that the industrialized world long ago made health care almost synonymous with dependence on medical professionals and expensive curative care. The notion, essential to health strategies in poor countries, that primary responsibility for health can be taken by the individual is only lately being widely reclaimed in rich countries, with the new attention to smoking, exercise and diet.
Individual involvement, however, can't begin until local governments provide the materials and services that, minimal as they are, are crucial to putting the program into gear. Thus last June 23, July 28 and Aug. 24 were great days in Colombia, which became, it seems, the first developing country to conduct a UNICEF-style national immunization campaign. President Belisario Betancur made it a big political thing, and the private sector and voluntary organizations (church, Red Cross, media) pitched in. For UNICEF it was progress in moving its program out of the labs, off the policy papers, beyond test runs, and into full-scale national applications that can be replicated around the world.
In this process, UNICEF suggests, nothing is quite so critical and delicate as "social marketing," inducing millions of parents to put life- saving information to use. As with the two relevant large-scale precedents, the high-tech Green Revolution and the family-planning movement, a political commitment by the leadership and the provision of resources are imperative, but it finally comes down to selling millions of individuals on changing their child- raising style.
UNICEF describes social marketing as "one of the most important tools for taking child protection strategies out of the medical chest and putting them into the hands of parents." It notes too its fear "that this potential will be squandered in facile imitation of the more visible techniques of commercial marketing. . . ."
"We are now talking," UNICEF concludes, "about a particular opportunity to save the lives of approximately 7 million young children a year, and to protect the normal development of many millions more, at a cost which certainly does not exceed a fraction of 1 percent of the world's gross international product. If the will to accept that challenge is missing, then perhaps it will never be there. For in all realism, it is unlikely that there will ever again be such an opportunity to do so much for so many, and for so little."