Thank you all. (Applause.) Thank you all very much. (Applause.) It is so very exciting for me to be here with you today, and we are honored to be joined by three First Ladies. I have, as you might guess, a really soft spot in my heart for First Ladies. (Laughter.) And you will be hearing from them later today, but if we could just ask them to stand– the First Lady of Mozambique, the First Lady of Sierra Leone, and the First Lady of Kenya. (Applause)
I want to thank Bo Cutter, the chairman of the board, all of the directors and members of this great organization’s board, a longtime friend, JoDee Winterhoff, who has brought to CARE the same passion and judgment that I so admired and depended on during the years we worked together.
And mostly, I want to thank Helene Gayle, because Helene Gayle has dedicated her career to making sure that the building blocks of healthy, secure lives are available not only just to citizens of wealthy nations, but to people everywhere. As a doctor and a public health expert, she has significantly advanced the global fight against AIDS, she’s championed the critical issue of health, particularly women’s health, and she’s made CARE – a great organization – even greater.
In fact, when I became Secretary of State, one of the very first people I reached out to was Helene. And I said, “Helene, do you have any interest in joining the Administration?” And she said, “Well, of course, I’m very excited about what can be done, but I care about CARE and I’m committed to CARE.” (Applause.) And I know a little bit about her tenacity as well. (Laughter.)
Now, as I look around this great space here, I see friends and colleagues and I know that there are representatives from so many backgrounds and walks of life, from governments, from NGOs, from academia – even the NBA. And I know whatever vocation has brought you here, whatever path you’ve traveled, we all have something in common: We’ve come together for the CARE Annual Conference because we care. We care not only about an organization that is so aptly named, but we care about the mission. And Bo read that mission statement at the very beginning.
We care about defending dignity and fighting poverty. And we care about people who work from sunup to sundown to secure the basics of a healthy life, about the repercussions of a global economic system that traps more than a billion people in poverty – most of them women and children, about the future of families and communities in the aftermath of natural disasters that in one instant can erase years, even decades, of progress.
But as you know so well, caring alone is not enough. I wish it were. I wish it were so self-evident that all we had to do was to say to one another, “Well, we care about this,” and action would somehow burst forth. But we need to be the actors. We need to channel our care into concrete actions, something that all of you do every single day.
CARE’s mission – to tackle the underlying causes of poverty so people can lead lives of dignity and self-sufficiency – is very close to my heart. And it’s a mission that we share in the Obama Administration, and especially at the State Department and USAID.
Because like CARE, we believe that by creating the conditions in which families and communities thrive, we can promote stability, opportunity, and progress far beyond any one community and even one country. And we can foster a new set of capable partners to help us meet global threats, from climate change to nuclear nonproliferation to terrorism.
And as we elevate development as a critical pillar of U.S. foreign policy and national security, right up there with diplomacy and defense, we’re taking a new approach. We’re supporting local and national leaders who are already driving progress and who can, with our help, improve and accelerate their work. Because our goal is to help our partners – partner countries, partner organizations, partner individuals – build their own capacity to provide citizens with the essentials like food, water, health care, education, economic opportunity, jobs, credit; responsive, accountable public institutions.
So to that end, we’re investing in innovation and we’re supporting entrepreneurs, both business and social entrepreneurs, who are putting their talents to work to address the unmet needs that they see. We’re designing programs with women in mind and increasing opportunities for women to lead, because, as the people of CARE know so well, women are powerful.
We’re using our convening power to bring together governments, businesses, foundations, NGOs, universities, all of which offer valuable and complementary expertise and resources. And we’re reaching out more than ever to the private sector to get their assistance and ideas, because we’re committed to getting results not measured in dollars but in lasting changes in people’s lives.
Now, I could discuss many issues with you today that showcase this new approach to development. But I’m going to focus on one that holds a special urgency and does represent a new strategy that we are employing; namely, nutrition.
Few issues provide a more direct, affordable, and effective way to save and improve lives. But as experts on nutrition will attest, it has long been overlooked by a global community focused on other priorities, because there are so many priorities that capture our hearts, that really speak to us. As governments and organizations search for strategic interventions in the fight against poverty, places where our money and our effort can make the biggest and most lasting differences, nutrition represents a ripe opportunity and one that can be addressed from many different angles.
For example, in Kenya, as Mrs. Odinga knows, women scientists are developing bio-fortified crops. Women scientists whom I have met with who are out in the fields representing the fact that more than 60 percent of all the farmers in Kenya, just like more than 60 percent of the farmers in Africa, are women. So these women scientists and researchers are going to farmers – mostly women – helping them increase their harvest even in times of drought to be able to grow more nutritious food for their family, to increase their productivity, to have more at the marketplace.
At a clinic in South Africa, community health workers offer comprehensive care, including nutrition to people with HIV and AIDS. In a neighborhood in Jakarta, new mothers can have their infants weighed and measured to make sure they are growing as they should. And here at home, more than 30 million American children receive free or reduced-priced meals at school. And for many, that’s their only reliable source of good nutrition. And in the face of an obesity crisis that could lead to this generation of American children becoming the first in history with shorter life spans than their parents, advocates – including First Lady Michelle Obama – are leading the charge for healthier food both in school and at home.
Now, whether the primary focus of these programs is agriculture, health, or education, nutrition is the common thread because it’s an issue that cuts across every sector. It’s an economic issue. The World Bank estimates that up to 3 percent of gross domestic product is lost to under-nutrition in the hardest-hit countries. And under-nutrition costs individuals more than 10 percent of their lifetime earnings. It’s an education issue. Undernourished children struggle to learn and to stay in school, and it is, of course, a health issue.
One in three children worldwide suffers from under-nutrition. In some countries, half of all children are stunted, which impedes their brain development and causes lifelong health and learning problems. More than 3 million children and 100,000 mothers die every year from causes related to under-nutrition, which weakens immune systems, makes people susceptible to other health problems such as anemia, which is a leading contributor of maternal mortality, and pneumonia, which is the leading cause of death for children worldwide.
Under-nutrition impairs the effectiveness of life-saving medications, including the antiretrovirals needed by people living with HIV and AIDS. And the effects of under-nutrition linger for generations. Girls stunted by under-nutrition grow up to be women who are more likely to endure, if they survive, difficult pregnancies. And then their children, too, come into life undernourished.
So nutrition is a universal need and people of all ages and circumstances deserve access to nutritious foods. But the two groups that have the most acute need for improved nutrition are pregnant women and children, particularly babies. This is due in part to feeding practices that have women and children, particularly girls, eating last and eating least. But it also reflects the particular health needs of women, especially mothers and especially young children.
Nutrition plays the most critical role in a person’s life during a narrow window of time – the 1,000 days that begin at the start of a pregnancy and continue through the second year of life. The quality of nutrition during those 1,000 days can help determine whether a mother and child survive pregnancy and whether a child will contract a common childhood disease, experience enough brain development to go to school and hold a job as an adult.
The science of nutrition points to a strategy. If we target that brief critical period during which nutrition has the biggest impact and focus on improving nutrition for expectant mothers, new mothers, and young children, we can accomplish several things at once. We can save lives, we can help children start life on a better path, and we can bolster economic development and learning down the road.
So that’s the thinking behind the Obama Administration’s new approach to nutrition. For the first time, the United States is focusing our investments on that 1,000-day window. We’re identifying millions of young children who need nutritional support and we’re sticking with them for a three-year period to give them a foundation to lead healthy lives. We’re also significantly scaling up our investments in research and development to discover what we hope will be path-breaking tools and technologies, ranging from new techniques for measuring under-nutrition to new supplements to new bio-fortified crops.
We’re focusing on women – the mothers, the farmers, the health workers, the community leaders whose insights and efforts can make the difference between a successful program and one that falls short. And we’re putting an end to the stove-piping that has long hindered our government’s nutrition efforts. For years, experts have been saying that this is a problem that must be addressed through a comprehensive response that unites experts and programs from across different fields. But for too long, the agricultural experts didn’t talk to the neonatal experts who didn’t talk to the early childhood experts.
Well, we’re trying to end that and we’re trying to make nutrition the intersection of two major new policy initiatives – the Global Health Initiative, a six-year, $63 billion effort to strengthen the health systems of our partner countries and Feed the Future, our hunger and food security initiative of at least three years and $3.5 billion to improve agricultural systems from farms to markets.
We aim to reduce child under-nutrition by 30 percent in our partner countries and we know there’s not one-size-fits-all approach. Different communities face different challenges. In some places, the problem is a lack of affordable, diverse, protein-rich foods. In others, the key constraint may be chronic gastrointestinal disease caused by unsafe drinking water. In still others, people are switching from traditional diets to unfortified, processed foods – sounds familiar – with unhealthy results.
To succeed, we have to tailor our strategies to suit our partners’ specific needs and strengths. So we’re supporting nutrition education for farmers and parents so everyone knows the nutritional value of a diverse diet and mothers understand the benefits of good feeding practices during their child’s first two years. Many mothers who can breastfeed still switch too early to foods mixed with unclean water, which causes diarrheal disease, the second-leading killer of children worldwide.
And after infancy, many mothers do not know when they should introduce foods that should be rich in the nutrients children need at critical times in their development. Of course, encouraging mothers to feed their children well won’t work if nutrient-rich foods aren’t available or if they aren’t affordable. Through the Feed the Future Initiative, we’re helping to strengthen agricultural systems to accomplish three things – increase the amount and diversity of food grown, improve markets so people have access to that food, and increase people’s income so they can afford to buy more and better quality food and put more of their daughters and sons in school.
All three outcomes, we believe, will help reduce under-nutrition, particularly if we ensure that the benefits reach women who are more likely to pass them on to their children. That’s a lesson we’ve learned in microfinance and in most programs – focus on women if you want lasting, measurable results.
So as our partner countries devise national strategies to fight under-nutrition, we will help carry them out. For example, Rwanda, a country in which one and two – one in two children is stunted. They have created a comprehensive plan that they are executing with our support. Last year, the health ministry trained every community health worker in the country to screen children for under-nutrition; more than a million children were evaluated. And more Rwandan farmers are now planting diverse, nutrient-rich crops—not just the staple starches, but fruits and vegetables, too.
We’re making existing remedies more widely available. Some of the worst effects of under-nutrition can be alleviated through simple interventions, like giving pregnant women iron to prevent anemia or giving children oral rehydration salts to manage diarrhea. For want of these basic treatments, millions of people die every year. These deaths are intolerable, because they are preventable. And through the Global Health Initiative, we’re strengthening health systems with an emphasis on nutrition, so health workers will know to provide nutritional support, even if the patients don’t know to ask for it. And children receiving vaccinations will also receive critical supplements, and health workers will be able to identify early those children most vulnerable to under-nutrition and treat them in their homes, while their families receive the education they need to keep their children nourished.
We’re also working to improve access to safe drinking water. We know that protects children from diarrheal diseases that deplete them of nourishment. In Port au Prince today, the percentage of people with access to clean drinking water is actually higher than it was before the earthquake. (Applause.) Now we have to maintain and increase those numbers so that the efforts of parents, doctors, families, so many aid workers, so many organizations like CARE, so many governments like our own, won’t be undone with the return of unsafe water.
So prevention is the watchword of our efforts. We not only want to save the lives of under-nourished children, but to prevent children from becoming under-nourished in the first place. Prevention is a long-term investment, and in many ways it is more difficult than short-term rescue. But its payoffs are far greater.
Our partnerships in this field are strong and growing. In September, the United States will host a nutrition and food security event at the Millennium Development Goals Summit in New York with Ireland – a country with firsthand experience of the devastation caused by food shortages, and a leader in the global fight against hunger and under-nutrition. We are also working with DFID, the United Kingdom’s Department for International Development, which just published its first-ever strategy for under-nutrition, titled “The Neglected Crisis.” Together, in places including Bangladesh and Ethiopia, we will help to undo the effects of that neglect.
And we will continue to work with groups like CARE. CARE has spent decades promoting effective, innovative strategies for nutrition, women’s health, children’s health, agricultural development, and other related issues. Many of the best ideas for how to solve this problem have been conceived by or refined through the work of CARE and its partners. And we’re building on that foundation because we think it will serve us well in the future. Now, we have a choice to make.
Ten years ago, the world made a historic promise to solve global challenges together. Our commitment is enshrined in the Millennium Development Goals—and nutrition is front and center as part of Goal 1 and it’s critical to Goals 4 and 5 as well. But our progress on nutrition has been too slow. In fact, while we have been working on the problem of under-nutrition, the problem of obesity and chronic diseases has been growing by leaps and bounds. So now we are facing a continuum of nutrition challenges. We still have hundreds of millions of under-nourished people in the world and we increasingly have in our own country and elsewhere, children as well as adults, becoming obese in ways that undermine their health and shorten their lifespan.
So nutrition is a focus primarily for us because of under-nutrition, but we are well aware of the fact that dealing with the causes and consequences of obesity, particularly the alarming increase in chronic disease in countries like India and China, requires us to stay focused on nutrition.
Our principal concern are our children. Because ultimately, that’s who we’re working to protect – the children whose lives and futures are most vulnerable to the dangers and deprivations of poverty. Their health is a leading indicator of a nation’s stability, security, and prosperity. I often tell people as I travel around the world, “I you want to know how stable a country is, don’t count the number of advanced weapons, count the number of malnourished children.” (Applause.)
And people say, “Well, why do you focus on women and children?” Well, we focus on women because all of the research going back decades demonstrates the best development strategies are focused on women; that focusing on a woman, helping a woman get better nutrition, getting access to credit, getting education, improves life for the families. We focus on children because they’re children. They didn’t have anything to do with the situations into which they were born. They didn’t have any role to play in the governments that govern them and their families. And from the moment they’re born, hundreds of millions of children are burdened with disadvantages that shape the course of their lives – disadvantages they did not cause, disadvantages they do not deserve, and disadvantages they are powerless to change. (Applause.) So they look to us, not only to parents and extended family and communities and countries. They look to us. And we have no greater responsibility on this earth than to give each child a chance to make the most of his or her God-given potential.
In my many years of working in this area, the Children’s Defense Fund and in so many other settings, I’ve always seen how talent is universal, but opportunity is not. I honestly believe that we could go anywhere in the world today, into the poorest parts of the poorest communities, and you would find children who, with the right health and the right education, could be the next generation of doctors and business leaders and government leaders, and who could contribute to the world that they are inheriting from us.
This is a cause that I have worked on for my entire adult life. And in that time, the world has made great progress in the fight for children’s lives. Last fall, UNICEF announced that the numbers of children dying before their fifth birthday had fallen below nine million for the first time in recorded history. (Applause.) But nine million is still a lot of children. And I think about all of the heroes and heroines who have helped to make that possible. Many of the gains that we are now celebrating can be traced back to one person. Some of you knew him. He was a friend of mine, Jim Grant, the long-time head of UNICEF. And Jim Grant believed everything was possible, even when most people believed it was impossible. He believed we could vaccinate children in poor countries on the scale that we do in wealthy countries. He believed we could stop children from dying from preventable diseases like diarrhea and he pioneered the use of oral rehydration therapy and kept a package of salts in his pocket which he would take during meetings with leaders and say, “This costs less than a cup of tea and it can save the lives of hundreds of thousands of children in your country.” And one by one, he convinced governments and donors and health experts to join the cause. He turned skeptics into passionate supporters. And by the end of the 1980s through the widespread use of solutions that cost just pennies or, at most, dollars per child, the campaign for child survival was credited with saving 12 million lives. So I think about people like Jim or Norm Borlaug that did so much to stop the unnecessary deaths of millions of children through practical, down-to-earth, and, in most instances, inexpensive solutions.
Well, we each now have the potential in this globalized, interconnected world to act on that kind of inspiration, to have the bold ideas, the persistence, the tenacity to make them real; to see an opportunity to save lives, and then to follow where it leads; to turn that caring into concrete actions. I’m inspired by the example of so many people around the world every single day. The women and men whom I’ve met who against the most daunting odds, have made a difference for their families and their communities and just didn’t know the meaning of the word “impossible.” Well, CARE has been on the front lines of that struggle for such a long time. And I so admire the work of this organization, its global mission, its can-do spirit, its fearlessness in the face of insurmountable odds. But now we know more, we understand what works, and so we have no excuses left. Whether it’s a government or an NGO or an individual or a private business or anyone who cares, there’s a role for us to play and I thank each and every one of your for what you are doing on behalf of that mission.
And when you go to the Hill tomorrow to see my former colleagues, – (laughter) – I hope you will bring all that passion that really gets you up in the morning, but match it with the hard evidence about how much money we can save by doing it right the first time; about what a great investment prevention is instead of having to come in after the disaster strikes. Make that case and make it again and again and again till you just wear them down. (Laughter.) Because even in this time of tight budgets and extraordinarily difficult economic challenges, we know we can do more with a little bit of help that we then match – NGO, government, individual, business – and make a difference. And when we make that difference, it’s not only for the individuals whose lives are changed and improved, but it makes a difference for our country.
Because it says more loudly than a million speeches could who we are as Americans, what we stand for, what our values are, and what kind of future we want to see for our children as well. Thank you all very much. (Applause.)