Nearly 10 years ago South African James Gow, created a brilliant video contending that the way to change the world was to Aim Lower, Think Smaller, Give up and Go have a Cup of Coffee. Gow’s mantra was more than just clever writing. For Gow, aiming lower and thinking smaller meant focusing on children rather than adults. Giving up meant to quit seeking credit and obsessing over and promoting our own egos and logos. And finally, grabbing a cup of coffee meant to sit down with another group of do-gooders or opponents rather than see them as competition. Gow’s message was religious in nature, aimed as a critique of his fellow Christians. But it was also a perfect treatise on global health efforts to make the world better. It’s one the World Bank needs to hear.
As the annual meeting of the World Bank occurs in Washington, I’d contend that this aim lower, think smaller language and attitude should dominate the agenda. They meet at a time when intense winds are blowing, tossing and turning the economic landscape, uprooting lives, knocking down borders, leaving families homeless. And as usual, these winds disproportionately affect the youngest and most vulnerable humans.
Today, as these strong and deadly winds blow, children in places like South Sudan, Somalia and Syria all live on the edge of proverbial cliffs and are particularly subject to the winds that blow in their particular little corner of the world. The gusting, foul winds of famine, war, political instability, corruption and abject poverty affect every human living in troubled lands. But these winds are deadly for the children who are born hungry to hungry moms, perched precariously on the edge of nutritional cliffs. They are deadly because their little brains are growing and they are chronically undernourished. In Africa, for example, malnutrition is a swift killer when helped along by winds like cholera, malaria, war and drought. It harms everyone, but kills little kids because when those children miss a meal or two, their brains never stop demanding the essential nutrients they need to keep that brain growing. When you or I miss a meal or two or even a week’s worth as adults, our metabolisms slow down and we lose a few pounds–but we don't die. When kids in this situation are malnourished, they die. Simple as that. The winds are just strong enough to blow their fragile bodies right over the edge.
So this year as they meet in DC, the World Bank needs to remind themselves to aim lower: focus on children under six. To think smaller: knowing that if we catch these kids before they blow off the cliff we can save them, but if we miss that window – it’s too late. When we talk about people dying of starvation in the world, the fact is, people don't really die that much of starvation. Not in droves anyway. Oh sure, there are extreme occasions when political hardship (i.e., an uncaring and dysfunctional political regime) is coupled with a terrible natural disaster or really bad luck like a prolonged famine. Those things happen and, yes, people die. Yet statistics are painfully clear, people don't die, kids die. SMALL people die. Kids die in droves because they get blown off the edge of a cliff by various winds. They are malnourished and when they get, for example, malaria, then they die. Malaria did not kill them, it just finished them off. Malaria was the wind, but living near the edge of the cliff is really what killed them.
So this call to aim lower and think smaller is urgent. Other problems are very complex and intractable and difficult. Controlling all the varied winds that blow is impossible. There is no one-size-fits-all solution because the causes of the winds of Syria and Somalia are either very different. But this one is actually fairly simple. We can’t stop the winds, but we can move the kids back away from the edges of the cliffs. The way to do that is to focus on basic nutrition for kids under six. We have to get our heads out of the clouds and aim lower– think a little smaller.
While there is no one-size-fits-all solution, there is an amazing nutritional therapy called RUTF that is designed specifically for these kids living precariously on the edge of the nutritional cliff. It’s a simple peanut butter therapeutic intervention and when they eat packets of this stuff for a few weeks they are moved far away from that edge. Dr. Mark Manary of Project Peanut Butter is one of the pioneers and developers of RUTF and has seen it year after year after year. “I’ve seen thousands of children in Malawi and Sierra Leone and beyond, tens of thousands who otherwise would have died brought back by this simple intervention,” says Manary. “After 6 weeks they are fat and thriving and they begin living in a healthy nutritional state that often the average kids in their culture don’t tend to experience. So the vast majority of them don’t come back and need it again!” Dr. Manary, a researcher from Washington University in St Louis has conducted numerous studies showing that 95% of those treated never return. That's pretty amazing, because these children have effectively been picked up from a life they where were living on the edge of a cliff where the winds of malaria, political strife, death of a parent, drought - you name it - typically blow them off the edge. The RUTF does not stop the killer winds, but it sets the children so far back from the precipice that the winds can’t send these kids tumbling over the edge to their premature deaths. RUTF is one great example of how aiming lower and thinking smaller is a smart, effective and proven way to save precious lives.
So at this year’s World Bank meeting let’s hope they aim lower, think smaller, give up (on a few old ideas) and grab some coffee. It may not sound like much of a plan, but it’s a plan we already know will save tens of thousands of lives, transform economies and save the world tens of millions of dollars.
Mark Moore is the CEO and co-founder of Mana Nutrition, a non-profit producer and distributer of RUTF.