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Jimmy Carter
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A former president's journey of discovery.

PRESIDENT JIMMY CARTER: I wish I had known when I was in the White House what I know now about the Third World.

BRANCACCIO: He's criss-crossed the developing world and found millions could be saved from dying of preventable diseases.

PRESIDENT JIMMY CARTER: It's very difficult for the American people to believe that our government, one of the richest on Earth, is also one of the stingiest on Earth.

BRANCACCIO: Jimmy Carter on America and the health of the world

BRANCACCIO: Welcome to a special edition of NOW.

When I met up with him, he was just off the plane from Ethiopia, Nigeria and Mali, fresh from visiting villages where innovative approaches to fighting diseases are bearing fruit. I'm talking about the last American to win the Nobel Peace Prize, the 39th president of the United States, Jimmy Carter.

The man just doesn't have it in him to lounge through his golden years on a golf course. President Carter has practical experience working to wipe whole classes of diseases off the face of the Earth.

I sat down with the former president at the Carter Center in Atlanta.

BRANCACCIO: Well, President Carter, thank you so much for doing this.

PRESIDENT JIMMY CARTER: It's good to be with you. Thank you.

BRANCACCIO: Jimmy Carter, what is it about the diseases of poor people in poor countries that gets you so, really, excited?

PRESIDENT JIMMY CARTER: Well, I think all Americans believe in human rights. And health is an often overlooked aspect of basic human rights. And it's one that's easily corrected. The reason I say that is that many of the diseases that we treat around the world, I knew when I was a child. My mother was a registered nurse. And they no longer exist in our country.

Which proves two things. One is that we oughta be still concerned about 'em. And secondly, they can be easily controlled or prevented or eradicated completely if we just give the people there a chance. And that's what we do at the Carter Center. We give the people there a chance to correct their own problems.

BRANCACCIO: So something that's doable. Because this world, as you know, is full of very intractable problems. I mean, things that will take decades and decades to get at. And you're saying there are certain things that can extend people's lives, or even save lives, that really, if we just put our minds to it?

PRESIDENT JIMMY CARTER: Absolutely. Just a few hours before this interview-- my wife and I returned from Mali and Nigeria and Ethiopia. In Nigeria, for instance, 15 years ago when we first went there we found 653,000 cases of guinea worm, a horrible, indescribably bad disease.

BRANCACCIO: It's this disgusting worm that gets in the gut, and it comes out your skin--

PRESIDENT JIMMY CARTER: It comes out through your skin. Through women's breasts, through female organs and so forth.

BRANCACCIO: But we know what to do to stop that?

PRESIDENT JIMMY CARTER: Well, we just taught the people what caused it, and gave them a simple mechanism for correcting it. That is the filter cloth. So now instead of having 653,000 cases, they have 116 cases.

BRANCACCIO: A hundred and sixteen. Now you say a filter cloth? If you filter your water, you can't get the worm?

PRESIDENT JIMMY CARTER: Absolutely. It removes the worm, and so when you drink the water, you don't get guinea worm. So the people have done it, not us. We just give them the knowledge about what causes the disease, and give them a basic filter cloth that they can use.

BRANCACCIO: Now you must reflect on this a lot. If the Carter Center and individuals can make so much of a difference, imagine what you could do if you were to harness the power of government to--


BRANCACCIO: --fund even more. But what holds us back?

PRESIDENT JIMMY CARTER: One thing that holds us back is a misknowledge that erroneous belief that the people can't respond themselves. Because they are somehow incompetent, or too corrupt.

But our experience has been, in 35 nations in Africa, that the people there are just as intelligent, just as ambitious, just as hardworking, and their family values are just as good as mine. They are poor, and they don't have the facilities, and they're not literate. They don't understand the complexities of these diseases. Sometimes the complexities are very simple. But you give them a chance, and they respond overwhelmingly.

And this is what we have found to be a fact. So we deliver our services directly to the villages or directly to the families, or sometimes put medicine directly into the people's mouths. There's almost zero chance for corruption or diverting the funds or services. The people do it themselves. And it's remarkably effective.

BRANCACCIO: But this is what I wanted to ask. If you and your Center and the people on the ground, who embrace these opportunities to make such great inroads into these tropical diseases, into these diseases of poor countries, imagine what could be done when governments also do that. Is there a way that taxpayer money can be used more effectively to deal with the problems of the developing world when it comes to health?

PRESIDENT JIMMY CARTER: Absolutely. The problem is that American people, among the richest in the world-- have very little contact or awareness of or relationship with the poorest people in the world. I mention Mali, or Ethiopia.

In those countries 90 percent of the people live on less than $2 a day. Seventy percent live on less than $1 a day. It's hard to even imagine how I would live, for food, and housing and clothing on $1 a day. If I did, it wouldn't leave anything left over for education or health care or self-respect or hope for the future. And that's what is there.

But it's very difficult for the American people to believe that our government, one of the richest on Earth, is also one of the stingiest on Earth. We give so little even compared to other industrialized countries that it's almost unbelievable.

If you take every $100 that America earns in national income, we only give 16 cents out of $100 for all kinds of development assistance or foreign aid. And this includes, unfortunately, special favors for the nations that are important to us, that can give us something back. Or that align with us against others. And the most destitute people, who don't have any oil to provide and don't have any strategic importance in the world, they are at the end of the line.

BRANCACCIO: But you're thinking if they could get up that number from, you know, 16 cents on $100 to something higher--


BRANCACCIO: --some of these problems could be licked?

PRESIDENT JIMMY CARTER: Well, the target that has been set by the United Nations and others through the so-called Millennium Project is just to reach 40 cents a $100, which is still insignificant, by the year 2006. And to increase that eventually to 70 cents on $100. Still less than one percent.

BRANCACCIO: Over the next ten years. Europeans are making strides in this area, particularly Britain. How's it going? The president-- the current president of the United States, President Bush, at first embraced the Millennium--


BRANCACCIO: --goals. Then there was some vacillating in the administration. But just--

PRESIDENT JIMMY CARTER: And then disavowed it. Unfortunately. As you know-- in September, there was a great confluence of heads of state who came to the United Nations general assembly to endorse reform of the United Nations. And one of the targets that had been evolved earlier, by Secretary General Kofi Annan and others, was to set the seven-tenths of one percent as a target for the future.

The European countries endorsed it, the third world countries obviously endorsed it. The United States blocked it, because we thought that would be too much of a drain on America's own prosperity. Well, that was a very disappointing thing for the world.

But if you add all of the private donations from the great foundations, you increase the 16 cents to just 22 cents. That's still at the bottom of all the industrialized nations in the world. And the thing is that most Americans think we give about ten percent, or $10 out of $100--

BRANCACCIO: Yeah, when you ask 'em, they think we give a lot more than we do.

PRESIDENT JIMMY CARTER: Oh yeah. They think-- the average thinks we give at least $10 out of $100 to help poor people. Instead of giving $10, we give 16 cents.

BRANCACCIO: A lot of claims on our Treasury right now. We are, unfortunately still stuck in Iraq. Very expensive. There have been some terrible natural disasters that are ringing up high dollar figures. Does this kinda take the wind out of the sails of the movement toward increasing foreign aid?

PRESIDENT JIMMY CARTER: That depends on what the priorities are. I would say a top priority still in Washington, as this program is broadcast, is to reduce the estate tax on the richest people in the nation down to zero. They call it a death tax. And this is gonna cost our country $700 billion in a ten-year period. And this has been elevated as a very high priority.

Well, a tiny-- a tiny portion of that, if allocated for benevolent assistance or humanitarian aid, would more than meet all the expectations or needs that I've described to you in the last few minutes on this program. So it's a matter of priorities.

And obviously, we have to take care of the aftermath of Katrina. And we have to take care of needs of American people, 44 million of whom don't have any health care-- health insurance, and so forth. But still there's room for the alleviation of suffering among the poorest and most destitute, the most needy and forgotten people on Earth.

BRANCACCIO: You know, I go around America a lot for this show talking to hardworking Americans about what they worry about. And a lot of it is where their next dollar's gonna come from. What's the answer to them, when we raise these issues of pressing problems at home versus money to deal with problems far away?

PRESIDENT JIMMY CARTER: I think if you ask the average American family they would say, "I'm willing to share a little bit with my brothers and sisters who live in Africa. I would certainly be willing to give one percent of our nation's income to help them through my taxation and so forth." I think the-- average American would say, "I've got problems of my own, yes. But through my religious faith, or just my natural human benevolence, I would like to see us be more generous." I don't think there's any doubt about that.

BRANCACCIO: What about your personal journey on this? Did you turn around on these diseases of poor people in poor countries--


BRANCACCIO: --by going?

PRESIDENT JIMMY CARTER: Yes. I wish I had known when I was in the White House what I know now about the Third World. As a matter of fact, back in those days, neither I nor Gerald Ford nor Richard Nixon nor Lyndon Johnson nor John Kennedy had much trouble getting foreign aid allocated by the Congress. The reason was that we were a Cold War with the Soviet Union. If we didn't help Mali, then the Soviet Union would, and the Malians would turn toward communism, perhaps.

So when we put in a request for foreign aid the Congress was very generous, because it was a competition with the Soviet Union. Not only in Mali, but in almost every developed country in the world. With the end of the Cold War, then that competition dissipated and our foreign assistance went downhill. And now it ought to be rejuvenated and increased, just for benevolent causes.

And I think in addition to that, you have to remember that many of those diseases that I described to you can very well come and afflict us. One obvious example is HIV/AIDS, which came out of Africa, we believe, originally and now afflicts the United States

So, I think there's a direct feedback, not only in-- realizing that we are helping other people have a better life at a very low cost, but also it submits-- friendship And ties of cooperation between us and those people around the world who are in need.

The other thing is when folks in a foreign country, particularly a poverty stricken country reach a stage in life of despair, or hopelessness, or an absence of self-respect, they are much more inclined to resolve their problems with violence. Sometimes it creates civil war. And although it's not right, they are kind of a ripe grounds for the engenderment of terrorism. You know, these folks over a cause in fact--

BRANCACCIO: It's where you can find recruits, if--

PRESIDENT JIMMY CARTER: Oh yeah. The recruits who are misjudging the facts, they are susceptible to turn against the rich western world because "they don't care about us," and your children are starving or your children have guinea worm or your children are going blind. Or your children are having elephantiasis.

If the rich people cared about you-- they would be giving you help. They're not. Therefore, let's lash out against 'em. And a few of those suffering people are misguided enough to become associated with terrorism.

BRANCACCIO: Well, you're making the national security argument for eradicating disease in--


BRANCACCIO: --poor countries.

PRESIDENT JIMMY CARTER: I think that's a secondary reason to help eradicate disease in the Third world. But I think it's a very important factor, yes.

BRANCACCIO: You started to touch on a reason that you could selfishly want to pursue-- improving public health abroad. This notion that, in this era of globalization, you know, maybe we do sell goods abroad. But diseases can come back.

PRESIDENT JIMMY CARTER: Well, globalization obviously tends to-- level things-- or some have referred to it as a flat Earth. But the benefits come primarily from among the elite people. But below that is an arena of very poor people who are not only not helped by globalization, but with the increase of awareness of what goes on in the rest of the world, they become more aware of the difference between their life and the life of the outside world. So they tend to lash out at the affluent and fortunate world whom they look upon, I think perhaps accurately, as selfish and unconcerned.

So globalization helps in many ways to raise the average standard. But the ones who are left behind feel now an awareness that they-- are cheated.

BRANCACCIO: I'll tell you what I'll never forget-- Mr. Carter, our cameras were with you about three and a half years ago when you and Bill Gates' dad were going to Nigeria and the Central African Republic. And the issue on the table there was HIV/AIDS, and the need to get information about condom use out to the population. There's even a scene, I don't know if you remember this, where-- actually you, former president of the United States, is having a policy conversation with a with a sex worker.




BRANCACCIO: What-- do you remember that trip at all?

PRESIDENT JIMMY CARTER: Of course I remember it. Yeah. The Bill Gates Foundation, which is the largest in the world now, was looking for some facts on which to predicate a program to help reduce the incidence of AIDS. So we did a lot of background work with the most highly trained experts in the world on the basic causes of AIDS and what could be done to reduce the incidence and the affliction of AIDS.

And we learned a lot. And obviously one of the main things we learned was that there was an ABC policy that really worked. Abstinence, Be faithful, and Condoms. And the countries that faced the issues frankly with those three issues were very successful.

One of the prime successes was in Uganda where they had started out with 13 percent affliction of AIDS among their people, which is very high. And because of an emphasis on the use of condoms, and education, they had reduced it down to six percent. Unfortunately, lately that trend has reversed.

And-- there was an article in THE ECONOMIST magazine that showed that Uganda was now goin' in the other direction because the United States government has put tremendous pressure on the leaders of Uganda not to distribute condoms anymore.

BRANCACCIO: That of the ABC plan, U.S. policy doesn't encourage the C?

PRESIDENT JIMMY CARTER: No, nor family planning. And this is a devastating-- policy that is in contradiction to every other country in the world. And now instead of six percent of the women in Uganda having AIDS, now it's increased to nine percent. And the trend is in the other direction because the present administration in Washington, the Congress, are trying to prevent the use of condoms because of religious purposes, with which I don't disagree. But also this is the best avenue to control AIDS.

BRANCACCIO: But what's the answer, though, to the-- you have Christian groups who are very involved with the health care of poor countries. Actively. Pumping money in, working on the ground. But many Christians are really uncomfortable with this notion of--

PRESIDENT JIMMY CARTER: Some. Some are. But I would say that most Christians are not. But there's a tiny group of maybe fundamentalists or others who believe that even the use of condoms is contrary to Christian beliefs.

BRANCACCIO: What do you say to them?

PRESIDENT JIMMY CARTER: I say they're mistaken. You know-- I certainly have a problem with abortion. It's hard for me to believe that-- Jesus Christ would approve abortion. But the use of condoms that would prevent unwanted pregnancies, and the use of condoms to prevent the horrible pandemic of AIDS I think is going to far.

But there are a few very highly motivated people in the White House and also in the Congress who want to prevent the use of condoms. And this is contradicting the progress that has been made in the past to educate the people in Africa and to prevent the explosion of AIDS.

BRANCACCIO: Jimmy Carter, I wanted to ask you this. When-- when you get the Nobel Peace Prize, I heard that something else you get along the side is the ability to live at least till 100. So let me ask you about these diseases.


BRANCACCIO: In your lifetime, what do you think is achievable with regard to the health care of people in poor countries?

PRESIDENT JIMMY CARTER: The Carter Center has the only existing international taskforce on disease eradication. Which means a total elimination of a disease on the face of the Earth. In the history of the world, there's only been one disease eradicated: smallpox. The second disease, I think, is gonna be guinea worm. The third-- which is headed by the Carter Center. The third disease is very likely to be polio.

There are other diseases that we can eradicate. Right now, we have targeted lymphatic foloriasis, which most Americans know as elephantiasis. It's a disease where your sexual organs and your arms and legs swell up to grotesque sizes. That can be eradicated completely.

So the scientific knowledge of what's done, and the evolution of new treatments and preventives and cures is a very exciting element in my life and in the lives of many public health workers around the world. And I think it bodes well for the elimination of a lot of suffering, unnecessary suffering, that we know of specifically in the world today. And this has been proven as an opportunity, almost an inevitability, if the rich nations are just willing to share a little bit more with the countries that are in need around the world.

BRANCACCIO: Now you're knocking yourself out on this issue. But what do you want from us? What can individual Americans do about something as distance and sometimes complicated as global health?

PRESIDENT JIMMY CARTER: Well, the average viewer of this program can certainly take upon themselves one small portion of a crusade to convince the Congress of the United States, and the White House, "Let's be more generous. And at least meet the minimum standards of other industrialized or rich countries in the world." So that the United States is not on the bottom.

BRANCACCIO: Minimum standards for foreign aid?

PRESIDENT JIMMY CARTER: For foreign aid, which we call development assistance in the rest of the world. And the plan for doing this has already been carefully devised, and has been put forward in the United Nations or in the G-8 Summit in Scotland this year and so forth. And all the other developed countries-- rich countries have agreed. The United States is still the only holdout.

I think we can convince the president of the United States and his cabinet, and the Congress of the United States, let's at least come up and be an average country in our generosity. I think this is something the American people naturally would like to see. I hope that we could get up maybe toward the top. And- compete with Belgium, or compete with- Denmark or compete with Norway or Sweden or Canada and so forth, and say, "Let's be the most generous country on earth, not the least generous." That's what the American people I hope will demand and someday achieve.

BRANCACCIO: Well, former U.S. president and Nobel Peace Prize winner Jimmy Carter, thank you very much.

PRESIDENT JIMMY CARTER: I've enjoyed being with you. And the many viewers I hope will be watching this program.

BRANCACCIO: Coming up next on many PBS stations we continue our look at global health with a special one-hour now documentary that looks at President Bush's 15 billion dollar commitment to fighting HIV/AIDS in the developing world…now there's a battle among doctors, politicians, and religious groups over how to use the money.

JANICE CROUSE: I'm against condoms as a solution to the problem of sexually transmitted diseases. I'm against condoms as a solution to the AIDS epidemic.

BRANCACCIO: NOW's coverage of global health continues next with "Global Health: America's Response."

And that's it for NOW. From Washington, I'm David Brancaccio.

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