Speaker 1
This program was made possible by grants from the German Marshall Fund of the United States, the Corporation for Public Broadcasting, the Ford Foundation, and International Business Machines Corporation.

Bill Moyers
These are vibrant people. If the blindness is overcome, they can stay on this land. Life can be normal again and eye meant to see can see.

Bill Moyers 2:23
I'm Bill Moyers they're about 1 billion people in the world who live on what Robert McNamara calls the 'margins of life.' They live without enough to eat, and with very little hope that things will get better. There are many reasons why they're poor, and they usually can't control those reasons. Some of the victims of a cruel and capricious climate. Others were born where nature left nothing to grow ourselves. Still others live where opportunities are frustrated because of overcrowding, disease, corruption, and exploitation. In this edition of my journal, we will meet some people whose lives could be better, were it not for a tiny winged insect that thrives on the source of life itself. And we'll talk with the president the World Bank, Robert McNamara, who believes that it doesn't have to be that way.

Dr. Nemo
When this flight bites people, it transmits a worm, which we call the uncle circuit volvulus. And this worm is the smaller one. This smaller worm, or the onchocerca moves in the sub sub tissues of the human body, and it keeps moving, wandering around until it grows and becomes the adult. And you can get one male one female, always in a nodule, meeting together to produce many of the infant worms. And it's usually these infant worms which caused the trouble- they wander around the eye, produce certain changes and cause the blindness.

Bill Moyers 5:01
To the people of West Africa, the first of gifts is water, their most precious resource. But these fertile river valleys are also the home of the black fly. Entomologist Renee Labear of the World Health Organization.

Bill Moyers
Over river valleys are oases in a dry parched land. For people and animals alike, the river has established the rhythm of existence.

Bill Moyers 7:05
Without water, no life survives. Near it, a person can suffer as many as 13,000 fly bites in one day 13,000.

Speaker 4
When you leave out blindness, a lot of people are blind, but they eat so safe people has to work very much for them for children for old people and for blind people.

Bill Moyers 8:47
The burden on the families is enormous. Here the father, mother and three children are blind are suffering from other diseases. Only one son. age 11, is well on him as the weight is planting, harvesting and carrying water from the river. But he has the all too familiar nodules. Like his father, he too will one day be blind. Who will take care of the family then?

Bill Moyers
Young people leave as soon as they can, trying to escape the fly, there are fewer marriages and fewer children and the blind. The blind live on in darkness, isolated, lonely and dependent life at the end of a stick.

Bill Moyers 10:33
Chief Galbraith sobre rules the village of fungo, on the white volta, its villagers die 27 of the 200 people who live here are totally blind, others are beginning to lose their vision too. Chief Sabra cannot quite believe that a small black fly has been the thief of his sight. But having lived here all his life, he knows well the old village saying the river will eat the eye.

Bill Moyers
To these people blindness as another of life's mysteries of fate they can neither understand nor overcome.

Bill Moyers 11:19
Its toll is high. Along the White River volta almost 50 villages have been abandoned, and more are dying. If the black fly continues to thrive here, this rich Delta country of Africa could become a wasteland.

Dr. Nemo 11:38
The population is moving away from the river, across when has very close to the river does the time come over and bite them on when they move away from the river. Or the unfortunate thing is that they go on to some barren land so that they can't farm or they can't get good produce from the farms.

Bill Moyers
A small skin biopsy is the best method of diagnosis. Under a low power microscope, the disease bearing larva can be identified at an early stage. The use of this equipment is efficient, the results more accurate. Unfortunately, people must travel a long way to the clinic, and then wait, wait for some word that their disease can be arrested. wait to hear that. Maybe some sight can be saved. For many it is a frightening experience. As they wait they cannot forget that the disease they bear is hard to cure.

Man 13:42
(man speaking a Wes African language)

Bill Moyers 13:51
Two drugs are available today for treating river blindness. And both must be administered in clinics or hospitals that under the supervision of a doctor. While both drugs kill the worm, both also have unpleasant side effects. One causes toxic reactions, the other brings on a wild itching. The side effects require the constant presence of trained personnel. A simpler cure must be found

Bill Moyers
Scientists have come up with an insecticide that will kill the larva of the flight without harming other forms of plant or animal life. Bu to treat an entire region, with its several major river systems and 1000s of streams is an enormous task. After the insecticide has been distributed, it must be kept under constant surveillance, n case the fly develops a resistance to it, or the chemicals upset the delicate web of nature, and bring a Silent Spring to West Africa.

Bill Moyers 15:51
Helicopters are being used to carry the war against the flight to remote areas. During the rainy season, the foliage along the rivers thickens and hides countless streams and small rapids for the fly breed. Rains wash out the roads and make it impossible to reach the breeding site by land. Yet every location must be hit. The black fly has an amazing flight range of up to 100 miles and can easily return to lay more eggs.

Bill Moyers
There are still blind people here that the battle against the plague is being won that people in Finkolo can see again. To that day when blindness is rare. And the rivers once more bring life

Bill Moyers 18:24
Finkolo is just one village among many in the Volta Region area. Hope for the whole region depends on an international effort that has been mounted by four different agencies, the Food and Agricultural Organization, the United Nations Development Program, the World Health Organization, and the World Bank. Each plays a different part from helping to control the disease to treating the victims to marshaling financial resources to improving agricultural techniques. My guest this evening is the president of one of those organizations Robert McNamara of the World Bank. Mr. McNamara's former president of Ford Motor Company and Secretary of Defense under Lyndon Johnson and John F. Kennedy. The World Bank is the major international institution in the world for making loans for development.

Bill Moyers
Too optimistic?

Robert McNamara 20:26
Well, I think that they felt they had the answer and March of 1972, it's pretty clear now they didn't, but they were on the right track. They were designing new pesticides, they were designing new methods of applying the pesticides. And the project that we finally started as a matter of fact, just last week, the helicopters began spraying the area applying the pesticide which which over a period of 20 years, we believe will control the vector sufficiently to allow the the larva which exists in the human bodies to ultimately die. And that 20 year period is required for this because these larvae will live in a body 17 years and until the larva die, a resurgence of flies will allow them to transfer the larva from one body to another body and allow the whole disease to to expand again. So what So the the essence of the program is to kill the flies that grow in running water, we're applying pesticides by air to the running water to kill the flies. And as soon as that has reached a point where the fertile valleys the the white volta the red hole, the black hole, the valleys are reasonably clear flies people can move back to the fertile farmland is that they were forced out of by this disease become productive provide their own livelihood. It's a vision of hope.

Bill Moyers
2 billion?

Robert McNamara 23:00
2 billion people. Our objective is to help those 2 billion people help themselves. And we can only help them if we help them increase their productivity. And what kind of people are these? 1/3 to one half a little malnourished. The average caloric intake, for example, is roughly 2000 calories a day. Ours is 50% more. And it's becoming increasingly clear that that malnourishment itself is a cause of lack of development. We are now understanding that protein deficiency in the last part of pregnancy, the last third of pregnancy in the early years of life, literally restrict the development of the brain. And in individuals are denied the right to realize the potential of the genes they were born with. Malnutrition is number one, number two, high infant mortality. 20% of the children die before they're five years old. low life expectancy, our life expectancy is 20 years more than theirs. They're literally condemned to an early death at birth, high illiteracy, roughly 800 million illiterates out of these two, 2 billion 100 million more than 20 years ago, the percentage of illiteracy has dropped. But the population increase been so great that the numbers increase high unemployment. We're concerned about 8% in this country, rightly so. They have 20 to 25. This is the universe we deal with

Bill Moyers
About a year ago. In fact, as recently as a year ago, we were talking about the third world. This is a term that was commonly used around around the world. Now everybody's talking about the fourth world are you? Are these the people you're talking abou?

Robert McNamara 25:13
The fourth world might say, it consists of the perhaps 800 million to a billion people who have average incomes of less than $200 per capita, and that consists of Bangladesh. In India, Pakistan, the Sahelian zone I was talking about her earlier, upper golden, Melina Jarrett said are many of the countries of French, West Africa, Mauritania, for example, Senegal, Amman, East Africa, Kenya, Tanzania, that's the fourth world if by that you mean countries with incomes of roughly $200 per capita per person, it's very difficult for us to understand what that means our income per capita on a comparable basis is on the order of $5,000

Robert McNamara
Well, I read exactly the same argument two or three weeks ago and magazine section in the New York Times it was labeled triage. And they used use the illustration of the wounded after World War One, when or during World War One, when medical services weren't sufficient to take care of all they divided them groups, one group didn't need it. Another group needed it but wasn't enough to take care of them and let them die. The third group needed it and they applied it. The medical service, you can't deal with nations that way. They don't die, you can't bury them, they're there. That's number one. The second point they made was, it's like a lifeboat. We've got a lifeboat, the capacity is 100. We've got 125 people in a day, we don't quickly throw overboard 25 Let them die kill them. Every one of the 125 will die. It's morally repulsive. And it's technically wrong. If you want to use a lifeboat analogy that lifeboats capacity is 100. We only got 75 in it.

Bill Moyers
What about the argument, though, that nature is self regulating? Nature has its own limits, a rising death rate will compensate for the adversities brought on by a rising birth rate. And that the more we try to tamper with this system, the more actually in the long run, we're going to create misery.

Robert McNamara 28:22
I'm not sure we know the linkages there clearly linkages, but I think they might even be the reverse of just that argument. If we if we let more people die in reduce the thirst. I rather doubt that. It's interesting that in India, my statistics may be slightly off because they're from memory, bBut it illustrates the point. It's interesting that in India, the actual number of births per woman is on the order of 6.5. The number of births per woman required to have a high probability that a male will survive to the later years alive for the parents is on the order of 6.6 or seven. I don't think that's coincidental. I think it's the high mortality of Indian infants, that is driving up that fertility rate and therefore and so does the government by the way, and therefore the Indian government has asked us to work with them to develop a population project. We'll experiment with it. So we in two districts in India, each with populations of more than 10 million we have a population project, which is trying out a large number of actions designed to reduce the fertility rate. One of the actions is to change the nutrition by increasing the nutrition to try to reduce infant mortality to see whether that was will stimulate a reduction in fertility. We're almost certain it will.

Bill Moyers
So you think that the term you use last fall desperate. And you also use the term appalling, still is true in

Robert McNamara 31:03
No question about it, and 10s of 1000s, probably hundreds of 1000s are going to die in the next five or 10 years, because of neglect, neglect by their own governments and neglect by the governments of the Western world, including Japan.

Bill Moyers 31:18
So what's going to what what what, what is his going to do to the psychological attitude of the world?

Robert McNamara 31:25
I, in the short run not much. Because people have been dying from neglect by their own governments or other governments for centuries. And as I indicated, the life expectancy of these people who's rising, their condition is actually getting better. It's very hard to believe that when you see the terrible misery that exists in these cities, as I move around, I never come back from a visit to one of these fourth world countries out feeling depressed. But the conditions are better today than they were. And they will be better in the future. But the rate of advance is not yet optimal.

Bill Moyers
At the recent World Food conference, there was considerable talk that among newly developed nations that family planning is, to repeat your report, is not necessarily a cure for poverty. And they were constantly pointing to China, China's population has fallen tremendously, and yet they there's no famine in China. Do you think that China is a model for development in these countries?

Robert McNamara 33:51
Well let me say first, I never been to the People's Republic, since it was the People's Republic. I'm not an authority on it. I don't think we in the western world have sufficient knowledge to come to firm conclusions, but as your country. So let me just say this, that, that there's ample evidence my wife was in China a year and a half ago and from what she said and others have said, there's ample evidence that the Chinese have adopted a population planning program. They do have barefoot doctors, the Barefoot doctors do educate the people on the desirability of reducing fertility, they've raised the marriage age, they've taken a number of very important steps. They've increased nutrition. They've they have equalized the distribution of food, they've reduced. illiteracy, I should say, raise the role of women. All of this is very important in reducing fertility rates. So my impression is on the impression rather than final judgment, my impression is they've gone far, to effectively reduced fertility rates.

Bill Moyers
My wife is going to watch his show and she's going to say he singled out women and exposing them to the need for family planning techniques. What about men?

Robert McNamara 36:14
Well, certainly men too, and the most effective programs and family planning involve both the man and the wife. I mentioned women because women are discriminated against in, in many countries the world, not just perhaps some of them think they are. But in certainly in the developing countries, and particularly in education. If you look at the the rates of school attendance as a percentage of the primary age groups, you'll find that in many countries, only 8% of the females will be attending primary school, whereas perhaps 30% of the males will. It just shows the degree of discrimination. And there's ample evidence to show that that as the the literacy level of females is raised, their their it affects their desires for numbers of children.

Robert McNamara
It's worse than when they express it if that's the way they express it. Because not only is the has the growth, decline, there's been an actual setback. And the real income per capita in the US today is probably 5% less than it was a year ago. So how do we go to a person whose real income per capita has decreased and ask them to first support the existing programs and secondly, supporting an expanded program? Well, I think one approaches it on perhaps two or three grounds. First, he must understand that while he's had a setback, it's temporary. And it's a setback in a strongly rising trend. The real income per capita of the average American has increased about 100% in the last 25 years since the start of the Marshall Plan, as a matter of fact, and I don't care how you measure it. Meat consumption per capita is up 100%. Second cars, third TVs, the percentage of our of our children that are going to college is the security, the elderly, the life expectancy, the health, equity, and the health district in any way you want to measure the real income per capita, this country's increased dramatically. Therefore, our capacity to help others is increased. Now 25 years ago, when we had a real income per capita, perhaps half what it is today, our nation initiated the Marshall Plan, a program of help the Western Europe, Western Europe strong today, in part because of that Marshall Plan. At that time, we had half the real income per capita, but our economic assistance at the time of the Marshall Plan 25 years ago, in relation to the income was 10 times greater than it is today.

Bill Moyers
Are you saying that we can't help without giving up anything?

Robert McNamara 41:15
We cannot help without giving up something, but the amount we have to give up is very small, and it's out of a tremendously bountiful life?

Bill Moyers 41:22
Why shouldn't the oil producing countries take on the burden of this task? They have all this newfound cash?

Robert McNamara 41:26
Well of course, the answer is whether they should or not, they are and this is very interesting.

Bill Moyers 41:31
They are?

Robert McNamara 41:31
They are tremendous amount of economic assistance has been committed.

Bill Moyers 41:36
How much?

Bill Moyers
Do you think this is the result of insularity of retreating?

Robert McNamara 42:53
It's, it's a result of frustration? Yes, it isn't. It isn't insularity. And it is a retreat. And it's been more noticeable the last year or two, I think that's to be expected.

Bill Moyers 43:02
I'd Why do you think the last year or two?

Robert McNamara 43:05
Well we've we've, as I say, in this country, we've had an increase in real income of 100% in 25 years now, what's it represented by automobiles, some of them bought on time, credit, much improved housing, much of it mortgaged, increased participation by our children and colleges, some on a credit basis. And when when income declines 5% It's very difficult to adjust that consumption pattern 5% Not that the consumption pattern doesn't have a third TV set or a second automobile or a vacation home, that could be taken out of it. But it's very difficult to take it out after you bought it and its own mortgage payment.

Bill Moyers 43:45
So you say they feel frustrated.

Robert McNamara
The the economic systems if we increase it, which we haven't, but I hope we will, would not go to subsidize the transfer while the oil price increase occurred at a time when several other major changes in the world economy were adversely affecting the developing countries and it's this package of poor Problems that has to be dealt with the oil price is only one

Bill Moyers 45:04
what are the other two or three

Robert McNamara 45:05
The others are drought conditions in much of Asia and part of Africa, which lead to food scarcities serious food shortages and rising food prices. dramatic increases in in prices in the industrialized world because of prosperity. They the rates of development, the rates of economic advance, and in the Western Europe, Japan and North America in 1971, 2, & 3 were among the highest on record. This strain the production system, demand put pressure on supply, this tended to stimulate the price increase. That's been the major reason for worldwide inflation. As that occurred, governments tried to take action to correct it, the actions lead to recession as the recession occurred, the export markets of these developing countries began to shrink. And they depend on exports for foreign exchange, to pay for their imports, the imports, they need for more fertilizer, more, more irrigation. Foundation for their economic advance. So that occurred at the same time, their terms of trade began to deteriorate, which simply means the prices their imports went up more rapidly than the prices of their, their exports. And the combination of these several things, the increase in the price of oil, the shortage of food and rising prices of food imports, the reduction in their export markets, and the deterioration in their terms of trade. It's that package of adversity that we have to try to help them deal with.

Robert McNamara
Well, the first problem is that it's caused by the fact that the oil that we're buying, we can't pay foreign goods today. Because the oil producers lack the capacity to absorb the goods. In a sense, that's good, because we don't pay for it and goods, there's no pain to us, we're paying for the oil in part with paper. And we pass the paper over to the oil producers, and then that paper must circulate through the world evenly. So that they'll take the Bangladesh paper and Italy, paper, Italian paper and the paper from Great Britain and all nations equally. And if that paper stopped circulating, then we have a serious disruption in the world economy, there was danger that the paper would stop circulating the risks of standing behind it. We're getting greater than the commercial banking system or the world could accept, and it was necessary for governments to agree to begin to accept some of those risks. That's essentially what was done. Last week and the week before the finance ministers agreed to set up two funds. One known as the safety net fund that Secretary Kissinger had posted proposed and has to be set up by the OECD nations and the other known as the oil facility, the International Monetary Fund was to be set up by all the nations that are members that and these two funds will help assure that these pieces of paper continue to flow evenly and help assure therefore that that there is no serious distortion of the economies of these consuming nations caused by a failure of the paper to flow evenly during the next year. Similarly, these finance ministers approved the expanded bank, world bank lending program, we borrow from OPEC, we put those funds to work in the developing countries. This is another form of what's known as recycling all designed to minimize the impact of this oil price increase. Ultimately the world will have to adjust to it too. They'll have to adjust to the oil price increase by transferring goods to the oil producer.

Bill Moyers
But you are saying some structure is emerging that will give some consistency to the world,

Robert McNamara 50:28
some structure exactly some structures emerging, which will allow the world to adjust over a period of time to this price, assuming the price continues.

Bill Moyers 50:36
You've been in this job now, six years. You have the image to many people of the modern manager, Harvard Business School, Ford Motor Company, Secretary of Defense for seven, eight years. Have you learned anything at the World Bank that would startle or scare your old friends about the nature of the world economy?

Robert McNamara 50:58
Well one thing I've learned, I've learned my wife was right, she pointed out to me four or five years ago, a passage from T.S. Eliot, which I haven't forgotten since then, he wrote it. I think it was in his Fourth Quartet, he wrote these lines, we shall not cease from exploring. And at the end of our exploration, we will return to where we started, and know the place for the first time. And I think that my service with the World Bank is part of this journey of exploration. And it's it's tremendously expanded my understanding of nations and peoples.

Bill Moyers
What I was getting at in particular is that if you take the bank where I think, and others think you seem to be taking it, you're going to go right into the heart of some of the most difficult questions we face in the world, the redistribution of income and wealth, taking it from here and giving it to here, and land reform. And every time you get into land reform in many countries, the ruling class says, Wait a minute, not here. Isn't that going to cause you some consternation

Bill Moyers
The landless poor

Robert McNamara 54:32
The landless poor, exactly refer what we call the lowest 40%. The only way to deal with the lowest 40% is to raise their productivity, redistribution of income is not going to do it, but to raise their productivity. There has to be a redistribution of government services. You got to stop treating the urban centers as privileged centers for purposes of primary education and get that primary education on to the rural areas. You've got to have roads out there. I think I'm right in saying 50% of the rural people in in Ethiopia are more than one day's walk from the nearest dirt road? How can you expect them to do increase their productivity and produce a surplus for cash sale, which they may then used to build a better house or buy a school or something when they can't get their product to market? But throughout the developing world, there's a maldistribution of services, education, health, water, etc, that's got to be changed, it's going to take time to do it. The political power is in the hands of those who don't want to give it up.

Bill Moyers
One final question. When you come into confrontation with these facts of nature, with power, with a disparities in income, when, as you have done, you see the faces of these 800 million people who are living in what you call desperate conditions, what is there that makes you not simply want to chuck it all? And, and, and go lead a more serene life?

Robert McNamara 56:40
Well, hope, I guess, first a realization that progress has been made. Sometimes I forget that. And I have to go back and read the data and read the story to really refresh my mind and see that there is a basis for hope. Because all we really need to do is, is extend the trend of the past. The last 25 years, I've seen tremendous advances. There's widespread misery today, but much less today than it was 25 years ago. I can remember it in part myself. A little over 25 years ago, I was in the US Air Force India. At the time I was in Calcutta. There were 10,000 dead bodies on the streets of Calcutta. They weren't dying by the 1000s they were dying by the hundreds of 1000s in India at that time, that was the terrible famine of 1943. We haven't had that today. We need not have it tomorrow. And it's a hope to avoid it. I think underlies our world.

Speaker 1
For a transcript, please send $1 to Bill Moyers Journal box 345 New York New York 10019. This program was made possible by grants from the German Marshall Fund of the United States, the Corporation for Public Broadcasting, the Ford Foundation, and International Business Machines Corporation.