Child Health and Human Rights

An Address by

James P. Grant

Executive Director of the United Nations Children's Fund

to the

Committee on Health and Human Rights Lecture Program

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C. 1994



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Child Health and Human Rights Child Health and Human Rights An Address by James P. Grant Executive Director of the United Nations Children's Fund to the Committee on Health and Human Rights Lecture Program INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1994

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Child Health and Human Rights NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W.Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this study was provided by the John D. and Catherine T. MacArthur Foundation, but the support of this organization does not imply that it takes responsibility for any statements or views expressed in this report. Additional copies of this report are available in limited quantities from: Committee on Health and Human Rights Institute of Medicine (FO 3037) 2101 Constitution Avenue, N.W. Washington, DC 20418 Printed in the United States of America Copyright 1994 by the National Academy of Sciences. All rights reserved. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logo-type by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemusseen in Berlin.

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Child Health and Human Rights COMMITTEE ON HEALTH AND HUMAN RIGHTS ROBERT S. LAWRENCE, M.D., * Chair, Director, Health Sciences, The Rockefeller Foundation MARY ELLEN AVERY, M.D., * Thomas Morgan Rotch Professor of Pediatrics, Harvard Medical School CHRISTINE K. CASSEL, M.D., * Professor of Medicine and Professor of Public Policy Studies, University of Chicago Medical Center CASWELL A. EVANS, Jr., D.D.S., M.P.H., * Assistant Director of Health Services, Director of Public Health Programs and Services, County of Los Angeles CLAIRE FAGIN, Ph.D., R.N., * Dean and Professor, School of Nursing, University of Pennsylvania WILLIAM C. HSIAO, Ph.D., * Professor of Economics and Health Policy, Harvard School of Public Health GEORGE I. LYTHCOTT, M.D., * Assistant Commissioner (Retired), School of Health and Adolescent Medicine, New York City Department of Health ALICIA H. MUNNELL, Ph.D., * Assistant Secretary for Economic Policy, U.S. Department of the Treasury PAUL GRANT ROGERS, J.D., * Partner, Hogan and Hartson JANE G. SCHALLER, M.D., * David and Leona Karp Professor and Chairman, Department of Pediatrics, Tufts University School of Medicine, Pediatrician-in-Chief, New England Medical Center Hospitals * Member, Institute of Medicine

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Child Health and Human Rights ADVISORY GROUP ON THE ANNUAL LECTURE PROGRAM ELENA O. NIGHTINGALE, M.D., Ph.D., * Chair, Senior Program Officer and Special Advisor to the President, The Carnegie Corporation of New York SOLOMON R. BENATAR, M.D., * Professor of Medicine and Head, Department of Medicine, University of Cape Town and Groote Schuur Hospital DON E. DETMER, M.D., * Vice President and Provost for Health Sciences, University of Virginia CLAIRE FAGIN, Ph.D., R.N., * Dean and Professor, School of Nursing, University of Pennsylvania ROBERT S. LAWRENCE, M.D., * Director, Health Sciences, The Rockefeller Foundation GEORGE I. LYTHCOTT, M.D., * Assistant Commissioner (Retired), School of Health and Adolescent Medicine, New York City Department of Health ROBERT F. MURRAY, Jr., M.D., * Professor of Pediatrics, Medicine, and Genetics, Howard University College of Medicine ADAM YARMOLINSKY, LL.B., * Regents Professor of Public Policy, University of Maryland, Baltimore County INSTITUTE OF MEDICINE STAFF JOSEPH S. CASSELLS, M.D., Study Director, Committee on Health and Human Rights CONSTANCE M. PECHURA, Ph.D., Study Director, Annual Lecture Advisory Group ROSEMARY CHALK, Editor TERRI BARBA, Project Assistant * Member, Institute of Medicine

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Child Health and Human Rights Preface Societies can be judged to a significant extent by the manner in which they deal with their vulnerable citizens—the elderly, those who are sick or disabled, and children. The future of any society literally depends on the future of its children. James P. Grant has dedicated his life to these issues. In this volume, he communicates both the wisdom and the caring for which he is so well known and to which we would hope all leaders aspire. The Institute of Medicine (IOM) is deeply indebted to Elena Nightingale, chair of the IOM Human Rights Lecture Program, and Robert Lawrence, chair of the IOM Committee of Health and Human Rights, which sponsored Mr. Grant's address. The Institute is committed to the protection of human rights and to the improvement in the well-being of children in the United States and around the world. Kenneth I. Shine, M.D. President Institute of Medicine

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