Jimmy Carter's Hidden Legacy

Carter's post-presidency was transformative. And while he's well-known for his contributions to democracy, he deserves immense credit for his incredible successes with global public health.

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Former American president Jimmy Carter has died.

The 39th president of the United States saw immense change in his lifetime, as he was born in 1924, five years before the beginning of the Great Depression. A century later, Carter had, by every conceivable metric, a life well lived.

The obituaries will now follow. Hopefully, they will offer a corrective to a skewed narrative of Carter as a failure. He has been unfairly maligned for decades, his achievements and foresight overshadowed by his inability to get re-elected and by foreign policy debacles that have seemingly undercut everything else he achieved.

But achieve much he did.

Carter deregulated airlines, bringing affordble air travel to the masses; he appointed 57 ethnic minority judges to the bench, along with 41 female judges—more than all of his predecessors combined; he advocated for environmental policies that were decades before their time; and in an era in which the United States was notorious for propping up murderous regimes across the globe so long as they were our allies, he put human rights center stage in American foreign policy debates.

Carter was a consequential president.

But unlike most presidents, Carter did more for humanity after leaving the White House. The Carter Center, the NGO that he founded in 1982, has been a crucial force for good, known primarily for its work on successfully promoting democracy and providing high-quality election monitoring across the globe. It deserves that reputation. (A decade ago, I served as the political adviser for The Carter Center’s election observation mission to Madagascar. Their work is a rare bright spot of impartial global election oversight, ruthlessly committed to democracy, divorced from the biases of geopolitics).

However, few people know about some of Carter’s most astonishing post-presidency achievements in the field of public health. These are his hidden legacies, the gifts he’s bestowed on humanity that will be reducing suffering for millions of people, long after his death.

Carter deserves immense credit for them.

Guinea worm and river blindness

In the mid-1980s, nearly four million people were infected by Guinea Worm each year. Caused by the parasitic roundworm Dracunculus medinensis, it’s certainly a disease you wouldn’t want to experience. The infections come from stagnant water, in which the worms lay their larvae, but the worms mature inside the human body. Over the course of a year, an infected person eventually plays host to a worm that grows to become one meter (3.3 feet) long.

Once fully grown, the worm creates a lesion on the skin and then escapes from the body, usually producing agonizing pain in the process. Most of the time, these worms exit through the legs or the feet, and you can imagine it’s not a pleasant experience to have a three foot-long worm crawling out of you.

Fully removing the worm can take days or weeks. It’s extremely painful, and often leads to secondary infections. Most people who get sick are debilitated for weeks or months, and some develop permanently disabling joint pain. It is a nasty parasite.

Jimmy Carter decided to do something about it.

There was no glory in it. This wasn’t like cutting a ribbon or raising funds for a high-profile cause. In the United States and other rich countries, few people had ever heard of guinea worm, so Carter wasn’t exactly about to generate front page publicity for taking the parasite on, but he nonetheless decided to make it a core of his post-presidency public health agenda.

And it’s hard to overstate just how successful he was. Take a look at this chart (from NPR), showing the estimated number of cases in 1986 versus today, due to the Carter Center’s investments to eradicate the disease.

Before Carter got involved, Guinea Worm was prevalent in 21 countries, infecting at least 3.5 million people per year. Today, that figure is down to just 13 cases per year. It’s a reduction of 99.99% in just a few decades, making it one of the most successful public health interventions in history. Experts estimate that, without the efforts of the Carter Center, roughly 80 million more people would have been infected by Guinea Worm. Instead, they were saved from excruciating pain and crippling disease by a former president who gave a damn about a disease that nobody else seemed to care about.

Similarly, the Carter Center has done tremendous work at tackling onchocerciasis, or river blindness. That disease comes from black fly bites, and it’s prevalent in 31 countries, mostly in sub-Saharan Africa. Again, it’s a largely neglected disease, despite the fact that just shy of 20 million people are currently infected, with about a million of them having lost their vision due to the infection.

Here’s the regional distribution of where the disease persists, from Our World in Data.

The Carter Center has provided hundreds of millions of rounds of treatment for river blindness, drastically alleviating avoidable suffering. It doesn’t generate headlines, nor is it usually mentioned as a core part of Carter’s reputation in American political discourse, but had Jimmy Carter not decided to devote his efforts to these programs, millions more people would have been needlessly blinded by a devastating parasite.

The post-presidency reveals a president’s true character

There are good presidents and bad ones, but it’s often difficult to disentangle how much of a president’s legacy is down to character, how much is down to skill, and how much is down to luck.

After all, it’s much easier to get things done if Congress is from the same party, and it’s much better to preside over a global period of immense peace and economic growth (as Bill Clinton did) than to govern during a time of upheaval or war. Presidents affect outcomes, but they don’t control them, and to a certain extent, they are beholden to the whims of history. Carter was no exception.

That’s why post-presidency legacies are so fascinating, because they reveal true character that is dissociated from the vicious political battles in Washington and the flukes of history.

Herbert Hoover’s political choices in the White House helped spark the Great Depression. But after his presidency, he helped feed German children following World War II and successfully oversaw substantial US government reforms that were widely regarded as a monumental achievement.

Rutherford B. Hayes, one of the most forgotten presidents, devoted his post-presidency to educational justice. And Bill Clinton has produced tremendous success through the Clinton Foundation and Clinton Global Initiative, most notably after the devastating 2010 Haiti earthquake.

Admittedly, post-presidencies have gotten much longer in recent decades, given modern presidents more of a shot at making an impact. George Washington died just two years after leaving the presidency, coming down with a fatal illness while riding a horse around his farm in 1799. Carter, by contrast, was a former president for more than four decades.

We have lost Jimmy Carter, but Carter’s presence will be felt around the world for decades to come. Now that he has died, consider his hidden legacies—because he has literally saved millions upon millions of people from excruciating pain, debilitating disease, and blindness. That, surely, is a legacy we can all agree is worth celebrating.

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