The list of public health threats Dr. Reimert Ravenholt battled reads like a history of the field itself.
Soon after joining the Seattle-King County health department in the 1950s, he organized the first mass immunization of Seattle school children against polio. When rates of postpartum infections among new mothers started to soar, he traced the problem to poor sanitation and handwashing in local hospitals.
A water-testing program he devised measured the human waste seeping into Lake Washington and helped spur cleanup and construction of a sewer system. Ravenholt, who died at the age of 95 at his Seattle home Oct. 1, was also ahead of many of his peers in recognizing the risk from what he called “tobaccosis.” He investigated the way mutagenic chemicals from smoking circulate throughout the body and pushed the University of Washington Hospital to get rid of cigarette vending machines.
And that was just the beginning of a career that spanned more than four decades.
“He was one of those people who fits into the category of a polymath,” said Dr. William Foege, who led the campaign to eradicate smallpox and later became director of the U.S. Centers for Disease Control and Prevention. Foege was a medical student at UW when he started working for Ravenholt’s epidemiology team after school and on Saturdays.
“I regard him as one of my most important mentors because of his clear thinking and ambitious ideas about what could be done,” Foege said.
Ravenholt’s greatest ambition was to slow population growth, which in the mid-1960s was widely viewed as an existential threat to humanity and perhaps the greatest impediment to economic growth in the developing world. As the first director of the Office of Population at the U.S. Agency for International Development (USAID), he defied conventional wisdom to create a program that for nearly 15 years provided nations in Asia, Latin America, Africa and the Middle East with abundant supplies of condoms, birth control pills and IUDs.
Opposition was fierce within the agency, which was leery of getting entangled in such an intimate and politically sensitive issue. Most experts were dubious that family planning programs would make much difference. The prevailing notion was that it would take years or decades of economic development and improvements in health systems and education before couples in poor countries would be interested in using contraceptives.
Steven Sinding, who became leader of the population office in 1983, was among those skeptics. But he later came to agree with many of Ravenholt’s maverick notions.
“I would argue today that the population program Ravenholt devised and led through its first 10 years is one of the most successful development cooperation programs of all time,” Sinding said. “And USAID was far and away the leading agency in the revolution in reproductive behavior that occurred over the second half of the 20th century.”
U.S. efforts to lower birth rates in other countries have been criticized as ethnocentric, paternalistic and at least partly motivated by the Vietnam-era obsession with limiting the spread of communism. But unlike many of his male counterparts at the time, Ravenholt actually sought out the opinions of women in the developing world, Sinding said. He was inspired by conversations with rural women in India and Pakistan, who told him they didn’t want to be pregnant all the time and would prefer to have fewer children.
“Rei said: ‘Let’s give people the opportunity to use family planning and see what happens,”” said Joe Speidel, who was Ravenholt’s deputy and successor in the population office. “What happened is birth rates went down and children survived better.”
Among the innovations Ravenholt pioneered were home delivery of contraceptives by midwives or community health workers and a network of nonprofit organizations to coordinate the programs. He also supported research on new types of contraceptives and less invasive sterilization methods that eliminated the need for hospital stays.
Ravenholt insisted all USAID-funded family planning programs be voluntary, with no coercion or financial incentives, Speidel said. But several national governments, including India and China, adopted their own coercive policies which led to involuntary sterilizations and other strong-arm tactics and spawned anger and resentment. “Those bad apples gave family planning a bad name,” Speidel said.
Tall and charismatic, Ravenholt was a forceful advocate — and not known for his diplomatic skills, Sinding said. “He was a big man with a deep, booming voice and a radiant smile and an intensity that was remarkable.”
He used condoms as business cards and often traveled with a suitcase full — which he would sometimes pass out on airplanes, Sinding recalled. He also had a flair for marketing, like promoting colored and flavored condoms.
“I’ve said that Rei would have more ideas in one week than most people would have in a career,” said Speidel. Many were flaky. Some were brilliant. Part of Speidel’s job was sorting them out.
“He was somebody who just worked tirelessly. There was no such thing as a weekend for Rei.”
Ravenholt’s wife of 39 years, Betty Butler Ravenholt, recalled how he was once introduced at a conference as someone who not only thought “outside the box” — but had never been inside the box in the first place. “He had such an unfettered imagination and intellect,” she said.
One of Ravenholt’s nicknames was the “Great Dane,” a nod to his immigrant parents who homesteaded in Wisconsin. With nine children, the family lost its farm to foreclosure in the Great Depression. Ravenholt grew up speaking Danish and worked as a hired hand on neighboring farms while the family lived in rentals until they could afford another property.
After medical school, Ravenholt was recruited into the second class of the CDC’s Epidemic Intelligence Service — training ground for the elite corps of disease-detectives that investigate outbreaks around the world.
His tenure at USAID came to an end in 1979, in part because of his outspoken support for voluntary sterilization and abortion. His single-minded focus on delivering contraceptives was also being supplanted by a more holistic view of women’s reproductive health, said Barbara Crane, who studied U.S. population policies and served at USAID during the Clinton Administration.
“He became the lightning rod for critics on both the left and the right,” Crane said.
Ravenholt went on to work at the CDC, the Food and Drug Administration and the National Institute on Drug Abuse, where he continued his crusade against smoking. He retired in 1987 and returned to Seattle, where he pursued his eclectic interests — among them historical epidemiology. A paper he published in 1994 suggested that explorer Meriwether Lewis’ mysterious death by stabbing in 1809 was suicide precipitated by despair and mental illness from advanced syphilis.
“That’s an example of how he was always thinking just a little bit ahead of, and in a little bit of a different direction, from other people,” Foege said.
In addition to his wife, Ravenholt is survived by five children and their spouses, five grandchildren and two great-grandchildren. The cause of death was complications from kidney disease. Remembrances may be made to West Denmark Lutheran Church, or to Planned Parenthood of the Great Northwest and Hawaiian Islands.