Richard Cash remembered as public health pioneer, inspirational educator
Richard Cash believed in the power of simple, affordable solutions for public health problems. A senior lecturer on global health at Harvard T.H. Chan School of Public Health from 1979 until his death in Oct. 2024, Cash is renowned for his key role in the development of Oral Rehydration Therapy (ORT), a combination of sugar, salt, and water that proved remarkably effective at rehydrating people suffering from cholera and other diarrheal diseases. It’s been called potentially the most significant medical advance of the 20th century by the Lancet and is credited with saving an estimated 82 million lives around the world since the 1970s.
At a memorial celebration held in Kresge G1 on Nov. 21, Cash’s colleagues in the Department of Global Health and Population (GHP) joined collaborators from around the world, former students, friends, and family members to remember his life and achievements as a public health pioneer, educator, and mentor. During a panel discussion and in-person and recorded remarks, speakers described Cash as an unconventional thinker who was warm, generous, insatiably curious about the world and other people, and always up for a good debate.
In her introductory remarks, Marcia Castro, Andelot Professor of Demography and GHP chair, recalled meeting Cash while she was interviewing to join the Harvard Chan School faculty. He showed her his statue of Shitala, the Hindu goddess of smallpox, and joked that there hadn’t been any cases of smallpox since he’d had the statue in his office. “At that moment, I didn’t know if I was going to get the job, but I knew I wanted to be friends with him,” Castro said. A Star Wars fan, Castro said that she always saw Cash as the film series’ wise mentor Obi Wan Kenobi. “The Force was strong in Richard,” she said. “He was firm in his beliefs, and he always spoke the truth.”
A lifesaving drink
Soon after graduating from medical school, Cash started his work on ORT in East Pakistan (now Bangladesh) in 1967 as part of a U.S. Public Health Service response to a cholera outbreak. Patients with the disease suffer from acute diarrhea, which causes them to lose both water and salts (electrolytes). Intravenous saline was used to treat cases of extreme dehydration, but in Bangladesh at that time, IV solution was expensive and difficult to supply.
Working at the Pakistan-SEATO Cholera Research Laboratory, Cash and his colleague David Nalin, another young U.S. physician, conducted clinical studies that showed the effectiveness of giving patients an oral solution containing glucose and electrolytes. They published the results in a landmark paper in The Lancet in 1968. The pair later worked with a local nonprofit, the Bangladesh Rehabilitation Assistance Committee (BRAC), to teach Bangladeshi mothers how to administer a version of the treatment at home using household ingredients: a pinch of salt, a fistful of sugar, and half a liter of clean water. ORT is now commonly used across the world, and Cash received numerous awards for his contributions, including Thailand’s 2006 Prince Mahidol Award.
Castro stressed that the development of ORT was possible because Cash and Nalin—who spoke at the event about the treatment’s history—were in the field working directly with affected people. “You have to understand public health problems not based on all the certainties that you could have from the ivory tower, but by being there on the ground,” Castro said.
Over the decades following his initial work on ORT, Cash made frequent visits back to Bangladesh as well as other Asian and African nations to teach and work on public health projects. He supported the founding of the BRAC James P. Grant School of Public Health in Bangladesh, and taught there as a visiting professor for 20 years.
Inspirational teacher, mentor, and debate partner
Cash came to Harvard in 1977 as a fellow at the Harvard Institute for International Development and joined the School two years later.
Former Dean Barry Bloom, Joan L. and Julius H. Jacobson Professor of Public Health, Emeritus, said that he and Cash often disagreed on public health issues. “Our relationship was really a 25-year-long argument in the very best sense. He challenged most of my ideas and made me think again and again of how what I did could make a difference for real people,” Bloom said.
Sriram Venkitaraman, MPH ’19, a physician and government officer in India, recalled Cash as an inspirational teacher. “He taught us that the best public health work begins when we start listening instead of enforcing what we already know.”
What made Cash great as an educator was his ability to bring his deeply rooted knowledge to life in the classroom, said Aisha Yousafzai, professor of child development and health, who co-taught with Cash. “I will always cherish the wisdom that Richard so generously shared, and I hope to be able to continue, like all of us, taking that forward in the work that we do and the relationships that we build.”
In her closing remarks, Castro announced that GHP will launch an annual Richard A. Cash Lecture on Infectious Diseases, supported by the Richard Cash Memorial Fund.
A new portrait of Cash by artist Stephen Coit was also unveiled at the event. It will be displayed in the GHP office on the 11th floor of Building One.
