Richard Alan Cash’s life has been a testament to the power of simple solutions and the profound impact one individual can have on the lives of many. He passed away on October 22, but his work continues to save lives globally.
In the 1960s, East Pakistan (now Bangladesh) faced a dire public health crisis. Twice a year, the Ganges-Brahmaputra Delta would flood, spreading cholera and other deadly diarrheal diseases. Cholera had no accessible cure at the time, and while urban hospitals offered IV infusions to rehydrate patients, many in rural areas simply died without treatment.
At just 26, fresh out of medical school, Richard arrived in Dhaka. A pacifist during the Vietnam War, he chose to join the National Institutes of Health rather than serve in combat. Alongside Dr. David Nalin, Richard conducted the first clinical trials of Oral Rehydration Therapy (ORT), a simple mixture of salt, sugar, and water that could restore hydration in patients suffering from cholera. Their work revolutionized treatment, saving millions of lives. ORT’s effectiveness was demonstrated on a large scale in 1971, during the India-Pakistan War, when it was successfully used to treat large numbers of refugees.
ORT was not just a medical breakthrough—it was a lesson in the power of simplicity. As Richard often noted, “Simple doesn’t mean second-class.” He understood that while complex technologies might seem more impressive, real progress often comes from reducing problems to their most basic elements. “It really is much harder to make something simple than to make it complicated,” he would say, a philosophy that shaped his life’s work.
By 1978, the Lancet had named ORT the most important medical breakthrough of the 20th century, and the World Health Organization estimates that it has saved over 60 million lives. But Richard knew that discovery alone wasn’t enough—implementation was key. He was a driving force behind the global adoption of ORT, working with BRAC, the world’s largest NGO, to teach millions of caregivers how to prepare the solution at home. Over 13 million mothers were taught to save their children’s lives using nothing more than sugar, salt, and water, an achievement that transformed global health.
Richard Cash was never a big fan of the Bayh-Dole amendment, the legislation that allows researchers and institutions to patent discoveries made with federally funded research. For him, the promise of financial gain wasn’t what motivated scientific discovery, and he doubted it was what drove young scientists either.
In the late 1970s, Richard returned to Harvard University as a fellow. By 1979, he began teaching and mentoring students at the Harvard School of Public Health. His influence extended across Asia, Africa, and Latin America, as he led international research projects and helped establish the Applied Diarrheal Disease Research (ADDR) Project. Under him, this initiative funded over 150 studies in 12 countries, contributing greatly to the world’s understanding of infectious diseases in the poorest regions.
For Richard, it wasn’t just about creating a cure; it was about making it accessible and usable for the people who needed it most. And that required understanding human behavior. “A solution that can’t be applied,” he often said, “is really no solution at all.” He advocated for health interventions to be practical, fundamentally grounded in the realities of the communities they served. This meant training people and engaging entire communities, not just handing over a set of instructions.
Throughout his career, Richard was honored with numerous accolades, including the 2006 Prince Mahidol Award and the 2011 Fries Prize for Improving Health. But despite the recognition, he remained humble, focused on the work itself rather than the accolades that followed.
In his later years, Richard continued to influence public health as a visiting professor at institutions in India, Bangladesh, and Japan. His commitment to mentoring the next generation of health professionals never waned.
Richard Cash’s life teaches us that real change is slow, and often hard-won—that sometimes, the simplest solutions are the ones that matter most. It is perhaps befitting that the first time I saw the man who went on to become my mentor and professor was on the banks of the Ganges, right in the middle of the Kumbh Mela, over a decade ago. He along with countless others waded the Ganges. Them, seeking healing and absolution; him working on understanding and improving sanitation, in the largest informal gathering of humans in the world.
The irony edifies. The Kumbh Mela is not merely a congregation of souls seeking absolution but a microcosm of the disparities that riddle our world. People with the same basic needs, fears and hopes. Yet, worlds apart in the same regard. In India, as elsewhere, distances are not measured in kilometers but the chasms in opportunities, health and dignity. Staring hopefully into the waters that day, along with countless others was a grizzled gentleman. His quest far from individual, was deeply human.
Nanki Singh, MSc. Nanki Singh is a Researcher in the Department of Population Health, Section for Excellence in Health Equity at NYU Langone’s Grossman School of Medicine, as well as with the Harvard T.H. Chan School of Public Health. She hold an MSc in Global Health and Population from the Harvard T.H. Chan School of Public Health and her bachelor’s degree from Duke University. Her work focuses on advancing global health equity through qualitative and mixed methods approaches, with a particular emphasis on infectious diseases and sexual and reproductive health, in resource strapped communities. Previously, she worked in the development sector in India, with organizations including the Bill & Melinda Gates Foundation, the Clinton Health Access Initiative.