Saturday, April 21, 2012
Extended deadline for PHA3 registration: 30 April 2012
Dear PHM Friends!
Greetings from the global secretariat
With less then 3 months to go and mobilisation activities around the globe, the PHA3 is approaching quickly!
So far the registration has been a success and we are looking forward welcoming old and new friends to the movement! For those who have not registered yet, we are happy to announce the deadline for registration to be extended to 30 April 2012!
Extended deadline for online PHA3 registration : 30 April 2012
REGISTER NOW by following this link
(Please spread this message wide and far by forwarding this email to your mailing lists)
Wishing you all a lovely week!
Anneleen
On behalf of the PHA3 International Organising Committee
--
Global Secretariat
People's Health Movement (PHM)
Email: globalsecretariat@phmovement.org
Web: www.phmovement.org
Friday, February 10, 2012
Global Health Watch 3 is available online
From Amit Sengupta wrote:
Global Health Watch 3 is now available online on the GHW site (www.ghwatch.org).
The direct link is: www.ghwatch.org/sites/www.ghwatch.org/files/global%20health%20watch%203.pdf.
Do spread the word around.
Global Health Watch 3 is now available online on the GHW site (www.ghwatch.org).
The direct link is: www.ghwatch.org/sites/www.ghwatch.org/files/global%20health%20watch%203.pdf.
Do spread the word around.
Wednesday, February 1, 2012
SCALING UP NUTRITION (SUN)
January blog
by Claudio Schuftan
I have to admit my columns are not always calming.
SCALING UP NUTRITION (SUN)
LET US HOPE THAT THE SUN INITIATIVE CAN REALLY
PUT NUTRITION AT THE CENTRE OF DEVELOPMENT
I here now ask questions and make comments about the rather big SUN (Scaling Up Nutrition) worldwide initiative endorsed by the World Bank and the pertinent UN agencies plus some international NGOs.
Our colleagues who are driving and steering SUN, some of whom I have known well for many years, call once again for nutrition to be mainstreamed in development work. This time the energy, declared commitment, and stated engagement of powerful players, looks stronger than ever before. I applaud this. All public-spirited professionals concerned with malnutrition should respect SUN; we should continue to engage with its process, make clear proposals for improvement and press for these, as well as be constructively critical when needed. A friend who is nothing more than a yes-person is not a true friend. Those who are driving SUN deserve respect; my column this month is written in that spirit.
I consider myself a nutrition activist. As such, I try to have my practical experience influence my theory. Our engagement in nutrition work should lead to a praxis in which profession, empathy, concern and political solidarity become one and the same. Without these bearings I fear that we will just go in circles. I fear that the SUN initiative does not – at least yet – have these bearings. In any case, we need to discuss it, as between colleagues and friends. Here, I call for us to build up our capacities as nutrition activists to motivate others to be equally constructively critical.
Box 1
SUN
The Scaling Up Nutrition (SUN) Initiative is, in one way or another, steadily engaging more and more public health nutrition and allied professionals throughout the world. It is the most ambitious, highly-geared, integrated multi-actor programme of its type ever attempted. Its vision is once and for all effectively to address undernutrition, food and nutrition insecurity, and their consequences, particularly in the most highly burdened countries. A recent issue of the Food and Nutrition Bulletin linked here summarises some of SUN’s purposes and ambitions.
One of the concerns is that any programme initiated at top level may well not succeed in achieving the lasting results that only active community engagement can make possible. There are other concerns too, like the state of the most vulnerable in many parts of the world. They also include concerns about the heavy external debt burdens, rapidly increasing inequity between and within nations, the collapse of public health services, and rising and volatile food prices, all suffered by the most vulnerable populations, any of which are liable to vitiate any form of development initiative. These oppressions are not necessarily the responsibility of those who have devised SUN, granted. But they cannot be overlooked.
THOSE WHO HAVE THE POWER ARE
NOT THOSE WHO HAVE THE PROBLEMS
Now I proceed to ask some general questions, and also some questions addressed to the leaders of the SUN initiative. I hope this will generate a dialogue.
Here is my first question. Can we now at last, begin to shift our attention away from merely 'reaching the poor with nutrition interventions’, towards deep understanding of the fundamental drivers of poverty and inequality, as these affect nutrition? What ultimately counts, I contend, is our social and political accountability, and also carrying out our work in true partnership with populations and communities that happen to be impoverished.
It is political processes and issues of power that determine the content, direction and implementation of food and nutrition policies and programmes. As nutrition activists we can be strong political players, instead of – implicitly or by default – merely protecting narrow group interests. But we have to be mindful of the fact that we mostly work under the wings of governments, industry, or international agencies that are often unmindful of the real interests of those who are impoverished, despite their public statements to the contrary. We all know that the people who have the power are not the people who have the problems.
Our networked influence as public health nutritionists can and must contribute to realisation of the human right to nutrition; and also, to the reversing of violations of this right in all domains. So my second question to the SUN leaders is: Does the SUN initiative also mean and intend this? So far the drafters of its documents seem to skip the human rights dimension –at least explicitly. Is this my misunderstanding?
The processes that make people poor and malnourished are becoming more ingrained every day. So my next question is: Is the SUN Initiative fostering ‘survival’, or sustained ‘better living’ Poverty changes people’s incentives and the constraints under which they operate; it causes a chronic sense of helplessness. Impoverished people are excluded from a share of their nation's resources. That is why, to end protein-energy malnutrition, the distribution of wealth is as important, if not more important, as its creation. I am not sure that the World Bank, a backer of SUN, fully understands or accepts this point. Perhaps in pronouncements, but in practice?
People experience poverty and the violation of their right to nutrition differently, according to their gender, age, caste, class and ethnicity. For us, in nutrition work, poverty is multi-dimensional. It relates to powerlessness, to exclusion, to exploitation, to victimisation and to violence. It is also related to migration, to forced displacement, to rising urbanisation and to loss of livelihoods. Do the leaders of the SUN initiative see this at par value?
Let’s face a hard fact. Much of our work, such as that which involves micronutrients, remains a ‘nutrition repair industry’ of damage done by impoverishment. A sustainable approach to poverty reduction is complex. It requires three types of measure. These are to ensure that the ‘improving poor people’ continue to improve; that the ‘coping poor people’ graduate out of their precarious state; and that the ‘declining poor people’ have an opportunity to reverse their condition. I ask: How much of this do we really do in our nutrition work?
SO HOW CAN THE SUN INITIATIVE REALLY PUT
NUTRITION AT THE CENTRE OF DEVELOPMENT?
Poverty that is forced on individuals and on families who have no other choice, is unequivocally linked to injustice – and potentially to rebellion, uprising, and even wars. It is a denial of human rights on a massive scale. Should this fact not make a difference in our day-to-day work? And so, to my next question is: Do those shaping the SUN Initiative, in their call for nutrition to be placed more at the centre of development, accept this, with all its implications? We need to engage in sincere dialogue on this and the other questions asked here.
The gap in policy processes towards better food security and nutrition interventions is not mainly a gap between knowledge and action. Food and nutrition issues generally have had little policy attention from decision-makers. The lack of action this entails is not due to a lack of knowledge. Ignorance is not the issue. It is more a matter of a deliberate choice not to attend to food and nutrition matters.
Crucial partners in the SUN initiative are food and nutrition research organisations, such as those associated with the UN and World Bank funded CGIAR consortium, originally named the Consultative Group on International Agricultural Research, These employ and engage thousands of highly trained and committed professionals. But as far as I can see, they have hardly engaged in the needed consciousness-raising about the structural causes of malnutrition.
If I am wrong in this, let’s have a response please. Most such organisations seem to think that if decision-makers have, or are given, more and better knowledge that they will indeed take the urgently needed decisions. But this is not how the political world works. People in power rarely go against their own interests. What is missing is something that SUN, by its nature, is not supplying. This is organised methodical intelligent, informed and energetic pressure from below, from empowered claim-holders.
I will now explore this somewhat further here, in a point-counterpoint fashion.
Point 1
Most nutrition colleagues will, I think, agree that the right food and nutrition policy decisions are not being made, in a world where malnutrition is still a serious public health nutrition problem, and where a host of options for action exist. Why is this? Why do decision-makers overall pay little attention to food and nutrition issues?
Counterpoint 1
Some researchers in the food and nutrition community are indeed looking for ways to reduce the gap between knowledge and action. As said above, the issue is deliberate overlooking and ignoring of the food and nutrition problem, as long as this does not get to the stage of social and political unrest and uprising, and thus jeopardising the stability of the system controlled by those who hold the power. Knowledge gaps most decidedly exist, but are of little significance. Policy is only minimally affected by knowledge alone. It is political factors that determine the policies that get priority. It is power politics that drive policy choices.
The communities most affected by impoverishment are usually not being engaged in the policy making process. They do not have a voice; they do not influence policy. They need to be empowered to do so in order to claim this right. And thus another question: Will the SUN Initiative embark on this?
The more militant civil society organisations have indeed contributed to some real changes. There is much to be learned from them. We need to help budding civil society organisations to achieve the power to demand needed changes and to monitor their implementation.
Point 2
Existing food and nutrition research organisations like the CGIAR consortium often engage in attempts to influence policy-makers by communicating their findings to them and by contributing new information at conferences and other policy fora.
Counterpoint 2
But merely communicating and contributing new information to decision-makers will not achieve needed changes, unless this information addresses political issues. Furthermore, new information and ideas need to come not just from discussion with professional peers, but with the claim-holders themselves. Just how often does this actually happen? Perhaps more often than I think, so examples please, from knowledgeable readers.
Point 3
These organisations claim there is a disconnect between the sphere of policy-making and the sphere of science-and-knowledge; that the need is to break ground methodologically, to engage policy-makers for decisions to be made.
Counterpoint 3
This has been one of the problems of these food and nutrition research organisations all the time. They try to connect policy with science-and-knowledge, and not with politics. Does any knowledgeable professional in these fields really still think that if decision-makers have more and better knowledge, they will make decisions that are against their political interests? In their guts, politicians already know what scientists want to tell them. They may not have quantified information, but they know. The need is not to break new methodological ground. The need is to break through politically.
Point 4
These organisations still often call for more interdisciplinary research.
Counterpoint 4
However, almost all the hurdles are ideological. Multidisciplinary teams of conservative researchers will produce conservative, ‘focused’ (meaning narrow) results and recommendations that merely tinker with the immediate and, perhaps, underlying causes, strictly consistent with the established order – or disorder.
What is needed, above all, are structural changes that address the basic causes of preventable hunger and malnutrition. It is definitely not a dearth of multi- or interdisciplinary work that has hampered progress. ‘Selling' research findings to decision-makers is, I think, likely to bring more of the same disappointments. Policy makers tend not to listen, unless claim-holders put pressure on them.
Point 5
Many of these organisations call for setting up social protection and safety nets.
Counterpoint 5
Let us now, once and for all, stop talking about safety nets! This is what leads to mere tinkering within the system. The ongoing casino capitalism with its global restructuring, creates the problems, and food and nutrition professionals are supposed to pick up the pieces? Just so that poor and marginalised people do not revolt? Who is cheating whom here? We need to stop victimising poor people and them throwing them bread-crumbs. What about changing the system that makes safety nets for poor people necessary to begin with?
Point 6
The CGIAR and similar organisations have proven their ability to communicate effectively, to bring relevant actors together to promote action.
Counterpoint 6
True, but what are they communicating? Rice with added iron or vitamin A? The horrible impact of AIDS on agriculture, economies and social stability? The need for improved agro-forestry? Super new strains of staple foods? None of this is enough. In any case, do such proposals lead to policy-makers listening, acting, and going on to make structural changes? I think not.
Food and nutrition issues appear on the public policy agenda almost always only when it is in the interest of the decision-makers, or when international pressures become unbearable. Is the SUN initiative a response to such a pressure?
Only occasionally do leaders have a clear mind and determination about the importance of food and nutrition, in a genuine equitable and sustainable development process. But we need to remember that some governments do place a high priority on reducing hunger and malnutrition. Take Vietnam, China, Brazil, Costa Rica, Cuba, and Kerala state in India. The common denominator among them is political determination at the highest level, in some cases spurred by engagement and partnership with strong civil society organisations.
Ultimately, the crucial factor is organised pressure from below; thus the importance of empowering and mobilising beneficiaries. Current legislation and legal systems do not affect action to reduce hunger and malnutrition to any great degree. Laws may be passed, but are often not enforced. National leaderships often feel content with having made the laws, and do not care much about their enforcement. Legislation is also frequently in response to international pressures and not to a real felt need. So a similar question to the last one is: Is the SUN initiative a response to such pressure?
So how can all the actors allied and working together within the SUN initiative, create the conditions for actions that really will effectively reduce hunger and malnutrition in impoverished countries? In my view and that of many experienced colleagues, they will first need to go through a deep process of revising and redefining their vision and their mission. Above all, they need to incorporate the human right to nutrition in their policies and actions. Will the SUN initiative mark the end of the donor-driven, philanthropic and charitable approach to what actually are human rights? I hope so. I pause, for a reply.
Please cite as: Schuftan C. Let us hope that the SUN Initiative can really put nutrition at the centre of development. [Column]. Website of the World Public Health Nutrition Association, January 2012. Obtainable at www.wphna.org
cschuftan@phmovement.org
www.phmovement.org
www.humaninfo.org/aviva
by Claudio Schuftan
I have to admit my columns are not always calming.
SCALING UP NUTRITION (SUN)
LET US HOPE THAT THE SUN INITIATIVE CAN REALLY
PUT NUTRITION AT THE CENTRE OF DEVELOPMENT
I here now ask questions and make comments about the rather big SUN (Scaling Up Nutrition) worldwide initiative endorsed by the World Bank and the pertinent UN agencies plus some international NGOs.
Our colleagues who are driving and steering SUN, some of whom I have known well for many years, call once again for nutrition to be mainstreamed in development work. This time the energy, declared commitment, and stated engagement of powerful players, looks stronger than ever before. I applaud this. All public-spirited professionals concerned with malnutrition should respect SUN; we should continue to engage with its process, make clear proposals for improvement and press for these, as well as be constructively critical when needed. A friend who is nothing more than a yes-person is not a true friend. Those who are driving SUN deserve respect; my column this month is written in that spirit.
I consider myself a nutrition activist. As such, I try to have my practical experience influence my theory. Our engagement in nutrition work should lead to a praxis in which profession, empathy, concern and political solidarity become one and the same. Without these bearings I fear that we will just go in circles. I fear that the SUN initiative does not – at least yet – have these bearings. In any case, we need to discuss it, as between colleagues and friends. Here, I call for us to build up our capacities as nutrition activists to motivate others to be equally constructively critical.
Box 1
SUN
The Scaling Up Nutrition (SUN) Initiative is, in one way or another, steadily engaging more and more public health nutrition and allied professionals throughout the world. It is the most ambitious, highly-geared, integrated multi-actor programme of its type ever attempted. Its vision is once and for all effectively to address undernutrition, food and nutrition insecurity, and their consequences, particularly in the most highly burdened countries. A recent issue of the Food and Nutrition Bulletin linked here summarises some of SUN’s purposes and ambitions.
One of the concerns is that any programme initiated at top level may well not succeed in achieving the lasting results that only active community engagement can make possible. There are other concerns too, like the state of the most vulnerable in many parts of the world. They also include concerns about the heavy external debt burdens, rapidly increasing inequity between and within nations, the collapse of public health services, and rising and volatile food prices, all suffered by the most vulnerable populations, any of which are liable to vitiate any form of development initiative. These oppressions are not necessarily the responsibility of those who have devised SUN, granted. But they cannot be overlooked.
THOSE WHO HAVE THE POWER ARE
NOT THOSE WHO HAVE THE PROBLEMS
Now I proceed to ask some general questions, and also some questions addressed to the leaders of the SUN initiative. I hope this will generate a dialogue.
Here is my first question. Can we now at last, begin to shift our attention away from merely 'reaching the poor with nutrition interventions’, towards deep understanding of the fundamental drivers of poverty and inequality, as these affect nutrition? What ultimately counts, I contend, is our social and political accountability, and also carrying out our work in true partnership with populations and communities that happen to be impoverished.
It is political processes and issues of power that determine the content, direction and implementation of food and nutrition policies and programmes. As nutrition activists we can be strong political players, instead of – implicitly or by default – merely protecting narrow group interests. But we have to be mindful of the fact that we mostly work under the wings of governments, industry, or international agencies that are often unmindful of the real interests of those who are impoverished, despite their public statements to the contrary. We all know that the people who have the power are not the people who have the problems.
Our networked influence as public health nutritionists can and must contribute to realisation of the human right to nutrition; and also, to the reversing of violations of this right in all domains. So my second question to the SUN leaders is: Does the SUN initiative also mean and intend this? So far the drafters of its documents seem to skip the human rights dimension –at least explicitly. Is this my misunderstanding?
The processes that make people poor and malnourished are becoming more ingrained every day. So my next question is: Is the SUN Initiative fostering ‘survival’, or sustained ‘better living’ Poverty changes people’s incentives and the constraints under which they operate; it causes a chronic sense of helplessness. Impoverished people are excluded from a share of their nation's resources. That is why, to end protein-energy malnutrition, the distribution of wealth is as important, if not more important, as its creation. I am not sure that the World Bank, a backer of SUN, fully understands or accepts this point. Perhaps in pronouncements, but in practice?
People experience poverty and the violation of their right to nutrition differently, according to their gender, age, caste, class and ethnicity. For us, in nutrition work, poverty is multi-dimensional. It relates to powerlessness, to exclusion, to exploitation, to victimisation and to violence. It is also related to migration, to forced displacement, to rising urbanisation and to loss of livelihoods. Do the leaders of the SUN initiative see this at par value?
Let’s face a hard fact. Much of our work, such as that which involves micronutrients, remains a ‘nutrition repair industry’ of damage done by impoverishment. A sustainable approach to poverty reduction is complex. It requires three types of measure. These are to ensure that the ‘improving poor people’ continue to improve; that the ‘coping poor people’ graduate out of their precarious state; and that the ‘declining poor people’ have an opportunity to reverse their condition. I ask: How much of this do we really do in our nutrition work?
SO HOW CAN THE SUN INITIATIVE REALLY PUT
NUTRITION AT THE CENTRE OF DEVELOPMENT?
Poverty that is forced on individuals and on families who have no other choice, is unequivocally linked to injustice – and potentially to rebellion, uprising, and even wars. It is a denial of human rights on a massive scale. Should this fact not make a difference in our day-to-day work? And so, to my next question is: Do those shaping the SUN Initiative, in their call for nutrition to be placed more at the centre of development, accept this, with all its implications? We need to engage in sincere dialogue on this and the other questions asked here.
The gap in policy processes towards better food security and nutrition interventions is not mainly a gap between knowledge and action. Food and nutrition issues generally have had little policy attention from decision-makers. The lack of action this entails is not due to a lack of knowledge. Ignorance is not the issue. It is more a matter of a deliberate choice not to attend to food and nutrition matters.
Crucial partners in the SUN initiative are food and nutrition research organisations, such as those associated with the UN and World Bank funded CGIAR consortium, originally named the Consultative Group on International Agricultural Research, These employ and engage thousands of highly trained and committed professionals. But as far as I can see, they have hardly engaged in the needed consciousness-raising about the structural causes of malnutrition.
If I am wrong in this, let’s have a response please. Most such organisations seem to think that if decision-makers have, or are given, more and better knowledge that they will indeed take the urgently needed decisions. But this is not how the political world works. People in power rarely go against their own interests. What is missing is something that SUN, by its nature, is not supplying. This is organised methodical intelligent, informed and energetic pressure from below, from empowered claim-holders.
I will now explore this somewhat further here, in a point-counterpoint fashion.
Point 1
Most nutrition colleagues will, I think, agree that the right food and nutrition policy decisions are not being made, in a world where malnutrition is still a serious public health nutrition problem, and where a host of options for action exist. Why is this? Why do decision-makers overall pay little attention to food and nutrition issues?
Counterpoint 1
Some researchers in the food and nutrition community are indeed looking for ways to reduce the gap between knowledge and action. As said above, the issue is deliberate overlooking and ignoring of the food and nutrition problem, as long as this does not get to the stage of social and political unrest and uprising, and thus jeopardising the stability of the system controlled by those who hold the power. Knowledge gaps most decidedly exist, but are of little significance. Policy is only minimally affected by knowledge alone. It is political factors that determine the policies that get priority. It is power politics that drive policy choices.
The communities most affected by impoverishment are usually not being engaged in the policy making process. They do not have a voice; they do not influence policy. They need to be empowered to do so in order to claim this right. And thus another question: Will the SUN Initiative embark on this?
The more militant civil society organisations have indeed contributed to some real changes. There is much to be learned from them. We need to help budding civil society organisations to achieve the power to demand needed changes and to monitor their implementation.
Point 2
Existing food and nutrition research organisations like the CGIAR consortium often engage in attempts to influence policy-makers by communicating their findings to them and by contributing new information at conferences and other policy fora.
Counterpoint 2
But merely communicating and contributing new information to decision-makers will not achieve needed changes, unless this information addresses political issues. Furthermore, new information and ideas need to come not just from discussion with professional peers, but with the claim-holders themselves. Just how often does this actually happen? Perhaps more often than I think, so examples please, from knowledgeable readers.
Point 3
These organisations claim there is a disconnect between the sphere of policy-making and the sphere of science-and-knowledge; that the need is to break ground methodologically, to engage policy-makers for decisions to be made.
Counterpoint 3
This has been one of the problems of these food and nutrition research organisations all the time. They try to connect policy with science-and-knowledge, and not with politics. Does any knowledgeable professional in these fields really still think that if decision-makers have more and better knowledge, they will make decisions that are against their political interests? In their guts, politicians already know what scientists want to tell them. They may not have quantified information, but they know. The need is not to break new methodological ground. The need is to break through politically.
Point 4
These organisations still often call for more interdisciplinary research.
Counterpoint 4
However, almost all the hurdles are ideological. Multidisciplinary teams of conservative researchers will produce conservative, ‘focused’ (meaning narrow) results and recommendations that merely tinker with the immediate and, perhaps, underlying causes, strictly consistent with the established order – or disorder.
What is needed, above all, are structural changes that address the basic causes of preventable hunger and malnutrition. It is definitely not a dearth of multi- or interdisciplinary work that has hampered progress. ‘Selling' research findings to decision-makers is, I think, likely to bring more of the same disappointments. Policy makers tend not to listen, unless claim-holders put pressure on them.
Point 5
Many of these organisations call for setting up social protection and safety nets.
Counterpoint 5
Let us now, once and for all, stop talking about safety nets! This is what leads to mere tinkering within the system. The ongoing casino capitalism with its global restructuring, creates the problems, and food and nutrition professionals are supposed to pick up the pieces? Just so that poor and marginalised people do not revolt? Who is cheating whom here? We need to stop victimising poor people and them throwing them bread-crumbs. What about changing the system that makes safety nets for poor people necessary to begin with?
Point 6
The CGIAR and similar organisations have proven their ability to communicate effectively, to bring relevant actors together to promote action.
Counterpoint 6
True, but what are they communicating? Rice with added iron or vitamin A? The horrible impact of AIDS on agriculture, economies and social stability? The need for improved agro-forestry? Super new strains of staple foods? None of this is enough. In any case, do such proposals lead to policy-makers listening, acting, and going on to make structural changes? I think not.
Food and nutrition issues appear on the public policy agenda almost always only when it is in the interest of the decision-makers, or when international pressures become unbearable. Is the SUN initiative a response to such a pressure?
Only occasionally do leaders have a clear mind and determination about the importance of food and nutrition, in a genuine equitable and sustainable development process. But we need to remember that some governments do place a high priority on reducing hunger and malnutrition. Take Vietnam, China, Brazil, Costa Rica, Cuba, and Kerala state in India. The common denominator among them is political determination at the highest level, in some cases spurred by engagement and partnership with strong civil society organisations.
Ultimately, the crucial factor is organised pressure from below; thus the importance of empowering and mobilising beneficiaries. Current legislation and legal systems do not affect action to reduce hunger and malnutrition to any great degree. Laws may be passed, but are often not enforced. National leaderships often feel content with having made the laws, and do not care much about their enforcement. Legislation is also frequently in response to international pressures and not to a real felt need. So a similar question to the last one is: Is the SUN initiative a response to such pressure?
So how can all the actors allied and working together within the SUN initiative, create the conditions for actions that really will effectively reduce hunger and malnutrition in impoverished countries? In my view and that of many experienced colleagues, they will first need to go through a deep process of revising and redefining their vision and their mission. Above all, they need to incorporate the human right to nutrition in their policies and actions. Will the SUN initiative mark the end of the donor-driven, philanthropic and charitable approach to what actually are human rights? I hope so. I pause, for a reply.
Please cite as: Schuftan C. Let us hope that the SUN Initiative can really put nutrition at the centre of development. [Column]. Website of the World Public Health Nutrition Association, January 2012. Obtainable at www.wphna.org
cschuftan@phmovement.org
www.phmovement.org
www.humaninfo.org/aviva
Friday, January 20, 2012
PHM: WHO Exec Bd 130 Report Day 3
From: Alice Fabbri
alealifab@gmail.com
Report the WHO watchers prepared on the third day of the 130th Executive Board just uploaded.
The report is available at:http://www.ghwatch.org/node/448
Highlights from the third day of the 130th Executive Board
Geneva, 18.01.12
Nomination of the Director-General
Dr Margaret Chan was nominated by the Executive Board for a second term as Director-General of the Organisation. This nomination will be submitted for approval to the Sixty-fifth World Health Assembly in May 2012.
The first part of this session was not open to NGOs. When the session was opened again, Dr Chan took the floor thanking the Board for their confidence and support.
She stated that the work in public health is never done, with the exception of disease eradication, and reaffirmed her commitment by saying: “First time I promised to work tirelessly. I have done so.[...] I will work even harder to ensure everyone reaches the highest attainable status of health”.
All Member States expressed their appreciation and congratulated Dr Chan for the nomination.
However, it has to be mentioned that no other candidates were proposed for the DG position and this situation leaves room for some considerations about the impact of geopolitics on the Organisation management.
WHO Reform
Programmes and priority setting
The discussion about the WHO reform began with comments on document EB 130/5 Add.1 “Programmes and Priority Setting”. Commenting on the 7 proposed categories for the next general programme of work, some Latin American countries asked how these categories came to be suggested. Following this observation, Norway and Switzerland, explicitly suggested, at this point in time, to focus on the process and criteria for priority setting rather than on the priorities themselves. On the same issue, Estonia, talking on behalf of EU, directly asked the Secretariat to set up a drafting group that should work separately during the EB, to define the Terms of Reference for priority setting through a Member States-driven process.
Beyond technical arrangements, Estonia as well as Japan and Germany pointed out that priority setting should be linked with the financial reform and that resource mobilization and allocation should necessarily be subordinated to the identified areas of work.
According to Member States suggestions, priority definition should be based on a bottom-up approach taking individual country needs as a starting point. Striking a discordant note, US suggested that global objectives should guide regional and local ones and eventually go back to the centre. The discussion on country needs led to question the resource allocation among the three level of the Organisation and the concept of country grouping proposed in the document (Par. 12). India and China highlighted how the 5 categories proposed are almost entirely based on level of development rather than on the burden of diseases and how countries in the same group can have different health needs.
Last but not least, Ecuador and France complained about the late release of the document EB130/5 Add. 1 and Add.2, which prevented Member States to adequately analyze and react on them.
Afterwards, three NGOs took the floor: Medicines Sans Frontiere, Medicus Mundi International and the People’s Health Movement, and Democratizing Global Health Coalition (a group of public interest organizations that have come together to focus on the WHO Reform). Civil society comments were recalled also in the final speech by the Director General who congratulated them by saying “You have done a lot of work and you could really highlight the important points” but she didn’t really answered the question posed.
At this point, Dr. Chan summarized the discussion and cleverly clarified that the EB documents prepared by the Secretariat were not meant to be the basis for a negotiation, but just an instrument to stimulate the discussion. She also said: “This is not a decision making time”.
Addressing Member States suggestions and concerns, she grouped the interventions into two broad categories: process and content.
Concerning the content, she declared to be happy to hear that many countries agreed that priority setting should give very strong attention to country needs. Trying to address Member States concerns about the 5 typologies of country and the 7 categories of work, Dr. Chan declared that these were just a first attempt to systematize the available information as well as the current activities of the Organization.
Regarding the process, she fully agreed on the EU proposal to create a working group to set ToR and the scope for the Member State-driven process. Moreover she proposed to adopt the first option mentioned in paragraph 55 which means starting the Member States-driven process with a main meeting to be held in late February. Although this option was fully supported by many countries, others, especially the furthest (Japan) and the smallest (Bahamas and Barbados), expressed their concerns on the economical and human resources sustainability.
alealifab@gmail.com
Report the WHO watchers prepared on the third day of the 130th Executive Board just uploaded.
The report is available at:http://www.ghwatch.org/node/448
Highlights from the third day of the 130th Executive Board
Geneva, 18.01.12
Nomination of the Director-General
Dr Margaret Chan was nominated by the Executive Board for a second term as Director-General of the Organisation. This nomination will be submitted for approval to the Sixty-fifth World Health Assembly in May 2012.
The first part of this session was not open to NGOs. When the session was opened again, Dr Chan took the floor thanking the Board for their confidence and support.
She stated that the work in public health is never done, with the exception of disease eradication, and reaffirmed her commitment by saying: “First time I promised to work tirelessly. I have done so.[...] I will work even harder to ensure everyone reaches the highest attainable status of health”.
All Member States expressed their appreciation and congratulated Dr Chan for the nomination.
However, it has to be mentioned that no other candidates were proposed for the DG position and this situation leaves room for some considerations about the impact of geopolitics on the Organisation management.
WHO Reform
Programmes and priority setting
The discussion about the WHO reform began with comments on document EB 130/5 Add.1 “Programmes and Priority Setting”. Commenting on the 7 proposed categories for the next general programme of work, some Latin American countries asked how these categories came to be suggested. Following this observation, Norway and Switzerland, explicitly suggested, at this point in time, to focus on the process and criteria for priority setting rather than on the priorities themselves. On the same issue, Estonia, talking on behalf of EU, directly asked the Secretariat to set up a drafting group that should work separately during the EB, to define the Terms of Reference for priority setting through a Member States-driven process.
Beyond technical arrangements, Estonia as well as Japan and Germany pointed out that priority setting should be linked with the financial reform and that resource mobilization and allocation should necessarily be subordinated to the identified areas of work.
According to Member States suggestions, priority definition should be based on a bottom-up approach taking individual country needs as a starting point. Striking a discordant note, US suggested that global objectives should guide regional and local ones and eventually go back to the centre. The discussion on country needs led to question the resource allocation among the three level of the Organisation and the concept of country grouping proposed in the document (Par. 12). India and China highlighted how the 5 categories proposed are almost entirely based on level of development rather than on the burden of diseases and how countries in the same group can have different health needs.
Last but not least, Ecuador and France complained about the late release of the document EB130/5 Add. 1 and Add.2, which prevented Member States to adequately analyze and react on them.
Afterwards, three NGOs took the floor: Medicines Sans Frontiere, Medicus Mundi International and the People’s Health Movement, and Democratizing Global Health Coalition (a group of public interest organizations that have come together to focus on the WHO Reform). Civil society comments were recalled also in the final speech by the Director General who congratulated them by saying “You have done a lot of work and you could really highlight the important points” but she didn’t really answered the question posed.
At this point, Dr. Chan summarized the discussion and cleverly clarified that the EB documents prepared by the Secretariat were not meant to be the basis for a negotiation, but just an instrument to stimulate the discussion. She also said: “This is not a decision making time”.
Addressing Member States suggestions and concerns, she grouped the interventions into two broad categories: process and content.
Concerning the content, she declared to be happy to hear that many countries agreed that priority setting should give very strong attention to country needs. Trying to address Member States concerns about the 5 typologies of country and the 7 categories of work, Dr. Chan declared that these were just a first attempt to systematize the available information as well as the current activities of the Organization.
Regarding the process, she fully agreed on the EU proposal to create a working group to set ToR and the scope for the Member State-driven process. Moreover she proposed to adopt the first option mentioned in paragraph 55 which means starting the Member States-driven process with a main meeting to be held in late February. Although this option was fully supported by many countries, others, especially the furthest (Japan) and the smallest (Bahamas and Barbados), expressed their concerns on the economical and human resources sustainability.
Tuesday, January 17, 2012
PHM Commentary on ongoing WHO EB meeting
From: amit sen
Issues for consideration at the 130th Session of the WHO Executive Board
We hereby submit the comments and suggestions included below (see link) regarding some of the items appearing on the agenda of the WHO Executive Board.
PHM is committed to a stronger WHO, adequately funded, with appropriate powers and playing the leading role in global health governance. PHM follows closely the work of the WHO, through the governing bodies and the secretariat. Across our networks we have technical experts and grass roots organisations with close interests in many of the issues coming before you over the next week.
However, WHO does not make it easy for civil society NGOs to contribute to its consideration of the issues coming before it.
It limits the number of organisations which have an official relationship with WHO and has recently restricted access to spaces in the Palais de Nations during the WHA. You may also know that civil society organisations have to submit their statements 24 hours before they are delivered. This rule often results in the statements getting censored, refused altogether, or, the least, rendering these interventions of little use for Member States, being written long before their deliberations.
Over the last week members of the PHM WHO liaison group have been working through the EB Agenda with the assistance of high level experts from a number of collaborating networks and NGOs. This workshop was part of our Global Health Governance Initiative which involves both watching and advocacy. In the course of these discussions we have prepared the following comments on some of the key issues coming before you. (You can follow the analysis in detail at www.ghwatch.org , and specifically for this EB meeting at: www.ghwatch.org/node/448 )
Members of the PHM WHO liaison group will be following the discussion at the EB over the next week.
PHM Comments to the 130th EB session, January 2012 2
PHM Comments on Various Agenda Items:
Here's the link of the PHM commentary on the WHO EB meeting, just uploaded:
http://www.ghwatch.org/sites/www.ghwatch.org/files/final%20PHM%20Comments_EB130_Jan2012.pdf
Issues for consideration at the 130th Session of the WHO Executive Board
We hereby submit the comments and suggestions included below (see link) regarding some of the items appearing on the agenda of the WHO Executive Board.
PHM is committed to a stronger WHO, adequately funded, with appropriate powers and playing the leading role in global health governance. PHM follows closely the work of the WHO, through the governing bodies and the secretariat. Across our networks we have technical experts and grass roots organisations with close interests in many of the issues coming before you over the next week.
However, WHO does not make it easy for civil society NGOs to contribute to its consideration of the issues coming before it.
It limits the number of organisations which have an official relationship with WHO and has recently restricted access to spaces in the Palais de Nations during the WHA. You may also know that civil society organisations have to submit their statements 24 hours before they are delivered. This rule often results in the statements getting censored, refused altogether, or, the least, rendering these interventions of little use for Member States, being written long before their deliberations.
Over the last week members of the PHM WHO liaison group have been working through the EB Agenda with the assistance of high level experts from a number of collaborating networks and NGOs. This workshop was part of our Global Health Governance Initiative which involves both watching and advocacy. In the course of these discussions we have prepared the following comments on some of the key issues coming before you. (You can follow the analysis in detail at www.ghwatch.org , and specifically for this EB meeting at: www.ghwatch.org/node/448 )
Members of the PHM WHO liaison group will be following the discussion at the EB over the next week.
PHM Comments to the 130th EB session, January 2012 2
PHM Comments on Various Agenda Items:
Here's the link of the PHM commentary on the WHO EB meeting, just uploaded:
http://www.ghwatch.org/sites/www.ghwatch.org/files/final%20PHM%20Comments_EB130_Jan2012.pdf
Wednesday, January 11, 2012
Nutrition and sustainable development
December blog
by Claudio Schuftan
This month, I look forward to a world conference being held next June, in Rio de Janeiro. This is the ‘Rio+20’ Conference on Sustainable Development, whose website is at http://www.uncsd2012.org/rio20/
The overarching declared purpose of Rio+20 is once again, to raise consciousness of and arouse conscience on the environmental dimension, which until late last century was more or less forgotten. Veterans of world summits on any topic have reason for scepticism, but they are needed, and we must all do our best to see that Rio+20 really does mark a time when we all move towards living in ways that are fair and sane.
Adequate good nutrition is smack in the middle of sustainable development. Neither is possible without the other. But as I consider these issues, like you, I am also reflecting on what has been and is happening this year in the streets all over the world. This year has been and is one of direct action, and I believe that the unrest, riots and uprisings that we see and that some of us have experienced, whatever their immediate and obvious cause, all have a core mood in common. This is awareness that we are living in a world whose political and economic governance – or rather lack of governance and surrender to corporate greed – has gone wrong and has broken down.
The prevailing governance structure of the globe ignores the several crises the planet is facing, as well as the social determinants behind them. Food insecurity , preventable child and maternal deaths , price Barriers to accessing medicines , collapsing health systems share the fact that we do have enough resources to provide for them, but these resources instead flow to over-consumption. Military expenditure and obscene wealth for a small elite .
Food prices including those of staple foods all over the world remained stable from 1990 to 2007; since then, prices have rocketed and fluctuated wildly. One reason, as pointed out by Olivier De Schutter, the UN special rapporteur on the right to nutrition, is the recent vast increase of speculation in food commodity futures prices. The results, early this year, were food riots in many impoverished countries, leading to uprisings in North Africa that threatened and toppled governments.
My point here is that the triggers for the unrest that escalated very rapidly in a number of grossly unjust societies, were uncontrolled and chaotic food prices, in countries whose rulers had failed to protect their people by the use of regulations and controls that could have stabilised the cost of staple foods, as wise rulers throughout history have done.
NUTRITION AND SUSTAINABLE DEVELOPMENT
WE NEED TO HEAR WHAT THE PEOPLE ARE SAYING,
AND ‘THE PEOPLE’ SHOULD INCLUDE US.
THE CURRENT SYSTEM OF GOVERNANCE IS BROKEN.
The latest manifestation of this year’s phenomenal series of direct actions is the Occupy Movement, which includes the Occupy Wall Street movement. This began in the South in Kuala Lumpur, Malaysia on 30 July, spread to Zuccotti Park in New York on 17 September, and by early November had spread to 600 communities in the US and around 2,500 cities worldwide. Occupy is now supported or endorsed by political and other leaders even up to head of government level in many countries, including in the US and in the BRIC countries of Brazil, Russia, India and China.
The protests are against what is now often accurately termed ‘casino capitalism’. This monster has been created by what still remains the orthodox political and economic system known as ‘freeing the market’, which is technobabble for surrendering the responsibilities and duties of government, and letting transnational corporations use increasingly lenient laws they believe will increase their profits.
Until this abuse of governance is stopped and reversed, world summits on the environment, climate change, prevention of diabetes, cancer and heart disease, or the war on world poverty, are really hot air. They are also duplicitous, because the officials who organise them must surely be well aware of the big issue that is driving environmental wreckage, the melting of the Arctic and Antarctic ice-caps, and the outrageous combination of obesity, poverty and deficiency.
Box 1
Sustainable development
Eating the planet and having it
Whether we are policy-makers, professionals, citizens or consumers, or any combination of these, we won’t make progress with the idea of ‘sustainable development’ until we think through what these terms mean and imply. ‘Sustainable’ is perhaps easy to define. It means something like ‘capable of being continued indefinitely’ and in our context, taking human, living and physical resources into account. Thus, to use a well-known example, recommendations that everybody should eat more fish are not sustainable – unless few people pay attention to the recommendation.
So what about ‘development’? People like us have been brought up to believe in ‘development’. The concept of ‘underdeveloped’ and ‘developed’ countries, later tactfully changed to ‘developing’ and ‘developed’, is embedded in all discourses concerning human progress, as are allied terms like ‘emerging market economies’. What ‘development’ conventionally means is economic development. And the metric for this type of development, applied to any country, is Gross National Product. What this measures is the total amount of money turned over within a country. The more money circulates, the more economic development, which usually is simply termed ‘development’.
Human rights, justice and equity don’t enter this picture. A country whose population was mainly made up from relatively self-sufficient family farmers, with a small ruling class that was not rapacious, would by definition be ‘developing’ – or if it preferred to stay that way, ‘undeveloped’. By contrast, a country with a substantial number of vastly wealthy people and an economy based on money, whose public goods are privatised, and whose diseased population is mostly in a perpetual state of insecurity and even gross poverty if only because of the cost of health care, is ‘developed’. Another example would be a country whose national turnover of money depended on vast stocks of weapons of mass destruction, used from time to time to invade other countries. Such a country is counted as most developed. Sounds familiar?
My point here is that in its current conventional sense, ‘development’ cannot be sustainable, because it depends on increasingly rapacious and senseless exploitation of human, living and physical resources. The concept of ‘sustainable development’ in this sense is a contradiction in terms, it is in effect imagining that we can eat the planet and have it. Unless the leaders of the Rio+20 summit being held next June get their collective heads round this basic point, and insist on a new concept of ‘development’ based on rights, equity and justice, decency, happiness and freedom, we all will continue to roll on to doom.
What does this matter to us?
These seismic events are the context for the work of all professionals who, like us, are committed to doing our best to improve conditions in areas where we are competent.
So one of my first questions is: If we are trying to make nutrition interventions in impoverished countries more sustainable, why is most of what is said, written and done having so little effect? Here are some answers to this question:
· Our praxis, which is to say our application of principles and ideas, has become professionalised. In the process, we have devalued and demoted the proper role of popular knowledge in our teaching and practice.
· Our prevailing values and attitudes as researchers and practitioners are arrogant. They have impeded us from respecting and acting as equals with our national counterparts in the countries we work in.
· We still seek to control knowledge as part of an elite class. We thus fail to obtain a deeper understanding that will guide more appropriate actions which can only come from a process of genuine popular participation.
· The root of the problem is that real sustainable development involves process of popular enrichment, empowerment and participation which our technocratic project-orientated ideology by its nature fails to accommodate.
· Another reason for the irrelevance of many past and current approaches is that overall development education has continued to transmit societal values mostly as they are perceived in the North.
Those who teach or who taught us, inevitably teach us part of themselves and the frame of values that is part of their background. The context any teacher comes from has its own frame of assumptions about what is real, unshakeable and safe. These contexts can become cages.
Difficult problems tempt us to focus on their more manageable component parts. But this atomistic approach evades the more complex underlying and basic structural questions. This also prompts the ‘exclusion fallacy', in which what we choose not to discuss is assumed to have no bearing on the issue . An uncritical, repetitive reliance on the same old shallow data in the interpretation of unresolved issues, which avoids seeing malnutrition as an outcome of complex social and political processes, will not and cannot do.
The predominant theories of development still see society largely as an organic whole that is normally in equilibrium. This view does not fit well with the facts. Instead, we need to view society as a complex of forces in tension and conflict, because of the divergence of interests that drive them. We should not assume that conflicts are resolvable within what is now the prevailing political, economic and social system .
There is now much talk about the need for ‘multidisciplinary approaches’. In principle these are needed. In practice they often assume that looking at problems from a 'wider' perspective will automatically lead to rational and equitable solutions. But the mere act of putting together disciplines, without taking into account where the ‘experts’ are coming from ethically, ideologically and politically, has not and will not by itself make a significant difference. This will be all the more so, if beneficiaries – who need to become de-facto claim-holders – are not fully involved in decision-making processes.
NUTRITION AND SUSTAINABLE DEVELOPMENT
ANOTHER WORLD IS POSSIBLE, BUT ONLY IF
WE ALL ARE PREPARED TO MOVE FROM EVIDENCE
THROUGH POLICY TO DIRECT CONCERTED ACTION
The Millennium Development Goals initiative will, we now know for sure, fail to halve the 1990 global hunger rate by 2015. This is more than just a wretched item of news. For far too long now there has been a block in the way of our realising that malnutrition in all its forms is in part driven by a model of development that is inherently unsustainable, as summarised in Box 1. The people in the streets may help us to become unblocked. But this calls for us being able to understand what they (and) we are seeking so that we are more likely to get where we need to be and, once there, to know what to do.
Vocally opposing and manifesting against old ways is not enough. The current movement needs a new conceptual framework, a new system of principles and values. These need to be concrete, cogent and compelling. Debates about past historical rights and wrongs should be mainly to guide us to come up with more coherent propositions for tomorrow. We need a vision firmly embedded in a practice. We must not walk away from these debates.
In our own work, we need to open new space to discuss and agree what now must come about. We need to take full account of all causal levels of malnutrition in impoverished countries and settings, i.e., social, economic and environmental, immediate, underlying and basic causes. Vision must move to mission and to real work with tangible outcomes. A vision is not much good if it simply stays in the air as something devoutly to be desired. A vision of that sort is a mirage; it recedes as you approach it. To be of use, the vision has to point to a route, and to take into account a lot of unpleasant realities.
A vision is of no use unless it serves as a guide for effective actions. These will need to be biased towards the oppressed, because it is their rights that are being trampled. We ought to express and manifest solidarity towards the oppressed. Only then will our vision be shared with them and gain weight and credibility in its commitment to equity and justice. We can no longer abandon the have-nots to the dollar-dispensing Northern bilateral or multilateral agencies. The moment cries for us to press for more. Windows of opportunity have a way of slamming shut.
It is hard for many of us to maintain political agility in a hostile environment. But the role of an avant-garde is to cause ferment. Let’s not assume that somebody else is going to take care of issues that engage and involve us. We have to get active. A strategic overhaul of our actions requires a crisis in our thinking. This I believe is why the Occupy Movement is encouraging.
The future of our work in nutrition cannot be a simple extension of the past. Business as usual is no longer an option and in the times we now live in, has little if any meaning. Tuning the engine won’t work; it needs to be taken apart and put together again, for new purposes .
For a start, we have to work towards checking the malign forces that propel us as professionals in the generally hopeless direction we are moving. The fundamental changes now needed, can be brought about only by organisations and people that have no vested interest in the survival of the non-sustainable development system as it operates now, and that oppresses dependent countries and their impoverished people.
A new professionalism will emerge when we become explorers, always asking what and who will gain, or lose, from our choices and actions in our work in nutrition. New professionals 'who put the last first' already exist, but we remain a minority. Now we need to multiply, and interact, coalesce and organise dynamic networks among ourselves and between us and grassroots organisations.
A mere extension of what most of us have already been doing in public health and in nutrition is not strong enough to insert nutrition within sustainable development. Our big task now is not only to have conceptual breakthroughs, but also to design strategic plans that specify all necessary institutional changes.
NUTRITION AND SUSTAINABLE DEVELOPMENT
WE NEED TO TAKE OUR LEAD FROM THE PEOPLE
WHO MOST SUFFER INEQUITY AND INJUSTICE,
AND TO BE ACTORS AND NOT MERE BYSTANDERS
What’s in store, and what’s to do?
So what should we do now? I have given this some thought. In one column here I can’t attempt much more than a wake-up call at a very significant time in history, when so many ordinary decent citizens are expressing their outrage on the streets. How can we all make progress towards genuine sustainable development, based on principles of justice and equity which is most likely to preserve Earth for our grandchildren and their grandchildren? Here are some possibilities, which I regard very much as thoughts in progress, to be improved by discussion and exchanges:
· We need to de-professionalise our work. This will mean seeking, re-valuing and incorporating popular knowledge and know-how into planned actions.
· In this process, our local counterparts, and local civil society organisations, need to take a more visible lead, even at the cost of some possible mistakes.
· All relevant knowledge needs to be shared from the very start with the beneficiaries who in the process become claim-holders.
· We need to move away from the project-oriented approach and move towards processes of popular enrichment and empowerment.
· We now need to depend less on academicians, and professional practitioners, and listen more to the everyday sufferers from the prevalent inequitable system.
· They should define the changes that are needed. Action plans are thus to be negotiated and finalised in neighbourhoods and fields, not in our offices.
· Education has to be from the claim holders' perspective with their choice of contents and priorities. We have to be more open to their needs and values.
· Our analyses need to incorporate the structural causes of malnutrition as part of the 'big picture'. This includes changes made by economic globalisation.
· We will thus be forced to face the complex social and political forces of oppression that prevent populations and communities from improving their own nutrition.
· We have a duty to confront head-on and to expose the malign forces that oppose greater equity so as to neutralise them, from local to global levels.
· We need to use the internet to build networks of like-minded colleagues who can consolidate a strong worldwide solidarity movement.
· We have to confront the types of bilateral and multilateral aid – often no more than tinkering – that perpetuate inequitable and disempowered societies.
· We have to play a part in forcing institutional changes in aid agencies, the UN system included, so as to make them more democratic and transparent.
· We need a whole new curriculum for public health, nutrition and development professionals, to prepare a new generation of more enlightened professionals.
The processes that can lead to real sustainability, to the fulfilment of the human right to nutrition, and to equitable societies, can and should start with small direct actions that we can help bring about more easily.
Actions at grassroots level can take many forms. These should always include examination of who is losing and who is winning, and why. At higher levels, most of us have more experience on how to start discussions leading to change. We now have to follow through! We have to commit ourselves, in a more active and even militant way, to get and to keep the process of popular empowerment moving, always confronting the status-quo that gives the impression that nobody cares.
Examples where some of these elements have worked exist. Some of these, like the Indian state of Kerala, and Sri Lanka, Cuba, and Costa Rica, are well known. Others, like the primary health care work done in Iringa in Tanzania, and the Indian Jamkhed comprehensive rural health project in the state of Maharashtra, are also sources of insight and inspiration. They all have in common bottom-centred, gender-sensitive, empowering approaches and a political choice to tackle the underlying deep roots of poverty, injustice and ignorance.
The road to real development indicated here requires that we break with the old development paradigm, as summarised in Box 1. This will mean stepping on the toes of many powerful vested interests. It has always been like this, isn’t it?
I rejoice to see the people, especially the young people, now in the streets, sometimes passionately debating with courageous establishment figures who come to reason with them and learn from and sometimes join them. The present moment is full of promise. The old ideas are broken. An era is ending. We are in for an exciting new era. We need all the courage we can muster. It’s time, I believe, that we all stopped being mere bystanders and become actors. Addressing issues like these will have to pave the way to Rio+20.
Please cite as: Schuftan C. Nutrition and sustainable development. [Column] Website of the World Public Health Nutrition Association, December 2011. Obtainable at www.wphna.org
cschuftan@phmovement.org
www.phmovement.org
www.humaninfo.org/aviva
by Claudio Schuftan
This month, I look forward to a world conference being held next June, in Rio de Janeiro. This is the ‘Rio+20’ Conference on Sustainable Development, whose website is at http://www.uncsd2012.org/rio20/
The overarching declared purpose of Rio+20 is once again, to raise consciousness of and arouse conscience on the environmental dimension, which until late last century was more or less forgotten. Veterans of world summits on any topic have reason for scepticism, but they are needed, and we must all do our best to see that Rio+20 really does mark a time when we all move towards living in ways that are fair and sane.
Adequate good nutrition is smack in the middle of sustainable development. Neither is possible without the other. But as I consider these issues, like you, I am also reflecting on what has been and is happening this year in the streets all over the world. This year has been and is one of direct action, and I believe that the unrest, riots and uprisings that we see and that some of us have experienced, whatever their immediate and obvious cause, all have a core mood in common. This is awareness that we are living in a world whose political and economic governance – or rather lack of governance and surrender to corporate greed – has gone wrong and has broken down.
The prevailing governance structure of the globe ignores the several crises the planet is facing, as well as the social determinants behind them. Food insecurity , preventable child and maternal deaths , price Barriers to accessing medicines , collapsing health systems share the fact that we do have enough resources to provide for them, but these resources instead flow to over-consumption. Military expenditure and obscene wealth for a small elite .
Food prices including those of staple foods all over the world remained stable from 1990 to 2007; since then, prices have rocketed and fluctuated wildly. One reason, as pointed out by Olivier De Schutter, the UN special rapporteur on the right to nutrition, is the recent vast increase of speculation in food commodity futures prices. The results, early this year, were food riots in many impoverished countries, leading to uprisings in North Africa that threatened and toppled governments.
My point here is that the triggers for the unrest that escalated very rapidly in a number of grossly unjust societies, were uncontrolled and chaotic food prices, in countries whose rulers had failed to protect their people by the use of regulations and controls that could have stabilised the cost of staple foods, as wise rulers throughout history have done.
NUTRITION AND SUSTAINABLE DEVELOPMENT
WE NEED TO HEAR WHAT THE PEOPLE ARE SAYING,
AND ‘THE PEOPLE’ SHOULD INCLUDE US.
THE CURRENT SYSTEM OF GOVERNANCE IS BROKEN.
The latest manifestation of this year’s phenomenal series of direct actions is the Occupy Movement, which includes the Occupy Wall Street movement. This began in the South in Kuala Lumpur, Malaysia on 30 July, spread to Zuccotti Park in New York on 17 September, and by early November had spread to 600 communities in the US and around 2,500 cities worldwide. Occupy is now supported or endorsed by political and other leaders even up to head of government level in many countries, including in the US and in the BRIC countries of Brazil, Russia, India and China.
The protests are against what is now often accurately termed ‘casino capitalism’. This monster has been created by what still remains the orthodox political and economic system known as ‘freeing the market’, which is technobabble for surrendering the responsibilities and duties of government, and letting transnational corporations use increasingly lenient laws they believe will increase their profits.
Until this abuse of governance is stopped and reversed, world summits on the environment, climate change, prevention of diabetes, cancer and heart disease, or the war on world poverty, are really hot air. They are also duplicitous, because the officials who organise them must surely be well aware of the big issue that is driving environmental wreckage, the melting of the Arctic and Antarctic ice-caps, and the outrageous combination of obesity, poverty and deficiency.
Box 1
Sustainable development
Eating the planet and having it
Whether we are policy-makers, professionals, citizens or consumers, or any combination of these, we won’t make progress with the idea of ‘sustainable development’ until we think through what these terms mean and imply. ‘Sustainable’ is perhaps easy to define. It means something like ‘capable of being continued indefinitely’ and in our context, taking human, living and physical resources into account. Thus, to use a well-known example, recommendations that everybody should eat more fish are not sustainable – unless few people pay attention to the recommendation.
So what about ‘development’? People like us have been brought up to believe in ‘development’. The concept of ‘underdeveloped’ and ‘developed’ countries, later tactfully changed to ‘developing’ and ‘developed’, is embedded in all discourses concerning human progress, as are allied terms like ‘emerging market economies’. What ‘development’ conventionally means is economic development. And the metric for this type of development, applied to any country, is Gross National Product. What this measures is the total amount of money turned over within a country. The more money circulates, the more economic development, which usually is simply termed ‘development’.
Human rights, justice and equity don’t enter this picture. A country whose population was mainly made up from relatively self-sufficient family farmers, with a small ruling class that was not rapacious, would by definition be ‘developing’ – or if it preferred to stay that way, ‘undeveloped’. By contrast, a country with a substantial number of vastly wealthy people and an economy based on money, whose public goods are privatised, and whose diseased population is mostly in a perpetual state of insecurity and even gross poverty if only because of the cost of health care, is ‘developed’. Another example would be a country whose national turnover of money depended on vast stocks of weapons of mass destruction, used from time to time to invade other countries. Such a country is counted as most developed. Sounds familiar?
My point here is that in its current conventional sense, ‘development’ cannot be sustainable, because it depends on increasingly rapacious and senseless exploitation of human, living and physical resources. The concept of ‘sustainable development’ in this sense is a contradiction in terms, it is in effect imagining that we can eat the planet and have it. Unless the leaders of the Rio+20 summit being held next June get their collective heads round this basic point, and insist on a new concept of ‘development’ based on rights, equity and justice, decency, happiness and freedom, we all will continue to roll on to doom.
What does this matter to us?
These seismic events are the context for the work of all professionals who, like us, are committed to doing our best to improve conditions in areas where we are competent.
So one of my first questions is: If we are trying to make nutrition interventions in impoverished countries more sustainable, why is most of what is said, written and done having so little effect? Here are some answers to this question:
· Our praxis, which is to say our application of principles and ideas, has become professionalised. In the process, we have devalued and demoted the proper role of popular knowledge in our teaching and practice.
· Our prevailing values and attitudes as researchers and practitioners are arrogant. They have impeded us from respecting and acting as equals with our national counterparts in the countries we work in.
· We still seek to control knowledge as part of an elite class. We thus fail to obtain a deeper understanding that will guide more appropriate actions which can only come from a process of genuine popular participation.
· The root of the problem is that real sustainable development involves process of popular enrichment, empowerment and participation which our technocratic project-orientated ideology by its nature fails to accommodate.
· Another reason for the irrelevance of many past and current approaches is that overall development education has continued to transmit societal values mostly as they are perceived in the North.
Those who teach or who taught us, inevitably teach us part of themselves and the frame of values that is part of their background. The context any teacher comes from has its own frame of assumptions about what is real, unshakeable and safe. These contexts can become cages.
Difficult problems tempt us to focus on their more manageable component parts. But this atomistic approach evades the more complex underlying and basic structural questions. This also prompts the ‘exclusion fallacy', in which what we choose not to discuss is assumed to have no bearing on the issue . An uncritical, repetitive reliance on the same old shallow data in the interpretation of unresolved issues, which avoids seeing malnutrition as an outcome of complex social and political processes, will not and cannot do.
The predominant theories of development still see society largely as an organic whole that is normally in equilibrium. This view does not fit well with the facts. Instead, we need to view society as a complex of forces in tension and conflict, because of the divergence of interests that drive them. We should not assume that conflicts are resolvable within what is now the prevailing political, economic and social system .
There is now much talk about the need for ‘multidisciplinary approaches’. In principle these are needed. In practice they often assume that looking at problems from a 'wider' perspective will automatically lead to rational and equitable solutions. But the mere act of putting together disciplines, without taking into account where the ‘experts’ are coming from ethically, ideologically and politically, has not and will not by itself make a significant difference. This will be all the more so, if beneficiaries – who need to become de-facto claim-holders – are not fully involved in decision-making processes.
NUTRITION AND SUSTAINABLE DEVELOPMENT
ANOTHER WORLD IS POSSIBLE, BUT ONLY IF
WE ALL ARE PREPARED TO MOVE FROM EVIDENCE
THROUGH POLICY TO DIRECT CONCERTED ACTION
The Millennium Development Goals initiative will, we now know for sure, fail to halve the 1990 global hunger rate by 2015. This is more than just a wretched item of news. For far too long now there has been a block in the way of our realising that malnutrition in all its forms is in part driven by a model of development that is inherently unsustainable, as summarised in Box 1. The people in the streets may help us to become unblocked. But this calls for us being able to understand what they (and) we are seeking so that we are more likely to get where we need to be and, once there, to know what to do.
Vocally opposing and manifesting against old ways is not enough. The current movement needs a new conceptual framework, a new system of principles and values. These need to be concrete, cogent and compelling. Debates about past historical rights and wrongs should be mainly to guide us to come up with more coherent propositions for tomorrow. We need a vision firmly embedded in a practice. We must not walk away from these debates.
In our own work, we need to open new space to discuss and agree what now must come about. We need to take full account of all causal levels of malnutrition in impoverished countries and settings, i.e., social, economic and environmental, immediate, underlying and basic causes. Vision must move to mission and to real work with tangible outcomes. A vision is not much good if it simply stays in the air as something devoutly to be desired. A vision of that sort is a mirage; it recedes as you approach it. To be of use, the vision has to point to a route, and to take into account a lot of unpleasant realities.
A vision is of no use unless it serves as a guide for effective actions. These will need to be biased towards the oppressed, because it is their rights that are being trampled. We ought to express and manifest solidarity towards the oppressed. Only then will our vision be shared with them and gain weight and credibility in its commitment to equity and justice. We can no longer abandon the have-nots to the dollar-dispensing Northern bilateral or multilateral agencies. The moment cries for us to press for more. Windows of opportunity have a way of slamming shut.
It is hard for many of us to maintain political agility in a hostile environment. But the role of an avant-garde is to cause ferment. Let’s not assume that somebody else is going to take care of issues that engage and involve us. We have to get active. A strategic overhaul of our actions requires a crisis in our thinking. This I believe is why the Occupy Movement is encouraging.
The future of our work in nutrition cannot be a simple extension of the past. Business as usual is no longer an option and in the times we now live in, has little if any meaning. Tuning the engine won’t work; it needs to be taken apart and put together again, for new purposes .
For a start, we have to work towards checking the malign forces that propel us as professionals in the generally hopeless direction we are moving. The fundamental changes now needed, can be brought about only by organisations and people that have no vested interest in the survival of the non-sustainable development system as it operates now, and that oppresses dependent countries and their impoverished people.
A new professionalism will emerge when we become explorers, always asking what and who will gain, or lose, from our choices and actions in our work in nutrition. New professionals 'who put the last first' already exist, but we remain a minority. Now we need to multiply, and interact, coalesce and organise dynamic networks among ourselves and between us and grassroots organisations.
A mere extension of what most of us have already been doing in public health and in nutrition is not strong enough to insert nutrition within sustainable development. Our big task now is not only to have conceptual breakthroughs, but also to design strategic plans that specify all necessary institutional changes.
NUTRITION AND SUSTAINABLE DEVELOPMENT
WE NEED TO TAKE OUR LEAD FROM THE PEOPLE
WHO MOST SUFFER INEQUITY AND INJUSTICE,
AND TO BE ACTORS AND NOT MERE BYSTANDERS
What’s in store, and what’s to do?
So what should we do now? I have given this some thought. In one column here I can’t attempt much more than a wake-up call at a very significant time in history, when so many ordinary decent citizens are expressing their outrage on the streets. How can we all make progress towards genuine sustainable development, based on principles of justice and equity which is most likely to preserve Earth for our grandchildren and their grandchildren? Here are some possibilities, which I regard very much as thoughts in progress, to be improved by discussion and exchanges:
· We need to de-professionalise our work. This will mean seeking, re-valuing and incorporating popular knowledge and know-how into planned actions.
· In this process, our local counterparts, and local civil society organisations, need to take a more visible lead, even at the cost of some possible mistakes.
· All relevant knowledge needs to be shared from the very start with the beneficiaries who in the process become claim-holders.
· We need to move away from the project-oriented approach and move towards processes of popular enrichment and empowerment.
· We now need to depend less on academicians, and professional practitioners, and listen more to the everyday sufferers from the prevalent inequitable system.
· They should define the changes that are needed. Action plans are thus to be negotiated and finalised in neighbourhoods and fields, not in our offices.
· Education has to be from the claim holders' perspective with their choice of contents and priorities. We have to be more open to their needs and values.
· Our analyses need to incorporate the structural causes of malnutrition as part of the 'big picture'. This includes changes made by economic globalisation.
· We will thus be forced to face the complex social and political forces of oppression that prevent populations and communities from improving their own nutrition.
· We have a duty to confront head-on and to expose the malign forces that oppose greater equity so as to neutralise them, from local to global levels.
· We need to use the internet to build networks of like-minded colleagues who can consolidate a strong worldwide solidarity movement.
· We have to confront the types of bilateral and multilateral aid – often no more than tinkering – that perpetuate inequitable and disempowered societies.
· We have to play a part in forcing institutional changes in aid agencies, the UN system included, so as to make them more democratic and transparent.
· We need a whole new curriculum for public health, nutrition and development professionals, to prepare a new generation of more enlightened professionals.
The processes that can lead to real sustainability, to the fulfilment of the human right to nutrition, and to equitable societies, can and should start with small direct actions that we can help bring about more easily.
Actions at grassroots level can take many forms. These should always include examination of who is losing and who is winning, and why. At higher levels, most of us have more experience on how to start discussions leading to change. We now have to follow through! We have to commit ourselves, in a more active and even militant way, to get and to keep the process of popular empowerment moving, always confronting the status-quo that gives the impression that nobody cares.
Examples where some of these elements have worked exist. Some of these, like the Indian state of Kerala, and Sri Lanka, Cuba, and Costa Rica, are well known. Others, like the primary health care work done in Iringa in Tanzania, and the Indian Jamkhed comprehensive rural health project in the state of Maharashtra, are also sources of insight and inspiration. They all have in common bottom-centred, gender-sensitive, empowering approaches and a political choice to tackle the underlying deep roots of poverty, injustice and ignorance.
The road to real development indicated here requires that we break with the old development paradigm, as summarised in Box 1. This will mean stepping on the toes of many powerful vested interests. It has always been like this, isn’t it?
I rejoice to see the people, especially the young people, now in the streets, sometimes passionately debating with courageous establishment figures who come to reason with them and learn from and sometimes join them. The present moment is full of promise. The old ideas are broken. An era is ending. We are in for an exciting new era. We need all the courage we can muster. It’s time, I believe, that we all stopped being mere bystanders and become actors. Addressing issues like these will have to pave the way to Rio+20.
Please cite as: Schuftan C. Nutrition and sustainable development. [Column] Website of the World Public Health Nutrition Association, December 2011. Obtainable at www.wphna.org
cschuftan@phmovement.org
www.phmovement.org
www.humaninfo.org/aviva
Wednesday, December 28, 2011
travaux du cercle phm de djibouti
Le cercle de PHM de Djibouti a organisé dimanche dernier une rencontre entres des jeunes filles de Djibouti ville et d’Arta qui ont débattu des risques de contamination du VIH/Sida, des infections sexuellement transmissibles et des grossesses non désirées au chef lieu de la plus jeune des régions de l’intérieur. 
Le cercle de PHM de djibouti a dimanche dernier eu la bonne idée d’emmener des jeunes filles, issues respectivement des quartiers populaires 5, 6,7 de la capitale au chef lieu de la région d’Arta.
Celles-ci y ont rencontré des congénères de leur classe d’âge parmi la gent féminine d’Arta.
Les unes et les autres ont pu soulever des sujets sensibles sous les regards bienveillants et protecteurs des facilitatrices du cercle phm dans un local d’une association féminine de la petite ville d’Arta.
De leurs discussions, il ressort que de nombreuses femmes subissent de multiples situations de violence au quotidien. Ce phénomène accentue la fragilité des jeunes filles et femmes dans la construction d’une stratégie de réduction tournée vers la réduction des risques de contamination du VIH/Sida, des infections sexuellement transmissibles et des grossesses non désirées.
Le constat a suscité un consensus entier parmi les participantes de l’atelier de sensibilisation sur le VIH/Sida qui ciblait un public de jeunes filles. Lesquelles ont besoin de plus de temps et mise en confiance pour parler de leur sexualité.
C’est pourquoi les programmes nationaux de lutte contre la terrible pandémie privilégient un accès équitable aux informations clés, un renforcement de capacités de la gent féminine dans l’optique d’un changement de comportement face au virus mortel.
La parenthèse souligne assez la pertinence des échanges d’expériences sur cette problématique entre les jeunes filles d’horizons divers, réunies dimanche dernier au chef lieu de la région d’Arta sur l’initiative louable des facilitatrices du cercle Phm.
Le cercle de PHM de djibouti a dimanche dernier eu la bonne idée d’emmener des jeunes filles, issues respectivement des quartiers populaires 5, 6,7 de la capitale au chef lieu de la région d’Arta.
Celles-ci y ont rencontré des congénères de leur classe d’âge parmi la gent féminine d’Arta.
Les unes et les autres ont pu soulever des sujets sensibles sous les regards bienveillants et protecteurs des facilitatrices du cercle phm dans un local d’une association féminine de la petite ville d’Arta.
De leurs discussions, il ressort que de nombreuses femmes subissent de multiples situations de violence au quotidien. Ce phénomène accentue la fragilité des jeunes filles et femmes dans la construction d’une stratégie de réduction tournée vers la réduction des risques de contamination du VIH/Sida, des infections sexuellement transmissibles et des grossesses non désirées.
Le constat a suscité un consensus entier parmi les participantes de l’atelier de sensibilisation sur le VIH/Sida qui ciblait un public de jeunes filles. Lesquelles ont besoin de plus de temps et mise en confiance pour parler de leur sexualité.
C’est pourquoi les programmes nationaux de lutte contre la terrible pandémie privilégient un accès équitable aux informations clés, un renforcement de capacités de la gent féminine dans l’optique d’un changement de comportement face au virus mortel.
La parenthèse souligne assez la pertinence des échanges d’expériences sur cette problématique entre les jeunes filles d’horizons divers, réunies dimanche dernier au chef lieu de la région d’Arta sur l’initiative louable des facilitatrices du cercle Phm.
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