PHM Africa Learning Space

SCALING UP NUTRITION (SUN)

2012-02-01T01:15:00.001-08:00

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

PHM: WHO Exec Bd 130 Report Day 3

2012-01-20T00:33:00.000-08:00

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.

PHM Commentary on ongoing WHO EB meeting

2012-01-17T22:59:00.001-08:00

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

Nutrition and sustainable development

2012-01-11T02:56:00.000-08:00

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

travaux du cercle phm de djibouti

2011-12-28T00:12:00.000-08:00

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.

Social determinants of health : a Rio recap

2011-12-27T22:57:00.000-08:00

November blog
by Claudio Schuftan

This is a bit belated report from the Rio World Conference on the Social Determinants of Health. The conference was convened by the World Health Organization together with the government of Brazil, to whom many thanks, for their enabling many colleagues from the People’s Health Movement to attend.

The conference was billed as the way to advance the cause of Closing The Gap in a Generation (1), the report of the WHO Commission on the Social Determinants of Health. Cynics had a feeling that it would be nothing of the kind, and once again, the facts supported cynicism, I am sorry to say. Preparations for the conference turned out to be a case study of what is now amounting to a kind of ‘war of the words’. This is being fought between all those in the UN system and member states who believe in public health and public goods, and those who remain committed to ‘business as usual’ at the time when the world’s financial institutions and banks are collapsing under the weight of their own greed.
Successive drafts of the final conference’s Political Declaration were covered in crossed-out and bracketed clauses and phrases, as the wealthy nations got to work, ‘toning down’ and eliminating almost all traces of real quantifiable concrete measurable and accountable progress on behalf of the majority of people in the world whose suffering increases.

As battle-scarred public health warriors expected, the powerful nations won most of the battles. But not all. We did not come or go quietly, and it became apparent in the conference that more and more key people in the UN system and national governments have also concluded that the current systems of political, financial and social governance are broken. In clear interventions, WHO director-general Margaret Chan indicated this almost in so many words. But UN agencies are choked with executives who believe in alliances with the transnational corporations that with its allies are wrecking our world. Some of these executives will perhaps be working for such corporations in due course. That’s where the stock options and nice pensions are.
The frustration in the conference halls was so intense that no less than three alternative declarations were circulated. One of them came from the organisation of which I am a member, the People’s Health Movement; one from the Latin American Association of Social Medicine (www.alames.org ); and one from the International Federation of Medical Students’ Associations (www.ifmsa.org ). Revealing too was the fact that the representative of civil society in the panel in the closing ceremony, our PHM colleague David Sanders, was the one person during the three days to receive a standing ovation from the floor. He made comments fully in line with what I say here below.

Sir Michael Marmot, chair of the WHO Social Determinants Commission, was at the centre of the Rio conference. We believe he is as frustrated as we are. Here is what he said in a recent issue of the WHO Bulletin (2). I insert my own comments.
‘Closing the Gap in a Generation is a rousing call. Did the World Health Organization’s Commission on Social Determinants of Health really believe it to be possible? Technically, certainly’. (This is a telling word. It’s code for saying that there is pressure to take the politics out of policy issues and reduce them to technical ‘fixes’)
‘Yes, there is a greater than 40-year spread in life expectancy among countries and dramatic social gradients in health within countries. But the evidence suggests that we can make great progress towards closing the health gap by improving, as the Commission put it, the conditions in which people are born, grow, live, work and age. These include ensuring: equity for every child from the start, healthier environments, fair employment and decent work, social protection across the life course and universal health care. To make such progress, we must also deal with inequalities in power, money and resources – the social injustice that is killing on a grand scale. At a more fundamental level, our vision is to create the conditions so that every person may enjoy the freedoms that lead to improved health – what we call empowerment’. (And does he believe that this now is really happening? Read on...)
In the three years since Closing the Gap in a Generation was published, there is no question that there is much to make us gloomy: the global financial crisis and the steps put in place to deal with it have worse impacts on the poor and relatively disadvantaged; the persistence of bad governance nationally and globally; climate change and inequitable measures for mitigation and adaptation and, in many countries, an increase in health inequalities’. (Quite. Exactly. He then goes on to make some rather vague positive points. But the signal is clear. The only conference that could start to make a real difference in favour of rights, equity and justice would be one that resulted in a Declaration that acknowledged the outrageous misery and poverty that has been and is being accelerated by the present dominant systems of governance. Did that happen? No, it did not. Did Michael Marmot expect this would happen? I have not asked him).

THE RIO SOCIAL DETERMINANTS MEETING
EPIDEMICS ARE GREAT WARNING
SIGNS AGAINST WHICH THE PROGRESS OF
CIVILISATIONS CAN BE JUDGED
Rudolf Virchow

The People’s Health Movement was invited by the WHO Commission on the Social Determinants of Health to give evidence, and to contribute to the Commission’s report which was published in 2008 (1).This we did. Since then it has become increasingly evident to us that the most powerful WHO member states – that is, national governments – are reluctant to redress, or even to discuss or acknowledge, the power politics that year in, year out, worsen health inequities.

Constantly, states of health and disease of populations are being reduced to technical issues, whereas in truth, these are political. This was understood during the Industrial Revolution, as the quotation from the great epidemiologist, pathologist and reformer Rudolf Virchow makes clear. Health inequities are determined by the social conditions in which people are born, grow, live, work, and age. This has always been well-known by those prepared to see what is in front of their eyes and to face these facts. Public health pioneers, such as Rudolf Virchow saw this. Robert Koch devoted a key part of his Nobel laureate speech in 1905 to the issue. Brock Chisholm, the first director-general of the World Health Organization, said in 1949 that ‘the death rate from pulmonary tuberculosis is now everywhere accepted as a sensitive index to the social state of a community’.

Margaret Chan, the current WHO director-general, also understands this, as well she might. In her opening address to the Rio conference she said: ‘Governments have responsibility towards people and their health… People are pushed into poverty due to catastrophic medical bills, and many governments are not preventing that. Progress in a civilised world should mean more than simply making more and more money. Globalisation was set to be the rising tide that would lift all boats, this never happened. It lifted the big boats but tended to sink many of the small ones. Globalisation creates benefits, sometimes big ones, but has no rules that ensure the distribution of those benefits. The world now is highly interconnected, but the prevailing goal remains to fulfil economic benefits and not to distribute them fairly or evenly. As a result differences in income, access to care, health outcomes are greater today than in any time in history’. Well said, but it would have been nice if Dr Chan stayed until the last day when the Political Declaration was presented. Instead, she left the night before the Conference ended. Is there a hint here?

Public health is not technical, it is political

The social determinants of health cannot be addressed by fixes that address policy coherence and inter-sectoral action in health, as is being called for. Platitudes like ‘inter-sectoral action’ and ‘policy coherence across sectors’ do nothing to address the continuing violation of the right to health. It is not policy incoherence that causes the negative impact of dominant macro-economic policies on health. Actually there is significant policy coherence across sectors, including the health sector. But these policies have been greatly influenced by the currently dominant political and economic ideology. This is the issue. It has promoted a ‘market’ approach that in effect privatises public health.

Why is this continually glossed over? Why are the features of what is a reckless and ruthless not recognised? Corporations remaining free to do whatever they want to protect their bottom line. Capital flight, and a continued unfair regime of patents especially of medicines are all widening health inequities in health, across the world. This is why obesity and diabetes have become not merely epidemic, but pandemic.

For us at the People’s Health Movement, comprehensive primary health care is the backbone of any equitable health system, but it cannot be supported without active community involvement. The same is true for nutrition.

Primary health care needs publicly provided, publicly accountable health care services, working in partnership with the communities from which the people who become patients live. It involves working with community networks and organisations and engaging with communities. This can never be properly provided by private systems whether or not these are supported by health insurance schemes. Health care provision has been increasingly privatised over the last three decades. Indeed, Big Pharma has become less and less regulated. Poor social policies and programmes, unfair economic arrangements, and bad politics, are robbing an increasing proportion of populations all over the world of the opportunity to lead healthy lives. Reduction of public health and nutrition inequities depends on reform of the global economy and of geopolitics generally.

The evil of ‘trade-offs’

Taking an non-political approach to such issues by saying, as we constantly hear, that conflicts and trade-offs between the interests of different sectors are inevitable, or that taking necessary actions will result in some negative impacts or costs for some groups, is mistaken. Differences among countries, between social classes, between men and women, between corporations and communities, can be reduced. These all are caused by the power politics that determine which actions will be taken and which will not, on the social determinants of health and nutrition. Willingness to transfer real power to communities is the key.

This is what we in the People’s Health Movement reminded delegates, in our own statements made before and during the Rio conference. But relentless pressures from the US and Europe continue to force governments of vulnerable and impoverished countries to sign up to basically unfair free trade agreements. These agreements force weak government to open their markets to – among many other items – the ultra-processed food and drink products that enrich and further empower transnational corporations. Reform of the global agricultural trade regime has continued to stall for years. Food systems thus become increasingly insecure and fragile.

The combination of the opening up of markets to the transnationals, massive subsidies to agribusiness in the North, and intellectual property rights that unfairly protect big business, gives increasing power to the transnational seeds, agribusiness and food and drink corporations, and undermines national food sovereignty. This process continues to accelerate. Thus between 1990 and 2001, foreign sales of the biggest food-related transnational corporations rose from $US 88.8 billion to $US 234.1 billion, with total foreign assets rising from $US 34.0 billion to $US 257.7 billion. These corporations increasingly dominate the global food supply system, which includes seeds, fertilisers and pesticides, the production, processing and manufacturing of food and drink products, and how these are marketed to consumers.

This trend, together with factors like speculation that creates chaos in food prices, the increasing proportion of US corn being used for bio-fuels, and the impact of industry-generated climate change, is primarily responsible for the recent critical food shortages in many impoverished countries. Food price increases and fluctuations in the last few years have done enormous damage to the reductions achieved in poverty and hunger in the past two decades. Such food insecurity has contributed to continuing widespread malnutrition, as evidenced by high stunting rates and micronutrient malnutrition, with an estimated 854 million undernourished people worldwide in 2001-2003. The UN Food and Agriculture Organizations estimates that food price rises alone have caused at least 50 million more people becoming hungry. At the same time, supplies of degraded ultra-processed snack products, sugared drinks and other degraded edible substances continue to erode and destroy previously established rational food systems, and are causing rocketing rates of obesity, diabetes and other chronic disease. Unless unfair social, economic and political regimes are successfully challenged, these pandemics will get worse.
'Gender issues are not ‘one of those things’

The global distribution of child and maternal malnutrition and mortality illustrate the significance of unequal power relations. Unequal gender relations are not easy to change. An important first step is to acknowledge that these exist and that they are maintained by prevailing political and economic policies. Practical steps towards women’s equality and empowerment must be taken.

Examining of the processes that led to the Rio conference, it was hard to believe these steps were really serious. They mostly evaded analysis or even acknowledgement of the power relations which maintain health and gender inequalities. People are poor because they live within unjust societies.

Now, after the Rio conference, let me acknowledge and highlight the commitment of so many representatives of the Brazilian government and civil society, in supporting and inspiring us in the People’s Health Movement. Interventions in Rio, from that of the Minister of Health to those of Brazilian grassroots organisation representatives, resonated with us. Other ministers of health from Latin America resisted the dilution of statements in successive drafts of the Political Declaration. In the final Declaration it was evident that they had lost some, but also that they won some.

The corporations, governments and other institutions that perpetuate the new world must be confronted. The mandate of WHO includes assistance to member states in addressing the ‘causes of the causes’ of malnutrition in all its forms. The rights-based approach to health equity provides WHO with a strong mandate to direct and coordinate realisation of equitable universal primary health care coverage. The right to health is enshrined in the constitution of WHO and in that of over 130 national constitutions. This needs to be used as a powerful tool for legalisation, enforceability and implementation of policies very urgently needed to enhance equity between and within nations.

THE PEOPLE’S HEALTH MOVEMENT
SPEAKING OUR TRUTH TO POWER
AND MAKING OUR MARK
THANKS TO WHO AND TO BRAZIL

The planners of the Rio conference on the social determinants of health constantly stated that its emphasis should be on practical initiatives designed to address inequity. These are conspicuous by their absence in the conference’s final Political Declaration.

Yet there are many practical examples of courageous countries and communities finding ways of managing national and international economic relations equitably. There is much to learn from such examples.

Confronting the power of transnational corporations in areas most relevant to global and national states of health is within the mandate of WHO. Thus, WHO has led the way in developing a global regulatory regime for tobacco control. After Big Tobacco, the next targets for rational and equitable regulation must be Big Booze and Big Snack.

Due to the economic crisis that impoverished countries did nothing to cause, there are now 200 million more people living on less than US$ 2 a day, existing in distress, malnutrition and ill-health. The international bankers and their representative organisations must be held accountable. They must contribute to addressing the vast resource gap in health, for example by paying a Tobin Tax on financial transactions. WHO member states should champion such an approach, which after all is in their own interests.

The danger now is that some countries may face the issues of the social determinants of health, but do so in a medicalised and individualistic way, by focusing on ‘risk factors’ and ‘individuals’ lifestyles’. But the real challenge is to renew relatively equitable politics and economics that truly will go towards ‘closing the gap’. We in the nutrition, public health and medical sectors are the professionals who patch up sick societies. There is ultimately not much we can do, unless we also engage politically.

The People’s Health Movement was present in force in Rio. We are thankful and feel this is a good sign. There, we were able to speak out what we believe in. We distributed our unofficial Political Declaration, which has been and evidently is being studied avidly by people in the UN system and national governments. And we have now launched our fresh-off-the-press third report, Global Health Watch 3 (www.ghwatch.org ). We believe we are making our mark. The change will come. It must come.

References

1 Commission on the Social Determinants of Health. Closing the Gap in a Generation. Health Equity Through Action on the Social Determinants of Health.
Geneva: WHO, 2008.

2 Marmot M. Closing the gap in a generation. Bulletin of the World Health

Organization 2011; 89, 702.

Please cite as: Schuftan C. The Rio Social Determinants Conference [Column] Website of the World Public Health Nutrition Association, November 2011. Obtainable at www.wphna.org

cschuftan@phmovement.org
www.phmovement.org
www.humaninfo.org/aviva

PHA3: Pre Assembly Activities

2011-12-21T05:40:00.000-08:00

Pre Assembly mobilisation will allow for more people to be able to participate in the process of the Assembly, as not everybody will be present at the actual event. The process of pre assembly mobilisation contributes to making the PHA3 a people’s driven assembly where people’s voices are the base for discussions and decisions at the Assembly.

Pre Assembly activities are not only about preparing for the PHA3, it is also about building a stronger health movement in your countries and globally, about building and strengthening grassroots activism and impacting directly on the struggle for social justice.

Read more Pre Assembly actvities and PHA3 on the link above

Coordinated launch of the Global Health Watch 3 in East African countries

2011-12-19T02:51:00.000-08:00

PHM East Africa sub-regional committee held a meeting in October 2011 and agreed to a coordinated launch of the Global Health Watch 3 in East African countries and to see how the countries can link local and country activities to some of the global issues. Tentatively plans are to have the launch March 2012 and are calling on other African country circles to join in so as to have an Africa-wide launch. The Global Health Watch,an Alternative World Health Report
is a collaborative effort by activists and academics from across the world. Designed to question present policies on health and to propose alternatives. Previous editions published in 2005 and 2008. The Global Health Watch 3 co-ordinated by five civil society organisations – the Peoples Health Movement, Medact, Health Action International, Medico International and Third World Network

Various pre-PHA3 activities are also being planned at country level. Contact details for the group: Leonce Byimana leonceby@gmail.com (Rwanda) and Omondi Otieno eomondi@acvkenya.org (Kenya).

Food for a thought beyond just believing

2011-12-12T02:33:00.000-08:00

By Claudio

Human Rights Reader 277

AS WE ALL WELL KNOW, ETHICS IS ONE OF THE ROOTS OF HUMAN RIGHTS. WHAT DO PHILOSOPHERS HAVE HAD TO SAY?

Historically, it is actually the organized pressure from minorities and from women on ethical grounds that have often given us the equal rights and the non-discrimination we now take for granted.

[I here attempt to bring-in the history of philosophy on ethics to support the concept and practice of human rights. I do not want to philosophize with you here, but to help you to consult your own moral inclinations by interpreting what you read below].

Here is a sample of the subtitles of this Reader:

Good moral rules help us act in the most rational way possible.

Human Rights are about respect for living in society and about the promotion of the public good.

Morality is not just obedience though; it is doing what is right.

We sometimes think that we are moral, just because we believe in moral principles. But believing is not enough; action is required.

In human rights work, we do not speak the voice of remorse, but the voice of outrage.

Knowing is creating, creating is law-giving; truth is power.

What is not possible is not to choose.

If statements of value are to be significant, it is indeed the business of human rights to pass judgments on what is right.

For the full Readers go to:

http://wp.me/plAxa-1xb

Claudio

People's Health Assembly 3 to be held in Cape Town, July 2012

2011-12-08T07:14:00.000-08:00

The PHA3 will take place from 6 – 11 JULY 2012! Venue: University of the Western Cape – South Africa.

We look forward welcoming you all to celebrate our years of activism, to re-asses and re-inspire our movement and to set an agenda for the future.

In less than one year, the Third People’s Health Assembly (PHA3) will be taking place in South Africa so it is time to start preparations! Around the world PHM health activists have initiated dialogues and started mobilisation towards PHA3.

Regular updates on the mobilisation and preparation will be published in a regular newsletter.

For more information on the programme structure, please visit our website. www.phmovement.org or the PHA3 Facebook page

Fwd: [ESCR-Right-to-Health] Call for submissions on child’s right to health

2011-12-05T00:38:00.000-08:00

---------- Forwarded message ----------
From: Leslie London
Date: Thu, Dec 1, 2011 at 7:22 AM
Subject: [ETiHHR-net-l] Fwd: [ESCR-Right-to-Health] Call for submissions on child’s right to health

>>> rajat khosla 2011/11/29 06:39 PM >>>

CRC General Comment on the right of the child to the enjoyment of the highest attainable standard of health (art. 24)

http://www2.ohchr.org/english/bodies/crc/callsubmissionsCRC.htm

Re: Call for submissions on child’s right to health

The Convention on the Rights of the Child (CRC) contains legally binding obligations in relation to the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health (art. 24). By virtue of its mandate, the Committee on the Rights of the Child (the CRC Committee) has decided to elaborate a General Comment on the right to health of children under eighteen.

The CRC Committee elaborates its General Comments with a view to clarifying the normative contents of specific rights provided for under the Convention on the Rights of the Child or particular themes of relevance to the Convention, as well as offer guidance about practical measures of implementation. General Comments provide interpretation and analysis of specific articles of the CRC or deal with thematic issues related to the rights of the child. General Comments constitute an authoritative interpretation as to what is expected of States parties as they implement the obligations contained in the CRC.

The General Comment on the right to health will clarify (a) the normative content of the right of the child and adolescent to enjoyment of the highest attainable standard of health, and to facilities for the treatment of illness and rehabilitation in relation to health care services and (b) the legally binding obligations of States parties to the CRC with respect to ensuring the full realization of the child’s right to health. The General Comment will provide a conceptual framework and recommendations for concrete measures and actions required by States Parties, and non-State actors, to fulfil these obligations.

Click here to see the detailed scope and proposed structure of the General Comment.

The CRC Committee welcomes inputs on the child’s right to health, in English, French or Spanish, particularly from interested organizations and individuals who have extensive experience or information on the right to health of children under eighteen. The submissions are invited to address the following questions:
(1) What should be the basic premises for the realization of children’s right to health?
(2) How can the principles of the CRC, in particular articles 2, 3, 6 and 12, be applied to designing, implementing and monitoring interventions to address child and adolescent health challenges and what aspects are specific to a child’s rights approach to health?
(3) What is the normative content of article 24? What are the specific obligations of States under article 24? What are the responsibilities of non-state actors under article 24?
(4) What are the priority concerns in general and in particular regions of the world for the implementation of article 24?
(5) Which concrete measures should be put in place to implement article 24?

The submissions shall not address the content of Article 24.3, which will be covered by a separate joint General Comment/Recommendation currently being produced by the CRC Committee in collaboration with the Committee on the Elimination of All Forms of Discrimination against Women (CEDAW).

The submissions should be limited to 5 pages and sent to the following email address in Word format by no later than 6 January 2012: crc@ohchr.org. All submissions should be accompanied by a brief presentation (1 paragraph is sufficient) on the experience of the submitting individual or organization in the subject matter. The submissions received will subsequently be posted on a webpage dedicated to the General Comment. Please note that the United Nations does not offer remuneration of any kind for inputs into General Comments.

.

Launching the Global Health Watch 3- PHM Zim

2011-11-14T06:03:00.000-08:00

The Peoples Health Movement Zimbabwe (PHM Zim) has the pleasure to invite you to participate at the Launch of the Global Health Watch 3, An Alternative World Health Report on Thursday 17 November 2011 18.00-21.00Hrs at the Jameson Hotel., Harare. This event is organised around the Community Working Group on Health (CWGH ) 18th National Meeting.

The Global Health Watch is designed to seek answers to why so little progress is being made in promoting health across the world and also to articulate solutions. It proposes an alternate vision of health located in a vision of equity, rights and empowerment. It is a collaborative civil society initiative, co-ordinated by the Peoples Health Movement, Medact, Medicos International, Health Action International and Third World Network. The Global Health is contributed to by researchers, academics and activist from across the globe. The Zimbabwe Launch shall take place during the Community Working Group on Health (CWGH) National Meeting on the 17 of November 2011 in Harare.

GHW 3:

* Analyses the global political and economic architecture,

* Takes a view of current issues and debates on health systems.

* Discuss issues beyond Health Care – the different determinants of health

* Watches global processes and institutions that are crucially important for health and health care

* Makes proposals for alternatives and relates stories of success and resistance

The Zimbabwe launch will be graced by Professor David Legge from PHM Global and Linda Mashingaidze the PHM Africa Regional Co-ordinator. About 100 delegates from civil society, CBOs, Parliamentarians, government official and UN Agencies are expected to attend.

The Community Working Group on Health (CWGH) is a network of civic and community based organisations that aim to promote health and particularly community participation in health systems in Zimbabwe.

In solidarity

Itai Rusike

Executive Director

Community Working Group on Health (CWGH) / PHM Zim Focal Person

114 McChlery Avenue

Eastlea

Harare

Zimbabwe

Tel: +263-4- 788 099/ 788 100

Cell: +263-772 363 991

Email: itai@cwgh.co.zw

Website: www.cwgh.co.zw

Facebook.com/CWGH

The CWGH demands the inclusion of the right to health in the new Zimbabwe constitution

Experience at the Southern Africa Social Forum Zambia 13-15 October

2011-10-28T01:57:00.000-07:00

The forum took place from the 13th to the 15 October 2011 in Lusaka, Zambia under the theme “Another Southern Africa is possible”. The forum was represented by various Southern African countries and these included Zimbabwe, South Africa, Mozambique, Malawi, Botswana, Swaziland, and Lesotho.

The forum began with a march to the venue with the theme “walking away from poverty”. Solidarity messages from different countries followed, with slogans from different countries.

There were various sessions that were hosted by various organisations highlighting the plight in Southern Africa. These included
• Global Financial Crisis on SADC
• Universal Education
• Debt & Trade-Regional Intergration
• Food Security and Land
• Gender and Women Rights
• Youth
• HIV/AIDS and Health
• Governance and Human Rights
• Social Services
• Indigenous peoples & Ethnic Minorities Rights
• Region and peacemaking
• Labour
• Media Arts and Culture
• Cross borders
• Environment and climate change

One of the sessions was the Roundtable discussion on Bilateral Trade Agreements and their impact on people’s livelihoods in Southern Africa organised by SEATINI. The presenters briefly introduced what these agreements were and a presentation was given on investments made between two entities. The discussion also highlighted the impact of liberalisation of sectors and gave the example of agriculture, as this has huge impacts on food security because the agriculture sector is left to operate freely. A study conducted by SEATINI, showed that small based units are producing the bulk of the maize consumed by families. As a recommendation, they found out that conservation agriculture was an alternative which can multiply yields. A presentation on MDGs was also linked with agriculture and the impact of trade agreements. The realisation of MDGs, which in themselves need to be reviewed to ensure that everyone is targeted, is unlikely due to the impact of agreements which lead to food insecurity, unemployment, lack of water, etc and women bear the greatest burden. A case study worth noting, highlighted by an activist from Lesotho is around the politics of water, citing the example of the Highlands water project in Lesotho. This is a project by South Africa and Lesotho which supplies water to SA from Lesotho and has left many families in Lesotho without water. As highlighted by one of the presenters, whilst the position of the developed countries in these agreements and investments is to create employment; technology upgrade and increased fiscal revenues through royalty and taxes and that of the developed countries is to seek protection from exploitation and seek the best possible environment, their study found that the agreements had conflicting objectives as evident on the ground and that the relaxations are ridiculous, if developing countries are to gain. More information on research on trade agreements and their impact can be found on the SEATINI website www.seatini.org

This is an example of some of the discussions that took place in different tents. On the final day, summaries of the discussions were presented in plenary and these will be made available on the forum communication channels.

A lesson to learn from the forum is that there are many struggles taking place within the region and coming together as in the forum helps to share struggles and experiences and alternatives towards improving the livelihoods of people on the region. The upcoming third People’s Health Assembly (PHA3) taking in Cape town South Africa, July 2012 is good opportunity to come together as health activists across the world to share experiences and actions. The themes discussed in the forum link closely with the upcoming assembly and some activists at the forum were very keen to participate in the assembly. Visit www.phmovement.org for more information on the PHA3.

Medico-partners (PHM Kenya) to help victims of drought in East Africa

2011-10-28T01:41:00.000-07:00

Medico supports the basic medical assistance and food distributions to its Kenyan partners in the People's Health Movement (PHM) Circle Kenya. The medico-partners are focusing their relief efforts to realize the large settlements outside refugee camps, the others already on the UN and major international aid agencies are supplied, as well as the local population in eastern Kenya is affected by the famine.

Read more by clicking on link below:

http://translate.google.de/translate?hl=de&sl=de&tl=en&u=http%3A%2F%2Fwww.medico.de%2Fthemen%2Fnothilfe%2Fdokumente%2Fbitte-spenden-sie-fuer-die-opfer-der-hungersnot-in-ostafrika%2F4062%2F

WHO cannot ignore the fact that poverty causes ill-health

2011-10-24T07:12:00.000-07:00

Read more on the link below on how "radical health campaigners rejected the official Rio Political Declaration on Social Determinants of Health, which had been carefully negotiated in advance in order not to upset sensitivities, and launched an alternative civil society Rio Declaration".

http://www.guardian.co.uk/global-development/poverty-matters/2011/oct/21/who-conference-poverty-causes-ill-health

Announcement & Call for Abstracts:54th ECSA Health Ministers’ Conference

2011-09-01T02:33:00.000-07:00

54th ECSA Health Ministers’ Conference

Mombasa, Kenya, 7 – 11 November 2011

ANNOUNCEMENT AND CALL FOR ABSTRACTS

Theme: Consolidating the Gains: Addressing High Impact Interventions for Improved Health Outcomes

The East, Central and Southern Africa Health Community (ECSA-HC), in collaboration with the Ministries of Public Health and Sanitation and Medical Services Republic of Kenya will host the 54th ECSA Health Minister’s Conference from 07 - 11 November 2011 in Mombasa, Republic of Kenya.

The Conference, will bring together Ministers of Health, Senior Officials from Ministries of Health, Experts, Health Researchers, Heads of Health Training Institutions from Member States of the ECSA Health Community; diverse Collaborating Partners in the region and beyond with the aim of identifying policy issues and making recommendations to facilitate the implementation of high impact interventions for improved health outcomes.

The theme of the 54th ECSA Health Ministers Conference is “Consolidating the gains: Addressing High Impact Interventions for Improved Health Outcomes”

See more on the following link with regards to abstracts: http://www.ecsahc.org/news.php?id=16

TARGETRY AND EQUITY 'FIXING THE WORST CASES' DOES NOT AND CANNOT ADDRESS THE BASIC ISSUES'

2011-08-31T02:41:00.000-07:00

By Claudio Schuftan

My column this month comes in two parts linked by one word. This is 'target' in two of its meanings. These are 'targetry' and also 'setting targets'. The concepts that I want to get across to you are self-evident as you read along.

In the name of greater equity, many currently proposed approaches to resolve the problems of nutrition still very often favour and select actions covering, for the most part, strategies that target services to the disadvantaged and malnourished, such as the measurements of weight and height of little children as shown above. This strategic approach, it is purported, represents a move towards equity. But is it really? Many of us rather think that what is needed is to mobilise a strong popular movement that demands a comprehensive, truly equity-oriented nutrition policy (1).

TARGETRY AND EQUITY 'FIXING THE WORST CASES' DOES NOT AND CANNOT ADDRESS THE BASIC ISSUES'

Many of us also think it is wrong to propose targeting as an alternative to making nutrition an integral part of primary health care – applied in its full Alma Ata spirit. Individual targeting is a variant of the ill-reputed 'selective primary health care' approach we all saw rise after Alma Ata. Its motto was: 'Go for the worst cases, fix them, and improve the statistics'. But this does not and cannot stop recurrence of the same problems.

Unfortunately, individual targeting is now seen as a central option by the World Bank and other major funding agencies, together with geographical and other types of targeting.How can this be fair? In an era of fee-for-service delivery systems promoted by free-market proponents, one of the key issues for individual targeting – to keep a semblance of equity – seems to be the exemption from user fees for the poor. Unfortunately, these waiver schemes, in all their variants worldwide, have proven to be mostly catastrophes. They simply do not work. Perhaps they are meant not to work. They are often implemented insincerely, only as a political manoeuvre to make user fees more palatable to the population when first introduced.

In my view, and that of many others, individual targeting cannot be made to work equitably. Nor is it effective. Weeding-out and providing the needed services that actually do target individuals or groups is a time-consuming and costly administrative process.

Geographical targeting, for instance of the most impoverished districts probably has more potential, and the more so if being made part of a comprehensive primary health care approach. But impoverished communities usually have little political clout to fight for their share. But even at somewhat higher cost, this type of focus on the poorest clusters of poor people makes sense in terms of equity – and of human rights.

Throwing crusts to the hungry

Individual targeting is a dangerous path to follow. It pursues a 'mirage of equity' that basically leaves the perennial determinants of the rich-poor gap untouched. It is like throwing a crust of bread to the hungry.

What's needed now is to compare the effects on long-term equity and on nutrition indicators of selected individual targeting interventions with a host of already tried direct poverty alleviation measures. The data for this may already be there or may be still missing.

Overall poverty reduction (or better, disparity reduction) is a theme yet again getting growing attention these days. So nutrition colleagues have a golden opportunity to work harder to influence overall development strategies towards equity in health and nutrition. We should not miss the opportunity. All the more so, because the health/nutrition sector cannot, by technical actions alone, make significant improvements in the health/nutrition conditions of impoverished populations.

The limits of data

Breaking down health and nutrition data by income quintiles, by gender and by ethnic background, as is now proposed by some donors, is a welcome first move. This can be used to consolidate credible national and international databases and thus track equity issues. Results of analysis of these data could usefully be published annually in a publication with the stature of the annual UN Development Programme World Development Report. Countries could be ranked according to their respective performance. Such a publication could further analyse existing gaps, and minimum performance objectives could be set for improvements for the immediately following years.

Using such data to tackle the inequities at sub-national and especially local level is where the real challenge lies. Donor agencies will have to be more forceful in advocating equity-promoting, human rights-based, participatory, bottom-centred interventions. They will also need to be more responsive to government-initiated requests from low-income countries for funding to prepare and execute policies specifically addressing what is the fundamental issue of equity.

Governments and donors will need to enter into binding commitments, perhaps with signed memoranda of understanding, in order to move in the direction of disparity reduction and greater equity. Close monitoring of progress will also be needed. These binding commitments should be a precondition for continued support. Funds could then be released in tranches based on the achievement of negotiated verifiable indicators of progress along the line of project implementation. At the same time, donors should develop formal relations with national and local civil society organisations. In the case of non-responsive or non-performing governments, donor funding should be progressively reallocated to what by that stage should be known to be a competent and trustworthy civil society organisation network.

All this may only add up to a start --and from the top at that. But it is a start.

SETTING TARGETS HEY DIDDLE DIDDLE, THE HYPE AND THE RIDDLE: THE GAP BETWEEN WISHING AND DOING

There is a big difference between the excitement and the expectations generated by setting goals and targets, on the one hand, and on the other hand, being able to claim that they actually work. Setting targets is typically not a participatory a process, and usually does not admit of public expressions of dissent. Further, in affirming goals and targets like those of the MDGs, countries pledge, but whether they really commit and comply is a whole different matter (2). More often than not, the processes to achieve the targets are left in the air (or only on paper).

Getting from where we are to where we want to be, requires quantifying where we want to be at a given time, and also requires specifying the process we are going to get there. Targets address the former. Processes are typically left to planners and implementers, and usually exclude any representation of those who are supposed to benefit. But it is the processes that contain the seeds of sustainability. Unfortunately, we nutritionists are good at setting targets, but not much good at prescribing sustainable processes – let alone denouncing processes we know do not work or are not working. Nor do we spend much time and energy on considering and agreeing what measurements can gauge progress towards fulfilling the right to nutrition. such as people's participation, mobilisation and empowerment. Instead, we spend so much time and money proposing and monitoring outcome targets that medicalise the nutrition problem. Think about it.

The need to get real

Some targets we set before and during the 1990s called for a number of pretty unrealistic measures. These could not be afforded by most lower-income countries, let alone by impoverished communities. The result has been low coverage rates and low compliance – ineffective and also wasteful.

It seems to me and many others that this basic mistake has been and is being made with the MDGs. Already in 2011, we have no assurance that the goals are really mobilising national governments beyond lip service. And to repeat what I have said in previous columns, political and economic 'business as usual' will not and cannot achieve targets for anaemia, stunting and underweight, and at present rates, it will take way beyond 2015 to halve the prevalence of child malnutrition.

Moreover, three serious concerns arise here:

One is on who should be the judges of what is realistic. Certainly these should not be only us, the technicians. Also, realism can no longer be based on targets set at national levels. National averages hide huge disparities.

Two is the quality of the data used to monitor progress towards achieving targets. If progress seems to be poor, this may reflect poor quality of the numbers from which the goals are derived.

Three, I keep hearing colleagues say that this or that target 'may be' too ambitious. The time has passed for 'maybe'. (A poster hanging on the wall of my office reads 'I said maybe, and that's final'). It is only through setting up processes of democratic consultation that we can expect to get realistic bases for concrete, feasible goals.

An issue not often considered is the convergence of the various goals and targets we technicians set, from the top down.

Actions to overcome specific aspects of malnutrition can be and are additive. For example, improvements in vitamin A status positively affect nutritional anaemia; improvements in iron status can positively affect the appetite of a child. Our actions to address micronutrient deficiencies and chronic malnutrition are thus complementary and impact on overall well-being of populations and families. But we need always to remember that they live in imperfect societies that ultimately cause them to suffer from the different forms of malnutrition. Yes, we can get the retinol levels of a child up to normal, but then the child may go on to die from malaria. So, to what avail our efforts?

BACK TO TARGETS AND RIGHTS: WHO SHOULD SET TARGETS, AND FOR WHAT? HOW CAN WE REALLY BE PART OF THE SOLUTION?

How can we make change sustainable? As always, we need to address the underlying and basic causes of malnutrition. We can start by de-medicalising our goals and targets, and by focusing both on processes and on outcomes.

The whole process of setting targets is, in a way, antithetical to human rights. The human rights principle is that we cannot rest until the rights of all are restored or instated, not 15 years ahead (and then another 15 years ahead), but in the present. We should be setting progressive, verifiable targets to be achieved year by year, in the process of progressive step by step fulfilment of human rights for all. A compromise position is to start working on targets in reverse. We could express targets as an expected year on year decrease in the number of malnourished at all including sub-national levels. Also, applying all specified interventions firstly to the easier to reach near poor – say, the second lowest income quintile – can move towards achievement of national average targets on schedule and also to reduction of inequity.

I disagree with colleagues when they say that consultation with beneficiaries (claim-holders) need to begin only when targets requiring direct action at community level begin to be achieved. To me, the idea of 'just some amount of community action' being needed is wrong. It implies a shift in the responsibility for doing something for the malnourished children in the community to the community itself. This victimises people who have been historically marginalised.

Donors: Fatigue or bad attitude?

More generally, why is donation of support for reduction of maternal and child malnutrition not working well?

Is this because of 'donor fatigue? Or have targets for reduction of malnutrition having been set too high? And if so, are we responsible for having set ourselves up for failure? On the whole I think that the answer to these questions is, no.

In the eyes of donors. and also of many among us, chronic malnutrition is more messy to deal with than iodine deficiency disorders or vitamin A deficiency disorders. With bigger issues such as protein-energy malnutrition (and perhaps also iron deficiency anaemia), it is obvious that bottom-up, community-driven action is needed, and that issues of equity are involved, as well as longer time horizons. Donors pay plenty more lip-service to what needs to be done than, so far, working hard on solutions for these bigger and broader issues.

This is not fatigue, it is not a lack of will. It is a political choice. Internal and external resources allocated to under 5 malnutrition have thus remained a pitiable and disgraceful pittance. And there is nothing in sight that tells me that this is changing soon, notwithstanding the World Bank inspired SUN Initiative (Scale Up Nutrition)
In the selection of targets and processes, and in the steps needed progressively to achieve them, donors and many among us have been and continue to be undemocratic. Thus we fail those whose nutrition rights are being violated. As long as we consider the strategies needed to tackle the basic causes of malnutrition to be outside the realm of our professional scope of work, we are part of the problem and not of the solution.
The poverty alleviation connection

Will a global shift of donor agencies towards strategies that really are design to alleviate poverty and reduce inequity, ever happen? I have my doubts.

Reduction of maternal and child malnutrition is selected in the MDGs as a key outcome indicator to measure progress in poverty alleviation. Yes, a decrease in poverty will improve nutrition. But, this does not automatically translate into greater advocacy, more actions and more donor resources for the prevention of malnutrition. Being an 'indicator' does not translate into anything much, let alone being the object of concerted new efforts and investments directed at halving malnutrition.

Finally, perhaps there is no such thing as realistic across the board targets. Perhaps targets can be proposed by us for participatory consideration, based on some technical grounds, together with an outline of possible processes to attain them. Rational and realistic consensus for targets and processes must be painstakingly built in many, many places with both bottom-up and top-down inputs. There are no short-cuts.

References

Schuftan C. Can significant major equity be achieved through targeting? abstract, Health Action, CHAI, India, 13, 12, December 2000.
Schuftan C. Aiming at the target: What's left for the devil to advocate?, SCN News 22, July 2001.
Please cite as: : Schuftan C. Targetry and equity. [Column] Website of the World Public Health Nutrition Association, August 2011. Obtainable at www.wphna.org

PHM Ghana Letter to MOH - 61st WHO Regional Committee for Africa

2011-08-31T00:29:00.000-07:00

People's Health Movement Ghana (PHM/Ghana)
Health for All Now!!
Ref: PHM-GH-WHO/AFRO/RC-1
30th August, 2011.

Hon. Joseph Yieleh-Chireh
Minister of Health,
Accra.

Dear Hon. Joseph Yieleh-Chireh,

Issues for consideration at the 61st WHO Regional Committee for Africa

We, the People’s Health Movement Ghana (PHM-Ghana) and representatives from a number of
civil society groups from across the country, write to you in connection with the 61st World
Health Organisation Regional Committee Meeting for Africa scheduled to take place in
Yamoussoukro from August 29th to September 2nd, 2011. The Regional Committee meeting
provides an opportunity to deliberate and commit to crucial issues of health in the WHO African
region.

PHM-Ghana is a registered civil society organization in Ghana, and is an affiliate (the Ghana
circle) of the People’s Health Movement (PHM). PHM is a global network of organizations
working locally, nationally and globally for ‘health for all’. Our basic platform is articulated in the People’s Charter for Health which was adopted at the first People’s Health Assembly in
December 2000. More information about PHM can be found on our website:
www.phmovement.org.

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 WHO
through the governing bodies and the secretariat. However, WHO in the African Region does
not make it easy for civil society participation in the regional committee meetings. The process
of participation is unclear and organizations in official relations with WHO are not invited to
attend. Further, the background documents for the regional committee meeting are not
uploaded on the website early enough to allow for a more thorough discussion and
consultation with various constituencies. We write to convey to you PHM-Ghana’s position on some of the key agenda items.

Agenda Item 8: Panel Discussion – Health financing: Sharing experiences in securing funding to achieve national health development goals
Secretariat’s Note
The panel discussion will be a forum to discuss and share experiences on how best to address the huge health financing needs in the African Region: to discuss the financial implications and funding requirements to meet the gap, attain national health development goals and sustain achievements; and share country experiences in securing funding; and strategize for the possible ways forward.

PHM-Ghana’s Comment
PHM-Ghana welcomes this discussion on health financing in Africa. However, PHM-Ghana is concerned that the panel discussion is not anchored on the right to health. Furthermore, PHM-Ghana recognizes that meeting health financing commitments, such as the 15% Abuja target, alone may not dramatically improve health. PHM-Ghana calls for health investments to be matched with investments in comprehensive primary health care and on the social determinants of health.

Agenda Item 9: Framework document for the African Public Health Emergency Fund

Secretariat’s Note
In recognition of the inadequate resources available to Member States of the WHO African Region to combat epidemics and other public health emergencies in the African Region, the 59th session of the WHO Regional Committee for Africa adopted Resolution AFR/RC59/R5 entitled “Strengthening outbreak preparedness and response in the African Region in the context of the current influenza pandemic”. The resolution requested the Regional Director to facilitate the creation of an “African Public Health Emergency Fund” that will support the investigation of and response to epidemics and other public health emergencies. The Regional Committee is invited to review and adopt this Framework and the related resolution, including taking decisions on options contained in the Framework.

PHM-Ghana’s Comment
The idea of an African Public Health Emergency fund is laudable and PHM-Ghana fully supports it. However, PHM-Ghana is concerned that the resolution is silent on countries defaulting on
3 their commitments regarding the agreed appropriations. Further, the document does not indicate how often the scenarios for determining levels of contributions will be reviewed.
The paper does not mention the importance of strengthening national public health emergency agencies and the need to put in place national and sub-national emergency preparedness plans. We believe actions aim at preventing or minimizing the impact of public health emergencies are of equal importance as actions during emergencies.

Agenda Item 10: WHO Reform for a Healthy Future

Secretariat’s Note
By its resolution WHA64.2 entitled “The future of financing for WHO”, the Sixty-fourth World Health Assembly, endorsed the agenda for reform as set out in the Director-General’s report in document A64/4. Resolution WHA64.2 requests the Director-General to present: (i) a detailed concept paper for the November 2012 World Health Forum; (ii) a first report on the independent evaluation of the work of the WHO to the Sixty-fifth World Health Assembly in May 2012. The resolution also requests the WHO Executive Board to establish an appropriate process to examine the issues related to WHO’s governance identified in the report.

PHM-Ghana’s Comment
 First, the overview of the WHO Reform Agenda (document AFR/RC61/5) indicates that the Regional Committees will receive an overview paper, along with three Concept papers – on the governance of WHO, an independent evaluation of WHO, and the World Health Forum – together with a summary of a consultation with the Geneva-based missions. However, the documents shared do not include the summary of the July consultations as promised.
 Further, the resolution states that consultation with Member States and staff will continue throughout the coming months. However, there is no opportunity for civil society to contribute to these consultations.
 On the Concept Paper on Governance (AFR/RC61/CP/1), PHM-Ghana supports the fourth proposal for the promotion of more active engagement and participation of all Member States in the governance of WHO. PHM-Ghana calls of Members States to consider the inclusion of Civil Society in these discussions.
 The proposed World Health Forum (AFR/RC61/CP/3) has the potential to promote the interest of the private sector at the expense of a member states’ driven process. The rationale and need for such a forum is not made clear; and there is no discussion about how such a proposal would avoid undermining or duplicating the role and mandate of the WHO. The WHO must not pursue public-private partnerships without ensuring safeguards against corporate influence over policy making and pernicious conflicts of interest. We urge you to consider the risks of this proposal and hope you will not endorse it in its current form.

Agenda Item 13: Measles elimination by 2020: A strategy for the African Region

Secretariat’s Note
This document summarizes the progress made in achieving current targets and goals and presents information on the feasibility of achieving a further goal of measles eradication. It provides an assessment of programmatic challenges to achieving measles elimination in each WHO region, and proposes milestones and intermediate targets to be attained

PHM-Ghana’s Comment
 There is need to emphasis routine immunization as the foundation. PHM-Ghana calls for efforts to be made to ensure that routine immunization programs are strengthened to the greatest extent possible to serve as the backbone for embarking on eradication.
 It is recognized that effective and efficient vaccine delivery requires and should be mediated through well functioning health systems. It is less widely recognized that a pre-occupation immunisation delivery can disrupt health care delivery with serious negative consequences.
 The strategy called for Member States to achieve the highest quality of case-based surveillance systems including laboratory services. However, given that most rural communities do not have access to laboratory services, and cognizance of the way specimens are handled and transported, Member States will have to consider investing in those resources especially at the sub-national levels.
 There is need to invest in community mobilization strategies and actions on the social determinants of health. This will contribute to addressing the resistance of some communities to immunization.
 Furthermore, PHM-Ghana calls on Member States to show sustained commitment at the highest levels, including providing financial commitments for implementing the Operational Plans for these strategies at the national level.

Conclusion
We sincerely hope that you will be able to incorporate our recommendations into the draft documents and resolutions. We would also like to stress that we see the need for the highest level of official representation in the regional committee meeting.

Yours sincerely,
John Eliasu Mahama
Coordinator, PHM-Ghana
PHM-Ghana, Box CT 6103, Cantonments, Accra. Email: phmghana@gmail.com
Globally, People’s Health Movement (PHM) has an organized presence in 86 countries
E-mail: globalsecretariat@phmovement.org Web: www.phmovement.org

Cc:
Minister of Foreign Affairs
Accra, Ghana.

Chief Director,
Ministry of Health,
Accra, Ghana.

Director General,
Ghana Health Service,
Accra, Ghana.

Ghanaian Embassy in Abidjan,
Abidjan, Cote d´Ivoire.

The WHO Country Coordinator
Accra, Ghana.

Call to Action - Development of Position Paper for 61st WHO Africa Regional Committee Meeting

2011-08-26T00:51:00.000-07:00

Dear PHM colleagues

PHM Ghana is in the process of developing a position paper in the lead up to the 61st WHO Africa Regional Committee Meeting. Please see email below. They are calling on friends and members for input which you can send to the PHM Ghana email phmghana@gmail.com.

Regards

Linda

Dear Colleagues and Friends of PHM-Ghana,

Next week our Minister of Health will be attending the 61st WHO Africa Regional Committee Meeting in Yamoussoukro, Cote d'Ivore, together with 45 other Ministers of Health from other African countries. The documents and resolutions that will be discussed at this meeting have now been uploaded on the website: http://www.afro.who.int/en/sixty-first-session.

We are calling on friends and members of PHM-Ghana to contribute to discussions on the agenda items through a joint position paper to Ghana's delegation (most likely civil society will not be included in this delegation). Note that unlike meetings of the WHO Headquarters, where there are clear procedures on the participation of civil society, the process of civil society's participation in the regional committee meeting is unclear.

PHM-Ghana is suggesting the preparation of a joint civil society position paper on the agenda items for submission to the MoH ahead of the meeting. Given that we have less than a week to do this, we will have to work mainly online and possibly with a few meetings in Accra. By tomorrow we will circulate a more detailed road-map on the way forward.

In the meantime, we have gone through and prioritized the items from the meeting agenda to five core items (note that the prioritization is necessary given the limited time left):
Agenda item 8. Panel Discussion: Health Financing - Sharing experiences in securing funding to achieve national health development goals (Document AFR/RC61/PD/1)
Agenda item 9. Framework document for the African Public Health Emergency Fund (Document AFR/RC61/4)
Agenda item 10. WHO Reform for a Healthy Future (Document AFR/RC61/5)
Agenda item 13. Measles elimination by 2020: A strategy for the African Region (Document AFR/RC61/8)
Agenda item 15. Framework for public health adaptation to climate change in the African Region (Document AFR/RC61/10)
Thank you and looking forward to working with you all in the coming days,

John, Kingsley, Rudolf, Hor, Grace and Nicholas
PHM-Ghana

PHA3 Mobilisation: Africa update

2011-07-20T04:03:00.000-07:00

PHA3 mobilisation: Africa Update

Various pre- PHA3 mobilisation activities have begun in the region and in attempt to have a coordinated efforts towards the assembly, mobilisation committees have been set up. Four sub-regional committees have been formed: West Africa, East Africa, Southern Africa and Central.

Contacts of PHM exist in the following countries

West Africa: Ghana, Mali, Mauritania, Nigeria, Ivory Coast, Burkina Faso, Togo, Benin, Sierra Leone, Gambia and Senegal
East Africa: Tanzania, Kenya, Djibouti, Rwanda, Uganda and Ethiopia
Southern Africa: Zimbabwe, Zambia, Mozambique, Botswana, Malawi, Angola and South Africa
Central Africa: Cameroun, Gabon, DRC and Congo.

A regional mobilisation committee will be developed from representatives of these sub-regions.

Recently the East Africa sub-regional committee held their first meeting on Wednesday 13 July 2011 to identify possible mobilisation ideas, themes, terms of reference and identifying two representatives for regional mobilisation committee. West Africa also held a meeting on Saturday 16 July and will resume another meeting to ensure all countries in West Africa participate. Efforts are also taking place in Central and Southern Africa to coordinated similar platforms.

We encourage that if you are interested in being part of this exciting assembly and mobilisation that brings together health activists together from across the globe, you can get involved with your sub-regional committee to be involved in different mobilisation activities in the region and country.

You can also post your national efforts or regional efforts directly onto the PHA3 Face book Third People’s Health Assembly or the PHM Africa blog www.phmafrica.blogspot.com of PHM Africa Facebook!!!

PHM Sierra Leone: TB Drugs not available at health centres in Sierra Leone

2011-07-01T05:26:00.000-07:00

People’s Health Movement- Sierra Leone Chapter

PRESS RELEASE
Freetown , 15th June 2011

TB DRUGS NOT AVAILABLE AT HEALTH CENTRES IN SIERRA LEONE – PATIENTS ARE DYING

We, people infected and affected by HIV and Tuberculosis and health workers in the People’s Health Movement- Sierra Leone Chapter , are alarmed by the absolute shortage of supply of TB drugs at health centres in the country for over two months now. Over this period of drug shortage , TB patients who have started treatment have stopped treatment prematurely because health care workers cannot provide the drugs either in intensive or continuation phases . This appalling state of national health care service that exists without explanation is shameful , demonstrating wide cracks in the National Health system that allows vulnerable persons to fall through. In spite of repeated enquiries to get clarification on theshortage of drugs no information seems to come through . We doubt if WHO and Ministry of Health and Sanitation are aware of thisstate of desperation for the common citizens of this country.

For us and our families whose lives are touched by these diseases of HIV and TB, non-availability of drugs for TB is a violation of our right to life and health ; enshrined in the constitution of Sierra Leone (1991). Without TB drugs , HIV patients will suffer agonizing pain and die untimely, even with Anti-retroviral drugs around . Where treatment is prematurely stopped due to lack of drugs , the citizens are bound to suffer the consequence of Multidrug Resistant TB and high mortality in children and productive population who are most hit by the dual epidemics of TB and HIV . Treating TB is important not only for saving the individual lives of patients and their families from eminent suffering and death, but for preventing an upsurge of MDR TB which is costly and complicated to treat and with success rate of only 30% patients on treatment. Drugs for MDR TB are not available in Sierra Leone, considering its prohibitive cost of treatment which ranges between $15,000 – 25,000 per patient.

CSOs Call on Government to Act :

We, people living with HIV and TB held a civil society consultative meeting on TB and HIV from 14 -15 June 2011 in Freetown to review drug availability for TB and HIV, and to develop appropriate advocacy strategy to communicate our suffering and the risks the lack of TB drugs poses to Public Health. We therefore urge the Government of the republic of Sierra Leone and its partners particularly WHO, GFATM, World Bank, Irish AID, UNAIDS, UNICEF, UNDP and UNIFEM to take the shortage of TB drugs as a public health crisis of national emergency and act upon it in this regard .

We are aware of the many priorities of Government of Sierra Leone in meeting the aspirations of the agenda for change. However, providing essential ,life-saving medications such as TB drugs is fundamental to laying the building blocks of poverty reduction in Sierra Leone whose citizens are very poor, 70% of them living on less than $1 a day, illiterate and lacking gainful employment. This state of abject poverty is a recipe for high burden of sputum smear positive TB which is estimated at 14700 cases per annum (WHO estimate of TB burden for Sierra Leone 2010). This form of TB is airborne and easily develops into disease in persons with low immunity. As people living with HIV and TB, we are not in this business by our own self-will , but compelled to respond as activists who are struggling to survive together with our families . If we allow complacency and denial to overtake us because of stigma and shame, the consequence for us as individuals, families and country will be disastrous, fatal and regrettable.

In cognizance of this responsibility to preventapublic health crisis on an epidemic scale, we call upon the Government of the Republic of Sierra Leone and WHO to take the following urgent steps:
1. Convene a partnership meeting of stakeholders to discuss a national response to the crisis of shortage of TB drugs
2. Mobilize financial resources to purchase TB drugs without delay
3. WHO to liaise with National TB Programs in neighboring countries to ‘’loan’’ TB drugs to Sierra Leone urgently. This supply can be airlifted to avoid undue delay

Furthermore we demand :

4. Design a drug distribution system for TB drugs that is District Health Team managed to avoid shortage of drugs at health centres which has occurred repeatedly in the recent past.
5. Engage people living with HIV and TB in the development of National TB Control programme policy and implementation
6. Establish a Public-Private stakeholders Committee to support the effort of NLTCP in policy development and programme implementation such that decisions are participatory and mutually owned by Government, NGOs working in TB and patient support groups.
7. Establish or enforce a national collaborative TB and HIV policy that promotes integration and complementarity of actions on both TB and HIV at policy and implementation levels.
8. Enforce rigorous monitoring of service quality to assure quality and equity. It is sad to note that in the wake of GFATM funding to TB and DOTS supposed to be free of charge , some health care workers continue to solicit informal payments for TB treatment. Thisbarrier must stop.
9. Government of the republic of Sierra Leone and ministry of Health and sanitationmust disclose to the public the annual budget allocation to TB control and to commit minimum of 15% of public expenditure to national health care in compliance with the Abuja Declaration.
10. WHO and international partners encourage the Government of Sierra Leone to increase funding to TB and HIV, if national ownership is tobe assumed overtime. This needed change of approach to international aid management is an evidence of ministerial leadership for national priorities such as TB and HIV. Providing the acting space for Civil Society participation in monitoring of National Health policy is crucial to this end.
As TB and HIV patients, we are forced to stop taking TB drugs. We live with our children and other family members in the community in apprehension. We cough andhave no access toTB drugs . Please we demand urgent action to save precious lives.

End

Gabriel Madiye,
Executive Director
The Shepherd’s Hospice Sierra Leone
433A BaiBurehRoad , Lower Allentown
Freetown
00 232 76 620 661
Email:shepherdshospice@yahoo.co.uk

SulaimanJabati
Executive Secretary
Coalition for Justice and Accountability (COJA)
18 Pandemba Road
Freetown
Mobile :00 232 76 674 408
Scwgnec@yahoo.com

Pastor Albert Freeman
26 Magao Street , Kindeya Town
Bo
Mobile :00 232 76 674 408
Email: inerelasierraleone@yahoo.com

National Coordinator
Philip Kaitongi
HIV/TB support and Advocacy Association
433A BaiBureh Road
Lower Allentown
Freetown
00232 76 419 474
hasasl@gmail.com

opportunity

2011-06-15T06:29:00.001-07:00

The Beit Trust Scholarships for postgraduate studies to study in United Kingdom, Ireland or South Africa
Deadline: 31 August 2011
Malawi, Zambia and Zimbabwe
The Beit Trust seeks applications for a small number of Scholarships abroad for postgraduate studies or research to graduates from Malawi, Zambia and Zimbabwe (beneficial area). Scholarships are granted to study at a university in the United Kingdom, Ireland or South Africa...
http://www.fundsforngos.org/scholarships-2/beit-trust-scholarships-postgraduate-studies-malawi-zambia-zimbabwe-study-united-kingdom-ireland-south-africa/

WHO watch experience

2011-06-13T17:39:00.000-07:00

By Kemi Bello from PHM Nigeria

The WHO watch experience is definitely one I can never forget. I had a practical insight into the dealings and proceedings of the WHO. I learnt more things about the WHO in the few days I spent in Geneva, than I had learnt in the 6 years I spent in Medical School! It kind of struck me how much member states had the power to bring about positive changes to health that they never use. It also availed me the opportunity to meet with my Country (and some other African Countries) delegation who were much more open to discussion than they would ordinarily have been back home.

How can I also forget the wonderful dinner with Dr. Halfdan Mahler, an ex- WHO DG who shared with us stories and experiences money can’t buy?

In all, it was a very nice experience though I left Geneva with many more questions than I went with; from why should an individual address the assembly and have more time than that allocated to each MS to why the WHO has allowed itself to be boxed into a corner and now have to dance to the tunes of some of these ‘big actors’ and to why there is always so much emphasis placed on the wrong things?

However, I see a new ‘people oriented’ WHO coming, though it may take some time and hard work but nothing good usually comes easy and above all, I am excited to be a part of this process… Viva Healthcare!!!

****

Kemi from PHM Nigeria and John Mahama from PHM Ghana have written a detailed report on the WHO watch at the 64th World Health Assembly which we will share with all soon.

MICRONUTRIENT DEFICIENCIES AND PROTEIN-ENERGY MALNUTRITION

2011-06-13T17:24:00.000-07:00

By Claudio Schuftan

I share a concern with many so I have made it the topic of this column. (1) But in this day and age of information overload these things get forgotten, they get conveniently swept under the carpet.

I am intrigued to know whether you have come to a similar conclusion as that of this column, as regards the state of international nutrition and specifically the relative balance of attention given to solving the problems of micronutrient deficiencies and those of protein-energy malnutrition. I invite you to read on.

MICRONUTRIENT DEFICIENCIES AND PROTEIN-ENERGY MALNUTRITION
ARE WE KEEPING THE UNACCEPTABLE CAUSES OF BOTH MICRO- AND MACRONUTRIENT DEFICIENCIES IN THE PROPER PERSPECTIVE?

In my early days of work in nutrition, during the late 1970s and early 80s, most attention in impoverished countries focused on protein-energy malnutrition. Its culmination was the era of multisectoral nutrition planning in the 1970s, when we took this form of malnutrition seriously, and understood the importance of working with a range of development sectors. Those of us who pursued multisectoral planning met with disappointment, partly because of the mainly ‘nutricentric’ lens through which development was viewed, and partly because at least some of us failed to pay adequate attention to the underlying social, economic and political determinants of malnutrition.

A large portion of the nutrition community reacted by pulling in the opposite direction, labelled ‘nutrition isolationism’. This is, in effect: ‘If we will not be taken seriously by other development sectors, we will ignore them, and pursue nutrition interventions we can carry out and control largely on our own’. And indeed there were attractive candidates, such as new understandings of the consequences of micronutrient deficiencies, particularly iron, vitamin A, iodine, and now zinc. Improved technologies and logistics for delivering micronutrients in the form of massive dose supplements and fortification, made possible significant and attractive achievements within relatively short periods of time.
Hence, many in our profession have pursued such micronutrient interventions --in some cases with evident remarkable success-- and can take some pride in their accomplishments. Nothing in this column should suggest a reduction in efforts directed toward micronutrient malnutrition. But, at the same time, it is clear that we have neglected the overriding problems of inadequate caloric intake, inadequate care and inadequate health care and its determinants, which are continuing to take such an enormous toll on vulnerable populations.

Today, we know considerably more about addressing protein-energy malnutrition through the combined efforts of improving food sovereignty, food security, the nutritional care of women and children, and other public health interventions, than we did years ago. But the attention of the nutrition community and the resources of donors nowadays are still often more attracted by the glamour of micronutrients, a largely technical and often top-down solution (as close to a ‘quick fix’ magic bullet as we are likely to get in our field). Most of us, and donors, prefer this to the messier and often politically sensitive business of poverty alleviation, people's empowerment, and equity, and the need to be sure that mothers and children have access to care and needed services, and to sufficient and adequate food to eat year round.

Follow the grants

If one asks nutrition experts to list nutrition research priorities, even those coming from countries with disturbingly high rates of moderate and severe malnutrition, a majority will list micronutrient-related problems. This is not surprising, given the orientation of donor assistance and the appeal of journal articles. But the list hardly reflects the most urgent nutrition needs of, for sure, African and South Asian countries.

Governments and donors have all too often concluded that they can ‘check off’ their concern and attention to nutrition by launching a micronutrient project, or a pitifully isolated breastfeeding project, and ignore entirely the challenges of protein-energy malnutrition that so seriously affect the ultimate welfare of women and children between birth and 2 years, as well as the longer term development prospects of impoverished countries.

Here then is the challenge we face: We need not only to maintain our momentum in pursuing micronutrient interventions, which reduce suffering and save lives, but also to redress the imbalance, and the relative neglect of the problems of protein-energy malnutrition and household food insecurity, that often require a very different set of interventions.

Our hope in the years to come is that the technical skills and partnerships which have driven salt iodisation and vitamin A, iron and zinc supplementation programmes, can be coupled with the political acumen that has sparked successful social mobilisation movements to bring about the significant structural changes capable of the sustainable reduction in global undernutrition we all desire.

THE GAP BETWEEN ENGINEERS AND ACTIVISTS
DIFFERENT CHALLENGES IN COMBATING DEFICIENCIES AND PROTEIN-ENERGY MALNUTRITION

The time has come for the nutrition community to see that micronutrient interventions and protein-energy malnutrition interventions have progressively drifted apart (2). These have become different tracks, responding to what seem different challenges. More, they have grown into two, by now, well differentiated separate domains.

Recognising this fact is important, because it links this discussion to the future of international nutrition and to the evolving debate on public health nutrition and its future role central to our own Association. I invite you to respond to this column in the space provided at the bottom with a consenting or dissenting view on whether this imbalance is not as relevant today as it was in the final years of the last century.

More than before, in the last twenty or more years, and following sources of funding, a significant number of nutrition workers have chosen to focus their efforts on the alleviation of micronutrient deficiencies. Does this represent an attempt to avoid the more difficult choices and challenges in the battle against malnutrition? And further – in the name of nutrition – focusing on its more achievable areas of impact, thus choosing the relatively easier path to staying involved in nutrition work and in our profession?

Often, this greater micronutrient focus represents swings from earlier work in protein-energy malnutrition. Examples are manifold, for instance in the work of the US Agency for International Development (USAID), some of that of UNICEF and WHO, as well as that of bilateral donors, and certainly of the Micronutrient Initiative.

Technical and political issues

The difference between these two areas of concentration is between one that is primarily technical with only few political overtones, and one that is the opposite: primarily political with some added important technical challenges. The micronutrients endeavour does have a potential for silver bullet solutions to work, while working to alleviate protein-energy malnutrition does not. Professionals who seek tangible results to report in the literature, like to have silver bullets in their armamentarium.

Myself, I made my choice over 30 years ago. Having lost faith in silver bullets, I have steered my professional life in the direction of a primarily political focus with technical overtones. I have no regrets. Silver bullets have not worked beyond pilot stages, and are not replicable even close to the scale needed. Protein-energy malnutrition has always claimed my attention. It is a sore reminder of the social injustices that underlie it. If anything, my conviction has been strengthened since I adopted the human rights-based framework as my paradigm of action.

This is not an academic nuance. As you my readers will know, I am clear that solutions to protein-energy malnutrition are largely outside the field of nutrition itself, and solutions for micronutrient deficiencies are importantly, though not altogether, inside the realm of what we can do technically. It follows that these two components of nutrition work have to adopt different strategies and require different skills, approaches and tactics.

Colleagues who get involved in micronutrients work get absorbed in resolving mostly immediate causes, and only some of the underlying causes, of malnutrition. They rarely touch its basic causes. They also address more top-down programmatic challenges, such as management, distribution logistics, and food technology issues. Not all this type of work is strictly nutrition engineering though. Work on food fortification, in Brazil for example, tries to push the issues into the socioeconomic and cultural arena and tries to involve consumers and to promote community participation.

People involved in micronutrients work typically lobby for policy changes that are relatively uncontroversial and apolitical, and tend to get support more readily from national decision-makers. Examples of such policies are starting nutrient fortification schemes, or getting salt iodisation legislation and regulations passed.

When applying information, education and communication techniques in micronutrient work, such as seeking to change the dietary habits of a population, or changing the behaviour of pregnant and lactating mothers, colleagues face many more problems. Then, socioeconomic and irresponsible, aggressive marketing issues come to the fore. They feel they are less well equipped, or less in control, or less inclined, to handle those issues. Too often, nutritionists end up teaching mothers to feed themselves and their families foods that they cannot afford, or, when using social marketing techniques, seek to impose changes in behaviour without seeking people's understanding of why these changes are needed and beneficial. Social marketing fails to put people more in control of their own lives (3).

COMBATING PROTEIN-ENERGY MALNUTRITION
THIS IS ALL ABOUT POVERTY ALLEVIATION AND DISPARITY REDUCTION, NOT ECONOMIC GROWTH

To combat protein-energy malnutrition means dealing with issues of equity, popular participation, wealth redistribution, physical and economic access to health, and to education. It is about the appropriate care for women and children. All these have been adversely affected by the many structural adjustment programmes imposed on impoverished countries worldwide, as a condition of receiving foreign loans. (3) Protein-energy malnutrition does not respond unless its immediate, and also its underlying and basic causes are tackled simultaneously and all together. Interventions at each causal level are necessary, but not sufficient.

Because micronutrient strategies so heavily depend on government-based and donor-based service delivery and logistic interventions, as well as on ongoing capacity building at lower levels, they very often create dependency on a given technology and on the continuation of centrally funded and controlled services. For these and other reasons, sustainability remains elusive.

In contrast, resolving protein-energy malnutrition requires empowering people and communities to get involved in actions that they themselves select and demand as legitimate claim holders. Although often not yet achieved, this has the potential of creating less dependence and more self-reliance and sustainability (4).
Micronutrient interventions can reach coverages in the 90 per cent range almost universally - where there is massive funding and support by the donor community. Then what? Will we see a switch back to protein-energy malnutrition work, which by then may well have become worse? Protein-energy malnutrition will not go away in the next generation. The donor community pays mostly only lip-service to needed structural changes. Governments are not tackling these basic problems on their own either. Moreover, macroeconomic policies imposed by the World Bank and other Bretton Woods institutions more often than not have the effect of making protein-energy malnutrition worse(3).

Nutritionists tend to choose tracks in their careers according to their preference, plus the level of tolerance of frustration they can stand. Do political ideology and ethical commitments also shape their choices, especially when faced with only snail pace progress? Are ultimate goals of social transformation part of the equation in their choice? If the answer to this question is 'no', I see a bleak future for the role we can play in the battle against malnutrition in the world. Changes will come about without and despite us, and history will bypass us.

Engineering and activism

Challenges like these are not being clearly spelled out to young and aspiring professionals during their undergraduate and graduate training. Some say we are trained less than engineers (5). I would say we need more than engineers: we need nutrition activist engineers.

Any work in nutrition is not only engineering or activism. It involves both. But if we are to overcome the great challenges facing us, the balance must shift towards activism. We need more commitment to face the basic determinants of malnutrition and ill-health. We need to train young nutritionists accordingly, preparing them better for their role as activists, clearly understanding and capable of intervening in the political dimensions and determinants of malnutrition. Dr Rama would agree. So will Jim Levinson. They both are examples of people who live(d) their beliefs.

References

1 Schuftan. C. Ramalingaswami. V, Levinson. J. Micronutrient deficiencies
and protein-energy malnutrition. Letter to the Ediror, The Lancet 351,
p. 1812, June 13 1998.
2 Schuftan. C. Point counterpoint: The gap between nutrition engineers and
nutrition activists. Ecology of Food and Nutrition 38, 6, 1999.
3 Schuftan. C. Questioning the Solution: The Politics of Primary Health Care
and Child Survival. [Book review] Health Policy and Planning 13,1, March 1998.
4 Schuftan. C.: The community development dilemma: When are service delivery, capacity building, advocacy and social mobilization really empowering? Community Development Journal 3, 3, pp. 260-264, July 1996.
5 Berg. A. Sliding Toward Nutrition Malpractice – Time to Reconsider and
Redeploy. Martin Forman Memorial Lecture, 24 June 1991.

You are invited please to respond, comment, disagree, as you wish. You are free to make use of the material in this column.

Please cite as: Schuftan C. Micronutrient deficiencies and protein-energy malnutrition [Column] Website of the World Public Health Nutrition Association, April 2011. Obtainable at www.wphna.org

cschuftan@phmovement.org
www.phmovement.org
www.humaninfo.org/aviva

Seeking Organisational Endorsements: Comments on ‘Draft Technical Paper’ prepared for the World Conference on SDH

2011-06-08T00:28:00.000-07:00

Seeking Endorsements: Comments on ‘Draft Technical Paper’ prepared for the World Conference on Social Determinants of Health

The World Health Organization (WHO) is convening the World Conference on Social Determinants of Health (WCSDH) from 19-21 October 2011 in Rio de Janeiro with the support of the Government of Brazil. The Conference will be organized in accordance with the Resolution 62.14 of the 62nd World Health Assembly and as a follow-up for the work of the WHO Commission on the Social Determinants of Health (CSDH).

The WHO has published a ‘Draft Technical Paper’ on the WCSDH and initiated a consultation around it through inviting online submissions.

The People’s Health Movement (PHM), in association with several public interest groups and networks, has been coordinating a collective civil society response to the Draft Technical Paper which we strongly believe is a step back from the report of the CSDH ‘Closing the Gap in a Generation: Health equity through action on social determinants of health’. We would like to get as many individual and organisational endorsements as possible.

This letter seeks:

Endorsements to the attached statement. You may wish to make your endorsement through:
filling-in the attached ‘Endorsement Form’ and sending it back by email to globalsecretariat@phmovement.org OR
submitting your endorsement online at http://www.phmovement.org/en/wcsdh-endorse-statement
Endorsements should be received by 01 PM GMT time on 09th June 2011

If you have any questions on this feel free to contact me at any time,

Thank you!

--
Global Secretariat
People's Health Movement (PHM)
Email: globalsecretariat@phmovement.org
Web: www.phmovement.org

HRH: Health Surveillance Assistants (HSAs) in Malawi

2011-06-01T02:54:00.000-07:00

Dear PHM Friends

Please find below an interesting link that was shared which describes the role of Health Surveillance assistants in Malawi. It is worth reading and learning from this experience. In some parts of Africa, the role of health surveillance assistants is similar to that of Community Health Workers.

See link below:

http://www.unicef.org/evaldatabase/files/MLW_01-04.pdf

WHO watch open for business

2011-05-11T00:37:00.000-07:00

From: David Legge

Follow and participate in the 64th World Health Assembly on the WHO Watch portal.

The WHA Watch Portal is now open for business (http://www.ghwatch.org/who-watch/WHA64). The Agenda of the World Health Assembly is demystified with links to official papers and to more critical commentary. Over the next three weeks additional commentary will appear, reports of discussion at the WHA and a lively open comment space will operate.

Keep up to the minute on Twitter. Follow @WHOWatch and receive notifications of updates on the WHA Watch website and other events in Geneva.

WHO Watch is also cooperating with the World Open Health Assembly during the WHA presented by iMAXi (http://imaxi.org/content/coming-soon-world-open-health-assembly-2011).

WHO Watch is a project of the Democratising Global Health Governance Coalition, a group of civil society organisations and networks committed to the urgent reform of the forces and structures which shape global decision making and which affect the global health crisis and the right to health. More about the Democratising GHG Initiative at: http://www.ghwatch.org/who-watch/ghg.

2011-05-05T02:05:00.000-07:00

By Claudio

Dr Ravi Narayan of the Centre for Public Health and Equity, Bangalore is a dear friend and colleague. Beginning in 2003, he was the second global secretary of the People’s Health Movement (PHM) which, during his years in the post, started to monitor the activities of the World Health Organization and other relevant UN agencies. (For the PHM’s comments on the appointment of Ann Veneman as executive director of UNICEF, marshalled by Ravi when he was PHM’s global secretary, see the lead news story on the Association’s website this month). A central criticism of WHO has been that, for many years, it abandoned its commitment to the primary health care approach in a number of areas, including nutrition.

PHM’s People’s Charter for Health calls on ‘people of the world to demand a radical transformation of the World Health Organization, so that it responds to health challenges in a manner which benefits the poor, avoids vertical approaches, ensures intersectoral work, involves people’s organisations views in WHO’s annual World Health Assembly, and ensures independence from corporate interests’.

My column this month is drawn from successive People’s Health Movement statements, agreed after extensive consultation. Ravi has always been involved in this work. Said statements have repeatedly criticised WHO for too strong a reliance on so-called ‘public-private partnerships’ with industry for a big part of its budget. This, despite a lack of objective evidence of the effectiveness of this approach in either improving public health and nutrition, or in improving access to care for those who happen to be poor. Despite real and active participation of civil society representatives in WHO’s work being crucial, civil society initiatives designed to work with WHO have become increasingly sidelined. WHO’s attitude has to change from lukewarm to committed and enthusiastic in this respect.

A NEW VISION FOR WHO
MANY HUNDREDS OF MILLIONS OF PEOPLE HOPE THAT THE WORLD HEALTH ORGANIZATION WILL BE WISE AND COURAGEOUS, AND WILL ALWAYS GIVE FIRST PRIORITY TO FAIRNESS AND JUSTICE

Margaret Chan, Director-General of WHO, speaking in Mexico on the topic of prevention of obesity and chronic diseases, on 25 February 2011. Her point is enjoyed by Mexican President Felipe Calderon, and his Health Minister. Rates of obesity are rocketing in Mexico. One reason, as Mexican politicians know, is unfair terms of trade with the US. These also increase poverty and create destitution among Mexican farming communities.
________________________________________________________________
The World Health Organisation, the UN agency most responsible for global health decision-making, has so far not fully lived up to the hope expressed in the heading above this section. WHO does not seem to be giving first priority to fairness and justice. To varying degrees, WHO and its leaders in the last decades have not succeeded in encouraging member states in many crucial ways. They have:
• Lacked a commitment (active, beyond pronouncements and some good reports) to equity, social justice and the human right to health and to nutrition.
• Lacked an action-oriented implementation of the principles and public health orientation of the Alma Ata Declaration on comprehensive primary health care, as well as a commitment to manage WHO on the basis of these principles, especially given the current still prevailing trend towards selective and vertical health care and nutrition programs.
• Lacked an ability to establish WHO as the acknowledged leader of global advocacy for the attainment of the universal right to essential health care and nutrition.
• Lacked an ability to forcefully stand behind an agenda based on the principles of equity, integration, inclusiveness and public service ethics.
• Avoided an inappropriate relationships with the corporate sector whose interests conflict with public health, particularly the pharmaceutical, alcohol, and processed foods and drinks manufacturers.
• Lacked the courage and readiness to stand up to the inappropriate influence of the major donor countries.
• Lacked a commitment to strengthening civil society’s involvement within WHO’s decision making process, especially grassroots organisations and particularly from developing countries.
• Lacked a real willingness to follow-up on the recommendations from the Commission on the Social Determinants of Health to tackle the social, political and economic determinants of ill-health, malnutrition and preventable deaths at global and national levels.
• Lacked a commitment to speak up and prevent the negative health and nutrition effects of policies pursued by the World Trade Organisation, the World Bank, the International Monetary Fund and the ‘G8’ richest countries.
• Lacked an ability to support and strengthen the weaker regional offices of the World Health Organisation, in particular the WHO African Regional Office.
• Lacked a commitment to fair in-house labour practices, the advancement of committed and technically competent staff and a more multi-disciplinary staff composition representing all regions of the world.

Following the money
Civil society organisations expect WHO to be the number one international advocate for their most cherished principles, values and approaches. These include the ethics of nutrition and of public health, equity, primary health care, community-based health care and nutrition, community participation and empowerment, use of appropriate technology, and intersectoral cooperation. Civil society organisations also look to WHO as the standard bearer on health and nutrition issues.

But now this role appears to have been usurped by other organisations, particularly the World Bank. WHO comes with technical advice, the World Bank comes with money; national governments usually prefer the money --despite the indebtedness involved.
Many non-governmental organisations have, from many years ago, formal relations with WHO and thus can have a voice at WHO meetings. Unfortunately these tend to be those that are relatively malleable, without a strong social consciousness. They usually do not actively lobby for agendas that more forcefully address the needs of the poor.
What WHO should do
Here is what PHM thinks the World Health Organization should do. The list below is ambitious. Some may say that WHO can do only what its member states instruct it to do. Formally this is true, but WHO still has a duty to set rational and progressive agendas and to guide and help member states to address the social determinants of health, particularly in those countries with least resources. WHO thus should:
• Become a real strong advocate of poverty eradication (or, better, of disparity reduction) particularly in its interactions with the World Trade Organization, the World Bank, and the International Monetary Fund.
• Take a more forceful stand with the above institutions, to make them more responsive to greater equity; cancellation of foreign debt; fairer trade; more just intellectual property rights; promotion of comprehensive primary health care.
• Oppose the privatisation and commoditisation of health care.
• Resist vertical, overwhelmingly technical initiatives.
• Involve community and people’s organisations in evidence seeking and in the drafting and carrying out of action plans.
• Involve people’s organisations in WHO’s work at national, regional and headquarters levels.
• Advise and help member states to strengthen the public sector for health and nutrition.
• Prevent any agenda setting by corporate interests.
• Ensure that transnational corporations (particularly those whose activities impact health and nutrition) are effectively regulated.
• Promote more participatory, relevant and transparent public health and public health nutrition policy processes and initiatives by giving civil society a greater voice in the annual WHO World Health Assembly.

A NEW DIRECTION FOR WHO
A PREVIOUS WHO DIRECTOR-GENERAL SAID THAT GRASS-ROOTS POPLE’S MOVEMENTS BRING FORWARD THE VIEWS, FEELINGS AND EXPRESSIONS OF THOSE WHO REALLY KNOW

The mighty meet to save the world at the World Economic Forum, Davos, 28 January 2011. Left to right: Josette Sheeran, head of the World Food Programme; Melinda Gates of the Gates Foundation (on-screen); Margaret Chan of WHO; Bono, the pop star and champion of ‘Make Poverty History’; Muhtar Kent, CEO of Coca-Cola; and Lars Sorensen, CEO of Nordisk. They hear one another. Are they listening to the people?
__________________________________________________________________

He also said: ‘It seems so strange for WHO staff in Geneva to be talking about poverty, destitution, misery and hunger, as they pay 2 Swiss francs (equivalent to $US 2) for a cup of coffee, while millions struggle to survive and sustain their families on the equivalent of $US 1.25 a day’.
It is time now for WHO to take a new direction. It currently is moving in the wrong direction, towards its control by corporations. The call to the leaders of WHO, beginning with its current Director-General Dr Margaret Chan, is as follows: (Many more points can really be added…)
• Reaffirm the principles of comprehensive primary health care approaches and translate them into concrete activities in all WHO programmes.
• Review the Millennium Development Goals, and the recommendations of the Commission on Macroeconomics and Health, in terms of their compatibility with the principles of primary health care as stated in the Alma Ata Declaration; moreover, health and nutrition are to be taken for what they are --human rights-- rather than primarily inputs to economic development.
• Evaluate different approaches to primary health care by both governments and NGOs in order to improve their implementation worldwide.
• Instruct WHO personnel in WHO headquarters in Geneva, and in WHO regional and in country offices, to engage actively with both government and NGOs primary heath care initiatives, and to determine their capacity gaps so as to face and overcome demographic, epidemiological and socio-economic challenges.
• Continue to support countries that are improving the quality and quantity of health personnel in order to improve access to comprehensive services, especially for people who happen to be poor.
• Emphasise implementation of locally determined models of primary health care that are flexible and well adapted.
• Monitor global policies in trade, development and economic restructuring for their effects on the health and nutrition status of those who happen to be poor.
• Identify and oppose policies that are having an adverse impact on primary health care.
• Organise a series of periodic meetings on future strategic directions for primary health care that capture grass roots experiences, and involve grassroots organisations such as the People’s Health Movement.
Needed: attention to the people at the grassroots

In a meeting with the People’s Health Movement, the immediately past Director General of WHO, Jong-Wook Lee, further said that ‘WHO urgently needs to listen to the people and their movements have to say. Many of these organisations have for too long felt powerless. But by uniting forces, they have now reached a critical mass, in part through the People’s Health Movement. WHO must now listen to voices from communities’. And he was right.

Needed: new accountability and transparency
Today, WHO’s accountability is no longer mainly owed to national governments, who in the UN context are preoccupied with their own status, the trading of favours, and continental rotations of top posts, including that of the director-general. Accountability is primarily owed to the people, legitimately represented by civil society organisations. We in civil society now should demand an open dialogue, to discuss WHO’s policies and programmes in all its areas, including public health nutrition.

Acknowledgement and request

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Schuftan C. Hundreds of millions of people across the world... [Column] Website of the World Public Health Nutrition Association, March 2011. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column is reviewed by Geoffrey Cannon.
cschuftan@phmovement.org
www.phmovement.org
www.humaninfo.org/aviva

March blog: Claudio Schuftan
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the role of health and nutrition in the context of development

2011-05-05T02:01:00.000-07:00

By
Claudio Schuftan

Halfdan Mahler is a cherished friend, and a member of the People’s Health Movement. He was the Director-General of the World Health Organization for 15 years, from 1973 to 1988. He is now 87 years old. During his period of office, WHO co-sponsored the 1978 Alma Ata conference, where the bold goal of ‘Health for All by the Year 2000’ was proclaimed. How sad, that some 30-plus years later, this expansive vision of health, founded on the principles of primary health care and social change, has been replaced by the miserly and narrow-minded Millennium Development Goals (1).

In May 2008, Dr. Mahler addressed the WHO sixty-first World Health Assembly. He called again for an integrated approach to health, and what he said was followed by a standing ovation from the delegates of all member states present. Two statements he made were for me outstanding. The first was:

EQUITY
UNLESS WE ALL BECOME PARTISANS IN RENEWED LOCAL AND GLOBAL BATTLES FOR SOCIAL AND ECONOMIC EQUITY... WE SHALL INDEED BETRAY THE FUTURE OF OUR CHILDREN AND GRANDCHILDREN.
So now, as a tribute to Dr Mahler, and in recognition of the truth of what he says and stands for, and of his vision for a more equitable world, I present some thoughts and ideas about the role of health and nutrition in the context of development.
Solving the problems of malnutrition was for many years considered primarily a health activity and prerogative. Unfortunately in many circles it still is. But there is much more to malnutrition than that.
After having witnessed the failure of many attempts to solve malnutrition through health and other specialist sectoral interventions alone, it is time that we all approached malnutrition as a human rights issue. As soon as we do this, we are directed towards looking at what are the basic causes of malnutrition and their resolution.
The food and nutrition chain is usually seen as a series of linked processes that food follows from its production (or import) to its consumption and utilisation. The links in the food chain are the following:
storage
Production ---------- transport,marketing,consumption,utilisation:
processing

- digestion
- absorption
- metabolism

At each link in the chain there are weaknesses that directly or indirectly contribute to malnutrition. One of the tasks of the human rights-minded nutritionist is to identify these weaknesses, together with the claim holders, so as to strengthen as many of them as possible. In such an analysis:

• Political, economic, infrastructural, manpower, agricultural, educational,
environmental, health and other constraints all need to be considered.
• Solutions often far removed from strict nutrition interventions are indispensable to succeed in the battle against malnutrition.
• Primary health care, agricultural, and rural development activities, all require a
human rights focus, as demanded by organised claim holder groups.

Rural/urban imbalance

One of the weak links in the food chain is migration from rural to urban areas. The downside of this is that cities will continue to deteriorate if the countryside does not prosper. Every urban-migrating young adult is two less arms to produce food, and one more mouth to feed in the city. Those who stay behind increasingly are older women, children and elderly men. Given the current and projected massive urbanisation trends, increases in food supplies are liable to be only moderate in the future.
The traditional agricultural sector will, for years to come, continue to be the first driving force in many countries. Overall, it produces more than three-quarters of all food consumed. Availability of productive employment, revenue and food – in particular, staples – is often seasonal in rural areas. This compounds problems of health and nutrition during the hungry season.
In most lower-income countries, a sizeable proportion of the population – those of low income or subsistence status – get less than the recommended average daily calorie intake specified by the Food and Agriculture Organization of the UN (FAO). Urban averages are often higher than the FAO recommendations, but income disparities are widest in cities. It is safe to assume that 30 or more per cent of urban dwellers are also short of calories. Further, a minimum cost diet for an average family of five or six people is often above the minimum wage of unskilled urban workers. In most countries the overall purchasing power of the more impoverished proportion of the population will improve only very slowly, if at all - hence, malnutrition.
How to alleviate hunger and malnutrition.
The list of determinants of malnutrition is extensive, intricate, and interrelated. Here follows a list of policies and interventions deemed necessary to move towards the eradication of malnutrition.
The capacity of any system to alleviate hunger and malnutrition depends on the concerted efforts government officers and political leaders at all levels make to address the basic, underlying and immediate causes of malnutrition. This is in turn related to whether those responsible are really actively and ongoingly pushed towards their obligations in this field by active groups of claim holders demanding greater equity and social justice.
Even if willing and capable, I contend that governments and other individuals or institutions in duty bearer roles will fail to do anything significant about malnutrition, unless a significant number of the following actions are planned and carried out in any national development programme:
• Strong encouragement of organisation of claim holders to secure their participation in development activities at all levels.
• Measures to slow down urban migration, such as increasing rural employment opportunities, making food crops more profitable to producers, and providing a minimum of infrastructural services in rural communities. These entail a change in investment priorities towards overall rural development.
• Measures to curb urban unemployment.
• Explicit incorporation of women into the development process, for example by making them eligible for agricultural extension, bank loans, and credit.
• Fair market prices for producers of cash crops.
• Agricultural banks to strike a fairer balance between cash-crop and food-crop credit allocation, favouring the latter.
• Minimum wages to be based on the results of balanced food-basket cost studies.
• Higher import duties to be levied on luxury items, especially luxury foods and drinks.
• Subsidies for selected durable inputs for small farmers, such as tools and small machines.
• Subsidy of fertilisers and pesticides. A fair balance to be struck between the proportion of these inputs going to food production as distinct from cash-crop production.
• Adequate logistical support for agricultural extension workers and community development workers.
• Priority given to home and school gardening programmes and small dry-season irrigation projects.
• Measures to improve farm-level food storage practices, in order to decrease food losses.
• Primary school enrolment to be increased especially for girls, and more teaching of work-related skills within school curricula.
• Adult literacy campaigns, with emphasis on women, to be intensified.
• Organisation and financing of a network of day-care centres in the country.
This list is by no means complete. It probably includes most of the more rights- and equity-oriented actions duty-bearers should embark on. It is essential that all such actions are monitored by claim holders.
The bottom line is as follows: Improving the nutritional status of vulnerable groups in the population remains closely related to the alleviation of poverty. It also requires specific interventions in several sectors. Only some of the determinants of malnutrition can by partially or totally corrected by explicit health interventions.

VISIONARIES
LET US NOT FORGET THAT VISIONARIES HAVE
BEEN THE REALISTS IN HUMAN PROGRESSION.
Halfdan Mahler gave his address to the 2008 World Health Assembly sitting next to the current WHO director-general Margaret Chan, as you can see below. Above is the second statement made by Dr Mahler on that occasion that I especially cherish.

Inspired by Dr Mahler and what he stands for, it is fitting for us nutrition workers to explore the special role of primary health care in the battle against malnutrition.
The vision of universal primary health care
Primary health care is the most viable, logical and best possible approach to progressively reach the goal of health for all. Whenever it has gained a real commitment beyond lip service in the allocation of resources in a country, it has improved the health and nutrition of its people, especially through the active community involvement it calls for. By doing so, it addresses the host of local health and nutrition problems as felt by the users of health and nutrition services.
Primary health care goes beyond conventional health care as it organises claim holders around activities aimed at addressing the three levels of causality of ill-health, malnutrition and poverty. In the spirit of Alma Ata, it actually can mobilise claim holders to change some of the determinants of their neglected condition. Happily, 2010 has seen a revival of the call for primary health care, and also for universal health coverage, from WHO and also from civil society organisations (2).
A real emphasis on primary health care involves the shifting of priorities away from urban-biased, hospital-centred and physician-centred approaches. Interventions that indicate primary health care goals are being seriously pursued include:
• Construction, staffing, equipping and opening to use of more primary health care centres.
• Training of relevant paramedical personnel, village health workers and traditional birth attendants.
• A higher percentage of the national health budget shifted to preventive services, including nutrition.
• Ensuring the required national vaccination coverage is attained and maintained.
• Expansion and extension of the coverage of overall maternal-child health services including nutrition and child-spacing (family planning).
• Ensuring preventive and curative approaches to, malaria, tuberculosis and HIV and AIDS, not forgetting respiratory infections, intestinal parasites and diarrhoeal diseases.
• Increasing the number of deliveries properly attended by trained personnel.
• Expansion of the pre- and post-natal supervision of mothers, to include monitoring maternal nutrition during pregnancy and lactation, and provision of iron and folate supplements, plus tetanus vaccination and malaria prevention during pregnancy.
• Promotion and expansion of latrine construction programmes through self-help.
• The number of households with access to safe and sufficient drinking water to be increased through community-managed projects.
• Introduction and use of growth monitoring and nutrition counselling in all communities, to include the training of personnel and of community members.
• Retraining of field health personnel with emphasis on nutrition and preventive health activities.
• Development of nutrition protocols for the treatment of malnourished children, to standardise the therapeutic approach at the national level.
• Mechanisms put in place to record and periodically report birth weight data.
• Review and improvement of the nutrition curriculum in all university health related courses.
• Introduction of health and nutrition education through the radio.
• Introduction of health and nutrition modules in the science curricula of primary, secondary and technical schools;
• Marketing controls of baby formula and of baby weaning foods. Banning of promotion of these products through the media and directly to mothers.
This list is also not exhaustive and, as said, includes some actions that are not strictly in the realm of primary health care. But all of them, and other more, are related to the problem of malnutrition and how to ameliorate it. Assessing national health plans to see if they incorporate these activities, and to what degree, will help to determine the capacity of the health sector to tackle the social determinants of malnutrition.

Implementation of all these interventions will be expensive and maybe beyond the capacity of poor countries in the short run. Nevertheless, progressive realisation strategies for health and nutrition, with measurable benchmarks for claim holders to monitor, have to be set. The alternative would be to relegate primary health care to a token programme within the national health strategy – a policy that should be fiercely opposed by claim holders.

Resources, dependency and power imbalances

To be effective, policies need to be rational and technically feasible. But this is not enough. There is also the question of human, financial and other material resources.
Can the rightful demands of claim holders be met, with existing primary care resources in a country? If no, then strengthening of primary health care capabilities needs to become a key national priority. Too often this has been overlooked and otherwise well-conceived nutrition components of primary health care programmes have remained and remain on paper only. Inventories need to be made of existing available resources. This done, the missing resources, and the needs and areas for improvement, can be identified.
Foreign aid, such as World Bank loans, in part intended to alleviate hunger and malnutrition, has created dependency. The foreign debt this kind of aid generates is a constant reminder of the neo-colonial domination by countries of the North. Part of such borrowed money is used to maintain consumption levels, mostly for urban populations, while the prices of impoverished countries' export commodities generally fall. Little of such borrowed money has contributed to equitable economic growth and food self-sufficiency.
Yes, much more investment is needed in better health and nutrition programmes. But there is another issue here. Governments are likely to feel threatened by empowered and autonomous and driven claim holders, as much as this is exactly the purpose of universal primary health care. So here, maybe, is the greatest challenge faced by committed health and nutrition workers: to be aware that they are engaged in shifting the power imbalances between the governing and the governed.
We ought to be advocates of the poor. Are we? Putting nutrition into primary health care programmes is of itself not enough. There are bigger issues, such as land mal-distribution, low farm gate prices, lack of investment in the peasant sector, and in health, in education, in water and in sanitation. More specifically, the control of food production and the value of food produced is still taken off the hands of food producers. Further, peasants are pressed by their governments, in turn pressed externally, to favour technically advanced, large-scale agribusiness, which will never reverse the impoverished countries’ food shortages.
Poverty – and to be more precisely the process of impoverishment - is the main issue here. Emphasis on more production of food fails to address the issues of why people in rural areas are poor, are in poor health, and are malnourished. These people are not fatalists or short-sighted or lazy and unimaginative. They are oppressed. Food and nutrition are political issues, and we professionals need to recognise this and act accordingly. One way forward is to insist on equity, on the human rights-based approach, and on universal primary health care, with what can then be an effective nutrition component. This is what Halfdan Mahler believes and stands for, and he is right. I sent him this column in draft, and in his response he quoted a verse of Halfdan Rasmussen:

I fear
not execution,
not torture and not hate,
not death from rifle barrels or
the shadows on the gate,
I fear not restless nights
with shooting stars of streaking pain,
I fear but blindness from a World
indifferent and insane.

References

1 Editorial, Social Medicine, Vol. 3, No. 2, May (2008).
2 World Health Organization. Health Systems Financing: the Path to Universal
Coverage. World Health Report. Geneva: WHO, 2010.

Acknowledgment and request

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Schuftan C. The role of health and nutrition in development [Column]. Website of the World Public Health Nutrition Association, February 2011. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column is reviewed by Geoffrey Cannon.
cschuftan@phmovement.org
www.phmovement.org
www.humaninfo.org/aviva

February blog: Claudio Schuftan
Respond below please

what our role as ‘nutritionists-helping to-shape-society’ ought to be

2011-05-05T01:53:00.000-07:00

BY Claudio Schuftan

San Jose, California. Since I am back in the Americas for holidays, I start this month by quoting some views of the prominent Uruguayan journalist and essayist Eduardo Galeano, written some 40 years ago, but still salient today. Yes, it is not me, but him pictured above. He is well known among many of us for his always sharp-as-a-whistle incisive social commentary.
Reviewing his reflections prompted me to ask myself what our role as ‘nutritionists-helping to-shape-society’ ought to be. In rather strong terms, I here argue for what our obligations should be, beyond liberalism: I call for a greater engagement in political action as the true test of our values as nutrition professionals.

GLOBALISATION
IT’S THE RICH THAT GET THE GRAVY,
IT’S THE POOR THAT GET THE BLAME.
AIN’T IT ALL A BLEEDING SHAME
As you may know, I am originally from Chile, and I am indebted to my fellow Latin American Eduardo Galeano and his book The Open Veins of Latin America, for the eight reflections that follow. The book was banned in the 1970s by the military dictatorships in Argentina, Brazil, Chile and Uruguay.
One. The international labour division consists of some countries specialising in winning, and others in losing. The latter continue to work as servants of the former.
Two. The defeat of the have-nots has always been implicit in the victory of the haves. The labour of the have-nots has always generated their own poverty, since it has fed the wealth of the haves.
Three. The strength of the globalised system rests on the necessary inequity of the parties that make it up. This inequity assumes ever more dramatic proportions. The dominant classes in poor countries have no interest in finding out whether patriotism could be more profitable than treason, or if begging and dependence are the only possible way for their countries’ international politics. Countries thus end up mortgaging their sovereignty, because, we are told: ‘There is no other way’.
Four. The globalised system is very rational from the point of view of their foreign owners and of our ‘hamburgeoisies’ that have sold their soul to the devil.
Five. The globalised system has a thorn in its side. We have too many people. And people reproduce. They make love with enthusiasm and without precautions. More and more, people are left on the verge of the road, jobless. So the empire gets worried: unable to produce more bread, it does what it can to get rid of those sitting around the table. ‘Fight poverty! Kill a beggar!’ a master of black humour wrote on a wall in the city of La Paz.
Six. The globalised system thus convinces poor people that poverty is the result of not avoiding having children. So it now proposes, in panic, measures to resolve the problem. Population control measures are the preferred policy.
Seven. We have social classes, and the oppression of one class by another. The system calls that ‘adopting a Western lifestyle’.
Eight. Poverty is not written in the stars. Underdevelopment is not the result of an obscure will of God. People are waking up, and are demanding changes.

NUTRITIONISTS
OF THE WORLD, UNITE!
WE HAVE NOTHING TO LOSE
BUT OUR SELF-SATISFACTION!
Are nutritionists as intellectuals a class apart, responsible only to their own inner urges, and to their own vision of human needs? Are we not duty-bound to immerse ourselves in our respective societies to foster a higher level of social consciousness? Are we assuming our role as natural leaders, destined not only to provide key ideas that can reshape society, but also to make sure that these ideas become actions?
The public health nutrition congress held in Porto last September was a gathering of such selected intellectuals. But did they act as ‘a class apart’ or as bona-fide duty-bearers? There was some criticism reported on the Porto meeting on the home page of this website earlier, so I add no more. A reason for hope is our Association’s promise of a totally different type of meeting in Rio 2012.
So what role should we all play, in our troubled early 21st century world?
Intellectuals too often do bend the rules of discourse to suit their own interests; too often they do argue for what they want to believe. Their theories do end up justifying the status-quo. Nutritionists in higher education too often do not question the privileges of certain groups in society -privileges that ultimately end up perpetuating hunger and malnutrition.
Intellectuals are part of the system
But scholar intellectuals do not float somewhere above the economic system; they – meaning we – are part of it. Few scholars can resist the pressure of the scholarly tradition in which they work. Only by expunging that tradition’s false preconceptions can they break from its grip. This is possible only by challenging the ideology behind that tradition that many of us find abhorrent. Are we thus guilty of perpetuating passivity – the ‘passivist’ position of Geoffrey Cannon’s November column? An intellectual rebellion is difficult to achieve; many of us are prisoners of our own past training and other peoples’ thoughts (1).
We often use statistical illusions palatable to our own academic elites that do not really reflect the real world. Measuring poverty in detail can often be a substitute or an excuse for not acting in response to clearly visible needs (2).
To avoid discord or conflict, too many of our peers and too many international organisations take the politics out of the political economy of hunger and malnutrition in their daily decision making process. Using the economists’ yardstick only leads to a non-political bias… The abolition of slavery, or child labour laws, never would have passed a cost-benefit test (3).
Separating nutritional from political analyses, results in a reluctance to call a bean a bean. There is a tendency to stop the analysis where ‘politics’ begins, with formulations like: ‘This, however, is a political question’. But that is where the analysis should very often start. Our task is not merely to reflect the world, but to do something about it! Recognising trends and acting promptly at the right time, differentiates the politician from the theoretician (4).
The complex nature of the problems of hunger and malnutrition complicate our policy making. The essence of the problem transcends looking at it from an interdisciplinary view. A new world view, and a set of values into which all the determinants of hunger and malnutrition blend, is needed. The development of such a philosophy has been avoided by too many of our peers, because it raises larger issues and challenges the current system. We need effective tactics, yes, but first we need innovative strategies.
We need to move from our perennial critique to actual concrete actions. We need to plan for positive alternatives. These need to go beyond the expedient goal of obtaining the type of lowest common denominator results whose real purpose too often is to alleviate guilt feelings (5).
Our inherent obligations
We must not retreat into helpless passivity, watching the biological, ecological and social systems around us deteriorate. We can alter trends and avert catastrophes if we recognise and exercise our own power to make a difference. (6).
The greatest challenge we face today is to meet the inalienable human rights of poor and marginalised people. Past and present nutrition research too often has little or no relevance to our concern for the right to nutrition of the people. Furthermore, international and national nutrition conferences too often become exercises in futility, organised and orchestrated by the same conservative groups, year after year (7, 8).
Meeting the right to nutrition of the people will, in most countries, require political solutions that are likely to need technical inputs. But the political solutions are not dependent on first making the technical inputs available (9). Devoid of a clear ideological orientation, the right to nutrition does not clarify, but mystifies; it does not mobilise, but manipulates.
Not everyone who says ‘human rights’ supports human rights principles. These include: empowering participation in decision-making, social inclusion, rule of law, non-discrimination, dignity and accountability. The Roman emperors provided ‘bread and circuses’ for the masses. Authoritarian regimes present modern variants, such as beans and football stadia. Human rights defined in material terms, planned by an elite and delivered by a bureaucracy, create client groups, demobilise mass organisations, and create new patterns of dependency.
Technocratic models, like those proposed in The Lancet Series on Nutrition (to be found at.http://www-tc.iaea.org/tcweb/abouttc/tcseminar/Sem6-ExeSum.pdf) assume that the problems are largely scientific, and can be solved by closing management gaps found in decision-making groups (10).
There is no easy or short-term solution to the syndrome of underdevelopment, of which nutritional status is an important indicator. Too many non-solutions are proposed as answers. For instance, the provision of primary health care alone will not bring about better nutrition. Primary health care is necessary, but not sufficient. Ultimately, levels of health, nutritional status and living standards are determined by national development strategies and the international economic order. Straight public health and nutrition programmes, while aiming for greater equity, do not contain interventions that move towards more egalitarian societies (11).
Many of us are content to take life as it comes when things go reasonably well, preferring to evade the troublesome question of life’s purpose or meaning. In times of trouble, however, problems force themselves on our awareness and our consciousness. (12).
As scientists, technicians and intellectuals we are restless, often dissatisfied and critical, and in urgent need of an ideology. At the same time we are doing quite nicely: we have a vested interest in the status quo. And what is the ideology to be? Just a vague consensus for equal opportunity? We are good at exposing unintended consequences of well-meant measures. But this can be downright dangerous. This position threatens to give legitimacy to conditions set by corporate elites, where gross inequities are rationalised as a fact of life (13).

LIBERALS
BELIEVE IN ‘WIN-WIN SITUATIONS’
BUT IN THEIR WORLD THE
DISPOSSESSED ARE ALWAYS LOSERS
With a liberal ideology, we are committed more to stability than to justice and to fairness. As liberals, we have connections in the Establishment. We do not address fundamental questions. We are experts (technocrats). We think we are ‘reform professionals’, but more often actually are ‘stability professionals’ (13). We may make powerful diagnoses, but then offer feeble therapies.
‘Positive-sum games’, in which everybody or almost everybody wins something, are next to impossible when applying the radical therapies needed. That is why we now speak of disparity reduction instead of poverty alleviation. The rich simply have to give up some of their privileges! They are good at allocating gains, but horrible at sharing out losses. Honest rationality and self-interest frequently clash. Can we then stall indefinitely on needed policies and changes (14)?
Much of what has been called liberalism in the last half century has been merely an accommodation to historical change --to circumstances. It represents a triumph of circumstance over ideology. Liberals make a virtue of adjustment, of a kind of adaptive pragmatism. The disparity between what liberals say in public and what they do in private, is why it is so easy for young people to unmask the hypocrisy of their parents (15).
In the world that liberalism finally made, the world of the welfare state and the transnational corporation, liberalism itself has become politically and intellectually bankrupt. The welfare state of liberalism absolves individuals of moral responsibility, and treats poor and malnourished people as victims of ‘social circumstances’. It still condemns the lower class to a second rate education, yes even in the USA, and thus perpetuates the inequities it is supposed to abolish (16).
In the liberal tradition of the West, individual rights are valued more than social rights, and civil and political rights are deemed more important than economic, social and cultural rights. In socialism, on the other hand, the right to work, and to acceptable levels of nutrition and education, outweigh the importance of personal freedoms. To socialists, freedom from hunger, from ignorance and from disease is more important than freedom of expression (3).
It is no surprise that liberals believe in the globalised ‘free market’ and in competition. Liberals now seldom see trades unions as valid actors in the market or as institutions to be backed. Liberalism has no operational political economy at its core. It expunges any real perception of the nature of political and economic conflict perceived in terms of interest groups or of class.
Socialists espouse equality as an absolute, and measure injustice by distribution of wealth. But the right and the left do not occupy two extremes with a middle made up of liberals. Liberalism is another dimension altogether. It is empty of standards (17). It is often easy to see what liberal groups are opposed to or worried about. But what do they stand for? This is often an unresolved puzzle (13).
The core issues
So, here comes the question modern liberalism has always ducked. Why is the wealth of any self-proclaimed ‘egalitarian’ nation distributed so unjustly? The long march of liberal solutions to social injustice evades the more fundamental questions about wealth and its gross maldistribution.
The liberal mindset, well-intended as it may be, avoids confronting harsh realities. One of these is that in the final balance, welfare states care most for the prosperous, not the poor (18).
For a long time now, including in countries not really committed to genuine social development, health and nutrition programmes have become popular. These suggest a political adherence to the ‘ideals of health and nutrition’, without real commitment to deal with the deep-rooted social problems behind them (19).
Do liberal planners, programme officers, administrators and advisors really have anything relevant to offer in this world in 2011? The technocrats among us dodge the political issues behind undernutrition: “We are afraid to confront the hard-nosed reality of nutritional issues, because they come down to political questions and are non-scientific and hard to grapple with – so we shy away from them” (20).
Our predilection for nutrition education interventions comes from our believing in a concept of society in which there are ‘practical difficulties’ and ‘obstacles to desirable changes’, but ‘fortunately there are also various services or facilities available to overcome them, so in the end everything will be fine’.
But the way the world is going now, everything will in the end not be fine. We now need to analyse and expose the impact of systemic barriers to good health and nutrition. For instance, in the US, where I am now writing this column from, the strategy of ‘life-style policies’ for correcting deficits and imbalances in the diets of the population, by individually changing the food consumption patterns of individuals, avoids the political question of why those individuals consume that diet as they do. It ignores the enormous power and the economic interests of the gigantic corporations that determine food systems and thus dietary patterns (19).
We are in for a period of agonising reappraisal if we are to contribute to a world that is changing with remarkable speed. We need to make governments conscious that health and agricultural production interventions alone do not solve nutritional problems, and that the answer is not to be found in small projects, or with a few experts running around (20)

What it is that makes me tick

People ask me why I subject myself to the daily ordeal of spreading the
word on the right to nutrition. Perhaps the most honest response is that it
has long dawned on me that I am addicted to gambling. I play the ghastly
everyday power game. Anything else my peers want to convince me about is
an illusion. If questioned further I might say that I have no wish to say
any more about it.

References

1 Ul Haq. M.: The fault is ours. New Internationalist, No. 32, Oct., p. 19 (1975).
2 Lehman-Haupt. C. reviewing The Mismeasure of Man by Stephen Jay Gould. International Herald Tribune, Oct. 31/Nov. 1 (1981).
3 Exact reference to these quotes lost to the author.
4 Galtung, J.: What is a strategy? IFDA Dossier 6, April (1979).
5 Hetzel, N.: A sustainable development strategy. IFDA Dossier 9, July
(1979).
6 West. M: Washington Post, Jan. 14: E-2 (1979).
7 Mattis. A.: Science and technology for self-reliant development. IFDA Dossier 4, Feb.(1979).
8 Schuftan, C.: Do international conferences solve world problems? PHP, vol. 7, No. 11, Tokyo 1976.
9 Adapted from Kirkpatrick, J.: De-westernizing medicine: concepts and issues in the literature, mimeo. Proceedings of the 10th International Congress of Anthropology and Ethnographical Sciences, Pune, 1978.
10 Green, RH.: Basic human needs: a strategic conceptualization toward another development. IFDA Dossier 2, Nov. (1978).
11 Mangahas, M.: Why are we reluctant to set numerical equity targets?. Nutrition Planning, 3: 102 (1980).
12 Adapted from Bettelheim, B.: Surviving and Other Essays. (Knopf, New York 1979).
13 Adapted from Geyelin, P.: Book review of The neo-conservatives by Peter Steinfels. Book World, Washington Post, April 27(1980).
14 Adapted from Lekachman, R.: Book review of The Zero-Sum Society by Lester Thurow. Book World, Washington Post, April 27 (1980).
15 McWilliams, W.C: Liberal dialogue: Do you want to talk about it? Book World. Washington Post, Dec 21: 9 (1980).
16 Lasch, C.: The Culture of Narcissism: American Life in an Age of Diminishing Expectations, as reviewed by William McPherson, Washington Post Feb. 4: E-1 (1979).
17 Lowi, T.J.: Where is liberalism, now that we really need it? Washington Post, Oct. 31: C-8 (1982)
18 Greider, W.: A radical idea as old as Lincoln. Washington Post, March 11: C-3 (1979).
19 Bantje, H.: Constraint mechanisms and social theory in nutrition education, mimeo. BRALUP, University of Dar Es Salaam. Tanzania. Proceedings of the 11th International Congress of the IUNS, Rio de Janeiro 1978.
20 Navarro, V.: The industrialization of fetishism or, the fetishism of industrialization: a critique of Ivan Illich. Social Science and Medicine, 9: 360 (1975).

Acknowledgement and request

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Schuftan C. Globalisation. It’s the rich that get the gravy, and other items. [Column]. Website of the World Public Health Nutrition Association, January 2011. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.
This column is reviewed by Geoffrey Cannon.

cschuftan@phmovement.org
www.phmovement.org

January 2011 blog: Claudio Schuftan
Respond below please

Africa gets 'holistic' drug discovery centre

2011-04-20T00:15:00.000-07:00

Munyaradzi Makoni
14 April 2011
http://www.scidev.net/en/sub-suharan-africa/africa-gets-holistic-drug-discovery-centre.html?utm_source=link&utm_medium=rss&utm_campaign=en_subsuharanafrica

[CAPE TOWN] A "holistic" research centre described as the first of its kind in Sub-Saharan Africa to bridge the gap between basic sciences and drug development was launched in South Africa last week (7 April).

The Drug Discovery and Development Centre, known by the acronym H-3D, will focus on developing and testing preclinical drug candidates for diseases afflicting the continent, and will train African scientists in skills needed for drug discovery, integrating medicinal chemistry, biology and pharmacology.

It will allow "Africans to find their own solutions to their own health problems," said Kelly Chibale, founding director and a chemist at University of Cape Town (UCT), which will host the centre.

The aim is to achieve a "critical mass of personnel" to help make Africa competitive enough to attract contracts from the pharmaceutical industry and research organisations, and create jobs in Africa, Chibale said.

"South Africa has a strong reputation in developing basic sciences and clinical studies, so researchers will bridge the gap that has always existed in translating knowledge into new medicines," Chibale told SciDev.Net. But he added that even South Africa, the most technologically advanced economy in Sub-Saharan Africa, has gaps in knowledge and expertise of the drug discovery chain something the centre will try to fill.

Research will focus on drugs for the treatment of malaria, tuberculosis and cardio-vascular diseases.

Mamphela Ramphele, chairperson of the Technology Innovation Agency (TIA), South Africa, said researchers should seize this opportunity to also tackle diseases such as typhoid, cholera and river blindness, which are largely confined to Africa.

But it will be a long time before drugs could start rolling out, Chibale cautioned: "I don't want to create any unrealistic expectations. We will kiss many frogs before meeting the prince."

Timothy Wells, chief scientific officer at the Medicines for Malaria Venture (MMV) told SciDev.Net the centre is an opportunity to provide original home-grown drugs for diseases that developed countries hardly pay attention to.

Apart from the MMV, the centre is collaborating with the US National Institutes of Health's National Institute of Allergy and Infectious Diseases, and pharmaceutical companies such as Novartis and GlaxoSmithKline.

The MMV and the TIA will co-fund H-3D to the tune of 20 million rand (around US$3 million) for the next four years. The MMV will also sponsor mentoring programmes for South African researchers.

--

People's Charter for Health translated into Wolof and Serrere (Senegal)

2011-04-01T00:23:00.000-07:00

The People's Charter for Health is now available in two local languages, Wolof and Serrere. The two languages are used by more than 90% of the population in Senegal. The two translations will soon be available on the PHM website www.phmovement.org.

The People's Charter for Health is a tool for advocacy and a call for action,defining Health as a Human Right, gives an analysis of global health and gives a broad way to achieve it :
http://www.phmovement.org/en/resources/charters/peopleshealth

Well done to PHM Senegal for translating the Charter. For more details on PHM activities in Senegal you can contact Amacodou Diouf on amacodou1@orange.sn.

*****

Sexual Violence and its impacts.

2011-03-30T11:52:00.000-07:00

From Abdulai Bangura from Sierra Leone gbondoab2003@yahoo.com

I see sexual violence as being a problem still occurring at an alarming rate in my country. Therefore I see the need to write something about it.

To give a brief definition about the topic, any unapproved sexual act, unwanted sexual comment or advances, attempts to obtain a sexual satisfaction against the consent of the opposite partner etc, could be referred to as sexual violence. Sexual violence can take place in different circumstances and settings. These include force sex in marriage and dating relationship, rape by foreigners, sexual abuse of children, sexual abuse of people with mental and physical disabilities, child marriage, denial of the right to use contraceptives etc.

Any sexual violation can be emotionally traumatic, whether by a stranger, acquaintances or intimate partner. Trauma can be devastating and lasts for long time. Victims of rape often suffer serious and long psychological effects. Victims of sexual trauma are often left with feeling of anxiety, overwhelmed and confused, sleeplessness, flashbacks, inability to focus or concentrate, generalized fears or panic attacks are all common manifestations of trauma.

However, the social and economic costs of violence against women are enormous. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities and limited ability to care for themselves and their children.

In my country Sierra Leone particularly, women suffer a great deal of sexual violence as compared to men. Therefore, even though it is indisputable that men can as well experience sexual violence, studies including mine have shown beyond all reasonable doubts that women suffer by far a greater percentage of sexual violence.

Victims of sexual violence in Sierra Leone face a number of challenges seeking to achieve justice. These include the absence of legal aid for women, high illiteracy rate among women, forceful marriage, forceful female genital mutilation, prevailing culture of silence, lack of temporary shelter for victims of sexual violence etc. There is no doubt that sexual violence poses many adverse effects on the victims, which include sexual and reproductive health hazard, death, mental malfunctioning, physical health abnormalities, negative psychological impacts, stigmatization among others .

Preventive measures need to be established to protect women from sexual violence. To fight against this unacceptable practice, I recommend the following as preventive mechanisms to avert the problem of sexual violence:

Ø Mass public education campaigns.

Ø Attitudinal change towards gender inequalities and the acceptability of violence.

Ø Supportive programmes for children who have witnessed intimate partner violence.

Ø Work with teenagers to reduce dating violence.

Ø Increase education and opportunities for women and girls.

Ø Improve on self-esteem advocacy for victims.

Ø Allocate adequate resources to bodies and organizations that propagate the fight against sexual violence.

Ø There should be a strong political will to design policies and enact laws that can put protective fence around women and girls.

Yours sincerely,
Abdulai Gbondo Bangura.gbondoab2003@yahoo.com

HUNGER: IN SEARCH OF THE BIG PICTURE IN OUR WORK IN DEVELOPMENT

2011-03-28T03:43:00.000-07:00

Claudio Schuftan
cschuftan@phmovement.org

Africa is a good continent to be in. I have done much work here; always going after what the real causes of malnutrition are (here meaning undernutrition and nutrition insecurity, or to speak plain, hunger).
Macro- and micro-causes
For many of us, undernutrition and hunger are nothing but the biological translation of a social disease with particular historical roots in each case. Their basic causes will here be called macro-causes. The more immediate and underlying causes will here be called micro-causes.
Macro-causes are conditioned by the overall policies that govern economies, both within any country and in foreign relations and trade. With many others, I contend that macro-causes explain most undernutrition and hunger in societies with capitalist modes of production. Nutritional vulnerability is a manifestation of a society's inability to enable its poor populations to earn their livelihoods adequately and not an issue of overpopulation or of insufficient agricultural production. In short, impoverished societies struggle for their own livelihood while actually contributing to the livelihood of other societies (1).
Political and technical approaches
Macro-causes are not removed or even touched by the vast majority of conventional nutrition intervention programmes. The fight against undernutrition and hunger thus has to change, to become much more of a political struggle. Technical approaches simply cannot achieve the fundamental structural changes needed to end hunger.
Removal of a few (or even one) of the main macro-causes is more likely to alleviate undernutrition and hunger than acting on many micro-causes simultaneously. Macro-causes are now frequently mentioned and identified by planners analysing specific country situations, but the plans they devise seldom address these causes frontally.
Micro-causes impinge on the physiological condition of malnutrition. These include health, environmental, and biological factors. These are those most frequently identified and selected for direct intervention by Northern planners. They largely emphasise technical approaches, and justify Northern-trained experts who often come with ready-made off-the-shelf analyses…and ‘packages’. To many of us, The Lancet Series on Nutrition suffered, to a great extent, from such an outlook.
All experts bring their own view of development. Nothing new here. Their proposals for nutrition programmes will reflect their ideology, of which they may be unaware. Over the years, a focus on micro-causes has led to myriad packages of solutions or interventions that pretend to be apolitical and free of ideological connotations or influence. But ultimately one either bows to the system or objects to it, totally or partially. Is not this a political stance?
As nutritionists, we keep inventing new ‘more comprehensive’ or ‘multi-sectoral’ or ‘evidence-based’ approaches to old problems, as if these would change major contradictions and maldistribution of power in the system that is causing the problems of malnutrition to begin with.
How to get to the point
I contend we basically cannot agree on the content of needed nutrition interventions if we do not share the same understanding of why people are poor, undernourished and hungry to begin with. Different socioeconomic contexts call for different nutrition plans. This does not imply that only macro-causes should be identified and acted upon. An appropriate understanding of hunger and malnutrition will include consideration of and acting upon a mix of macro- and micro-causes.
The challenge here is to determine, in each national (or regional) context, how much and what kind of macro-changes are needed for micro-changes to have some chance of success. The connections between macro- and micro-causes must be made explicit so as to justify the needed macro-changes. Any plan or programme geared to ameliorating malnutrition as a public health and social problem will have to include a mix of interventions designed to affect change in both macro- and micro-causes. Technical measures in themselves are not tools for income redistribution; at most, they may have a partial redistribution impact as a side-effect – assuming that they reach the lowest income and marginalised groups.
In this context, our role is indeed delicate. Sensitisation and advocacy skills are perhaps more important than technical know-how. The strategy that is to follow a comprehensive diagnosis of the problem(s) at hand can either a) first, define a set of specific activities directed to address and remove or minimise the effect of micro determinants (the classical approach) followed by an estimate of the potential of such a package of interventions to solve or address the major problems of hunger and malnutrition, or, b) alternatively, invert this sequence).
So that anybody can understand these links, a list of the key macro-causes should be identified with beneficiaries (claim holders), and a summary made of why and how each one of them contributes to the persistence of undernutrition and hunger; a list of possible interventions should then be prepared also with beneficiaries’ participation. Through a process of ensuing social mobilisation, the list will become the basis for demanding the removal of some of the structural constraints that are ultimately determining the state of chronic hunger in identified sectors of the population.
Why populations are impoverished
Countries that are poor, and poor regions and communities within any country, are impoverished through similar pathways. Consider the following 20 macro-causes of undernutrition and hunger:
• Low percentage of national income going to the lowest 20 percent of the population (income maldistribution);
• Land maldistribution;
• High percentage of landless agricultural labourers;
• Rural unemployment;
• Urban migration;
• Urban unemployment;
• Low minimum wage policies not in tune with the cost of a minimum food basket and not following food price inflation;
• Low farm-gate prices for food crops as opposed to their urban retail prices;
• Marketing boards' of agricultural commodities exploitative practices towards small farmers;
• Low percentage of foreign export earnings reinvested in agriculture;
• Food import policies (or food aid) in contradiction with national efforts to increase local food production;
• The share of agriculture in the national GDP slipping in favour of other sectors of the economy;
• Credit bias towards the modern agricultural sector as opposed to the traditional agricultural sector;
• Lack of agricultural input subsidisation for small farmers, especially for food crops;
• Foreign aid not reaching the neediest;
• Women left outside development programmes with little incentives to incorporate them in the money economy;
• Little emphasis and scanty budgets for genuine community development and rural cooperatives;
• Low primary school enrolment rates especially for girls;
• Feeble efforts to increase adult literacy, especially for women; and
• Scanty budgets for preventive health services.
Undernutrition and hunger is indeed a social disease! It cannot be eradicated by medical interventions, not even if these are comprehensive. Nor can it be eradicated by a combination of medical and agricultural interventions.
Redistribution of resources and wealth, and the consequent increase in purchasing power of the needy majority, are necessary to reduce undernutrition and hunger. But not even these are sufficient. Poverty has many masks, such as cultural and educational deprivation, poor health, and inadequate sanitation and housing, each with its own features. We should not think that improvement of the features of such masks will have any lasting effect. The real face of poverty is socioeconomic deprivation and gross power imbalances in society.
How far can we go?
Many among us have divided the remedial actions finally proposed into two groups: ‘recommendations’ and ‘interventions’. Recommendations often concern macro-causes and the need to change or remove them; they are usually worded in very vague, general terms and have no specific implementation budgets or deadlines set aside. Interventions often concern micro-causes, are prepared in more detail, have a fixed implementation deadline, and usually have budgets.
How outspoken are we prepared to be in proposing corrective measures directed to the macro-causes? This will depend on the political environment in which each of us works. Political and professional risks are usually high (2). Many colleagues feel that their positions in academe, government, or international or private organisations might be jeopardised if they demand radical solutions. They take a ‘survivor's’ attitude. This is disturbing.
We need to stop thinking that we cannot contribute much to the selection and implementation of non-nutritional interventions that are outside our immediate field of expertise.
Raising consciousness
Macro-causes can be exposed in a number of ways. Not all of these need to be dramatic or sensationalistic. For example, the possible interventions that flow from the analysis of macro-causes could be listed under a soft yet realistic title, such as: ‘Conditions under which interventions addressing the more immediate determinants of malnutrition will have a better chance of having an impact’ (3).
This should be followed by an estimate of the realistic potential of each macro- intervention to ameliorate undernutrition and hunger. This should include, and be based on, the demands that mobilised groups of claim holders will place in front of authorities. This kind of presentation is meant to show that, if macro-causes are removed or minimised, interventions that follow, geared towards removing micro-causes, are more likely to have a real and lasting impact.
Political and ideological constraints, as well as the attitude and commitment of decision-makers towards eradicating hunger, will determine how far any planning team can go. Beware though that such constraints can be overcome; social mobilization is the key that unlocks the Gordian knot.
The main problem with taking a ‘macro’ approach, is that it will look ‘too politically radical’ to the governments addressed. If so, they are probably not genuinely interested in solving the problems at hand. We often underestimate this. Sometimes it is hard to tell, given the lip service governments pay to their commitments.
Analyses of the type summarised here hopefully have an educational value, especially if they are documented with some hard evidence about issues that politicians and decision makers already know well, but choose to ignore.
We tend to assume that decision makers are rational and righteous, and will accept hard scientific evidence and react to outrageous injustice. Such assumptions are usually mistaken.
Colleagues who participate in the planning process may gain a new consciousness as a consequence of using this approach. This alone makes the effort worthwhile.
References
1 Makhoul N. Agricultural Research and Human Nutrition: A Comparative Analysis of Brazil. Cuba, Israel and the US. International Journal of Health Services 1983, 13, 1:15-24
2 Chossudowsky W. The Neoliberal model and the mechanisms of economic repression. Coexistence 1975, 12, 1
3 Schuftan C et al. Recommended national food and nutrition plan for Liberia. Mimeo. Interministerial technical committee on food and nutrition planning. Monrovia, 1982).

SO WHAT...
SO MANY WORDS AND
WHERE IS THE ACTION...

After reading an exceptionally long list of emails I have just received, I fell into a pessimistic mood. I was thinking of roads paved with good intentions. This is what came out:

1 So we organise, expose, rationalise, denounce, analyse, network, liberalise, accuse, mobilise, study, decentralise, communicate, prioritise, implement, point a finger at, develop, monitor, evaluate, (reanalyse), measure, research, publish, present, advocate, persuade, correspond, orient, contribute to a list server, meet, declare, assess, legislate, decree, (reorganise), define, negotiate, devolve, fund, train, invest, capacitate, (reorient), build, seek answers in the internet, strengthen, deliver services, educate, give credit to, (redefine), provide literacy, procrastinate, lose our temper, despair, dismiss, reform, impose conditionalities, ...or throw money at...

2 And then do all the above some more...

3 But what does this really do to stop the relentless march towards pauperisation, polarisation, violations, globalisation, desperation, exploitation, conglomerisation, monopolisation, transnationalisation, 'IMFisation', depreciation, masculinisation, centralisation, global speculation, devaluation, degradation, privatisation, depletion, erosion, deforestation, malnutrition, corruption, unfair competition, pollution, domination, oppression, repression, growing gaps, fundamentalism, authoritarian regimes, mergers, ill-health, disempowerment, growing inequities, free market excesses and abuses, maldevelopment, social unrest, trade imbalances, displacements, refugees, tribalism, and nepotism ?

4 So what? Who are we really failing, serving, fooling, satisfying, helping, cheating, speaking for, representing, defending, misleading, pleasing, empowering, condoning, letting get away with, supporting (by design and by default)?

Does anybody out there care to add to this list... or make it rhyme... or help me out of this terrible mood? Where has the big picture gone? And what are we doing about it?

The Causes of Hunger and Malnutrition: Macro and Micro Determinants.

2011-03-28T03:39:00.000-07:00

Claudio Schuftan
cschuftan@phmovement.org

How can we identify and act upon the major causes of hunger and malnutrition? Here I will review the principal characteristics of these determinants, and explore how we can convince others (peers, beneficiaries, and decision-makers) of the implications for action that the profound understanding of these causes has, especially in terms of our attitude towards them as committed professionals active in different contexts.

This examination looks at malnutrition (undernutrition) as the biological translation of a social disease with historical roots; therefore, all basic determinants of the social and economic conditions that lead to the malnutrition of certain sectors of the population will, for easier understanding, here be considered macro determinants. The more immediate and underlying causes responsible for malnutrition will here be called micro determinants.
Macro and micro causes of malnutrition

Macro determinants of hunger and malnutrition are conditioned by the overall policies that govern national economics (both internally and in foreign relations and trade). In a way, macro determinants are more ‘indirectly’ related to malnutrition; they are always related to international, national, and village level constraints. Together with many others, I contend that macro causes explain most malnutrition in societies with capitalist modes of production. Malnutrition, or actually nutritional vulnerability, is a manifestation of a society's inability to allow its poor populations to earn their livelihoods adequately and is neither a manifestation of modern medicine leading to overpopulated societies nor the result of agricultural production being insufficient. (One can actually ask oneself whether underdeveloped countries struggling for their own livelihood, oddly, produce to better the livelihood of other countries...). (1)
Macro causes usually relate to the major social contradictions in a given society, especially in rural areas. Macro causes are responsible for a myriad of constraints to meaningful changes.
If one were to characterize macro determinants negatively, one would say that they correspond to those causes of malnutrition that are not removed or even touched-by the vast majority of traditional nutrition intervention programs. (A good example is nutrition surveillance). Since technology cannot achieve the fundamental structural changes needed to end hunger and malnutrition, in the long run, the fight against hunger and malnutrition thus has to become more of an eminently political struggle and not a technical one.
Removal of a few (or even one) of the main macro causes is more likely to alleviate malnutrition than acting on many micro determinants simultaneously. Nowadays, macro determinants are very frequently mentioned and identified by planners analyzing specific situations, but the plans they then devise seldom attack these determinants frontally.
Micro determinants more directly impinge on the physiological condition of malnutrition. Among other, they include health, environmental, and educational determinants; these are the ones most frequently identified and selected for direct intervention by Northern planning approaches. They largely emphasize technical approaches and have justified the need for Northern-trained experts who often come with ready-made analyses…and ‘packages’. The recent Lancet series can be said to, in good part, fall under this characterisation, I would say.
Every expert brings his own view and values of development, and their suggestions for nutrition programs will reflect that ideology.
Taken together, any attack on micro determinants only leads to a package of solutions or interventions that pretend to be apolitical and free of ideological connotations or influence. However, despite the fact that the spectrum of choices is a continuum, in the final analysis, one either bows to the system or objects to it, totally or partially. Any of these are political stances.
As nutritionists, we keep inventing new ‘more comprehensive’ or ‘multisectoral or ‘evidence-based’ approaches to old problems as if these would change the major contradictions and the distribution of power within the system that is causing the problems of malnutrition to begin with.
Diagnosing the causes of hunger and malnutrition

It should be clear that we cannot agree on the content of needed nutrition interventions if we do not share the same understanding of why people are poor and malnourished. Different socioeconomic contexts call for different nutrition plans. This does not imply that only macro causes should be identified and acted upon. An appropriate understanding of hunger and malnutrition will include consideration of and action upon a mix of macro and micro determinants.
The challenge for us is to determine, in each national (or regional) context, how much and what kind of macro changes are necessary for the micro changes to have some prospect for success. The connections between macro and micro causes must be made explicit so as to justify the needed macro changes. This unequivocally means that any plan or program geared to ameliorating malnutrition as a public health and social problem will have to include a mix of interventions designed to affect change in both macro and micro determinants. For example, technical measures in themselves are not tools for income redistribution, but they may have a partial redistribution impact as a side-effect --assuming that they reach the lowest income and marginalized groups, which is a big if.
In this context, our role is beyond doubt a delicate one. Sensitization and advocacy skills are perhaps more important than technical know-how. The type of strategy or plan that should follow a comprehensive diagnosis using the conceptual framework should be geared, first, to defining a set of specific activities directed to address and remove or minimize the effect of micro determinants, a classical approach, followed by an estimation of the potential of such a package of interventions to solve or address the major basic causes of hunger and malnutrition…or vice-versa?
A list of the key macro causes should be identified and a brief analysis made of why and how each one of them contributes to the persistence of malnutrition, so that anybody can understand these links. A list of possible interventions should be prepared with beneficiaries’ de-facto participation. Engaging then in social mobilization, the list will aim at removing some of the structural bottlenecks or constraints that are ultimately determining a state of chronic hunger in defined sectors of the population. (The human rights-based approach reviewed in my column last month works on details to this end).
The similarities between poor countries being many, the following are some examples of national-level manifestations of macro causes:
• low percentage of national income received by the lowest 20 percent of the population (income maldistribution);
• land maldistribution;
• high percentage of landless agricultural laborers;
• rural unemployment;
• urban migration and urban unemployment;
• low minimum wage policies in all sectors of the economy, not in tune with the cost of a minimum food basket and not following food price inflation;
• low farm-gate prices for food crops as opposed to their urban retail prices;
• marketing boards' exploitative practices towards small farmers;
• imbalance between cash and food crops (as relates to land allocation and incentives);
• low percentage of foreign export earnings reinvested in agriculture;
• food import policies contradictory to national efforts to increase local food production;
• the share of agriculture in the national GDP slipping in favor of other sectors of the economy;
• credit bias towards the modern agricultural sector as opposed to the traditional, small farmers agricultural sector;
• lack of agricultural input subsidization for small farmers, especially for food crops;
• foreign aid not reaching the neediest;
• women left outside development programmes with little incentive to incorporate them in the money economy;
• little emphasis on the scanty budgets for genuine community development and rural cooperatives;
• low primary school enrolment rates especially for girls;
• feeble efforts to increase adult literacy, especially for women; and
• scanty budgets for preventive health services.
Proposing solutions
Malnutrition as a social disease cannot be cured through medical interventions (not even in a wide and comprehensive health package) nor can it be cured through the latter plus a package of agricultural interventions.

Redistribution of resources and the consequent increase in purchasing power of the marginalized majority is a necessary, though not sufficient, solution to the problem of hunger. Poverty wears many other masks (e.g., cultural and educational deprivation, poor health, inadequate sanitation and housing), and each mask has its own features. We should not be tempted, through a lack of perspective, to try to improve only the features of the masks, without doing anything about the real face of poverty, which is socioeconomic deprivation and gross power imbalances in society.
I feel that many among us have divided the remedial actions they finally propose into two groups: recommendations and interventions. The former, which often concern macro determinants and the need to change or remove them, are worded in very vague, general terms and have no specific implementation budget set aside; the latter, which often concern micro determinants, are prepared in more detail, have a fixed implementation deadline, and are usually budgeted for. (In the logical framework of projects, recommendations are often worded or hidden as risks, i.e. saying we assume the government will do such and such for our project to really succeed; those are very often macro issues).
The outspokenness with which we state the need for corrective measures directed to the macro determinants will depend on the political environment in which each of us works. Political and professional risks are usually high (2), and many colleagues feel that their positions in academe, government, or international or private organizations might be jeopardized if they demand radical solutions. They take a ‘survivor's attitude’ --and this is disturbing.
We simply need to stop thinking that we cannot contribute much to the selection and implementation of non-nutritional interventions that are outside our immediate field of expertise and DO impinge on nutrition.
Macro determinants can be exposed in a number of ways, not all of which are dramatic or sensationalistic. For example, the possible interventions that flow from the analysis of the macro determinants could be listed under a title that could read something like. "Conditions under which Interventions Addressing the Immediate and Underlying Causes of Malnutrition Will Have a Better Chance of Having an Impact." (3) This should be followed by a subjective estimate of the realistic potential of each macro intervention to ameliorate malnutrition –including, and based-on, the de-facto demands that mobilized groups of beneficiaries will place in front of authorities. (The human rights-based approach reviewed in my column last month works on details to this end as well). The idea is to contrast the potential of the latter with the potential a package of micro interventions to achieve the same or similar goals has. In other words, what this kind of a presentation tries to emphasize is that:
If macro determinants are removed (or minimized) interventions that follow such removal and that are geared towards removing micro determinants stand a much better chance of having a real and lasting impact.
Political and ideological constraints, as well as the attitude and commitment of decision-makers towards eradicating hunger will determine how far the planning team can go in this.
The major problem with this approach is that it will look ‘too politically radical’ to the powers that be. If this is the case, then the particular governments are most probably not genuinely interested in solving the problems at hand --and I think we too often underestimate this. But this may be difficult to determine, given the frequency with which governments pay just lip service to their commitments.
At the very least, a presentation such as the one proposed here has an educational value, especially if it is documented with some hard evidence --surely including things that politicians and decision makers have probably known all along...
We sometimes wrongly assume that decisions makers are rational, righteous, and pious and will accept hard scientific evidence or react to outrageous injustice.
Colleagues who participate in the planning process may gain a new consciousness as a consequence of using this approach, a fact that is of value per-se and that makes the effort worthwhile.
The role of ideology (4)(5)
Nutrition seems to be as good an entry point as any other (education, energy, natural resources, climate, the environment, etc.) for getting involved in questions of equity in our societies.
Nutrition can lead to global considerations if it is not seen as an isolated issue.

Malnutrition should not be attacked on grounds of utility, but because such an attack is morally necessary. What we need to fight for is equity, not utility. Poverty should not be seen as an inevitable evil, but as a basic injustice to be corrected. In that sense, poverty is to be considered more as a relative rather than an absolute condition.
The ideology and outlook on world affairs of the individual searching for the determinants of hunger and malnutrition (largely determined by social class extraction) play a vital role in the selection of the contents of the final in-depth analysis used (one seems to see only what one wants to see). Once a certain level of consciousness is attained, an action-oriented attitude usually follows. At this point, there is a convergence of ideology and action that makes the difference between taking an observer's as opposed to a protagonist's role. Knowing about injustice does not move many of us: becoming conscious about it generates a creative anger that calls for involvement in corrective actions. The latter can only happen within the framework of an ideology consciously acquired. In the context of nutrition, then, ideology carries the additional connotation of commitment, both emotional and intellectual, as well as being action-oriented.
Ideology is not simply a body of ideas determining goals; it also includes the instruments, strategies, and tactics to be used in planning for economic and social change. (6)
Objectivity in the analytical stages of the planning process is nothing but a myth, and since the solutions proposed will heavily depend on the final diagnosis of the causes identified, there is no assurance that by following the procedures described above for the identification of macro and micro determinants, one will end up with a better, more comprehensive plan to ameliorate hunger and malnutrition in any specific situation. The implications of this, center at least around two issues:
i. Will the outlook for eliminating hunger and malnutrition in the world be any better without a concomitant process of political maturation of the people involved in nutrition work?
ii. Would more efforts towards demonstrating the futility of ongoing food and nutrition programmes mark the beginning of a new, more aggressive approach?

The possible answers to these two questions are again ideologically charged.
In trying to solve the problem of malnutrition, intra-professional responsibility should not be neglected. This responsibility has to be taken up starting with a process that critically analyzes our professional affairs and goals with their inherent contradictions. Basically, nutritionists should be searching for a new ethos, a professional, political ethos. The sense of responsibility found in many scientists does not seem to be sufficient to see necessary changes occur; it leads nowhere. It may solve the conscience problems of the person who devotes time and effort to doing ‘something’ to solve, malnutrition. However, it seems to have little effect on the real problems of poor people and the malnourished.
An isolated emotional commitment is loose and romantic; ideological commitment is militant. The concept of being socially responsible is nothing but a euphemism for what really should be called political responsibility. Political commitment is important precisely because governments function as political entities. (7)
Political forces are fought with political actions, not with morals, or with technological fixes.
It is precisely a misunderstanding of reality (or a partial understanding of it) that often reinforces the amoral position of some colleagues --or some of them may not really want to understand; they have, all too often and for all the wrong reasons, already made up their minds about one reality, thus often searching for the statistical ‘whats’ instead of analyzing the ‘whys’. (8)
Used as a technical tool, nutrition science offers no real solution, no matter how much new coordination between different sectors (e.g., health, agriculture, education) it succeeds in setting up at any or at all levels. To continue pushing such technical tools is to perpetuate the problems. In the vast majority of cases, it will mean a waste of scarce resources and of precious time.
Critically speaking, nutrition science will continue to offer us no more than a good diagnostic tool, a not-so-good framework to consider alternative intervention strategies…and a basis to validate ideologically charged policy decisions.
Working with the community
If little can be expected from nutrition programmes pushed from the central level, then community-level (grassroots) organization around food and nutrition issues may be the more viable answer in the long run.
Popular participation and mobilization is absolutely key to success in nutrition work but, as nutritionists, we have persistently disregarded this central issue --or have only tinkered with participatory approaches. What is needed is more dedication to working directly with those who happen to be poor and/or discriminated so they can tackle the causes of their poverty and malnutrition themselves. This calls for us to go, as much as possible, back to field work and out of our offices or laboratories. Only there can the strengths needed for a change in direction and perspective be found.
Nutritionists need to learn from the people and from their perceptions of the problems, establish links with local mass movements and participate in their consciousness raising.
The participation of the affected population begins with creating awareness that they have a problem --and that their right to nutrition is being violated. This, to be followed by ample discussion about what can be done about it. Here, the outsider's role is to ask the right questions and not to point at what s/he thinks is wrong.
It is only through praxis that political consciousness can be strengthened, and it is only when people are convinced that change is in fact beginning to take place that they will listen and learn the more abstract concepts we use; the same must fit into their experience. (9) In our work with the community, we have to pass from a mutually shared analysis and understanding of the local micro determinants of malnutrition, which should be more easily identifiable and perceived by the community at the beginning, to the analysis and understanding of the local and then national and global macro determinants of that (their) condition.
For the latter to be possible, the community will probably have to go through a slow process of political maturation before effectively gaining consciousness of the role of the social and economic constraints that determine malnutrition in their milieu. People have to become aware of their problems in a specific context first and then in an ideological one. The exposure to them of the basic macro constraints should, in the first instance, lead to generating social commitment to effecting the needed structural changes.
It is important to demonstrate to the community that it is in their power to change not only the physical reality that surrounds them but the social reality as well. (10)
There are three levels of possible involvement in fieldwork. (11) At the first level, one solicits the participation of the community in a given project. (Participation has turned out to be harmless for the vested interests and is, therefore, a regular appendage of every government project these days). A second level calls for outright consciousness raising among the population. At the third level, an effort is made towards the mobilization of the masses and the effective empowering of the poor.
Because village problems are often not a priority for governments, local felt needs have to be converted into concrete issues so that a course of action to address them can be mapped out. This may involve developing functional knowledge about people's rights, or challenging public agencies, landlords or other powerful people or institutions by filing specific demands or claims. A new type of community-oriented nutritionist is needed for this Herculean task: one that plans with people to get organized to work together in solving the problems.
We need to move in the direction of training nutritionists as trainers of others so that their own community-oriented experiences can be reproduced at many levels in each country. The shortcomings of this approach are many, not the least of which is the fact that it is a very slow process, based on mutual trust in each community and that its replicability is also very slow even in the best of cases. The dangers, of course, are also significant, especially when the government is hostile to community mobilization.
The question that still remains at the end of this discussion is whether this approach is realistic or not. If it is not, let us keep in mind that not being realistic is a judgment that history can change: what might sound unrealistic today can very well become true tomorrow, if we work for it with decision.

The Causes of Hunger and Malnutrition: Macro and Micro Determinants.

2011-03-28T03:36:00.000-07:00

How can we identify and act upon the major causes of hunger and malnutrition? Here I will review the principal characteristics of these determinants, and explore how we can convince others (peers, beneficiaries, and decision-makers) of the implications for action that the profound understanding of these causes has, especially in terms of our attitude towards them as committed professionals active in different contexts.

This examination looks at malnutrition (undernutrition) as the biological translation of a social disease with historical roots; therefore, all basic determinants of the social and economic conditions that lead to the malnutrition of certain sectors of the population will, for easier understanding, here be considered macro determinants. The more immediate and underlying causes responsible for malnutrition will here be called micro determinants.
Macro and micro causes of malnutrition

Macro determinants of hunger and malnutrition are conditioned by the overall policies that govern national economics (both internally and in foreign relations and trade). In a way, macro determinants are more ‘indirectly’ related to malnutrition; they are always related to international, national, and village level constraints. Together with many others, I contend that macro causes explain most malnutrition in societies with capitalist modes of production. Malnutrition, or actually nutritional vulnerability, is a manifestation of a society's inability to allow its poor populations to earn their livelihoods adequately and is neither a manifestation of modern medicine leading to overpopulated societies nor the result of agricultural production being insufficient. (One can actually ask oneself whether underdeveloped countries struggling for their own livelihood, oddly, produce to better the livelihood of other countries...). (1)
Macro causes usually relate to the major social contradictions in a given society, especially in rural areas. Macro causes are responsible for a myriad of constraints to meaningful changes.
If one were to characterize macro determinants negatively, one would say that they correspond to those causes of malnutrition that are not removed or even touched-by the vast majority of traditional nutrition intervention programs. (A good example is nutrition surveillance). Since technology cannot achieve the fundamental structural changes needed to end hunger and malnutrition, in the long run, the fight against hunger and malnutrition thus has to become more of an eminently political struggle and not a technical one.
Removal of a few (or even one) of the main macro causes is more likely to alleviate malnutrition than acting on many micro determinants simultaneously. Nowadays, macro determinants are very frequently mentioned and identified by planners analyzing specific situations, but the plans they then devise seldom attack these determinants frontally.
Micro determinants more directly impinge on the physiological condition of malnutrition. Among other, they include health, environmental, and educational determinants; these are the ones most frequently identified and selected for direct intervention by Northern planning approaches. They largely emphasize technical approaches and have justified the need for Northern-trained experts who often come with ready-made analyses…and ‘packages’. The recent Lancet series can be said to, in good part, fall under this characterisation, I would say.
Every expert brings his own view and values of development, and their suggestions for nutrition programs will reflect that ideology.
Taken together, any attack on micro determinants only leads to a package of solutions or interventions that pretend to be apolitical and free of ideological connotations or influence. However, despite the fact that the spectrum of choices is a continuum, in the final analysis, one either bows to the system or objects to it, totally or partially. Any of these are political stances.
As nutritionists, we keep inventing new ‘more comprehensive’ or ‘multisectoral or ‘evidence-based’ approaches to old problems as if these would change the major contradictions and the distribution of power within the system that is causing the problems of malnutrition to begin with.
Diagnosing the causes of hunger and malnutrition

It should be clear that we cannot agree on the content of needed nutrition interventions if we do not share the same understanding of why people are poor and malnourished. Different socioeconomic contexts call for different nutrition plans. This does not imply that only macro causes should be identified and acted upon. An appropriate understanding of hunger and malnutrition will include consideration of and action upon a mix of macro and micro determinants.
The challenge for us is to determine, in each national (or regional) context, how much and what kind of macro changes are necessary for the micro changes to have some prospect for success. The connections between macro and micro causes must be made explicit so as to justify the needed macro changes. This unequivocally means that any plan or program geared to ameliorating malnutrition as a public health and social problem will have to include a mix of interventions designed to affect change in both macro and micro determinants. For example, technical measures in themselves are not tools for income redistribution, but they may have a partial redistribution impact as a side-effect --assuming that they reach the lowest income and marginalized groups, which is a big if.
In this context, our role is beyond doubt a delicate one. Sensitization and advocacy skills are perhaps more important than technical know-how. The type of strategy or plan that should follow a comprehensive diagnosis using the conceptual framework should be geared, first, to defining a set of specific activities directed to address and remove or minimize the effect of micro determinants, a classical approach, followed by an estimation of the potential of such a package of interventions to solve or address the major basic causes of hunger and malnutrition…or vice-versa?
A list of the key macro causes should be identified and a brief analysis made of why and how each one of them contributes to the persistence of malnutrition, so that anybody can understand these links. A list of possible interventions should be prepared with beneficiaries’ de-facto participation. Engaging then in social mobilization, the list will aim at removing some of the structural bottlenecks or constraints that are ultimately determining a state of chronic hunger in defined sectors of the population. (The human rights-based approach reviewed in my column last month works on details to this end).
The similarities between poor countries being many, the following are some examples of national-level manifestations of macro causes:
• low percentage of national income received by the lowest 20 percent of the population (income maldistribution);
• land maldistribution;
• high percentage of landless agricultural laborers;
• rural unemployment;
• urban migration and urban unemployment;
• low minimum wage policies in all sectors of the economy, not in tune with the cost of a minimum food basket and not following food price inflation;
• low farm-gate prices for food crops as opposed to their urban retail prices;
• marketing boards' exploitative practices towards small farmers;
• imbalance between cash and food crops (as relates to land allocation and incentives);
• low percentage of foreign export earnings reinvested in agriculture;
• food import policies contradictory to national efforts to increase local food production;
• the share of agriculture in the national GDP slipping in favor of other sectors of the economy;
• credit bias towards the modern agricultural sector as opposed to the traditional, small farmers agricultural sector;
• lack of agricultural input subsidization for small farmers, especially for food crops;
• foreign aid not reaching the neediest;
• women left outside development programmes with little incentive to incorporate them in the money economy;
• little emphasis on the scanty budgets for genuine community development and rural cooperatives;
• low primary school enrolment rates especially for girls;
• feeble efforts to increase adult literacy, especially for women; and
• scanty budgets for preventive health services.
Proposing solutions
Malnutrition as a social disease cannot be cured through medical interventions (not even in a wide and comprehensive health package) nor can it be cured through the latter plus a package of agricultural interventions.

Redistribution of resources and the consequent increase in purchasing power of the marginalized majority is a necessary, though not sufficient, solution to the problem of hunger. Poverty wears many other masks (e.g., cultural and educational deprivation, poor health, inadequate sanitation and housing), and each mask has its own features. We should not be tempted, through a lack of perspective, to try to improve only the features of the masks, without doing anything about the real face of poverty, which is socioeconomic deprivation and gross power imbalances in society.
I feel that many among us have divided the remedial actions they finally propose into two groups: recommendations and interventions. The former, which often concern macro determinants and the need to change or remove them, are worded in very vague, general terms and have no specific implementation budget set aside; the latter, which often concern micro determinants, are prepared in more detail, have a fixed implementation deadline, and are usually budgeted for. (In the logical framework of projects, recommendations are often worded or hidden as risks, i.e. saying we assume the government will do such and such for our project to really succeed; those are very often macro issues).
The outspokenness with which we state the need for corrective measures directed to the macro determinants will depend on the political environment in which each of us works. Political and professional risks are usually high (2), and many colleagues feel that their positions in academe, government, or international or private organizations might be jeopardized if they demand radical solutions. They take a ‘survivor's attitude’ --and this is disturbing.
We simply need to stop thinking that we cannot contribute much to the selection and implementation of non-nutritional interventions that are outside our immediate field of expertise and DO impinge on nutrition.
Macro determinants can be exposed in a number of ways, not all of which are dramatic or sensationalistic. For example, the possible interventions that flow from the analysis of the macro determinants could be listed under a title that could read something like. "Conditions under which Interventions Addressing the Immediate and Underlying Causes of Malnutrition Will Have a Better Chance of Having an Impact." (3) This should be followed by a subjective estimate of the realistic potential of each macro intervention to ameliorate malnutrition –including, and based-on, the de-facto demands that mobilized groups of beneficiaries will place in front of authorities. (The human rights-based approach reviewed in my column last month works on details to this end as well). The idea is to contrast the potential of the latter with the potential a package of micro interventions to achieve the same or similar goals has. In other words, what this kind of a presentation tries to emphasize is that:
If macro determinants are removed (or minimized) interventions that follow such removal and that are geared towards removing micro determinants stand a much better chance of having a real and lasting impact.
Political and ideological constraints, as well as the attitude and commitment of decision-makers towards eradicating hunger will determine how far the planning team can go in this.
The major problem with this approach is that it will look ‘too politically radical’ to the powers that be. If this is the case, then the particular governments are most probably not genuinely interested in solving the problems at hand --and I think we too often underestimate this. But this may be difficult to determine, given the frequency with which governments pay just lip service to their commitments.
At the very least, a presentation such as the one proposed here has an educational value, especially if it is documented with some hard evidence --surely including things that politicians and decision makers have probably known all along...
We sometimes wrongly assume that decisions makers are rational, righteous, and pious and will accept hard scientific evidence or react to outrageous injustice.
Colleagues who participate in the planning process may gain a new consciousness as a consequence of using this approach, a fact that is of value per-se and that makes the effort worthwhile.
The role of ideology (4)(5)
Nutrition seems to be as good an entry point as any other (education, energy, natural resources, climate, the environment, etc.) for getting involved in questions of equity in our societies.
Nutrition can lead to global considerations if it is not seen as an isolated issue.

Malnutrition should not be attacked on grounds of utility, but because such an attack is morally necessary. What we need to fight for is equity, not utility. Poverty should not be seen as an inevitable evil, but as a basic injustice to be corrected. In that sense, poverty is to be considered more as a relative rather than an absolute condition.
The ideology and outlook on world affairs of the individual searching for the determinants of hunger and malnutrition (largely determined by social class extraction) play a vital role in the selection of the contents of the final in-depth analysis used (one seems to see only what one wants to see). Once a certain level of consciousness is attained, an action-oriented attitude usually follows. At this point, there is a convergence of ideology and action that makes the difference between taking an observer's as opposed to a protagonist's role. Knowing about injustice does not move many of us: becoming conscious about it generates a creative anger that calls for involvement in corrective actions. The latter can only happen within the framework of an ideology consciously acquired. In the context of nutrition, then, ideology carries the additional connotation of commitment, both emotional and intellectual, as well as being action-oriented.
Ideology is not simply a body of ideas determining goals; it also includes the instruments, strategies, and tactics to be used in planning for economic and social change. (6)
Objectivity in the analytical stages of the planning process is nothing but a myth, and since the solutions proposed will heavily depend on the final diagnosis of the causes identified, there is no assurance that by following the procedures described above for the identification of macro and micro determinants, one will end up with a better, more comprehensive plan to ameliorate hunger and malnutrition in any specific situation. The implications of this, center at least around two issues:
i. Will the outlook for eliminating hunger and malnutrition in the world be any better without a concomitant process of political maturation of the people involved in nutrition work?
ii. Would more efforts towards demonstrating the futility of ongoing food and nutrition programmes mark the beginning of a new, more aggressive approach?

The possible answers to these two questions are again ideologically charged.
In trying to solve the problem of malnutrition, intra-professional responsibility should not be neglected. This responsibility has to be taken up starting with a process that critically analyzes our professional affairs and goals with their inherent contradictions. Basically, nutritionists should be searching for a new ethos, a professional, political ethos. The sense of responsibility found in many scientists does not seem to be sufficient to see necessary changes occur; it leads nowhere. It may solve the conscience problems of the person who devotes time and effort to doing ‘something’ to solve, malnutrition. However, it seems to have little effect on the real problems of poor people and the malnourished.
An isolated emotional commitment is loose and romantic; ideological commitment is militant. The concept of being socially responsible is nothing but a euphemism for what really should be called political responsibility. Political commitment is important precisely because governments function as political entities. (7)
Political forces are fought with political actions, not with morals, or with technological fixes.
It is precisely a misunderstanding of reality (or a partial understanding of it) that often reinforces the amoral position of some colleagues --or some of them may not really want to understand; they have, all too often and for all the wrong reasons, already made up their minds about one reality, thus often searching for the statistical ‘whats’ instead of analyzing the ‘whys’. (8)
Used as a technical tool, nutrition science offers no real solution, no matter how much new coordination between different sectors (e.g., health, agriculture, education) it succeeds in setting up at any or at all levels. To continue pushing such technical tools is to perpetuate the problems. In the vast majority of cases, it will mean a waste of scarce resources and of precious time.
Critically speaking, nutrition science will continue to offer us no more than a good diagnostic tool, a not-so-good framework to consider alternative intervention strategies…and a basis to validate ideologically charged policy decisions.
Working with the community
If little can be expected from nutrition programmes pushed from the central level, then community-level (grassroots) organization around food and nutrition issues may be the more viable answer in the long run.
Popular participation and mobilization is absolutely key to success in nutrition work but, as nutritionists, we have persistently disregarded this central issue --or have only tinkered with participatory approaches. What is needed is more dedication to working directly with those who happen to be poor and/or discriminated so they can tackle the causes of their poverty and malnutrition themselves. This calls for us to go, as much as possible, back to field work and out of our offices or laboratories. Only there can the strengths needed for a change in direction and perspective be found.
Nutritionists need to learn from the people and from their perceptions of the problems, establish links with local mass movements and participate in their consciousness raising.
The participation of the affected population begins with creating awareness that they have a problem --and that their right to nutrition is being violated. This, to be followed by ample discussion about what can be done about it. Here, the outsider's role is to ask the right questions and not to point at what s/he thinks is wrong.
It is only through praxis that political consciousness can be strengthened, and it is only when people are convinced that change is in fact beginning to take place that they will listen and learn the more abstract concepts we use; the same must fit into their experience. (9) In our work with the community, we have to pass from a mutually shared analysis and understanding of the local micro determinants of malnutrition, which should be more easily identifiable and perceived by the community at the beginning, to the analysis and understanding of the local and then national and global macro determinants of that (their) condition.
For the latter to be possible, the community will probably have to go through a slow process of political maturation before effectively gaining consciousness of the role of the social and economic constraints that determine malnutrition in their milieu. People have to become aware of their problems in a specific context first and then in an ideological one. The exposure to them of the basic macro constraints should, in the first instance, lead to generating social commitment to effecting the needed structural changes.
It is important to demonstrate to the community that it is in their power to change not only the physical reality that surrounds them but the social reality as well. (10)
There are three levels of possible involvement in fieldwork. (11) At the first level, one solicits the participation of the community in a given project. (Participation has turned out to be harmless for the vested interests and is, therefore, a regular appendage of every government project these days). A second level calls for outright consciousness raising among the population. At the third level, an effort is made towards the mobilization of the masses and the effective empowering of the poor.
Because village problems are often not a priority for governments, local felt needs have to be converted into concrete issues so that a course of action to address them can be mapped out. This may involve developing functional knowledge about people's rights, or challenging public agencies, landlords or other powerful people or institutions by filing specific demands or claims. A new type of community-oriented nutritionist is needed for this Herculean task: one that plans with people to get organized to work together in solving the problems.
We need to move in the direction of training nutritionists as trainers of others so that their own community-oriented experiences can be reproduced at many levels in each country. The shortcomings of this approach are many, not the least of which is the fact that it is a very slow process, based on mutual trust in each community and that its replicability is also very slow even in the best of cases. The dangers, of course, are also significant, especially when the government is hostile to community mobilization.
The question that still remains at the end of this discussion is whether this approach is realistic or not. If it is not, let us keep in mind that not being realistic is a judgment that history can change: what might sound unrealistic today can very well become true tomorrow, if we work for it with decision.

The Causes of Hunger and Malnutrition: Macro and Micro Determinants.

2011-03-28T02:31:00.000-07:00

How can we identify and act upon the major causes of hunger and malnutrition?

Here I will review the principal characteristics of these determinants, and explore how we can convince others (peers, beneficiaries, and decision-makers) of the implications for action that the profound understanding of these causes has, especially in terms of our attitude towards them as committed professionals active in different contexts.

The Causes of Hunger and Malnutrition: Macro and Micro Determinants.

This examination looks at malnutrition (undernutrition) as the biological translation of a social disease with historical roots; therefore, all basic determinants of the social and economic conditions that lead to the malnutrition of certain sectors of the population will, for easier understanding, here be considered macro determinants. The more immediate and underlying causes responsible for malnutrition will here be called micro determinants.

Macro and micro causes of malnutrition

Macro determinants of hunger and malnutrition are conditioned by the overall policies that govern national economics (both internally and in foreign relations and trade). In a way, macro determinants are more ‘indirectly’ related to malnutrition; they are always related to international, national, and village level constraints. Together with many others, I contend that macro causes explain most malnutrition in societies with capitalist modes of production. Malnutrition, or actually nutritional vulnerability, is a manifestation of a society's inability to allow its poor populations to earn their livelihoods adequately and is neither a manifestation of modern medicine leading to overpopulated societies nor the result of agricultural production being insufficient. (One can actually ask oneself whether underdeveloped countries struggling for their own livelihood, oddly, produce to better the livelihood of other countries...). (1)

Macro causes usually relate to the major social contradictions in a given society, especially in rural areas. Macro causes are responsible for a myriad of constraints to meaningful changes.
If one were to characterize macro determinants negatively, one would say that they correspond to those causes of malnutrition that are not removed or even touched-by the vast majority of traditional nutrition intervention programs. (A good example is nutrition surveillance). Since technology cannot achieve the fundamental structural changes needed to end hunger and malnutrition, in the long run, the fight against hunger and malnutrition thus has to become more of an eminently political struggle and not a technical one.
Removal of a few (or even one) of the main macro causes is more likely to alleviate malnutrition than acting on many micro determinants simultaneously. Nowadays, macro determinants are very frequently mentioned and identified by planners analyzing specific situations, but the plans they then devise seldom attack these determinants frontally.

Micro determinants more directly impinge on the physiological condition of malnutrition. Among other, they include health, environmental, and educational determinants; these are the ones most frequently identified and selected for direct intervention by Northern planning approaches. They largely emphasize technical approaches and have justified the need for Northern-trained experts who often come with ready-made analyses…and ‘packages’. The recent Lancet series can be said to, in good part, fall under this characterisation, I would say.
Every expert brings his own view and values of development, and their suggestions for nutrition programs will reflect that ideology.

Taken together, any attack on micro determinants only leads to a package of solutions or interventions that pretend to be apolitical and free of ideological connotations or influence. However, despite the fact that the spectrum of choices is a continuum, in the final analysis, one either bows to the system or objects to it, totally or partially. Any of these are political stances.

As nutritionists, we keep inventing new ‘more comprehensive’ or ‘multisectoral or ‘evidence-based’ approaches to old problems as if these would change the major contradictions and the distribution of power within the system that is causing the problems of malnutrition to begin with.

Diagnosing the causes of hunger and malnutrition

It should be clear that we cannot agree on the content of needed nutrition interventions if we do not share the same understanding of why people are poor and malnourished. Different socioeconomic contexts call for different nutrition plans. This does not imply that only macro causes should be identified and acted upon. An appropriate understanding of hunger and malnutrition will include consideration of and action upon a mix of macro and micro determinants.

The challenge for us is to determine, in each national (or regional) context, how much and what kind of macro changes are necessary for the micro changes to have some prospect for success. The connections between macro and micro causes must be made explicit so as to justify the needed macro changes. This unequivocally means that any plan or program geared to ameliorating malnutrition as a public health and social problem will have to include a mix of interventions designed to affect change in both macro and micro determinants. For example, technical measures in themselves are not tools for income redistribution, but they may have a partial redistribution impact as a side-effect --assuming that they reach the lowest income and marginalized groups, which is a big if.

In this context, our role is beyond doubt a delicate one. Sensitization and advocacy skills are perhaps more important than technical know-how. The type of strategy or plan that should follow a comprehensive diagnosis using the conceptual framework should be geared, first, to defining a set of specific activities directed to address and remove or minimize the effect of micro determinants, a classical approach, followed by an estimation of the potential of such a package of interventions to solve or address the major basic causes of hunger and malnutrition…or vice-versa?
A list of the key macro causes should be identified and a brief analysis made of why and how each one of them contributes to the persistence of malnutrition, so that anybody can understand these links. A list of possible interventions should be prepared with beneficiaries’ de-facto participation. Engaging then in social mobilization, the list will aim at removing some of the structural bottlenecks or constraints that are ultimately determining a state of chronic hunger in defined sectors of the population. (The human rights-based approach reviewed in my column last month works on details to this end).

The similarities between poor countries being many, the following are some examples of national-level manifestations of macro causes:
• low percentage of national income received by the lowest 20 percent of the population (income maldistribution);
• land maldistribution;
• high percentage of landless agricultural laborers;
• rural unemployment;
• urban migration and urban unemployment;
• low minimum wage policies in all sectors of the economy, not in tune with the cost of a minimum food basket and not following food price inflation;
• low farm-gate prices for food crops as opposed to their urban retail prices;
• marketing boards' exploitative practices towards small farmers;
• imbalance between cash and food crops (as relates to land allocation and incentives);
• low percentage of foreign export earnings reinvested in agriculture;
• food import policies contradictory to national efforts to increase local food production;
• the share of agriculture in the national GDP slipping in favor of other sectors of the economy;
• credit bias towards the modern agricultural sector as opposed to the traditional, small farmers agricultural sector;
• lack of agricultural input subsidization for small farmers, especially for food crops;
• foreign aid not reaching the neediest;
• women left outside development programmes with little incentive to incorporate them in the money economy;
• little emphasis on the scanty budgets for genuine community development and rural cooperatives;
• low primary school enrolment rates especially for girls;
• feeble efforts to increase adult literacy, especially for women; and
• scanty budgets for preventive health services.

Proposing solutions

Malnutrition as a social disease cannot be cured through medical interventions (not even in a wide and comprehensive health package) nor can it be cured through the latter plus a package of agricultural interventions.

Redistribution of resources and the consequent increase in purchasing power of the marginalized majority is a necessary, though not sufficient, solution to the problem of hunger. Poverty wears many other masks (e.g., cultural and educational deprivation, poor health, inadequate sanitation and housing), and each mask has its own features. We should not be tempted, through a lack of perspective, to try to improve only the features of the masks, without doing anything about the real face of poverty, which is socioeconomic deprivation and gross power imbalances in society.
I feel that many among us have divided the remedial actions they finally propose into two groups: recommendations and interventions. The former, which often concern macro determinants and the need to change or remove them, are worded in very vague, general terms and have no specific implementation budget set aside; the latter, which often concern micro determinants, are prepared in more detail, have a fixed implementation deadline, and are usually budgeted for. (In the logical framework of projects, recommendations are often worded or hidden as risks, i.e. saying we assume the government will do such and such for our project to really succeed; those are very often macro issues).

The outspokenness with which we state the need for corrective measures directed to the macro determinants will depend on the political environment in which each of us works. Political and professional risks are usually high (2), and many colleagues feel that their positions in academe, government, or international or private organizations might be jeopardized if they demand radical solutions. They take a ‘survivor's attitude’ --and this is disturbing.
We simply need to stop thinking that we cannot contribute much to the selection and implementation of non-nutritional interventions that are outside our immediate field of expertise and DO impinge on nutrition.

Macro determinants can be exposed in a number of ways, not all of which are dramatic or sensationalistic. For example, the possible interventions that flow from the analysis of the macro determinants could be listed under a title that could read something like. "Conditions under which Interventions Addressing the Immediate and Underlying Causes of Malnutrition Will Have a Better Chance of Having an Impact." (3) This should be followed by a subjective estimate of the realistic potential of each macro intervention to ameliorate malnutrition –including, and based-on, the de-facto demands that mobilized groups of beneficiaries will place in front of authorities. (The human rights-based approach reviewed in my column last month works on details to this end as well). The idea is to contrast the potential of the latter with the potential a package of micro interventions to achieve the same or similar goals has. In other words, what this kind of a presentation tries to emphasize is that:

If macro determinants are removed (or minimized) interventions that follow such removal and that are geared towards removing micro determinants stand a much better chance of having a real and lasting impact.

Political and ideological constraints, as well as the attitude and commitment of decision-makers towards eradicating hunger will determine how far the planning team can go in this.

The major problem with this approach is that it will look ‘too politically radical’ to the powers that be. If this is the case, then the particular governments are most probably not genuinely interested in solving the problems at hand --and I think we too often underestimate this. But this may be difficult to determine, given the frequency with which governments pay just lip service to their commitments.

At the very least, a presentation such as the one proposed here has an educational value, especially if it is documented with some hard evidence --surely including things that politicians and decision makers have probably known all along...
We sometimes wrongly assume that decisions makers are rational, righteous, and pious and will accept hard scientific evidence or react to outrageous injustice.
Colleagues who participate in the planning process may gain a new consciousness as a consequence of using this approach, a fact that is of value per-se and that makes the effort worthwhile.

The role of ideology (4)(5)

Nutrition seems to be as good an entry point as any other (education, energy, natural resources, climate, the environment, etc.) for getting involved in questions of equity in our societies.
Nutrition can lead to global considerations if it is not seen as an isolated issue.

Malnutrition should not be attacked on grounds of utility, but because such an attack is morally necessary. What we need to fight for is equity, not utility. Poverty should not be seen as an inevitable evil, but as a basic injustice to be corrected. In that sense, poverty is to be considered more as a relative rather than an absolute condition.
The ideology and outlook on world affairs of the individual searching for the determinants of hunger and malnutrition (largely determined by social class extraction) play a vital role in the selection of the contents of the final in-depth analysis used (one seems to see only what one wants to see). Once a certain level of consciousness is attained, an action-oriented attitude usually follows. At this point, there is a convergence of ideology and action that makes the difference between taking an observer's as opposed to a protagonist's role. Knowing about injustice does not move many of us: becoming conscious about it generates a creative anger that calls for involvement in corrective actions. The latter can only happen within the framework of an ideology consciously acquired. In the context of nutrition, then, ideology carries the additional connotation of commitment, both emotional and intellectual, as well as being action-oriented.
Ideology is not simply a body of ideas determining goals; it also includes the instruments, strategies, and tactics to be used in planning for economic and social change. (6)
Objectivity in the analytical stages of the planning process is nothing but a myth, and since the solutions proposed will heavily depend on the final diagnosis of the causes identified, there is no assurance that by following the procedures described above for the identification of macro and micro determinants, one will end up with a better, more comprehensive plan to ameliorate hunger and malnutrition in any specific situation. The implications of this, center at least around two issues:
i. Will the outlook for eliminating hunger and malnutrition in the world be any better without a concomitant process of political maturation of the people involved in nutrition work?
ii. Would more efforts towards demonstrating the futility of ongoing food and nutrition programmes mark the beginning of a new, more aggressive approach?

The possible answers to these two questions are again ideologically charged.
In trying to solve the problem of malnutrition, intra-professional responsibility should not be neglected. This responsibility has to be taken up starting with a process that critically analyzes our professional affairs and goals with their inherent contradictions. Basically, nutritionists should be searching for a new ethos, a professional, political ethos. The sense of responsibility found in many scientists does not seem to be sufficient to see necessary changes occur; it leads nowhere. It may solve the conscience problems of the person who devotes time and effort to doing ‘something’ to solve, malnutrition. However, it seems to have little effect on the real problems of poor people and the malnourished.
An isolated emotional commitment is loose and romantic; ideological commitment is militant. The concept of being socially responsible is nothing but a euphemism for what really should be called political responsibility. Political commitment is important precisely because governments function as political entities. (7)
Political forces are fought with political actions, not with morals, or with technological fixes.
It is precisely a misunderstanding of reality (or a partial understanding of it) that often reinforces the amoral position of some colleagues --or some of them may not really want to understand; they have, all too often and for all the wrong reasons, already made up their minds about one reality, thus often searching for the statistical ‘whats’ instead of analyzing the ‘whys’. (8)
Used as a technical tool, nutrition science offers no real solution, no matter how much new coordination between different sectors (e.g., health, agriculture, education) it succeeds in setting up at any or at all levels. To continue pushing such technical tools is to perpetuate the problems. In the vast majority of cases, it will mean a waste of scarce resources and of precious time.

Critically speaking, nutrition science will continue to offer us no more than a good diagnostic tool, a not-so-good framework to consider alternative intervention strategies…and a basis to validate ideologically charged policy decisions.

Working with the community

If little can be expected from nutrition programmes pushed from the central level, then community-level (grassroots) organization around food and nutrition issues may be the more viable answer in the long run.

Popular participation and mobilization is absolutely key to success in nutrition work but, as nutritionists, we have persistently disregarded this central issue --or have only tinkered with participatory approaches. What is needed is more dedication to working directly with those who happen to be poor and/or discriminated so they can tackle the causes of their poverty and malnutrition themselves. This calls for us to go, as much as possible, back to field work and out of our offices or laboratories. Only there can the strengths needed for a change in direction and perspective be found.

Nutritionists need to learn from the people and from their perceptions of the problems, establish links with local mass movements and participate in their consciousness raising.
The participation of the affected population begins with creating awareness that they have a problem --and that their right to nutrition is being violated. This, to be followed by ample discussion about what can be done about it. Here, the outsider's role is to ask the right questions and not to point at what s/he thinks is wrong.

It is only through praxis that political consciousness can be strengthened, and it is only when people are convinced that change is in fact beginning to take place that they will listen and learn the more abstract concepts we use; the same must fit into their experience. (9) In our work with the community, we have to pass from a mutually shared analysis and understanding of the local micro determinants of malnutrition, which should be more easily identifiable and perceived by the community at the beginning, to the analysis and understanding of the local and then national and global macro determinants of that (their) condition.

For the latter to be possible, the community will probably have to go through a slow process of political maturation before effectively gaining consciousness of the role of the social and economic constraints that determine malnutrition in their milieu. People have to become aware of their problems in a specific context first and then in an ideological one. The exposure to them of the basic macro constraints should, in the first instance, lead to generating social commitment to effecting the needed structural changes.

It is important to demonstrate to the community that it is in their power to change not only the physical reality that surrounds them but the social reality as well. (10)
There are three levels of possible involvement in fieldwork. (11) At the first level, one solicits the participation of the community in a given project. (Participation has turned out to be harmless for the vested interests and is, therefore, a regular appendage of every government project these days). A second level calls for outright consciousness raising among the population. At the third level, an effort is made towards the mobilization of the masses and the effective empowering of the poor.

Because village problems are often not a priority for governments, local felt needs have to be converted into concrete issues so that a course of action to address them can be mapped out. This may involve developing functional knowledge about people's rights, or challenging public agencies, landlords or other powerful people or institutions by filing specific demands or claims. A new type of community-oriented nutritionist is needed for this Herculean task: one that plans with people to get organized to work together in solving the problems.
We need to move in the direction of training nutritionists as trainers of others so that their own community-oriented experiences can be reproduced at many levels in each country. The shortcomings of this approach are many, not the least of which is the fact that it is a very slow process, based on mutual trust in each community and that its replicability is also very slow even in the best of cases. The dangers, of course, are also significant, especially when the government is hostile to community mobilization.

The question that still remains at the end of this discussion is whether this approach is realistic or not. If it is not, let us keep in mind that not being realistic is a judgment that history can change: what might sound unrealistic today can very well become true tomorrow, if we work for it with decision.

Request and acknowledgement

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Schuftan C. The Causes of Hunger and Malnutrition: Macro and Micro Determinants [Column] Website of the World Public Health Nutrition Association, September 2010. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column is reviewed by Geoffrey Cannon. Special thanks to 1. N. Makhoul, "Agricultural Research and Human Nutrition: A Comparative Analysis of Brazil. Cuba, Israel and the US". Intl. J. of Health Services. 13, 1:15-24 (1983). 2. W. Chossudowsky. "The Neoliberal Model and the Mechanisms of Economic Repression", Coexistence. 12, 1 (1975). 3. C. Schuftan, et at., Recommended national food and nutrition plan for Liberia, mimeo (Interministerial technical committee on food and nutrition planning, Monrovia, 1982). 4. C. Schuftan, "Nutrition Planning - What Relevance to Hunger?", Food Policy. 3, 1:59-55 (1978). 5. C. Schuftan, "Ethics, Ideology and Nutrition", Food Policy. 7, 2:159-164 (1982). 6. W. David, Management. Administration and Politics in the Development Process: With Special Reference to Nutrition, mimeo, (Meharry Medical College, Nashville. Tenn., November 1985). 7. B. Winikoff, "Political Commitment and Nutrition Policy", in B. Winikoff, ed., Nutrition and National Policy. MIT Press. Cambridge, MA, 1978. 8. R. Critchfield, "The Village: The World as It Really Is...It's Changing", USAID Agenda. 2, 8, (1979). 9. K. Constantino-David. "Issues in Community Organization", IFDA Dossier. 23:5 (1981). 10. A. Rahman. "Science for Social Revolution", IFDA Dossier, 4 (1979). 11. H. Bantje, Constraint Mechanisms and Social Theory in Nutrition Education, mimeo, presented at the XI Intl. Congress of the IUNS, Rio de Janeiro, August 1978 (BRALUP, Dar es Salaam, 1978).

cschuftan@phmovement.org
www.phmovement.org

HURRAY PHM LAGOS IS BORN- Pleased to share Minutes of our first meeting

2011-03-25T04:07:00.000-07:00

Dear All,
Please find below the minutes of the inaugural meeting of phm Lagos. We doff our caps but moving phm Lagos from an on line space to a physical space. Now that we have met and known ourselves as well as assigned tasks, we are imploring you to come and join. The letters to the Health agencies would be delivered on Tuesday march 29 2011. If you want to be part of the process you are welcome. The tentative dates for the courtesy visit remains April 5 and 7. If you would like to be part of the team please also experess your interest.

Below is the minutes of our 1st meeting and we are very pleased to share.
From PHM lagos Secretariate
Mrs. Nkiru Celine Okoro
Secretary/ Communications & Publicity
PHM lagos
08023039364
info@codnigeria.org
www.codnigeria.org

****

MINUTES OF INAUGURAL MEETING OF PEOPLES HEALTH MOVEMENT IN NIGERIA- LAGOS CHAPTER ON THURSDAY MARCH 10 2011 AT SUIT 29 BLOCK A PRIMALTEK PLAZA OKOTA ROAD OKOTA NEAR CELE BUS STOP

AGENDA:

Introductions: Who We Are, What We Do And The Organization We Represent.
Justification- Why Do We Need A Peoples Health Movement (All)
Structure Of The Movement Role, Membership And Composition Of Phm.
Who Can Participate?
Who Can Fund?
Tasks Ahead- National Workplan
Who Does What, When And How?
Laison With Ministry Of Health- On Going
Laison With Saca
Setting Up Committees Fundraising, Program/ Activity Development, Networking And Community Development
Appointment/ Election Of An Interim Executive
International Participation- Linkages/ Relationship With The International/ Regional Chapters
Aob/Closing.

ATTENDANCE …………………………..
1. ENGR. BALOGUN OLUSEGUN
2. MRS PHILOMENE OKURE
3. EKA KONSIT
4. BOSE IRONSI
5.MRS NKIRU OKORO
6. Uloma Laura Onyewuenyi (COD – Nigeria – Secretariat)

TIME AND DATE ………………………….12:30PM, 10/3/2011

OPENING PRAYER………………………EKA KONSIT

INTRODUCTION:
ENGR. BALOGUN OLUSEGUN: A Member of THE SOUND HEALTH ORGANIZATION

BOSE IRONSI: A Member of THE WOMEN’S HEALTH & RIGHT PROJECTS

MRS PHILOMENA OKURE: A Member of THE PEOPLE EMPOWERMENT ORGANIZATION
EKA KONSIT: A Member of THE PEOPLES EMPOWERMENT ORGANIZATION

MRS NKURU OKORO (HOST). CENTA FOR ORGANISATIONAL DEVELOPMENT
Uloma Laura Onyewuenyi (Secretariat – COD Nigeria) Note taking

OPENING/Welcome Remarks:
The meeting started at about midday with welcome remarks by Mrs. Nkiru Celine Okoro convener of the inaugural meeting who sought to set the tone using the agenda. Being an interactive and participatory session every member present contributed to the deliberations.

JUSTIFICATION:

BOSE: In her remarks decried the state of women’s health in Nigeria drawing her experience from a project she implemented in Eboyin state to call for the need for women to live Healthy considering their reproductive role in the society. Women’s Health should be put in political agenda unfortunately this is not resonating in the ongoing political campaigns and manifestoes of political parties in the run up to April 2011 elections.

MRS PHILOMENA: Because her primary assignment focuses on Women, Orphan, People living with HIV/AIDS, they are proud to be identify with anything that has to do with health and PHM lagos is providing that platform. She is keen on how they can be of help and also benefit from their membership of phm lagos.

EKA KONSIT; SAME AS ABOVE

MRS NKIRU OKRO: gave a brief background of how PHM Nigeria started first with the call for proposal, selection and funding to Kisumu. The birth of PHM Nigeria is a major outcome of April 2010 PHM funded Training in Kenya.
Copies of PHM charter, 2011 work plan and other PHM documentations were given to participants for free.

STRUCTURE:
A loose interim structure was adopted as follows

MRS BOSE IRONSI – PHM Lagos State Coordinator/Head & Interim Chairperson
MRS NKIRU/COD Nigeria (Secretary & secretariat/ Communications/publicity)
MRS PHILOMENA Fundraising and Treasury

WHO CAN PARTICIPATE?
Membership is open to all Nigerians who are passionate about improving the quality of life, health and well being of Nigerians in this case – Lagos & Environ.

WHO CAN FUND?
Individuals, Corporate Organizations, governments at all levels, International Development Partners, Networks, Groups etc

NEXT STEPS / FORWARD LOOKING STRATEGY:
LAISON WITH MINISTRY OF HEALTH through Courtesy visits to:

1. MINISTRY OF HEALTH LAGOS STATE,
2. SACA
3. ASSOCIATION OF MEDICAL DOCTORS
4. PHARMACEUTICAL ASSOCIATION OF NIGERIA
5. ASSOCIATION OF NURSES AND MIDWIVES,
Letter of Introduction to reach them by 30th March 2011.
Tentative dates for Courtesy visits between 5th and 7th of April 2011

About Media, Mrs Nkiru ask if we can call media, but fund seems to be the challenge but Mrs Bose added that unless we can get them to know about the movement and any amount can be given to them.

STANDING COMMITTEES
FUNDRAISING,
PROGRAM/ ACTIVITY DEVELOPMENT,
NETWORKING AND COMMUNITY DEVELOPMENT
They are not mutually exclusive but broadly interrelated.

AOB/ CLOSING REMARKS:
Bose called for team work, cooperation and understanding as a basis for success.

Eka Konsit: Said that she will communicate through E-mail for more Information and Contribution.

Nkiru. Called for a Spirit of understanding,

Formal inauguration of PHM Lagos was tentatively agreed for June /July 2011

The meeting came to a close with prayers by Philomena by 2pm.

HURRAY PHM LAGOS IS BORN

PHM Kenya Planning Meeting 22 March

2011-03-22T02:23:00.000-07:00

The PHM Kenya members have organised a planning meeting today (22 March) at 3pm at the AMREF HQ. We wish them all the best in their plans to strengthen health advocacy and activism in Kenya

*****

MDGs and HR available on youtube,video clip by Claudio Schuftan

2011-03-16T03:26:00.000-07:00

Click on the link below:

URL: http://www.youtube.com/watch?v=T6aceLsWS9w
18 mins.

INAUGURAL MEETING OF PEOPLES HEALTH MOVEMENT (PHM) LAGOS STATE CHAPTER.

2011-03-09T11:56:00.000-08:00

INAUGURAL MEETING OF PEOPLES HEALTH MOVEMENT (PHM) LAGOS STATE CHAPTER.

Nigeria is organising an inaugural meeting of the Lagos State Chapter of Peoples Health Movement Nigeria on Thursday March 10 2011 and has invited organisations across the Lagos state.
The Venue is Suit 29 Block A Primaltek Plaza, Okota Road Okota Near Cele – Itire/Ijesha Link Bridge by 11am prompt.

We wish them great success. Those is Lagos can confirm participation by sending an email to Mrs. Nkiru C. Okoro (Convener-PHM- Lagos): info@codnigeria.org,

PHM Zimbabwe Planning Meeting 4 March 2011

2011-03-03T21:20:00.000-08:00

The Community Working Group on Health (CWGH) has organised a PHM Zimbabwe Stakeholder Planning Meeting to be held on Friday 4 March 2011 at the Cresta Oasis Hotel. The Meeting will start at 9am and end at 1pm.

A total of about 15 participants have been drawn from the IPHU graduates, PHM activists and will also be attended by the PHM Regional Outreach Co-ordinator (Linda Mashingaidze-Shuro)who is based in South Africa.

The meeting aims to ensure active participation in shaping the PHM Zimbabwe.

The Millennium Development Goals: Who for, and what for?

2011-02-28T21:36:00.000-08:00

October blog
Claudio Schuftan

At the two-thirds point between 2000 and 2015, at a summit at UN headquarters in New York, the United Nations has just completed its assessment and review of the Millennium Development Goals. The Lancet has taken this opportunity to publish an appraisal of the MDGs, now and for the future, prepared by a distinguished group of London-based academics (1). The latter is critical of what it sees as the somewhat slow progress that has been made towards the achievement of the Goals, and also to some extent is critical of the Goals themselves.

We, at the Peoples’ Health Movement, have been for long saying that the MDGs, and the thinking behind them, are problematic. While this month’s column is by me, it also expresses the considered views of the PHM which, I believe, has more than any other organisation earned the right to speak for the people who are most affected by the MDGs, and by all aid and development programmes.

Reference and footnote

1 Waage J and the London International Development Centre Commission.
The Millennium Development Goals: a cross-sectional analysis and principles for goal-setting after 2015. Available on-line at: www.the lancet.com/mdgcommission. Editor’s note: please also see the news item on the home page of the October 2010 Association website.

THE MILLENNIUM DEVELOPMENT GOALS EMBODY A CONTRADICTION. POOR COUNTRIES ARE EXPECTED TO MEET THE GOALS WHILE AT THE SAME TIME CONTINUING TO SUBMIT TO THE NEO-LIBERAL POLICIES THAT HAVE LARGELY CAUSED THE VERY PROBLEMS THAT THE GOALS ARE SUPPOSED TO RESOLVE.

The Peoples’ Health Movement, as its name indicates, is a network of networks of civil society and grassroots organisations, health professionals and academics, with very many sympathisers within international institutions, UN agencies, and national governments and their agencies. PHM has a presence in over 70 countries. Its focus is on communities and citizens especially in impoverished countries – the people who the MDGs are or should be all about.

Six shortcomings

For long now, PHM has been raising awareness of the MDGs’ limitations, namely denouncing that the Goals suffer from:

• Donor over-influence.
• Technical over-emphasis.
• Inattention to action on underlying social and economic inequities.
• Lack of systematic long-term financial commitment.
• Predominant focus on health and education.
• Overlooking of the entire political and economic economy.

Five points you may not know

Our denunciations are further based on the following facts and observations, which also seem to be generally overlooked:

• The obligations of the rich countries are not quantified in the MDGs paradigm, whereas the obligations of the poor countries are. This evidently assumes that poverty is a problem of poor people only.
• Poverty is defined in the MDGs as a state in which people have to live in the equivalent of less than $US 1 a day. But inflation is likely to make the one dollar in 2000 worth around 60 cents by 2015.
• Official responses to the nutrition-related MDGs seem to be more concerned with quelling or preventing food riots than with addressing the underlying and basic deeper causes of chronic malnutrition.
• If current trends continue, by 2015, 3.7 million more children in Africa will suffer from malnutrition than are today.
• China, Cuba, and Vietnam (where, by the way, I live, so I am in a position to know), have long focused on core development concerns, but have not labeled them as ‘Millennium Development Goals’, i.e., not wanting to play the MDGs game.

Not to forget: 1. Malnutrition is a big human rights issue

Above all, even if the MDGs as currently conceived were ever achieved, this only could result in a modest improvement in global health and nutrition ...if at all. In any event, the Goals cannot be approached, let alone achieved, without adequate input from civil society, and this cannot mean simply a blind acquiescence with the assumptions and approaches proposed by the experts.

Therefore, it is a fallacy to suppose that health and nutrition programmes addressing the urgent needs of women and children implicitly address equality and human rights. In the human rights-based approach, to which we are committed, nothing is left implicit!

The MDGs operate too much using a ‘deficit-filling approach’ in addressing poverty and preventable ill-health, preventable malnutrition and preventable premature deaths. ‘Filling the last bit of the cup’ will not work. What is needed is re-filling the cup from the bottom.

Poverty, ill-health and malnutrition are the result of the ongoing process of social exclusion. The human rights-based approach specifically explores the exclusionary mechanisms that need to be dismantled – now! Consequently, concrete demands need to be placed on duty bearers – now! Where someone has a right, someone else has a duty. Gone are the days of us ‘working with beneficiaries’: We now need to act, to mobilise rights holders’ (claim holders) so that they demand their rights.

21 problems

Here are 21 more specific problems with the MDGs. (Yes, there are more!):

MDGs:

• Perpetuate a focus on communicable diseases.
• Encourage quick-fix technical approaches.
• Offer too little too late and are not really new, but rather rehashed versions from earlier goals set by international policy-makers.
• Emphasise average outcomes across an undifferentiated population; moreover, they focus on outcomes, disregarding the processes through which we are to achieve them.
• Provide mostly a ‘template of targets’ for the bureaucratic mind.
• Ignore the fact that poverty is a function of human rights violations.
• See housing, health care, and access to food and water not as non-negotiable and universal human rights, but as ‘needs’ to be met.
• Infuse neo-liberal priorities into development policies, often using just the language of human rights; ultimately, they attempt to ‘wash the face’ of neo-liberalism by emphasising what is possible and do-able …for donors and the market.
• Fail to represent a development paradigm break. Instead, they are a set of indicators embedded in a paradigm --the neoliberal paradigm.
• Come from the outside, in the North, resulting in what some consider ‘the ghettoisation of the problems of development’.
• Call for change, but not for creating the conditions to make real needed structural change possible.
• Overlook the roots of inequality.
• Seek to ‘eradicate extreme poverty and hunger’ (Goal 1), but rely on the discredited notion that economic growth at the national level (GNP) can eliminate poverty.
• Avoid denunciation of the bad governance of the rich ‘G8’ countries and of the international financial institutions.
• Represent a set of international obligations, and are not a real expression of local governmental goodwill.
• Fail to provide a real sense of ownership either by poor countries’ governments or their civil society actors.
• Place all responsibility on the separate national governments, with no real global authority in charge of their enforcement.
• Pretend to be a moral compass with a set of yardsticks to measure some types of progress, but are mostly a counting and accounting exercise.
• Disregard the effect of trade policies on malnutrition (the negative consequences of current unfair international trade policies are one of their major oversights).
• Fail to even mention women's labour and property rights, or violence against women, which is one of the most fundamental obstacles to ensuring women’s rights.
• Assume that privatisation of services is a strategy for, rather than an obstacle to, economic development and improved nutrition.

Not to forget: 2. Malnutrition is a political issue

The implications of all the above are clear. Political forces cannot be fought with moral attitudes and technical fixes. What is needed is determined and sustained political action, from the ground up.

Seen from another angle, the MDGs miss what most matters to people who happen to be poor, who are also known as ‘the bottom billion’; they overlook or ignore issues of risk, security, respect, status, dignity, voice, and vulnerability. All of these are as important to impoverished populations as issues of income and consumption.

Also, none of the Goals can be achieved without empowering women and without recognising the centrality of decent employment, which also is a human right.

Furthermore, debt relief is a precondition for even keeping up the hope of meeting the MDGs. In addition, market liberalisation strategies have been oblivious to the ideas behind the MDGs. Whatever their rhetoric may claim, transnational corporations are certainly not geared to invest in helping achieve the Goals. .

The human rights philosophy
A radical rethink needed

AS THINGS ARE, INEQUITIES WILL REMAIN ENTRENCHED EVEN IF THE MILLENNIUM DEVELOPMENT GOALS ARE ACHIEVED BY 2015 OR ANY OTHER YEAR. IT IS NOT INEQUITIES THAT KILL. IT IS THE
PEOPLE RESPONSIBLE FOR INEQUITIES WHO ARE THE KILLERS.

For all these many reasons the MDG approach badly needs rethinking. We need post-MDG policies, based on human rights principles. These need to be worked on and put into practice now, to minimise harm and disenchantment come 2015.

When all is said and done, it is human rights violations that are the raison d’etre of all the Goals. Therefore, applying the internationally agreed human rights framework to them, or perhaps better, replacing the MDGs approach altogether, will reveal the discrimination, social exclusion, and other human rights gaps in the Goals as currently framed and applied.

A call to action

So far, most civil society organisations are failing to challenge the system that constantly and continually recreates the condition of poverty. It is time for duty-bearers to be held to account. Are more members of the World Public Health Nutrition Association prepared to do this? We cannot, in good faith, remain aloof from politics.

At the Peoples’ Health Movement, we fear that, after 2015, what will have been achieved is no more than islands of progress in an ocean of remaining grievances and persisting human rights violations. By sticking to the MDGs paradigm, inequalities are staring us in the face now, but will be shouting at us after 2015.
The MDGs need not only to be attained, but also sustained long term - post 2015. As now framed, the Goals would enable halving the hunger of all under 5s in the world on 1 January 2015, simply by distributing a few hundred million sandwiches to hungry children the night before. That is why I say: Poverty reduction without redistribution is only to be seen as flimsy rhetoric. Political power is a crucial precondition for a country to rise out of the poverty trap once and for all.

We need to focus on the processes that will lead to overcoming malnutrition (or to achieving any of the other Goals). These processes have to be bottom-centered. Without the proper participatory processes, MDGs as outcomes may mean nothing – they will be like a Christmas toy car … batteries not included. The process must ‘pull’ needed changes, and not be the conduit for ‘pushed’, often packaged, solutions.

Walking the walk

It’s not enough for aid and development agencies, and non-governmental organisations of any type, simply to start inserting human rights language into their discourse. We hear a lot these days about a human rights ‘lens’, or adding a ‘human rights perspective’, or having ‘human rights projects’, or ‘mainstreaming human rights’. What is needed is to walk the walk. Policy-makers and decision-takers of all types at all levels have to embark in human rights-compatible programming, using the human rights-based approach, which is by now well delineated. We, in the Peoples’ Health Movement, feel there is now no other rational choice.

Non-governmental organisations (NGOs) have to decide what, now and when to move in this direction. Governments must be pushed to take up their international responsibilities towards nutrition. One thing this means is that NGOs need to shift their work from a welfare perspective to an economic justice perspective. This entails getting involved, hands-on, in the transformation of the current political and economic orthodoxy into systems that are fair for all. It will also involve engagement in authentic human rights dialogues between claim holders and duty bearers.

As surely we must all know now, what goes on in the world is increasingly shaped by powerful transnational forces. Many of these have dire consequences for the right to nutrition. Local and national level efforts to influence the determinants of malnutrition can have only a limited impact. It is easy to see why health professionals in the public sector so often feel powerless. What therefore is needed, is collective action - thus the Peoples’ Health Movement. What, then, about the World Public Health Nutrition Association…?

Seven final thoughts

I end this month with seven thoughts:

• Real life is more complex than Millennium Development Goal slogans.
• The poor and the marginalised are not where they are by chance.
• The objectives we should strive for are not to stabilise malnutrition, but to make it disappear by addressing its roots.
• Granted, not all the problems of malnutrition are structural. But if structural issues are not addressed, the chances of the MDGs sustaining a global improvement of health and nutrition are nil.
• We have to avoid ‘othering’ people as ‘poor’ and thus as inferior to the non poor. This is what the MDGs implicitly do a bit – or a lot.
• The specific, general and structural failings of the MDGs should be denounced publicly, to demystify the ‘silver bullet’ aura of just going-for and achieving the eight Goals.
• The MDGs cannot be achieved without respect for human rights overall and in particular for minority and women’s rights. Nor can they be achieved without redistribution of wealth from the rich to the poor.

So, in the name of the wretched of the earth, are we to change the world? Or are we the victims of those who have the power to change the world?

If the second is the case, is what we usually discuss in our professional meetings as public health nutritionists going to change things? Did you attend and participate in the Porto world public health nutrition congress that has just ended? Think back please. Did you sense a growing insistence that our profession must now take effective action to empower impoverished populations? I hope you did. But were most discussions in effect critical or did they support the current aid and development paradigms and programmes? I fear they were. As professionals and as part of this association, we all can do much better.

The human right to nutrition.

2011-02-24T00:14:00.000-08:00

I would like to think that you often ask yourself – as I do – what all of us could do
better to achieve greater justice, given that most of us work in or with countries with
appalling social inequities. Allow me to share with you some of my thoughts on this.

I see our role as helping put in place social processes and mechanisms that will
drive sustainable human rights-based policies and practices in health and nutrition.
These need to be part of how we help to instill a new will and commitment in decision-makers to change underlying preventable structural inequities in society.

We can come to this from an ethical motivation, or else from a political motivation.
Both stances drive us to become more involved in lessening inequities. They
should both propose, not packages of universal solutions, but paths to follow to get
things that need to be done done, specifiying by whom, with whom, and against whom.

Living as we do in a mean, unfair and selfish world, I believe we need to graduate
from the ‘universal package’ approach to the ‘paths to follow’ approach. Let me
explain why.

The human right to nutrition.

Rights are different from needs. Aid and development policies and programmes

based on the concept of need, as they almost invariably are, see the malnourished

child as an object. Needs do not necessarily imply duties or obligations, but may

invoke no more than promises. In the rights-based approach, the malnourished

child is seen as a subject with legitimate entitlements and claims. Rights always

imply, and carry with them, duties and obligations.

Human rights concepts applied to nutrition have evolved since the 1980s. Early

thinkers began by claiming an inalienable ‘right to food’ of all human beings. But

after the worldwide adoption of the UNICEF-proposed conceptual framework of

the underlying and basic, as well as the immediate causes of malnutrition, it became

clear that food security was only one element of nutritional well-being. This led to

the coining of the concept of the ‘right to nutrition’ (meaning adequate nutrition),

addressing all causes of malnutrition. This in turn led others to pursue a yet

more ambitious aspiration for the ‘right to development’.

The concept of ‘the right to nutrition’ has been opposed by the governments and

other policy-making bodies in high-income countries, particularly the US. Also, the

US concept of human rights differs substantially from much of the rest of the

world. In the US, civil and political rights carry more weight than economic, social

and cultural rights. The US government also objects to the idea that rich countries

have obligations towards impoverished countries, despite the rich continuing to be

responsible for their impoverishment and for infringing their economic, social and

other rights.

Why inequity is perpetuated by the neo-liberal ideology.

‘AS WITH SLAVERY, THERE ARE ETHICAL LIMITS TO THE TOLERATION OF EXTREME POVERTY’

Those responsible for the current process of globalisation, with its progressive
accumulation and concentration of economic and political capital, see human rights
as a threat, because the human rights-based approach is an alternative to neo-
liberalism: It has divergent and rival imperatives and justifications.

Conversely, the human rights based-approach sees neo-liberalism as a political and
economic system out of control, which creates uncertainty and dependency, brings
about fear, aggression, and fundamentalism, and makes ever-expanding spaces
for private interests. Neo-liberal politicians and economists push for the rights of
individuals (for example, property), limited state activity, and for a free-wheeling
market, and say that the poor are responsible for their own poverty. Hidden in
the unacceptable current social differences and social injustices clearly is the neo-liberal
ideology, with much money, much poverty, much silence, much omission, much
disdain, much disillusion.

Often, policy-makers in rich donor countries accuse human rights activists of not being
preoccupied with issues of bad governance in poor countries. We counter-argue
that political outcomes are not only determined by the interaction between content
matters (policy) and institutional structures (polity), but by raw political interests
(often post-colonial interests in the case of donors)…and those are the ones that need to be addressed.

In policy circles, concepts tend to be discussed sometimes ad-nauseam, but they are only rarely implemented in reality. Those that have the power to define what poverty is, also
have the power to define its causes, and thus to decide to act on what they see as solutions. Those in charge in rich countries think and act as if only their small cut-out of reality is the real valid one. They deny other dimensions of perceived reality.

In opposing this latest manifestation of globalisation, i.e., capitalism gone to its extreme,
what is missing is an integration of the multiple international human rights
obligations and, in the process of negotiating, among other issues, address debt relief and
free trade agreements. Existing arrangements are the result of poorly negotiated
multilateral or bilateral compromises. There is an asymmetry in the bargaining power
that rich and poor countries bring to these negotiations. It is thus urgent to carry out
human rights impact assessments in the contexts of debt and trade, especially their
effects on women and on other vulnerable groups. Additionally, we must confront
the unequal distribution of power structure within governments.

In other words, globalisation, unequal representation, free-wheeling markets,
dependency, the neo-liberal political and economic ideology, the debt crisis, and
international ‘free trade’ agreements, all limit national human rights policy space, as well as policy space for nutrition. This amounts to an outrage. As with slavery, there are ethical limits to the toleration of extreme poverty.

Nutrition professionals and the myth of the market.

‘THE BASIC AND STRUCTURAL CAUSES OF POVERTY ARE THE
MAIN DETERMINANTS OF PREVENTABLE ILL-HEALTH, MALNUTRITION AND PREMATURE DEATHS’.

Why are then nutritionists in their profession still not committed to a human rights
philosophy? Such a commitment does give us the best chance to counter the increasingly
negative impacts of globalisation in its current form, which is creating and
accelerating poverty – most often with malnutrition as an outcome. At the same
time, globalisation is creating growing disparities, exclusion, unemployment,
marginalisation, alienation, environmental degradation, exploitation, corruption,
violence and conflict, all of which in one way or another impinge on nutrition.

People who are being marginalised by globalisation today are being pushed to the limit, and they need to channel their frustrations into positive action. But people who happen to be poor are still being offered top-down social services and are thus not really active claimants of their rights.

Are we part of the problem?

The human rights approach introduces or reinforces a crucial missing element in
development work: people forcefully demanding what are their inalienable rights. This is its added value in all work being done in the area of nutrition. So why has it not generated more enthusiasm?

The rights-based approach takes the entitlements of those being marginalised as its
starting point. Human rights and equity go hand in hand. The rights-based approach
thus focuses on the basic and structural causes of poverty, which are the main
determinants of ill-health and malnutrition.

There is still a segment of the human rights community that thinks that world
order issues can be settled without confronting the power issues that are still slanted against the welfare of the majority of the marginalised. But is this a contradiction?

The Millennium Development Goal of halving worldwide malnutrition rates by 2015 will not be achieved through the piling up of yet more ‘benevolent’ free market policies. We are being sold a mythical utopia in the absurd belief that ultimately a global ‘free market’ will cater to everybody’s needs and make everybody happy. I ask: How much are nutrition professionals influenced by this myth?

How we can be part of the solution.

Because of the gross flaws of globalisation, a more humane global governance is now
needed – more than ever.

There is no need to argue about whether globalisation or bad governance is the most
important cause of human rights violations. The human rights approach shows us
what states should do or should not do. When they fail the test, many governments
complain of being victims of a global process as an excuse for not implementing
their obligations.

How much of their general budgets governments devote to nutrition, to health,
to food security, to education and to poverty alleviation is of substantive human
rights concern. So is how such expenditures are distributed among the various socio-
economic population groups. Governments violate human rights when they fail to
offer adequate and participatory health and nutrition services to the poor.

To take a very real current issue as an example, if the provision of such services
are privately organised, governments still remain responsible for the egalitarian
and quality provision of the same. But do they accept this responsibility?
Mostly they do not. Short of opposing it, civil society watchdog groups should be monitoring the privatisation of public goods and denouncing its shortcomings more forcefully.

A human rights-focused analysis of statistical data should examine to what extent
various expenditures on nutrition and other social services are equitably distributed

among the diverse socio-economic groups. The same watchdog groups have a role
in scrutinising the actions funded to make sure they ‘respect, protect and fulfil’ the
human rights of the poorest.

Are governments the sole holders of human rights duties? Legally, the answer is yes
– governments are the actual signatories of the respective covenants. But, in reality,
there are indeed other duty bearers.

Take the example of children as rights holders. The duty bearers of children’s rights
are, first and foremost, the immediate care-giver (the mother or other), followed by
the family or household members, the community and neighbours, and then local,
sub-national, national and international institutions. These all amount to a web of
complementary duty-bearers.

This points to nutrition, and the responsibility of its professionals. Together with
empowered community leaders, and working with civil society organisations, we
need to ensure duty bearers’ responses at all these levels.

What then is to be done?

This is the theory. The challenge right now is to convert these concepts into working
programmes, where people’s claims are forcefully exerted as their inalienable right.

The recognition of the fundamental right to nutrition of all humanity is
the ethical and political basis of the overall approach nutrition professionals should
embrace. But proper understanding of this right has largely so far been confined to
international institutions specifically engaged with human rights issues, especially
United Nations agencies. How much can these agencies shift current and upcoming
nutrition programmes to a human rights focus? Perhaps quite a bit. But all actors,
including health professionals, need to see the picture.

One first challenge will be to create a common language to be used by UN and other
international agencies, governments and their agencies, professional and civil society
organisations, and the beneficiaries. The language needs to be primarily based on
social commitments to human rights, and on raising the level of responsibility of the
different actors, as more active claim holders and as more responsive duty bearers.

Most governments unfortunately suppose that the recognition of the right to
nutrition would interfere with their current policy choices. But states have
already signed covenants that guarantee respect of the right to nutrition
under any circumstance, irrespective of their resources. While certain aspects of
the rights approach can be implemented progressively, governments need to be made to understand that there is a minimum core of rights that all states simply have to uphold.

A second challenge is to make the human rights approach concrete and to give it
substance. The field of nutrition is, for sure, an inescapable candidate. For nutrition
professionals, human rights objectives need to be better singled out, defined and
refined. The right to nutrition has yet to acquire a concrete meaning and
reality. This is an immediate responsibility for all nutrition professionals. Effectively
mainstreaming human rights in all nutrition activities remains a challenge of
enormous dimensions. The challenge is political. First, nutrition professionals need
to see that the human rights approach is crucial and fundamental. For many of us,
this involves new thinking and recognition and acceptance of a new conceptual
framework.

Personal illness, population health and the medical impediment.

‘HEALTH CARE IS INCREASINGLY USED AS A SUBTLE, WIDESPREAD INSTRUMENT OF SOCIAL CONTROL’.

Nutritionists are not helped when, as is now usual, they are trained in the context
of modern Western medicine. This treats disease at the individual level, rather
than promoting community health. It attributes the causes of illness to faulty
individual behaviour or natural misfortune, rather than to social injustice, economic
inequity, and oppressive political systems that disregard people’s human rights.

Malnutrition packs the equivalent of the Twin Towers September 11 death toll
every 3½ hours. Differences include that most of the victims are small children, and
that practically all the deaths follow weeks of tortuous misery. A larger number of
children do not die, but are left disabled or seriously ill. A substantial percentage of
malnourished children are child labourers.

Currently, only about 10 per cent of overseas development aid goes to health and
nutrition projects and programmes in lower-income countries. This means that
external funding for health care and nutrition in all these countries amounts currently
only to slightly more than $US 8 billion a year. Furthermore, health care in impoverished
countries is increasingly used as a subtle, widespread instrument of social control.

The gaps in health and nutrition equity worldwide - in terms of numbers of those
affected by preventable ill-health and malnutrition - continue to widen.
Health and nutrition are more about power imbalances, than about morbidity and
mortality. They are more about control over the basic determinants of ill-health
and malnutrition, than about the treatment of diseases and the rehabilitation of the
malnourished.

The right to nutrition and the fight for this right.

‘WE NOW NEED TO COMMIT OURSELVES TO THE NEW AGE OF THE HUMAN RIGHT TO NUTRITION’.

Making human rights basic and central to the work of nutrition professionals
involves the need to demand many things. Among these are:

• That economic and physical access to basic community-based nutrition
services be equally guaranteed for girls, women, the elderly, minorities and
the marginalised.
• That steps be taken progressively to achieve all human rights (the right to
nutrition being the point of departure for nutrition professionals).
• That the private sector (national and transnational) be made to comply with
human rights dispositions.
• That accountability, compliance and institutional responsibility be required
from relevant duty bearers in all processes aimed at improving nutrition.
• That administrative decisions in nutrition programmes are in compliance with
human rights obligations.
• That governments’ resilience to embark in meaningful nutrition interventions
be differentiated from their inability to comply.
• That, if unable to comply, governments be required to prove that there are
reasons beyond their control that stop them from fulfilling their responsibilities.
• That national strategies on the right to nutrition be adopted, using and defining clear, quantified verifiable benchmarks.
• That the implementation of national nutrition strategies or plans of action be
transparent and decentralised, and include people’s active participation.
• That the same plans progressively also move towards eliminating poverty,
the main determinant of malnutrition.
• That new legislation on the right to nutrition be developed involving civil society in its preparation, enforcement and monitoring.

If the above demands are met, the added value of the rights-based approach to
nutrition will be such that:

• Beneficiaries will become active claimants of their rights.
• Claims will be made more forcefully (making governments effectively liable).
• This will stress the international and national legal obligations of states.
• The right to nutrition will be the foundation for relevant programme decisions.
• This will move discussion from charity/compassion to the language of rights and duties.

In short, the human rights approach enhances the scope and effectiveness of nutritional,
social and economic corrective measures by directly referencing them to what
are already being universally accepted obligations found in related UN
covenants.

These obligations are in competition with obligations stemming from other rights,
especially when resources are scarce. But the duty to fulfil the right to nutrition does not depend on an economic justification, and does not disappear because it can be shown that tackling some other problems is more cost-effective.

To put things in a historical perspective, in the basic human needs-based
approach, beneficiaries had no active claim to their needs being met. The human
rights-based approach gives such claims legal and political status and force.

We nutrition professionals all need to commit ourselves, in our teaching and our practice,
to the new age of the right to nutrition.

cschuftan@phmovement.org
www.phmovement.org

PHM Participation at the World Social Forum March 6 Feb 2011

2011-02-06T14:36:00.000-08:00

Highlights of the WSF March

PHM Participation at the World Social Forum March 6 Feb 2011

2011-02-06T14:19:00.000-08:00

The People's Health Movement represented by more than 20 countries joined the rest of the world in the opening march of the World Social Forum on the 6th of February in Dakar Senegal.
See the attached photos on the highlights of the march

IPHU Dakar, Senegal -Day One Reflections

2011-02-01T16:11:00.000-08:00

Dear Friends

The IPHU has started off well in Dakar Senegal. Day one had a presentation on the People's Health Movement which included how the movement started in 2000 at the first People's Health Assembly, the various PHM programmes which include the Right to Health Campaign, the Global Health Watch, International People's Health University and the People's Health Assembly. We also had a presentation on the People's Charter for Health which was first developed at the first PHA as part of the preparations and during the assembly. The charter takes a political position and calls for action:
defining Health as a Human Right
gives an analysis of global health
mentions that resources for achieving health were available but people's right to health were denied by governments and institutions
it represents the voices of people and their demands

The charter is a tool for advocacy and calls for action as it summarises the failure to achieve Health for All and gives a broad way to achieve it.
It is available in 35 launguages on the website

Invitation to attend a Civil Society Meeting in Senegal (4 Feb 2011)

2011-01-27T12:53:00.000-08:00

Dear Friends,

Invitation to a Civil Society Meeting

People’s Health Movement (PHM) would like to invite you to attend a civil society meeting with civil society organizations in Senegal and in the region.
4th of February 2011
16h to 1930h
At School of Engineers, National School for Applied Economy (ENEA).
Address: Ouakam Street, Dakar

In line with the International People’s Health University (IPHU) in Senegal taking place from the 31st of January to the 11th of February 2011, PHM Global (www.phmovement.org), would like to convene civil society representatives interested in discussing a way forward to strengthen and support health advocacy and activism in Senegal and in the region within the principles of comprehensive primary health care and with a focus on social determinants of health. The meeting will also discuss plans and preparations for the 3rd People’s Health Assembly (PHA3) taking place in July 2012.

Aims of the meeting:
• to showcase PHM global and in the region as well as civil society action within Senegal and also more broadly in Africa in order better link people’s struggle for health on different levels;
• to promote regional co-operation and solidarity within PHM.
• To create opportunity to mobilise and strengthen activities in the region towards PHA3.

The suggested outline of the meeting would include:

- Review of civil society advocacy and activism around health in Senegal, and the region
-Presentation on PHM programmes and future plans which include PHA3, Global Health Watch 3 (GHW3), Right to Health Campaign (RTHC) and the IPHU- a vehicle for advocacy and activism towards Health for All
-Discussion on strengthening advocacy and activism and mobilisation for PHA3

The desired outcomes of the meeting include:

Key activities / Plan of action for PHM in the region
Commitments towards a key action/theme in the region focusing on activities to promote comprehensive primary health care principles and approach towards achieving health for all in Senegal and in the region (who, what, timeframes, etc).

We strongly believe that our organizations can work together in a number of meaningful ways to build a strong movement.

Please send confirmation of your attendance to linda@phmovement.org and anneleen@phmovement.org. Please do not hesitate to contact us for any further information.

Do please note that this invitation does not offer any financial support for travel or accommodation related to the meeting.

We look forward to your participation

PHM Global

Sida: LGBT and human rights course

2011-01-21T01:58:00.001-08:00

Swedish International Development Cooperation Agency: Lesbian, Gay, Bisexual and Transgender Persons

The Swedish International Development Cooperation Agency (Sida) works according to directives of the Swedish Parliament and Government to reduce poverty in the world. The overall goal of Swedish development cooperation is to contribute to making it possible for poor people to improve their living conditions. Sida is organised in nine departments.

Sida is conducting a three-week course on Lesbian, Gay, Bisexual and Transgender Persons (LGBT) and Human Rights.

The first part of the programme will take place in Stockholm, Sweden, from 17 October to 4 November 2011. The second part will take place in Africa region from 21-25 May 2012.

The programme purpose of the Lesbian, Gay, Bisexual and Transgender Persons (LGBT) and Human Rights training programme is that participants after the programme should have useful tools and perspectives for working for LGBT persons’ human rights.
The programme is designed for participants working in organisations or sectors giving them an influence on issues concerning LGBT and human rights. Applicants should have plans for, or ongoing, projects aiming at enhancing the human rights for LGBT persons in their respective country.

The course is open only to applicants from Botswana, Cameroon, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia and Zimbabwe.

The application deadline is 8 April 2011.

For more about this course, refer to: http://goo.gl/3LWa7.

Participate in the discussion on the EB agenda of WHO

2011-01-19T04:40:00.000-08:00

Those interested can follow the discussions at the Executive Board(EB) meeting of the WHO (17-25 Jan.)on www.ghwatch.org by clicking on: Participate in the discussion on the EB agenda of WHO.

Murder of Women's Human Rights Advocates: Immediate Solidarity Requested

2011-01-18T22:50:00.000-08:00

Hi all,

Below is an urgent petition & letter in response to a request from women's human rights and health rights groups in Mexico for solidarity in the face of the alarming situation in the northern border communities of femicides - brutal assassinations of women, with their bodies left mutilated and dismembered - as well as recurring incidences of rape and sexual violence targetted at women's rights advocates. To date the Mexican government has been unwilling to investigate these cases, and impunity continues. The latest murder happened on Jan. 6th, when a 36 year old community based advocate who was working tirelessly to end violence against women and coined the term "Ni Una Mas" [Not one more (murdered woman)] was killed. Her body was just found last week, dismembered and strangled with a bag over her head. You can take action by:

1. Signing this letter by Wed. Jan 19th midnight UTC(as an organisation and/or as an individual community advocate) by replying to this email (tanya@wgnrr.org). It will be delivered by a delegation of WGNRR members to the Mexican Embassy in Manila on Thursday.

2. Adding your endorsement to the petition here: http://www.tupuedessalvartuvida.org/nomasfeminicidios/

Coordinated events are happening this week in solidarity with women's human rights advocates in Mexico, including the sending of letters and delivering of petitions to embassies of Mexico around the world. As a result, we are responding quckly. We apologise for the short notice, but since many of you work on supporting cases concerning an end to violence against women/gender based violence, this urgency won't come as a surprise...

Thanks, and I look forward to hearing from you. Please feel free to forward to your allies and networks. Certainly also feel free to write your own letter to the Mexican embassy in your respective country. If you would like to use the duplicated petition we are using in Manila, please be in touch: tanya@wgnrr.org

In solidarity,

Tanya

Tanya Roberts
Campaigns Officer, Women's Global Network for Reproductive Rights (WGNRR)
T: + 63 (2) 913 6708 F: + 63 (2) 911 8293 www.wgnrr.org

::::::::::::::::::::::::
Ambassador of Mexico in the Philippines,
Embassy of Mexico, G.C. Corporate Plaza, 2nd. Floor
150 Legaspi Street, Makati City, Philippines

January 18, 2011

To the Ambassador of Mexico in the Philippines:

As advocates for women’s human rights, community health rights, and an end to sexual and gender violence, we, the undersigned members and allies of the Women’s Global Network for Reproductive Rights (WGNRR) denounce the ongoing brutal killings and gendered violence directed at the women’s rights advocates living in the communities of the Mexican state of Chihuahua. Over the past month, we have been appalled and simultaneously enraged to hear from Mexican based members and allies of WGNRR about the two recent assassinations of human rights defenders tirelessly working to end violence against women, Susana Chávez and Marisela Escobedo Ortiz (mother of another murder victim, Rubi Marisol Frayre Escobedo). In particular, the continued pattern of impunity that has pervaded the hundreds of cases of women who have been sexually violated or murdered and mutilated is thoroughly shocking and must end if there is ever to be a sense amongst women in state of Chihuahua that they can live their lives free of fear and with dignity. Of urgent concern is the corresponding lack of political will to advance satisfactory forms of justice for the women, their families, and their communities.

Mexico is signatory to the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW), the Convention Against Torture (CAT), the Covenants on Civil and Political Rights (ICCPR) and on Economic, Social and Cultural Rights (ICESCR), as well as party to the UN Declaration on Human Rights Defenders. Accordingly, Mexican authorities have a legally binding obligation to ensure that the women of communities within the state Chihuahua - and across the country - have their human rights recognised and respected, including those to life, to be free from gendered violence, to the highest possible standards of health, and to be compensated when violations of these rights occur. However, we are alarmed that despite signing onto regional and international human rights instruments, the Mexican administration continues to defy rulings by the Inter-American Court of Human Rights as well as recommendations by various UN rapporteurs and committees that call on the state to immediately address the intense levels of sexual violence, disappearances and murders of women in Chihuahua. Civil society and local communities have yet to hear how the state intends to take these rights-based mandates into consideration at the policy, legislative or programmatic levels.

Together with Mexican members and allies of WGNRR, we urge Mexican authorities to commit the political will and financial resources needed to:
· Conduct a thorough, independent investigation regarding the deaths of Marisela Escobedo Ortiz and Susana Chávez, and take measures to bring justice to these as well as all other unresolved murders of women in the State of Chihuahua - including reparations and redress to their families
· Ensure gender-specific protective measures and support mechanisms for the mothers, families, and friends of the victims, as well as that of the informants and defenders of women’s human rights working on the cases;
· Ensure that related commissions of inquiry/truth-seeking and policy developments comply with human rights outlined in CEDAW, the Beijing Platform for Action and ICESCR
· Promote community, state and national socio-cultural initiatives that support the dismantling and transformation of patriarchal, sexist norms amongst all generations so that this type of brutal, sexualised and gendered violence will not continue to be repeated.

We are calling on you, as the Mexican Ambassador, to forward these concerns to the state authorities in Mexico, including President Felipe Calderón Hinojosa and Chihuahua State Governor César Duarte Jáquez. We will remain alert to the situation through Mexican-based members and allies of the Women’s Global Network for Reproductive Rights, and will await news regarding how the Mexican state will take action to address these urgent matters. If you have any questions, please do not hesitate to contact the WGNRR campaigns officer, Tanya Roberts, by email or phone + 63 (2) 913 6708.

Sincerely,
1. ___________________
2.____________________

3. ___________________

4.____________________

5. ___________________

6.____________________

7. ___________________

8.____________________

9. ___________________

10.____________________

join the PHM Ghana google group

2011-01-10T02:32:00.000-08:00

PHM Ghana has recently created this googlegroups to facilitate communication among members of PHM Ghana and also to make it easier for new / interested members to join.

PHM-Ghana is the Ghana Circle of the People's Health Movement - a grassroot social movement encompassing many different people and institutions who share a commitment to community health.

If you are interested in joining the group you can send an email to PHM Ghana:phmghana@gmail.com OR phm-ghana@googlegroups.com or visit the url at http://groups.google.com/group/phm-ghana.

Civil society groups want SA to ratify key human rights treaty

2010-12-14T23:27:00.000-08:00

Civil society groups want SA to ratify key human rights treaty

FOR IMMEDIATE RELEASE
TUESDAY 07 DECEMBER, 2010

Leading civil society organisations have signed an open letter to President Jacob Zuma and the Speaker of the National Assembly, calling on government to ratify two landmark international human rights agreements. The Community Law Centre, Black Sash, People’s Health Movement South Africa, National Welfare Forum and ‘Global Call to Action against Poverty South Africa’ say it would be an appropriate way to mark the 62nd anniversary of the ‘Universal Declaration of Human Rights’ on Friday, 10 December 2010. Nelson Mandela signed the ‘International Covenant on Economic, Social and Cultural Rights’ (ICESCR) 16 years ago but South Africa remains one of the few countries in the world yet to ratify the treaty.

Black Sash Advocacy Programme Manager Phelisa Nkomo says the ICESCR is the principal UN human rights treaty that protects economic, social and cultural rights. “It will help advance rights like housing, water, health and education - rights that the South African people have consistently demanded from government. We believe human rights must be central to efforts to achieve the Millennium Development Goals aimed at reducing poverty. The agreements would also provide a legal obligation and accountability framework for ensuring that development needs and goals are fully realised,” explains Nkomo.

160 states around the world have ratified the ICESCR and 35 countries have signed the Optional Protocol to this treaty, which provides an important platform to expose abuses that are linked to poverty, discrimination and neglect. Ironically, South Africa played a very active role in the negotiation and adoption of the Optional Protocol but cannot ratify it, as it is not a party to the main treaty.
Dr Lilian Chenwi, senior researcher at Community Law Centre, says by ratifying the Covenant and the Protocol, the government would show its willingness to empower people living in poverty by enabling them to hold their elected leaders accountable. “It would also send a strong signal to other African countries not to be complacent about marginalisation or neglect those living in poverty,” says Dr Chenwi.

Convenor of Global Call to Action against Poverty South Africa, Rajesh Latchman, believes ratification would give life to the rights enshrined in the Constitution. “It would give us an opportunity to create a people-centred development agenda. It could be used as a nation building tool, with involvement from civil society, business and labour, to ensure that while we follow a new growth path, there will be real benefits for poor and marginalised people in our country,” says Latchman.

Brian Moody, Community Development Worker for the People’s Movement for Health South Africa, says ratifying ICESCR and adopting the Optional Protocol would finally fulfil the promise of the Universal Declaration of Human Rights, affirming that all human rights violations should be effectively remedied. “Government told Parliament back in 2007 that the time between signing and ratification shouldn’t be prolonged. But 16 years later, we are still waiting for this promise to be fulfilled,” says Moody.

Click here to download and read the letter sent to President Jacob Zuma

Click here to download and read the letter sent to the Speaker of the National Assembly

NOTES TO EDITORS:
Please note that the attached letters to government and parliament are open letters and may be published or quoted by the media.

The International Covenant on Economic, Social and Cultural Rights was signed by South Africa on 3 October 1994, thereby committing government to act within the spirit and purpose of the treaty, and to ratify it without delay. It provides for rights such as the right to water, food, work, housing, education, health, and an adequate standard living. South Africa has still not ratified the Covenant.
The Optional Protocol to the Covenant will give people the right, if they cannot secure justice in their country, to have a violation of these rights investigated by an independent, international panel of experts. Ecuador, Mongolia and Spain have ratified the Protocol.

The States that have signed the Protocol, thereby indicating their intention to ratify it, include: Argentina, Armenia, Azerbaijan, Belgium, Bolivia, Bosnia-Herzegovina, Chile, Congo, Democratic Republic of Congo, El Salvador, Finland, Gabon, Ghana, Guatemala, Guinea-Bissau, Italy, Luxembourg, Kazakhstan, Madagascar, Mali, Montenegro, Netherlands, Paraguay, Portugal, Senegal, Slovakia, Slovenia, Solomon Islands, Spain, Timor-Leste, Togo, Ukraine and Uruguay. South Africa may not ratify the Optional Protocol as it has not yet ratified the Covenant.

Find out more about the ICESCER and our campaign to have it ratified

For interview requests, please contact:

Phelisa Nkomo
Black Sash
072 613 3577

Dr. Lilian Chenwi
Community Law Centre
072 172 6346

Rajesh Latchman
National Welfare Forum /GCAP SA
083 443 0227

Brian Moody
Peoples Health Movement
021 447 2024

For more information, please contact:
Sarah Nicklin
Black Sash Media Officer
073 150 9525

Petition to stop the WikiLeaks crackdown

2010-12-14T23:25:00.001-08:00

Stop the WikiLeaks crackdown. http://www.avaaz.org/en/wikileaks_petition/96.php

Dear friends,

The massive campaign of intimidation against WikiLeaks is sending a chill through free press advocates everywhere.

Legal experts say WikiLeaks has likely broken no laws. Yet top US politicians have called it a terrorist group and commentators have urged assassination of its staff. The organization has come under massive government and corporat e attack, but WikiLeaks is only publishing information provided by a whistleblower. And it has partnered with the world's leading newspapers (NYT, Guardian, Spiegel etc) to carefully vet the information it publishes.

The massive extra-judicial intimidation of WikiLeaks is an attack on democracy. We urgently need a public outcry for freedom of the press and expression. Sign the petition to stop the crackdown and forward this email to everyone -- let's get to 1 million voices and take out full page ads in US newspapers this week!

http://www.avaaz.org/en/wikileaks_petition/97.php?cl_tta_sign=de6a1fd7513e57f13091ddb02fda0285

WikiLeaks isn't acting alone -- it's partnered with the top newspapers in the world (New York Times, The Guardian, Der Spiegel, etc) to carefully review 250,000 US diplomatic cables and remove any information that it is irresponsible to publish. Only 800 cables have been published so far. Past WikiLeaks publications have exposed government-backed torture, the murder of innocent civilians in Iraq and Afghanistan, and corporate corruption.

The US government is currently pursuing all legal avenues it has to stop WikiLeaks from publishing more cables, but the laws of democracies protect freedom of the press. The US and other governments may not like the laws that protect our freedom of expression, but that's exactly why it's so important that we have them, and why only a democratic process can change them.

Reasonable people can disagree on whether WikiLeaks and the leading newspapers it's partnered with are releasing more information than the public should see. Whether the releases undermine diplomatic confidentiality and whether that's a good thing. Whether WikiLeaks founder Julian Assange has the personal character of a hero or a villain. But none of this justifies a viciou s campaign of intimidation to silence a legal media outlet by governments and corporations. Click below to join the call to stop the crackdown:

http://www.avaaz.org/en/wikileaks_petition/97.php?cl_tta_sign=de6a1fd7513e57f13091ddb02fda0285

Ever wonder why the media so rarely gives the full story of what happens behind the scenes? This is why - because when they do, governments can be vicious in their response. And when that happens, it's up to the public to stand up for our democratic rights to a free press and freedom of expression. Never has there been a more vital time for us to do so.

With hope,
Ricken, Emma, Alex, Alice, Maria Paz and the rest of the Avaaz team.

SOURCES:

Law experts say WikiLeaks in the clear (ABC)
http://www.abc.net.au/worldtoday/content/2010/s3086781.htm

WikiLeaks are a bunch of terrorists, says leading U.S. congressman (Mail Online)
http://www.dailymail.co.uk/news/article-1333879/WikiLeaks-terrorists-says-leading-US-congressman-Peter-King.html

Cyber guerrillas can help US (Financial Times)
http://www.ft.com/cms/s/0/d3dd7c40-ff15-11df-956b-00144feab49a.html#axzz17QvQ4Ht5

Amazon drops WikiLeaks under political pressure (Yahoo)
http://news.yahoo.com/s/afp/20101201/tc_afp/usdiplomacyinternetwikileakscongressamazon

"WikiLeaks avenged by hacktivists" (PC World):
http://www.pcworld.com/businesscenter/article/212701/operation_payback_wikileaks_avenged_by_hacktivists.html

US Gov shows true control over Internet with WikiLeaks containment (Tippett.org)
http://www.tippett.org/2010/12/us-gov-shows-true-control-over-internet-with-wikileaks-containment/

US embassy cables culprit should be executed, says Mike Huckabee (The Guardian)
http://www.guardian.co.uk/world/2010/dec/01/us-embassy-cables-executed-mike-huckabee

WikiLeaks ditched by MasterCard, Visa. Who's next? (The Christian Science Monitor)
http://www.csmonitor.com/Innovation/Horizons/2010/1207/WikiLeaks-ditched-by-MasterCard-Visa.-Who-s-next

Assange's Interpol Warrant Is for Having Sex Without a Condom (The Slatest)
http://slatest.slate.com/id/2276690/

Ugandan paper will keep outing gays

2010-12-03T02:28:00.000-08:00

Read more

http://www.iol.co.za/news/africa/ugandan-paper-will-keep-outing-gays-1.894614

African ministers want 15% of national budgets for health

2010-12-03T02:19:00.000-08:00

Title: African ministers want 15% of national budgets for health
Author: Ifedayo Adebayo
Date: 01.12.10
Source: Next Community
http://234next.com/csp/cms/sites/Next/News/5647731-147/african_ministers_want_15_of_national.csp
African health and environment ministers, at the weekend in Angola, agreed to advocate for and monitor an allocation of 15% of government budgets to the health sector, as stated in the 2001 Abuja Declaration by African heads of states.

The two-day meeting in Luanda, Angola, with the adoption of the Luanda Commitment, which outlines the continent’s health and environment priorities and commits countries to take actions to address them, also agreed on accelerating the implementation of the Libreville Declaration and a substantial increase of allocations of government budgets to the environment sector.

“The Luanda Conference is a milestone, as the health and environment sectors become credible and strategic partners. I leave this meeting further convinced that the future of Africa is not cast anywhere. It is we who determine this by our commitments, our determination, and our actions,” the regional director and Representative of UNEP in Africa, Mounkaila Goumandakoye, said.

The meeting, which was the second Inter-Ministerial Conference on Health and Environment, was held at the initiative of the World Health Organization (WHO) and the United Nations Environment Programme (UNEP), in collaboration with the government of Angola.

According to a communiqué issued at the end of the meeting, which was also attended by Nigeria delegates, the priorities listed in the Luanda Commitment include “provision of safe drinking water; provision of sanitation and hygiene services; management of environmental and health risks related to climate change; sustainable management of forests and wetlands; management of water, soil, and air pollution; as well as biodiversity conservation.

“Other priorities are vector control and management of chemicals, particularly pesticides and wastes; food safety and security, including the management of genetically-modified organisms in food production; children’s health and women’s environmental health; health in the workplace; and the management of natural and human-induced disasters.”

Breaking grounds

Following its agreement that a proper implementation will have the right impact on the attainment of MDG goals 4, 5, 6 and 7 relating to child health, maternal health, communicable diseases, and environmental sustainability, the ministers resolved to complete the Situation Analyses and Needs Assessment (SANA) in all African countries and the preparation of National Plans of Joint Action by the end of 2012.

So far, SANA has been completed in 17 African countries. The ministers also established the Health and Environment Strategic Alliance (HESA), which they said is “a novel mechanism that will stimulate policies and investments in favour of enhanced joint actions for health and environment in Africa.”

Also, for the first time, African ministers of health and environment made their strongest pronouncement ever on climate change and health in the region, with the adoption of a Joint Statement on Climate Change and Health, which will be tabled before the ongoing 16th Conference of the Parties to the United Nations Framework Convention on Climate Change in Cancun, Mexico.

“The three tools that we have adopted at this conference are clear and consistent, and the decisions we have taken will serve us well in the implementation of the Libreville Declaration,” the WHO regional director for Africa, Luis Sambo, said.

World AIDS Day- The People's Charter on HIV and AIDS

2010-12-01T01:13:00.000-08:00

As we reflect on World AIDS Day;

The People's Charter on HIV and AIDS is a consensus document that amplifies the voices of the people affected, infected, living with and suffering from HIV/AIDS. It aims at providing a people's perspective on HIV/ AIDS and related issues like access, rights and trade issues.

The People's Charter on HIV and AIDS was officially released by the People's Health Movement during the International AIDS conference at Bangkok in July 2004.

Click here to read more on our site http://www.phmovement.org/en/node/28

Train the Trainer in Health and Human Rights

2010-11-26T01:50:00.000-08:00

please distribute widely

Human Rights Training for Health Professional Educators: “Train the Trainer” Course in Health and Human Rights
When: 24 – 28 January 2011

Where: Post-Graduate Room 1, Barnard Fuller Building, Health Sciences Faculty, University of Cape Town, South Africa

Who: Teaching staff in institutions who are responsible for training health professionals - Universities, Colleges and other Training Facilities. Participants should ideally be teachers active in undergraduate or postgraduate teaching and in a position to introduce or facilitate ongoing sustainability of training initiatives beyond the course.

Why: Training in human rights for health professionals has increasingly been identified as a critical need for the health sector. This is particularly the case in light of the findings of the Truth Commission that highlighted the role played by training institutions in human rights abuses under apartheid. Recently, professional councils have begun to focus on the extent and quality of teaching in human rights, ethics and law to students in the health professions and have recommended guidelines for the core competencies that would be expected of graduates in these areas.

Course objectives

This course will enable participants to:

Understand the conceptual framework for human rights and its relationship to health
Explore the historical context as well as contemporary national and international human rights debates relating health and human rights
Promote awareness of professional and ethical codes to support human rights
Explore the past and future roles of institutions in the health sector with regard to human rights
Recognise the importance of self-study and reflection on the past to plan for the future
Develop strategies for curriculum change, including multidisciplinary teaching, identifying clinical settings in which human rights abuses take place, and exploring the relationship between ethics and human rights
Identify core and discipline-specific competencies in human rights
Investigate, create and share teaching resources (electronic and other)
Co-Convenors

* Prof Leslie London (Head of Public Health and Family Medicine, UCT)

* Dr Pat Mayers (Nursing and Midwifery, UCT)

* Ms Baheya Najaar (Human Nutrition, UCT)

* Prof Laurel Baldwin-Ragaven (University of Connecticut/St Francis Family Medicine Residency Program, Hartford, USA)

Registration

To download the registration form, please go to the following link –
http://web.uct.ac.za/depts/hhr/documents/TraintheTrainer_Reg2011.xls

For further information visit: http://www.hhr.uct.ac.za/train/train.php / (OR)

* carmen.dekoker@uct.ac.za / ( +27 21 406 6300

- School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Anzio Rd, Observatory, 7925

Fees

• Course Fees: R3 800

• Above includes lunches, course materials, transport from local accommodation to the course venue, and welcoming dinner

• Course fees do not include accommodation

• Visit to Robben Island: R250 (optional)

PLEASE NOTE

· Proof of Payment for Registration will be required for entry into the Course. No participant will be able to enter the Course without Proof of Payment

· A cancellation fee will be charged to cover administration costs

Accommodation

• Six en-suite rooms are being held for participants at All Africa House (Stanley Road, Middle Campus)

• Alternatively, B&B Lists can be obtained from Carmen de Koker (See contact details above)

Places are limited so applicants are encouraged to apply early

Participants will be asked to complete a Pre-course Information Sheet to assist in needs assessment and planning

CPD points are available as follows:

· 10 General Points

· 6 Medical Ethics Points

-----------------------------------------------------------------------------------------------

Applications Invited - Postulez dès maintenant: IPHU course in Dakar, Senegal (Jan-Feb 2011)

2010-11-22T00:52:00.000-08:00

Français ci-dessus

Please distribute far and wide across your networks!

The International People's Health University (IPHU) of the People's Health Movement (PHM)
Jointly with Human Action for Integrated Development in Senegal (AHDIS) and Forum des Alternatives Maroc (FMAS)

are pleased to announce

THE STRUGGLE FOR HEALTH

a short course for young health activists, scheduled in Dakar, Senegal From 30 January to 11 February 2011 including participation in the World Social Forum (WSF) from 6 to 11 Feb. 2011)

The course will be conducted in French and English with simultaneous translation.

A limited number of scholarships for travel and/or accommodation will be available for qualified applicants.Priority will be given to qualified applicants from Senegal, other West African French-speaking countries and Maghreb region.

APPLICATIONS INVITED
Application deadline: 19 December 2010

Online application available
in English at: http://www.iphu.org/en/dakar/application
in French at: http://www.iphu.org/fr/dakar/application

Encourage young health activists to apply now!

Further details at:
http://www.iphu.org/en/dakar/announce

--------------------------

Français
SVP distribuer à travers vos réseaux!

L'Université Internationale pour la Santé des Peuples (IPHU) du Mouvement Populaire pour la Santé (MPS)
avec
Action Humaine pour le Développement Intégré au Sénégal (AHDIS) et Forum des Alternatives Maroc (FMAS)

annoncent

LA LUTTE POUR LA SANTE

une session de formation pratique pour les acteurs dans le domaine de la santé
du 30 janvier au 11 février 2011
à Dakar, Sénégal
avec la participation au Forum Social (WSF) du 6 au 11 février 2011

Les cours seront donnés en français et en anglais. La traduction instantanée sera disponible.

MPS-IPHU attribue un nombre limité de bourses d’étude qui pourraient couvrir les frais de voyage et/ ou de séjour des candidats qualifiés.
La priorité sera donnée aux candidats qualifiés du Sénégal et des autres pays ouest-africains d'expression française ainsi qu'au Magreb.

Postulez dès maintenant!
Dernier délai pour recevoir les formulaires de participation : 19 décembre 2010

Postulez en ligne en remplissant le formulaire de participation
en français à: www.iphu.org/fr/dakar/application
et en anglais à: www.iphu.org/en/dakar/application

Plus de détails à
www.iphu.org/fr/dakar/announce

People's Health Assembly 3 to be held in Cape Town, July 2012

2010-11-21T23:05:00.000-08:00

The 3rd People’s Health Assembly (PHA3) to be held in Cape Town in July 2012.

Over the past several years, PHM Circles across the globe have made great strides toward the goal of “Health for All Now,” and PHA3 is an opportunity to take stock of all aspects of the movement. It will be an opportunity to analyze the current global health situation, celebrate strengths and accomplishments of PHM, and to strengthen the global network.

It is now time to start preparing for PHA3! 2011 will be used for mobilization within countries and regions, in a lead up to and in preparation for the 3rd PHA. We encourage all PHM friends to use existing events in 2011 for this mobilization; and for building PHM.

Please keep us informed of any regional events taking place that you think could be used for mobilization towards the Assembly. Activities can include:
reviewing and / or translating the People’s Charter for Health (if not already translated; we have it in over 40 languages already; see www.phmovement.org);
preparing discussion papers;
developing action plans and campaigns towards a shared agenda for people’s health ;
plan actions around a Right to Health campaign using the events to develop testimonies, case studies and discussion papers.

The PHM Global Secretariat welcomes your participation in the planning and implementation of this event. As with the previous 2 assemblies, PHA3 promises to be an exciting opportunity to share ideas and network with health rights activists from around the globe.

--
Bridget Lloyd
Global Coordinator People's Health Movement

Tel: +27 (0) 21 447 3037 - Fax: +27 (0) 86 652 4805
Mailing Address: PO Box 13698, St Peter's Square, Mowbray 7705, Cape Town, South Africa
www.phmovement.org

European free trade agreements and the right to health in the south

2010-11-17T06:32:00.000-08:00

The right to health is a right for all. Even though states have to ensure that all citizens are able to enjoy this right, the right to health is being threatened by economic interests. This is illustrated by the free trade agreements the European Union is negotiating with countries in the South. Read the summary on the link below:

http://www.sante-solidarite.be/files/summary%20health%20and%20trade.pdf

The summary is drawn from the Platform's report "The EU's bilateral FTA Negotiations are a Threat to the Right to Health" (April 2010). The text of the full paper can be downloaded on: www.sante-solidarite.be.
For further information you can contact Wim De Ceukelaire at wim.deceukelaire@intal.be or Katrien Vervoot at kve@oxfamsol.be

Funding for HR prjoects/ financement pour projects de droits humains

2010-11-17T05:53:00.000-08:00

UN Fund for human rights, democracy, community development...

United Nations Democracy Fund accepting proposal applications from today onwards
Deadline: 31 December 2010
All Countries
The United Nations Democracy Fund is accepting proposal applications from civil society organizations to fund projects on human rights, democracy, community development, women, youth and the media...
http://www.fundsforngos.org/latest-funds-for-ngos/undef-accepting-proposals-today-support-ngos-promotion-democracy-human-rights

A Short Guide for NGOs to write proposal for United Nations Democracy Fund
Our unofficial guide to assist small and medium-sized organizations to understand and write effective application to apply for the United Nations Democracy Fund...
http://www.fundsforngos.org/undef10/guide-ngos-apply-grants-united-nations-democracy-fund

Deadlines approaching...
Human Rights Advocates Programme: Opportunity for human rights activists and NGOs - 19 November 2010
G/TIP International Grant Competition - 19 November 2010
International Human Rights Training Program - 21 November 2010
Front Line Fellowships for Human Rights Defenders - 30 Novmber 2010
AAI Transformational Leadership Program - 29 November 2010
SANAM Fellowship Programme - 18 November 2010
PWSCR's Leadership Institute - 19 November 2010
Grant for Strengthening capacities in the cultural sector - 19 November 2010

Experts push for ‘right to health’ clause in the new constitution

2010-10-25T01:51:00.000-07:00

Sunday, 24 October 2010 14:06

THE right to health must clearly be spelt out in the new constitution preferably under the Bill of Rights to ensure that everyone has access to health in the country, experts have said.
The Community Working Group on Health (CWGH), in its input document to the new constitution-making process, said the right to health must be clearly included in the new constitution. CWGH executive director Itai Rusike said the inclusion of the right to health in the new Zimbabwe constitution would be a show of commitment by the government in promoting social progress and better standards of life for Zimbabweans.

“We see that embedding the right to health in our constitution will give us the bottom we need to make it clear that everyone has a claim to health care, regardless of the economic, social-political status, race, creed, gender or other features,” said Rusike.

The CWGH recommended that the new constitution must have the right to safe drinking water and sanitation, food, shelter as well as access to health-related education and information.

It said, in the new constitution people affected by HIV/Aids must have the right to freedom from discrimination, right to life, equality before the law and the right to privacy.

Rusike said inclusion of the right to health in the new constitution will be a show of commitment by government in promoting social progress and better standards of life.

This, Rusike said, would be consistent with the state’s ratification of the International Covenant on Economic, Social and Cultural Right (ICESCR) in 1991. Article 12 of the ICESCR obligates states to recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, “including the right to healthy environments, prevention of disease and access to health care”. Rusike’s proposals were also supported by former chairman of the parliamentary portfolio committee on health. Blessing Chebundo, who said the
right to health must be included in the bill of rights.

Chebundo said he was concerned that very few people raised health related issues to be included in the new constitution during the outreach programmes, particularly in Midlands where he took part. “It was a cause of concern for me,” said Chebundo. “There was very little in terms of issues related to health raised during the Copac meetings in Midlands.”Chebundo was speaking at the CWGH national meeting whose theme was “Health for All – Campaigning for the Right to Health in the New Zimbabwe. Constitution” held last week. The meeting drew participants from the ministry of health, the Constitutional Parliamentary Select Committee, civil society and
community-based organisations.

A report by Unicef and the government late last year revealed a worsening situation for women and children in Zimbabwe.The report showed reduced access to key social services for the poorest
women and children, especially those in rural areas.Data from the report which is the result of a survey conducted in May 2009 shows a 20% increase in under five child mortality since 1990.
Most of the under fives succumb to HIV/Aids, newborn disorders, pneumonia and diarrhoea.
Children in rural areas and those from poor families, that comprise one fifth of the population are the most vulnerable, the report says.
The survey revealed stark disparities between the rich and poor saying the poor are hardest hit in terms of access to critical services in health and education. The data also shows that 79% of orphans and vulnerable children are not receiving any form of external assistance. Further, around two-thirds of all children in the country do not possess birth certificates. The survey was designed to provide policymakers with information they can use to make decisions on development priorities and budgets. Despite the inaccessibility of health care by women and children, Zimbabwe is a signatory to several international treaties governing the right to
health and health care.
Among those that the country has ratified include the African Charter on Human Rights and Peoples’ Rights, Convention Concerning Forced Labour, Convention against Torture and Other Cruel, Inhumane and Degrading Treatment or Punishment as well as Convention on the Elimination of All Forms of Discrimination Against Women.

BY CAIPHAS CHIMHETE

PHM Zimbabwe: Update

2010-10-20T02:11:00.000-07:00

The Community Working Group on Health (CWGH),coordinating the PHM activities in Zimbabwe has been doing a lot of field work participating in the constitution outreach meetings supporting the Right to Health Campaign in the new Zimbabwe Constitution. The Zimbabwe constitution is currently under review and input is being drawn on the areas to be included in the constitution. In 2008, national civil society at the Community Working Group on Health 15th National Conference demanded the right to health be included in new constitution, understanding the principle of progressive realization of this right thus the 35 national membership based organisations in CWGH including PHM Zimbabwe have been participating in the constitution making process through the 27 CWGH districts structures across the country.

CWGH has also invited the 2 Co- Chairpersons of the Parliamentary Select Committee COPAC who are coordinating the constitution making process including members of the Parliamentary Portfolio Committee on Health to the 17th CWGH National Meeting to be held this Thursday and Friday (21-22October) and will have more than 100 participants for a panel discussion on the inclusion of the right to health in the new Zimbabwe constitution. We will also have a one hour session on the activities of PHM Zimbabwe.

Focal person for PHM Zimbabwe is Itai Rusike:itai@cwgh.co.zw

Tough times for gays in Uganda

2010-10-20T01:59:00.000-07:00

Read the article on the link below:

http://www.iol.co.za/news/africa/tough-times-for-gays-in-uganda-1.687415

Re-Post: PHM Nigeria: First Online Meeting 2 October 2010

2010-10-18T02:38:00.000-07:00

Dear PHM Friends

Please note the correction on the email contact and plan for physical meeting in December not online.
***

PHM Nigeria held its first online meeting on the 2nd of October 2010 attended by interested organisations in Nigeria. Each organisation gave a brief profile of what they do and their interest in PHM. Outcomes of the meeting included:

- a steering committee was formed and adopted four thematic areas to focus on
- to get more commitment from people and to really know those that are interested in PHM and circulate a form to be filled which would also help develop a data base.
-possibility of registration of the Movement with Nigerian Corporate Affairs Commission.
-possibility of a physical meeting in December.

Contact details of PHM Nigeria: phmnigeria@gmail.com

PHM Ghana: Update on the Civil Society Health Forum III held in Accra on Oct 12th & 13th 2010.

2010-10-18T02:11:00.000-07:00

A presentation to introduce People's Health Movement (PHM) to the civil society group was made on the first day of the event. The event was attended by around 140 participants - mostly from local NGOs. This is the first time a presentation on PHM has been made to such a large group of civil society participants in Ghana; and for many of them it was the first time to hear about PHM. There were very fruitful discussions that followed the presentation. Participants readily identified with the People's Charter for Health (http://www.phmovement.org/en/resources/charters/peopleshealth?destination=home), and discussed how they could mainstream the principles espoused in the Charter in their work.

Copies of the Charter and Global Health Watch 2 were presented to the various networks
that form the Coalition of NGOs in Health. And a number of people expressed interest in learning more about the social determinants of health, health systems, and the links between trade and health. Earlier in the forum, the WHO Country Rep. for Ghana stressed the importance of civil society following the SDH and Health Systems, and the presentation on PHM threw more light on these issues.

Following this event, two important Actions are planned: getting involved in the Right to Health Campaign, and planning to host an IPHU short course at some point next year.

Contact details of PHM Ghana: phmghana@gmail.com

Kenyan Daily Nation news paper seeking your opinion on Homosexuality

2010-10-04T02:41:00.000-07:00

Dear Activists,

There is a debate question on page 14 of todays daily Nation where we are asked

'SHOULD HOMOSEXUALITY BE LEGALIZED IN KENYA AS MINISTER MURUNGI PROPOSES?'

Please send your comments to mailbox@ke.nationmedia.com

I urge all members of Gay and Lesbian Coalition of Kenya (GALCK) and others to respond and send your comments. Let's support the minister.

Regards
--
Elphas
From Kenya

Critical Health Perspectives

2010-09-16T02:03:00.000-07:00

Community Health Committees as a vehicle for participation in advancing the right to health.

Community participation has been considered one of several key ingredients required to improve community health yet, studies from Southern Africa underscore serious shortcomings in the implementation of meaningful community participation. This paper explores the role of Health Committees as a vehicle for participation in advancing the health rights of communities. Read the article in the link below:

http://www.phmovement.org/en/node/3116

******

Critical Health Perspectives - Call for Papers.
-----------------------------

CHP is a publication of the People's Health Movement, South Africa (South Africa). It is produced with the aim of offering an alternative, "peoples health" perspective and stimulating debate on critical issues related to health and health care in South Africa and elsewhere. CHP is distributed electronically directly to about 500 people, as well as to a number of email lists. The distribution list consist of professionals interested in health care issues, staff in NGO's, trade union membership, media, government officials, activists, etc.

You are hereby invited to submit papers or articles which are in alignment with the above objectives for publication. Contributions should be in English and not exceed 1,500 words. Please inform us if the articles have been submitted/published elsewhere.

Articles should fall within the broad framework of the People's Charter for Health, which is available on the PHM website www.phmovement.org

The editorial collective of CHP will consider submitted articles for publication. CHP reserves the right to edit all articles.

Articles to be submitted to nmyburgh@uwc.ac.za

Mozambique govt suspends SMSes

2010-09-13T07:54:00.000-07:00

As a follow up to the article on the power of sms in Mozambique protests, the Mozambican government has suspended SMSes. Read the article by following the link below:

http://www.mg.co.za/article/2010-09-11-mozambique-govt-suspends-smses