Health, nutrition and sustainable development
Some more FFT Claudio Schuftan 21.09.98
Re. Aviva last FFT Alain Mourey 22.09.98
more FFT (Food For Thought) Michael Golden 22.09.98
Re: more FFT (Food For Thought) RA Carr-Hill 24.09.98


From: Claudio Schuftan avivaatnetnam.org.vn

Date: Mon, 21 Sep 1998 09:58:28 +0700

Subject: Ngonut: Some more FFT

 

HEALTH, NUTRITION AND SUSTAINABLE DEVELOPMENT

At the closing of the century, the central question I think we are not often enough asking ourselves is:

If we are trying to insert health and nutrition interventions in the Third World more in the realm of sustainable development, why is so much that has been said, written and spent on this having so little effect on the problems that our actions are actually seeking to address?

The answer to this question lies in various fronts; among them, more often than not:

- following Northern-led approaches, our praxis has become professionalized and, in the process, we have devaluated and demoded the role of popular knowledge in our fields of expertise; - our prevailing values and attitudes as researchers and practitioners in this field have prevented us from acting as equals with our Third World national counterparts;

- we still control knowledge as part of the elite, and thus fail to get a deeper understanding that will guide more appropriate actions; the latter can only come from a process of genuine popular participation.

The root of the problem is that sustainable development is about processes of popular enrichment, empowerment and participation which the (our) technocratic project-oriented view has simply failed to accommodate.

Also contributing to the irrelevance of many past and current approaches is the fact that overall development education has continued its traditional conservative role of transmitting society's values mostly as they are perceived in the North. The time has come to demand profound changes that accommodate more multi-centric new approaches.

Those who teach us, inevitably teach us part of themselves and the frame of values that is part of their background. Each context they come from has its own frame of assumptions about what is real, what is unshakable and what is safe. The problem is that sometimes these contexts become cages, especially in our type of work in health and nutrition. The time has also come for new frameworks to break the old thinking patterns and make health and nutrition work more genuinely participative.

Unfortunately, difficult problems have the power of leading us to focus on their more manageable components thus totally avoiding the more complex, underlying and basic, structural question. This is known as 'the exclusion fallacy' in which what we choose not to discuss is assumed to have no bearing on the issue. (Mc Dermott)

We cannot, therefore, continue supporting an outlook on the future that is partly based on presumptions and forecasts rooted in desires from outsiders (no matter how well intended); we need facts about the whole picture, not only about health and nutrition.

But an uncritical, repetitive reliance on the same old shallow facts in the interpretation of unresolved issues --i.e. not considering ill-health and malnutrition as outcomes of complex social and political processes-- has equally foreseeable conservative consequences. Outlooks stemming from such vantage points particularly suffer from an inexcusable narrow understanding of the nature of control processes in society (both in the North and in the South).

The predominantly functionalist theories of development we mostly still fall back on, see society largely as an organic whole that is normally in equilibrium; dialectical theories view society as a complex of forces in tension and conflict by reason of the divergence of their interests.

The functionalist theories, which I criticize, assume that conflicts are resolvable within the existing social system. In dialectics, conflicts are supposed to lead to systemic change, to a more fundamental break with the existing order. (Langley)

Among the most prominent newer components of functionalist theories are all sorts of 'multidisciplinary approaches' to solve the problems of, in our case, ill-health and malnutrition. There is nothing terribly wrong with this concept, only that it gratuitously assumes that looking at the problems at hand from a 'wider', 'pluri-disciplinary' perspective is going to automatically lead us to the better, more rational and equitable solutions... Just by putting together disciplines and putting together brains 'sown' differently --without considering where they are coming from ethically, ideologically and politically-- has not, is not and will not, by itself, make a significant difference in the outcome and in the options chosen (for sure so, if also not incorporating beneficiaries in the decision-making process).

THE NEED FOR A MORE CRITICAL AND VISIONARY ATTITUDE

Our failure to reach Health (and Nutrition) For All by the Year 2000 has been more than a wretched fact in history. As far as I am concerned, it has been an ice-age in our thinking on how ill-health and malnutrition are deeply linked to an overall unsustainable development model. Now, we need to think what ought to follow during the current thaw. [To use a cliché: If we know what we are looking for, we are more likely to get there and to know when we do].

In this endeavor, opposing the old ways is not enough; we have to set out a counter-concept. The present moment is still full of promise, because the old conceptual clarities are breaking down; an era is expiring. Openings are being followed by partial closures.

Debates about historical rights and wrongs are to guide cohesive propositions for tomorrow. If there is no cohesion in our vision, though, the campaigners will weary and the campaign will perish; we thus need a vision firmly embedded in a practice. To walk away from these debates is a luxury we cannot afford. We need to wedge open a space for the larger discussion of what ought to follow, a discussion that looks at all levels of causality of ill-health and malnutrition in poor countries --from immediate to basic causes. Yes, this will mean changing the terms of the discussion, because 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 suggest a route, and this requires that it take into account a lot of unpleasant realities.

A vision is of no use unless it serves as a guide for effective action.

These actions will have to be biased towards the oppressed, because it is their rights that are being trampled-upon. We ought to express and manifest solidarity towards them, because only then will our (joint) vision 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. Widows of opportunity have a way of slamming shut. (Gitlin)

I am aware it is still very difficult for some of us to maintain our political agility in a hostile environment. But the role of an avant-garde is to cause fermentation. We cannot fall in the trap of believing someone else is going to take care of these things for us; we have to get active. A strategic overhaul of our actions requires nothing less than a crisis in our thinking and if by now there is no such a crisis in the horizon, we have to perhaps create one.

The future of our work in health and nutrition cannot be a simple extension of the past. If we try to pursue a path of business-as-usual we will find some altogether unusual consequences. However much we may engage in fine-tuning the engine, this will not suffice unless we redesign certain sizable parts of the motor itself. (Myers)

The future will have to inevitably differ. It is of un-postponable critical importance to deliberately concentrate on neutralizing the known social forces that are propelling us in the hopeless direction we are moving, both at the national and at the international level.

Changes as fundamental as the ones at stake here can only be promoted by people who have no vested interest in the survival of the non-sustainable development system as it operates now to the detriment of the dependent countries and their poor. (Herman, Bracho)

The brick wall of political will (the lack thereof) is best tackled through practical actions that take into account who will win and who will lose.

A new professionalism will emerge only if we are explorers and ask, again and again, who will benefit and who will lose from our choices and actions in our work in health and nutrition. New professionals who put the last first already exist; the hard question is how we can multiply and, most importantly, how we can interact, coalesce and organize dynamic networks among ourselves and between us and grassroots organizations.

In sum, I reiterate that a mere extension of what most of us have already been doing is not powerful enough to really get the goal of inserting health and nutrition more in a sustainable development path achieved. Not only do we need to come up with conceptual breakthroughs, but also to provide blueprints for the needed institutional changes that will support the new arrangements.

We need to act as what Antonio Gramsci called "organic intellectuals" --intellectuals whose work is directly connected with the popular struggle. "Orthopraxis" (right acting) is ultimately more important than "orthodoxy" (right doctrine)...even if it means temporarily retreating for tactical reasons: One who stands at the edge of the cliff is wise to define progress as a step backwards...

Claudio Schuftan, Hanoi

<avivaatnetnam.org.vn>

 

Endnote:

Making prescriptive recommendations on what each of us needs to do to contribute our individual grain of salt to making health and nutrition interventions more effective and sustainable would be presumptuous on my part (although I have attempted it elsewhere). This article has no such intention. It just is a wake-up call for some and an always timely reminder for others. It is about being more critical about what we do and see as a basis to develop our own vision for the future, in our specific settings, to share it and to act (together) accordingly.


From: "Alain Mourey" <amoureyaticrc.org>

Date: Tue, 22 Sep 1998 09:43:07 +0100

Subject: Ngonut: Re. Aviva last FFT

 

Fair enough to say that most nutrition interventions are besides the point.

It is going to be like that as long as nutrition is seen as a health related discipline. However, nutrition is before anything else related to the economy since the first step of the feeding process is to catch food, amongst other things. It is in the daily hard fight for life that malnutrition and ill-health take their root. It is well known that the improvement of nutrition in so called developed countries has not to do with nutrition intervention and knowledge but with economic prosperity.

Looking at present globalisation and neo-liberal economy, is it any hope that poor countries may get their chance through the fallacies of comparative advantages ? When the economy is purely reduced to mercantilism and escapes out of cultures and authority control in search of profit and profit only, what is the strategy going to be, to fight poverty, illiteracy, inequalities, ecological problems ? If there are any solutions to these world-wide evils, they are going to be political ones, and I fear quite violent ones.

The World Food Summit and the International Conference on Nutrition are full of nice declarations of intention. It has still to be proven that these declarations are going to move from intention into action. Then it is very good and probably correct to say that we nutritionists should change our current approach if we want to bring nutrition and health in sustainable development. However, with the present situation, is sustainable development something which can actually happen ? I have the impression that when facing the problem of world poverty and hunger today, it is as if the nutritionists were equiped with tea spoons to clear the Sahara of its sand. The nutritionists have probably a very good position because they know (they should know) about the problems leading to malnutrition and ill-health. If there is any other role that they may play to tackle these problems, it is in the field of advocacy, i.e. on the political stage. And not alone but with the support of economists, agronomists, ecologists, politicians and journalists, to reach a critical level to change behaviour and attitude. After all, in the United States, it has been possible to mount the public opinion to almost ban tobacco, and to accept that the president can be humiliated world-wide in having to disclose his private life in public. Not mentioning what my opinion is about these two events, I feel there is then a hope that proper advocacy can also achieve something in the field of alleviating poverty and inequalities. The crucial point is to reach the critical level of pressure so that public opinion can become powerful enough to bring changes on these issues. It is not going to be easy.

 

A. Mourey


Date: Tue, 22 Sep 1998 11:53:47 +0100

From: Michael Golden <refugeesatabdn.ac.uk>

Subject: Ngonut: more FFT (Food For Thought)

 

Poor nations must help themselves, the most important for this being the human resources they can retain within their boarders.

We can all help by transfer of knowledge and experience both ways - that is the purpose of ngonut, it is not tool for rhetoric or political action.

For a human rights approach - start with the two underlying principles: 1) right to freedom (thought, speech, movement, life) 2) right to share equitably in the wealth of the world.

The first embodies all those rights that cannot be purchased, and the second all those that are related to economic state (food, clean water, health etc). Because the rich of the world enjoy their standard of living by ensuring an unequal distribution of the World's wealth the second fundamental human right has, is and will always be, systematically denied to the poor and weak by the strong and rich. This is something that we will not change - even when it is in the interests of all that it should (see Willi Brant's report - North-South; also Jeddi Jagan's - The West on Trial; Michael Manley's - Up the down escalator, etc). Advocacy really means begging for bigger crumbs to fall off the rich man's table. Like Dicken's novels where he wanted the rich to be "kind and charitable" to the poor - but never suggested that they should be treated as equals.

Stamping our feet and getting hot about what we will not change is waste of energy. Let us use ngonut for the purpose it was designed - exchange of knowledge and wisdom.

Prof. Michael H.N.Golden


Date: Thu, 24 Sep 1998 22:57:39 +0100 (BST)

From: RA Carr-Hill <irss23atyork.ac.uk>

Subject: Re: Ngonut: more FFT (Food For Thought)

 

On Tue, 22 Sep 1998, Michael Golden wrote:

 

> Poor nations must help themselves, the most important for this being the

> human resources they can retain within their boarders.

> We can all help by transfer of knowledge and experience both ways - that is

> the purpose of ngonut, it is not tool for rhetoric or political action.

> For a human rights approach - start with the two underlying principles:

> 1) right to freedom (thought, speech, movement, life)

> 2) right to share equitably in the wealth of the world.

> The first embodies all those rights that cannot be purchased, and the

> second all those that are related to economic state (food, clean water,

> health etc). Because the rich of the world enjoy their standard of living

> by ensuring an unequal distribution of the World's wealth the second

> fundamental human right has, is and will always be, systematically denied

> to the poor and weak by the strong and rich. This is something that we

> will not change - even when it is in the interests of all that it should

> (see Willi Brant's report - North-South; also Jeddi Jagan's - The West on

> Trial; Michael Manley's - Up the down escalator, etc). Advocacy really

> means begging for bigger crumbs to fall off the rich man's table. Like

> Dicken's novels where he wanted the rich to be "kind and charitable" to the

> poor - but never suggested that they should be treated as equals.

Although I have been on this mail list for over a year now, this is the first time I have felt sufficienty confident that I understand the issue to join in. Of course there is no 'right' to equitable distribution of income and wealth: what does anyone think revolts and strikes were about in the first plac?e

 

> Stamping our feet and getting hot about what we will not change is waste of

> energy. Let us use ngonut for the purpose it was designed - exchange of

> knowledge and wisdom.

But that doesn't mean that poor populations - or their external advisors - are impotent. For example, given the current 'coming home to roost' of the financial chickens, it is worth discussing whether or not it would be in the interests of the World Poor to encourage developing nations to default on their loans in order to accelarate the collapse of finance capitalism. The poor are not impotent. Knowledge and Wisdom includes an understanding of the precarity of global financial capitalism