Ho Chi Minh City. After a long seven months in the US, I am back home. In about two years, my wife and I are planning to settle in California, leaving 18 years of a happy life in Vietnam behind us. As I write to you, I am back home by the river, and share with you the picture of calm above. This is actually our meditation house. The boat in the small fishpond sadly is now sunk with a hole in its bottom. So as our dear editor has also done, I share with you the outlook from my window. This helps to inspire my columns which, I have to admit, are not always calming.
SCALING UP NUTRITION (SUN)
LET US HOPE THAT THE SUN INITIATIVE CAN REALLY
PUT NUTRITION AT THE CENTRE OF DEVELOPMENT
The picture above is very definitely not a view from any window where I live. But it's rather inspiring, I feel. Here is the sun at dawn, lighting up what may at first sight seem to be a barren landscape, but which actually contains a river and forests that can be husbanded. Let's bear its message in mind, as I now ask questions and make comments about the SUN (Scaling Up Nutrition) initiative.
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. As such, we should continue to engage with its process and make clear proposals for improvement and press for these, as well as being 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 support; my column here 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 praxis, an integrated process, 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.
SUN. Editor's note
The Scaling Up Nutrition (SUN) initiative is in one way and another steadily engaging more and more public health nutrition and allied professionals all over 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, hunger, 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.
We plan to be carrying regular contributions on SUN and its vision, mission and work during this year. Our columnist Claudio Schuftan, in common with colleagues in the People's Health Movement and some other civil society organisations is, as can be seen here, troubled by aspects of SUN, while – as we all should – he supports and applauds its general purposes. This column here is the second he has written on the topic of SUN. The final section of an earlier column, written together with Urban Jonsson, was published six months ago and is linked here.
One of his 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. Other heavy issues are 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 these are liable to vitiate any form of development initiative. Those who have devised SUN have to work within these crises, which cannot be overlooked. In the coming months we will be opening our pages to a full and balanced account of SUN and its work, its promises, and its achievements. We particularly look forward to publishing contributions describing and commenting on progress in least resourced communities.
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. One good time to come up with a shared understanding will be the joint Association/ Abrasco Rio2012 congress in late April, with its motto 'knowledge-policy-action'. Many of those most deeply engaged with SUN, from different points of view, will be there.
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. All of which 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 fully understand this?
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, as I wrote in the June issue of World Nutrition. 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. 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? Surely 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 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 able to supply. 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.
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?
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.
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 forums.
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.
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.
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.
These organisations still often call for more interdisciplinary research.
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's need 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.
Many of these organisations call for setting up social protection and safety nets.
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?
The CGIAR and similar organisations have proven their ability to communicate effectively, to bring relevant actors together to promote action.
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 and threatening. Is the SUN initiative a response to such 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 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 adequate and healthy 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.
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. 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
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.