I would like to think that you often
ask yourself – as I do – what all of
us could all 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 can 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, specifying 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.
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The human right to
adequate 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 types of 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.
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Neo-liberal ideology
How inequity is perpetuated
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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 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).
In policy circles,
concepts tend to be
discussed over and
over again, 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 –
and these are those
that need to be
addressed.
In opposing this
latest manifestation
of globalisation –
which is capitalism
gone to extremes –
what is missing is
an integration of
the multiple
international human
rights obligations,
in the process of
negotiating, among
other issues, 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. They also
amount to an
outrage. As with
slavery, there are
ethical limits to
the toleration of
extreme poverty.
Nutrition
professionals
The myth of the
market
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THE STRUCTURAL
CAUSES OF POVERTY DETERMINE
PREVENTABLE ILL-HEALTH AND
PREMATURE DEATH |
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Why then are
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 and
past 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 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
adequate
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
adequate
nutrition would
interfere with
their current
policy choices.
But states have
already signed
covenants that
guarantee
respect of the
right to
adequate
nutrition under
any
circumstance,
irrespective of
their resources.
While certain
aspects of the
rights approach
can be
implemented
progessively,
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
adequate
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
The medical
impediment
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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 11
September
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
many types
of
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 adequate
nutrition
The fight
for rights
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WE NOW NEED TO COMMIT
OURSELVES TO THE NEW AGE
OF THE HUMAN RIGHT TO
ADEQUATE NUTRITION |
Making human
rights basic
and central
to the work
of nutrition
professionals
also
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
adequate
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
adequate
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
adequate
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
close to
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
adequate
nutrition
does not
depend on an
economic
justification,
and does not
disappear
when 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 adequate
nutrition.
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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. Decency
crumbles in the face of greed, and other items.
[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. It
is developed from my regular Human Rights
Reader. Special thanks to Weinstein L (ed):
Multiversidad, Editorial Universidad Bolivariana,
Coleccion Nuevos Paradigmas. Santiago, Chile,
2009. Also to: Labonte R, Schrecker T, Packer C,
Runnels V (eds). Globalization and Health.
Pathways, Evidence and Policy. London: Routledge,
2009
cschuftan@phmovement.org
www.phmovement.org
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