The United Nations has just
completed its assessment and review
of the
Millennium Development Goals, at
the two-thirds point between 2000
and 2015, at a summit at UN
headquarters in New York. 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). This is
critical of what they see as the
somewhat slow progress that has been
made towards achievement of the
Goals, and also to some extent is
critical of the Goals themselves.
We at the
Peoples’ Health Movement agree
emphatically 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
other aid and development
programmes.
Reference and footnote
-
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.thelancet.com/mdgcommission.
Editor’s note: please also see
the news item on the home page
of the October 2010 Association
website, and Reggie Annan’s
column, which also discusses the
latest MDG developments.
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The Millennium Development Goals
Who for, and what for?
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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
federation of civil
society
organisations,
health professionals
and academics, with
very many
sympathisers within
international
financial
institutions, UN
agencies, and
national governments
and their agencies.
Our focus is on
communities and
citizens especially
in impoverished
countries – the
people who the MDGs
are or should be all
about.
Six
shortcomings you
need to know
For long
now, we have been
raising awareness of
the MDGs’
limitations. 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 view is
influenced by the
following facts and
observations, which
seem also to be
generally
overlooked:
- The promises
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
MSDGs 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
MDGs concerned
with nutrition
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
labelled them as
‘Millennium
Development
Goals’, not
wanting to play
the MDG game.
Malnutrition is the
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
will not mean simply
a blind acquiescence
in their
assumptions, nature
and approach.
It is a fallacy to
suppose that health
and nutrition
programmes
addressing the
urgent needs of
women and children
therefore 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’s
needed is re-filling
the cup, with what
is genuinely
nourishing.
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. There
are more! They:
- 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.
More, 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 or of
the
international
financial
institutions..
- Constitute
pre-set
international
obligations, and
are not a real
expression of
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 these
rights,
- Assume that
privatisation of
services is a
strategy for,
rather than an
obstacle to,
economic
development and
improved
nutrition.
Malnutrition is a
political issue
The implications 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.
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 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
ideals of 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
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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 |
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For all
these reasons
the MDG approach
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.
It is, after
all, 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 them
altogether, will
reveal the
discrimination,
social
exclusion, and
other human
rights gaps in
the Goals as
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
oceans of
remaining
grievances and
persisting human
rights
violations. By
sticking to the
MDG 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. The Goals
as now framed
would enable the
halving of
hunger of all
under 5s in the
world on 1
January of any
year, simply by
distributing a
few hundred
million
sandwiches to
hungry children
the night
before. 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
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 with no
batteries. 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-government
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’, of
having ‘human
rights
projects’, or
‘mainstreaming
human rights’.
What’s 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.
Organisations
outside
government 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
non-government
organisations
need to shift
their work from
a welfare
perspective to
an economic
justice
perspective.
This entails the
transformation
of 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 now about
the World Public
Health Nutrition
Association?
Seven
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 pulling
it up at the
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 hat 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 was most
discussion in
effect
uncritical
support of the
current aid and
development
paradigms and
programmes? I
fear it was. As
professionals
and as part of
an organisation,
we all can do
much better than
this.
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 MDGs:
what for, and
who for?
[Column] Website
of the World
Public Health
Nutrition
Association,
October 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: The Broker,
issues 14 and
15, June and
Aug. 2009;
Development and
Cooperation)
issues 31:11,
Nov 2004; 31:12,
Dec 2004; 32:1,
Jan 2005; 32:2,
Feb 2005; 32:4,
April 2005;
32:5, May 2005,
32:6, June 2005,
32:7, July 2005,
and 32:8/9,
Aug/Sep 2005;
Finance and
Development),
41:3, Sept 2004.
SCN News No.29,
late 2004-early
2005. ‘Human
Rights, Health
and Poverty
Reduction
Strategies’,
draft, WHO/HDP/PRSP/05.1,
2005. and Yifat
Susskind,
www.madre.org/articles/int/mdgcritique.html.
Also to George
Kent and Vicente
Navarro.
cschuftan@phmovement.org
www.phmovement.org
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