Volume 2, Number 4, April 2011
Journal of the World Public Health Nutrition Association
RISING FOOD PRICES AND CHILDREN: Nutrition Implications.
People’s Health Movement
Biography posted at www.wphna.org
As pertains consequences, the question is not whether the needed solutions are too expensive; it is whether it will be too expensive not to do anything!
BBC World Service BBC News,3 March2011 Food prices hit new record highs, says UN food agency.
Global food prices have hit record highs, and could rise even further, according to the United Nations. The UN’s Food Price Index rose 2.2% in February to the highest level since the UN’s Food and Agriculture Organization (FAO) began monitoring prices in 1990. It also warned that spikes in the oil price could make the “already precarious” situation in the food market even worse. Apart from sugar, FAO said all commodity groups had risen in price. Oil prices recently hit two-and-a-half year highs due to political unrest in North Africa and the Middle East. FAO said the volatility in the oil markets was adding to an already difficult and uncertain situation. The International Monetary Fund (IMF) said it was “extremely concerned” about the situation. The prices of cereals, such as wheat, rice and maize, have risen by 70% in the past year. Current pressures could push prices higher.
The rising food bill –that some have called “agflation”– has its historical roots in the three decades between 1974 and 2005 in which real food prices declined by 75%. In the years since, they have risen dramatically and the price hikes affect nearly every food commodity. In short, prices in 2011 are higher than they have been in decades. This has to be put in the context that, not only poor city dwellers, but also many poor farmers in poor countries are net food buyers. (1)
A personal journey Geofffey, pick and chose from this
I am a social paediatrician, originally from Chile, 15 years resident in Vietnam. Prior to Vietnam, I lived seven years in Kenya. Both in Kenya and here I worked as a senior advisor in the ministry of health. Have been an academic for many years: in Chile, US and here. Currently a freelance consultant in public health and in public health nutrition. Between consultancies, now for many years, I devote my time to activities of the People’s Health Movement, or PHM for short (www.phmovement.org). I am one the founding members of this people’s network of networks with a presence in over 70 countries; am a member of its steering committee and moderate its list server. I also coordinate its global right to health campaign. I consider myself primarily a health activist devoted to fostering the respect of the human right to health and the right to nutrition. I am an avid writer with many, many publications (www.humaninfo.org/aviva). Since 2004, I write a short periodic column (the Human Rights Reader) that gets posted in several list servers. I participated actively in one of the 18 committees that prepared material for the Commission on the Social Determinants of Health of WHO. It was the committee on health governance. I am the Honorary Consul of Chile in Ho Chi Minh City. As an activist, I have significantly expanded the field of the practical application of the human rights-based approach to planning and programming. My Readers have explored new avenues. I am thus one of the many that has used the power of the internet to promote human rights, justice, fairness and above all accountability. In the 1980s I participated in the group that came up with the conceptual framework of the causes of malnutrition. In 1990, that framework became the official UNICEF framework. I was a co-drafter of the People’s Charter for Health, probably the most quoted manifesto of public health priorities now available in over 40 languages. (www.phmovement.org) I am passionate about the role activists have to play in our troubled world. I bring a political perspective to public health, to nutrition and to human rights issues. I am an avid reader and gobble gigabytes of information every month. I keep a balance between professional reading and reading for pleasure. Furthermore, I am a compulsive ‘clipper’ of materials I find in what I read; I use the clips extensively in my writings. Have my activist work been a source of successes or of disappointments? The response is a mixed bag. I have experienced both. The same as for you who are reading this, I have my days… When I look at what I was writing in the late 1970s and 1980s, I can see that quite a bit of what was ‘unconventional’ and ‘radical’ at the time, has now become mainstream: that is progress. But I am conscious of the two steps forward one (or one and a half) steps backwards aphorism –and that applies here. Sometimes I look at the mirror when I am shaving in the morning and ask myself: Shouldn’t I retire? I have done my bit. Let the younger take over. But the fighter in me will never let go: I have realized I am a positive pessimist!
One of the causes of currently rising food prices is protectionism in Europe and the United States. Both have remained committed to protect their own farm sectors while stymieing farmers abroad. In the US, the latest farm bill is awash in subsidy payments (a typical example of special interest legislation). There, family farmers (now less than 1% of the population) have disappeared as farm subsidies have gone to wealthy corporations active in agriculture. Protectionism causes losses of greater than U$70 billion a year and makes the world’s poorest people more vulnerable. The crux is that now, in times of soaring food prices, there is not even an economic justification for subsidies. It is thus political considerations that explain why crops are subsidised. As a result, the world is growing hungrier by the day. World prices have reached near record levels. Why now? (since protectionism has been with us for long): Half a billion new middle-class consumers in China and India are emulating rich people’s diets; recent increases in the price of oil have been passed-on to consumers; water scarcities for irrigation and cut-backs on arable land have had their contributory impact as has the diversion of food crops to bio fuels (one fifth of the American corn crop is now devoted to ethanol). (2)
It is the confluence of the above plus factors such as increased food demand and food preference shifts to meat (doubled in China from 1990 to 2005), to dairy products, to fruits and to vegetables– that explain agflation. Furthermore, rises in petroleum prices make it more expensive to operate farm machinery, to transport agricultural products and raises the cost of some fertilisers. As said, the diversion of food to bio fuels (that even receives subsidies!) is also making farmers switch to growing bio fuel feed stocks. Add to this natural disasters in Australia, West Africa, India and Bangladesh. Finally, not to be forgotten, speculation in commodity markets (importantly by a handful of monopolistic transnational corporations) has contributed to more volatile prices. (See box) (1)
The factors driving food prices up go beyond the ‘invisible hand’ of self-correcting cycles of supply and demand. All indicators suggest that food prices are unlikely to fall any time soon and, in fact, may rise much more. In the meantime, there is no guarantee that small farmers will be the ones to benefit from productivity increases and high prices. Larger landowners are in a better position to respond to market signals. Higher food prices will also raise the value of land in poor countries, increasing competition, to the detriment of smallholder farmers and pastoralists. (1)
It is foreseen that poor urban consumers (are feeling and) will continue to feel the most pain as food aid agencies have traditionally worked much more in rural areas. Anyway, rising food prices have strained the capacity of food these aid agencies. The crisis has consequently drawn extensive worldwide press coverage. (1, 3)
In sum, the current food prices crisis has highlighted the fragility of the world’s food system and its vulnerability to shock. (4)
Getting rich off hunger?
There is considerable evidence of increased speculative activity in jumpy food markets. Institutional investors have invested billions of dollars in US commodity futures markets. Many observers have fingered speculation as a primary cause of the market turmoil.
As futures markets attract capital from around the globe, the number of open futures contracts has increased between double and threefold depending on the commodity. At the end of March 2008, investors worldwide had an estimated $400 billion in commodity futures contracts, twice as much as in late 2005. They are doing so for two reasons: first, commodity investments generally increase in value when other assets decline; and second, many investors believe that the commodity markets are in the midst of a super-cycle –a long-term trend that will drive prices higher for years to come.
Hoarding also has been on the upswing in other areas of the world food economy: Some governments have restricted their exports of food; other countries have engaged in panic buying on international markets.
Low and declining food prices have long played a major role in keeping agricultural production stagnant in much of the developing world. Now, things are changing and high prices are attracting capital to agriculture. In theory this should be a good thing. But purely speculative investment is hardly what we in the development community had in mind.
We thus need to face the challenge of limiting speculation that distorts markets and to promote more transparency, as well as to reduce opportunities for market manipulation. This requires more comprehensive and detailed reporting of transactions, limiting the size of speculative positions and reforming the laws governing huge (largely US) pension funds limiting their ability to invest in commodity futures. (4)
While food prices are rising for a number of reasons, there is a growing concern that supply and demand does not adequately explain the speed and severity of the price increases. Whether current prices are telling the truth about supply and demand is thus not clear. If an agricultural bubble is under way, the consequences will be severe for farmers, as well as for consumers around the world –and thus for children. The enormous influx of capital mentioned above has resulted in the futures markets no longer reflecting supply and demand. Prices are totally out of proportion with market fundamentals. (3)
The likely impact of the current rising food prices crisis is that it will lead to low income, low net household food purchasing power, and reduced households dietary diversity (in an effort to maintain the overall consumption of staples) resulting in increased micronutrient malnutrition. This has very serious nutrition and public health implications and is clearly a threat to the right to food and adequate nutrition. (M. Cohen, Oxfam USA)
As a result of the crisis, consumers are now spending a much larger share of their income on food. Rice accounts for around 60% of the calories consumed in Asian countries…and several of them import a sizeable part of their grain needs. For these countries, the current situation is dealing a serious blow to the food security and diets of people who are already nutritionally vulnerable. If bio fuel production continues its course, calorie availability in Asia may fall close to 10% and the number of malnourished children will certainly increase by a couple million. [Note: 450 pounds of maize can be converted into enough ethanol to fill the 25 gallon tank of an SUV with pure ethanol one time –or used to provide enough calories to feed one person for a year]. (1)
Within countries, the urban poor are the most affected by high food prices, as part of the rural poor are more likely to be at least partially self-sufficient in food supplies. Households with income below the poverty line are least able to protect their income from inflation, but intra-household distribution issues are also important in identifying the most vulnerable groups. The urban poor, together with food-deficit farmers, are thus the worst affected by food price inflation, because they rely on food purchases for their food supply. Consequently, it is among them where the share of undernourished is likely to rise rapidly above the current thirty some percent of malnutrition rate of <5s in several of Asia’s countries. Some very poor countries will become more dependent on food aid as the food tonnage available for aid is rapidly shrinking. Food aid providers are being hit hard by the new high prices so that, in fact, food aid is already in the decline. (1) More specifically the direct nutritional consequences of the food price crisis are: • reduced intake of micronutrients (risk of xerophthalmia and iron deficiency anaemia); • reduced calorie intake (low birth weights, risk of wasting and then stunting and low weight for age with long-term health and child development and welfare consequences); and • reduction in breast feeding as mothers are required to work and also as a result of a decline in maternal nutrition. Note that it may take several years for the consequences, particularly in regard to long-term child development, to become apparent. Most importantly to keep in mind here is that the adequacy of nutrition among young children cannot be separated from the adequacy of their mother’s diet. One thing is almost sure: The welfare of children will deteriorate. The ability of families to continue to shield their children is being severely tested. To cope, families are reallocating their consumption to meet basic needs as they are concomitantly running down their savings. (5) In sum, the cost of doing nothing will ultimately be paid in increased low birth weight rates, decreased breastfeeding rates, increased malnutrition rates (stunting and micronutrients malnutrition), increased <5 mortality and, in general, a heavy toll on child development indicators. The myriad responses: In one way or another, we will have to come up with solutions that provide income support to the poorest people via cash transfers or vouchers to help them purchase the food they need. The farmers can benefit from the higher prices which, in theory, should raise production. But, as was noted earlier, in the current context, things are not as simple as they seem. Governments will also have to increase their investments in agriculture, not only to improve agricultural productivity, but also to act on the economic and social determinants of rural poverty. Also, poor countries’ governments in the region will have to beef up rural infrastructures and improve market access for small farmers, as well as expand social protection interventions, especially in relation to maternal and child nutrition. (1) Actions by national governments, with the support of the international community, are thus required in the short, medium and long term. Both governments and NGOs should thus deal with the continuum from urgent to longer term assistance. South-South cooperation must be encouraged as well. [As is known, UN agencies have had to step-in with food assistance; one would hope using local or regional purchases]. To help adjust to the higher food prices, low income, food importing countries will, in practice, need balance of payments support and/or budget support. A review-of and action-towards their debt servicing will also have to be undertaken especially simplifying their eligibility procedures. (3) Farmers in low income, food-deficit and most affected areas should be given access to appropriate locally adapted seeds, fertiliser, animal feed and other inputs, as well as technical assistance. The current low levels of grain reserves also need to be addressed. Therefore, assistance in developing the food stocking capacity of vulnerable populations is a step in the right direction. Moreover, unpredictable prices are among the farmer’s greatest enemies; risk mitigation and insurance schemes could help here. (3, 4) Potential interventions impacting on children in the realm of nutrition: The following are among the myriad interventions proposed in the literature: Scrapping food import tariff, food price subsidies, food supplementation during the last trimester of pregnancy and during lactation, promotion of breastfeeding to 24 months (exclusive for the first 6 months), complementary feeding for the age group 6-24 months, other care components directed at the mother and child, access to primary health care and to clean water, public awareness campaigns (especially on immunisations and sanitation issues), subsidised vitamin and mineral supplements (support for the distribution systems of iodine, iron, vitamin A and Zinc?) and school feeding programs (although not really a strictly nutrition intervention). The big question here is: What is politically feasible in each country in all of this? (5) Ensuring adequate income and supporting financial mechanisms at community level that provide access to credit are not to be forgotten as they are the most effective first line of defence against the economy-wide food prices shock. Families without resources --those close-to or below the poverty line and those with special needs-- will indeed require additional support mechanisms to provide relief for the particular needs of their children. Employment creation is to be preferred over systems based on income transfers, such as social security benefits. Communities should be used to assist in targeting assistance to the most needy: Community organisations and NGOs are increasingly to be seen as partners in the delivery of these services to children. Bypassing them may undermine their authority and capacity, and thus reduce their effectiveness. These organisations need to be involved in all plans and to be informed of developments; but they are also well placed to provide information that is essential to improve targeting and assess the effectiveness of ongoing programs. Sharing their experiences also helps identify relevant best practice. Therefore, focusing on participatory approaches to program design, recognising the growing role of NGOs in implementation and in monitoring, needs to be a central strategic point. (5) Finally, mechanisms to provide routine assessment of the effectiveness of interventions carried out --their efficiency, coverage and quality of outcomes-- are an important part of the planning and are essential for effective implementation. Moreover, it is not to be taken for granted that the continued monitoring and analysis of the global food security situation, in all its dimensions, is a must. (4, 5) Last, but not least, the importance of quickly channelling significant resources into mitigation efforts cannot be overemphasised…Mind you, we are months behind schedule… A Caveat: In the best of cases, assistance delivered often does not provide the most vulnerable children with a safety net. For children in families with extremely limited income-generating capacity, and for children without family support, additional and extra efforts are required if they are to be assisted. The crisis has highlighted the problems facing children in these situations, as it has exacerbated the situation for many. School drop-outs, street children, under-age children in the labour market and children in exploitative situations are difficult to target. But they are almost impossible to reach through general programs that rely on schools and families to deliver services or to identify needs. This is an area where more needs to be done. Providing resources is only part of the solution. Program adaptation to their special needs is a key element in reaching these vulnerable children]. (5) Box 3: The crisis seen through a human rights lens: More than 100 million people are now urgently at risk of not having enough food to eat. This, in addition to the over 860 million people who are already chronically food insecure. Soaring food prices have triggered food riots in a number of countries across Africa and Asia as people express their frustration at their growing difficulties in feeding their families. Therefore, the global food crisis must be treated, not like a natural disaster, but as a threat to the right to nutrition for millions of individuals and all States have an obligation to act. The human rights-based framework requires us to focus on the root causes underlying the lack of access to food, to health and to care, as well as focus on the negative repercussions of the current situation on specific groups, not only children, but the elderly, the marginalised, the people with special abilities. In this situation, the human rights-based framework compels us to: identify the most vulnerable; analyse the underlying social determinants of vulnerability (exclusion from policy formulation, no access to land, to property and to inheritance; lack of productive and economic resources, unemployment; no access to credit and social protection gaps…); and support individuals in feeding themselves and their families in the long-term --as opposed to the benevolence model of food aid. Urgent is to assess what exactly is happening and who it is affecting; followed by an analysis of why it is happening; and giving an overview of who has what obligations; this is to be followed by preparing guidelines for processes that should be followed when implementing plans. Additionally, monitoring will be needed to assure accountability. As relates to the assessment of each situation through the human rights lens, it is indispensable to disaggregate data by age, sex, socioeconomic and ethnic group and other relevant factors to discover patterns of discrimination, and to go down to the level of household to look at ways in which food is distributed within the family. One also has to consider the processes in place that either enable or constrain the realisation of the right to feed oneself. As relates to the situation analysis, the structural causes and underlying dynamics that drive the current crisis must be identified in a participatory manner. This, to move beyond a mere understanding of the immediate determinants to an understanding of the deeper economic, political and socio-cultural determinants and power relations that influence the ways in which rising food prices affect different people in different ways. This includes an analysis of national and international policies and actions by governments or other actors that are contributing-to and exacerbating, or otherwise failing to ameliorate the impacts of the crisis. The identification of key 'duty-bearers' to understand their ‘capacity gaps’ (i.e., the gaps in their authority and resources) is the ultimate aim of the analysis phase so that claim-holders can then advocate for the needed changes in these policies and actions. As relates to the delineation of specific duties, the whole range of relevant actors has to be identified, including those in the private sector, so that their unfulfilled duties are identified and eventually imposed by the active demands of mobilised claim-holders. [Given that some of the causes of the current food crisis lie outside of the control of some countries affected --i.e., with duty-bearers at the international level-- this suggests that it could be the responsibility of the UN at that level to contribute resolving such issues]. The resulting plans should then include concrete steps to assure the human rights principles of participation, non-discrimination, transparency and accountability. Needed immediate assistance should not be limited to short-term relief, as it should also begin to address the structural causes and national and international policies that are contributing-to and exacerbating the crisis. [Strengthening the capacity of duty-bearers is called-for so they can live-up to their obligations while also empowering rights-holders to claim their rights. Ultimately, the Sate has to be made responsible for the treaties to which it is party-of and the mechanisms of assuring the accountability of all duty-bearers involved have to be specified. Finally, the monitoring component of the human rights-based approach has to ask: Have indicators of progress been identified from the outset of the response and are they being tracked? Are enacted responses reaching the most vulnerable? Have empowering mechanisms been set up so that rights-holders can complain and seek redress? (6) RISING FOOD PRICES AND CHILDREN: Health Implications. Rising food prices have had and do have major impact on the lives of poor children and their families; they have proven to result in income inequality increasing both in poor and in rich countries. The United Nations Convention on the Rights of the Child focuses on three fundamental aspects of children’s rights --survival, development and protection. The economic and resulting social crisis brought about by increased food prices has posed risks to children in each of these areas posing increased threats to the pillars of child survival and development --nutrition, health and education. (5) More on the crisis Prices of food commodities actually only started booming in 2006 --much later than those of oil, metals, and other minerals. Since then, globally, food price inflation (weighted by GDP in purchasing power parity terms) almost doubled in 2007 alone. In some developing countries the inflationary impact of rising food and fuel prices has been amplified by continuing internal demand pressures. Many countries have experienced a severe negative shock (severe means their reserves are down to <1/2 month of imports). Until recently, adverse balance of payments effects of higher food and fuel prices had remained limited, but now they are having larger negative effects. The likely continuation of high food prices will, for sure, place serious strains on the balance of payments of many countries. Furthermore, inflation is on the rise, not only hurting the poor, but also putting fiscal balances under strain; hence the crisis. The crisis has simply brought into sharper focus long-standing issues and problems --most of which have been known to us from way before. (5, 7) Childhood poverty cannot be simply deduced from households’ poverty data; it is also shaped by the intra-households distribution of power and resources. (8) Per capita health expenditure is closely related to GDP per capita --the latter now representing significant less purchasing power given prevailing food and health costs. In low income countries, out of pocket expenditures on health care (often exceeding 50%) make up a larger share of total financial resources than in richer countries. Governments, with the support of grants from the international community, have in the past provided a safety net through the protection of programmes that supply services to families and children including education. But several poor countries in the region have narrow tax bases and rely on import tariffs and trade taxes for a large part of government revenue. In such countries, it is important to ensure that the revenue loss from tariff or trade tax reductions be accommodated without affecting the provision of health care services, especially for women and children. The challenge is thus to strengthen targeted transfer programs as part of the social safety net. [Governments that seek international loans to face the crisis, set themselves up with a debt burden for the future, limiting their future capacity to provide social safety nets]. (5, 7) Successful delivery of interventions addressing each of the vulnerable domains (nutrition, health, education and family support) is often dependent on providing the whole package…interventions in each area is necessary but not sufficient. The costs of continued deprivation in all of them are not short-term! Nevertheless, the full package is not a substitute for broadly based social welfare policies for children or programs for their economic and social development]. (5) Past examples of government programs that tried to cushion children from the worst impacts of the crisis have been: Protecting programs that impact on children from general budget cuts; providing subsidies, e.g., major price subsidy programs for basic foods and medicines; expanding coverage of ongoing nutrition programs (e.g., school lunches, and food distribution programs); and involvement of domestic NGOs. (5) The consequences Rising food and fuel prices both have had adverse effects on poverty, i.e., price increases have resulted in a decrease in real incomes for poor households; ergo, consumers have seen their purchasing power for food decrease. For this direct impact on poverty, our main concerns relate to the higher cost of food especially for the urban poor. The main reason is that the share of household expenditures spent on food is much greater. (7) The countries most vulnerable to the higher international food prices have faced a menu of options that is constrained though by their limited access to foreign financing, low reserve cushions and/or high external or public debt burdens. External financing that could help the private or public sectors cushion their difficult adjustment has been limited. Therefore, to the extent donors are not providing more aid to alleviate balance of payments pressures, these countries will have dangerously limited choices. (7) If we look at the truly cascading sequence of consequences, here is what we see: i. Households that are unable to adjust rapidly enough to the new price hikes are the ones that suffer the most. ii. Rising food prices change the relative outlook families have on their economic activities; some groups in a society may benefit while the majority loses; rising prices affect not only the households’ welfare, but also the welfare of individuals within. iii. Children will be affected in a variety of ways depending not only on the specific effects on household livelihoods, but also on the intra-household distribution of power and resources. iv. Rising food prices bring about reallocations in household spending which, although they have foreseeable welfare impacts, the same are often difficult to trace. How so? Domestic prices of foods are affected due to their direct links to international prices. This change in prices induces changes in labour income which, in turn, affects the allocation of intra-household time and resources, households’ consumption patterns, and ultimately households’ income. v. Governments’ higher expenditures on food imports affect the national budget and consequently very often its supply of services to the poor segments of the population. vi. Rising food prices affect the allocation of children’s time between work, school and play (it can lead to child labour since such opportunities do open up), their access to health services, and their consumption of food and other goods. vii. Rising food prices thus do affect child welfare, e.g., how child labour increases under such circumstances. We do know that short term vulnerabilities do arise and often divert children from school to work… and school attendance reductions will be larger for poor households. (Mind that both boys and girls are vulnerable if policies are not put in place to prevent this from happening). viii. Otherwise, increased adult female labour brought about by rising food prices leads to child care becoming the responsibility of older siblings in the family, reducing their chances of attending school. This has implications for the intergenerational transmission of poverty since less schooling means reducing investments in the formation of human capital (through cuts in expenditures on education by both, the state and the family). ix. School attendance is affected by two factors: households’ income being negatively affected so that parents have difficulty meeting educational expenditures; and, where employment for women increases, older children may, as said, have to baby-sit. x. To recap, key aspects of children’s wellbeing are: children’s work, educational attainment and health and nutritional status. With rising food prices these are compromised for the most vulnerable, i.e., for girls in general, for children of ethnic minority and of female-headed households that are already socially excluded, for households with low maternal education and other impoverished households with unskilled labour, as well as for entire communities with highly concentrated pockets of poverty. Nevertheless, some favourable local conditions may act as buffers and somewhat shield the losers. So each situation is different. [A caveat: clear winners and losers cannot be identified in advance; it depends on the appropriateness of policies to address the negative short-term effects of rising food prices]. (8) xi. Children being indeed susceptible to the negative effects of rising food prices, those from poor, marginalised and disempowered households are hit the worst so that they are the most at risk from the negative effects of rising food prices. xii. Complementary social protection policies are thus needed for both young and older children. (8) Take home messages Economic shocks experienced as an infant or child (such as those brought about by rising food prices) have lasting impact on human capacity development. Ergo, urgently overdue specific attention is to be paid to deepening childhood poverty effects. i. Price fluctuations result in changes in family income and are important factors in determining the fulfilment or non-fulfilment of children’s rights. ii. Household consumption patterns are affected by changes in prices of food; in the case of children, of particular concern are modifications in the households’ food basket, as well as families’ ability to afford education and health care. iii. Families do seek to shield children from the negative effects of such economic shocks, so that taking children out of school is a last resort coping mechanism when faced with these shocks. iv. Rising food prices result in declining poor household living standards leaving them with few alternative coping mechanisms: none of them good for children. v. Girls may have to help women shoulder both productive and caring work responsibilities with negative consequences on their schooling and leisure time. vi. Children’s work in household chores --equally taxing for children’s physical and mental health-- receives less attention than paid labour. (We note that boys are less likely to do domestic work). vii. Moreover, if rising food prices lead to decreased coverage of community health centres, increased reliance on private care is the only option left. Then, poor children’s health will, for sure, be negatively affected. The other side of the coin is: As family resources decline, they may have to increasingly rely on public health services, i.e., a possible shift in demand from private to public health services so that these services will face higher demand while their funding is being reduced. (Therefore, increases on the pressure on government staff and budgets must be addressed early in the crisis: The question is: Have we done so?). (5, 8) viii. Bottom line, one thing is certain: Social disparities will be exacerbated and access to services for children will become unequal. (8) Other very real possible consequences that should not be forgotten include: Damage to the social fabric due to the effect of the crisis on family support systems; declines in general health of children; increasing under five mortality rates; increased domestic violence and child neglect; abandonment of children by families no longer able to cope; consequent increase in the number of children without support; and an increase in the number of street children highly susceptible to violence, abuse and exploitation. (5) The myriad responses: A. Economic responses: Addressing the food crisis requires broad cooperation involving the countries affected, donors, and international organisations. Short of the needed structural changes, the best immediate option is to develop a well-targeted social safety net that can protect vulnerable households in the face of rising prices. This, keeping in mind that we need to adopt targeted specific programs for minorities and the marginalised. (7, 8) Children’s health and nutrition are thus affected by the degree to which the government is willing and able to fund palliative public programs. Decision-makers, not only from trade and economics ministries, but also those responsible for the social sector need to take concerted action for children and youth so that the negative impacts of rising food prices are at least minimised. (8) [A caveat: Civil society needs to make sure foreign aid in health to help in the current situation does not result in allowing governments to spend less of their own resources to resolve the problem]. Reductions in fuel and food taxes and tariffs, increases in universal subsidies, expansions in transfer programs, and public-sector wage increases have been tried. Net increases in fiscal costs stem from these measures. (7) Since 2006, many countries have reported reducing food sales taxes. Food import taxes were also decreased in some countries and the VAT was reduced in yet other countries. The annualised fiscal costs of food tax decreases are not insignificant, they can reach up to 1% of GDP. Almost all current food price subsidies are universal --that is, they accrue to anyone buying the product. Only some universal food price subsidies have been targeted, i.e., they apply to products that are disproportionately consumed by the poor. It is these subsidies that can increase the share of benefits going to poor households! (7) Targeted transfer programs have the potential to reach the poor much more efficiently and effectively than the tax decreases and price subsidies described above. They can protect the poor without distorting incentives for non-poor households and, as such, are the preferred response to food prices increases. However, the best of these programs require detailed planning and significant administrative capacity; they can vary from school lunch programs to public works projects all the way to conditional cash transfer schemes. Furthermore, countries can increase public sector wages to compensate workers and pensioners for higher prices. These adjustments to public sector wages in response to price increases are not a good example of targeting, as public servants are rarely in the lower ranges of the income distribution. (7) Complementary policies thus need to be put in place in order to cope with these vulnerabilities. Broad categories of options for these are as follows: -A contingency fund for use in cases of negative impact: losers are identified and appropriately helped and compensated. -Cash transfer programs to redress liquidity constraints resulting from shocks induced by rising food prices (these should provide higher amounts for girls). -Incentive mechanisms to reduce existing gender imbalances. -Increase in the number of publicly-funded day care centres. (8) B. Child-centred responses: To cope with the current situation, subsidised public health care will be necessary for years to come. Experience so far has shown that: i. We need to respond specifically to address the threats to children resulting from the crisis. ii. Governments and other agencies must recognise the crisis and act soon. They must first protect the programs that supply services to families and children and prevent school drop-outs. iii. Children must remain in school and continue to access health services particularly immunisations; the incidence of malnutrition must be monitored to detect exacerbations of rates that existed prior to the crisis. iv. To mitigate the threats to children, responses must be elicited not only from government, but also from local communities and families, as well as the international community. v. Because family coping mechanisms are the first line of defence, families must be helped to reallocate resources and consumption to protect spending on food and services for their children. Measures are also needed to jumpstart the families’ economic recovery. (Sustained economic recovery is essential for families to be able to continue to provide their own safety net for their children). vi. Community health programs have to be continued, while programs targeting the most vulnerable must be protected through reallocation of budgets to maintain them in operation. vii. Innovative programs and delivery mechanisms will be needed, with government forging partnerships with community and other groups (e.g., UNICEF) in targeting and delivering services for children. Effective partnerships will thus be critical to the response. viii. Employment creation schemes are more effective than transfer schemes (such as unemployment benefits) as mechanism for families to face the crisis. ix. Community-based groups are seen as the most effective approach to reach the most vulnerable who are extremely difficult to target; it is communities themselves that best identify children in need and best help address their needs. x. Decentralisation and devolution of responsibility for the delivery of services to local levels are also a priority in facing the crisis. (5) Other potential interventions directly impacting children’s health that need to be kept in mind include: Increased access to medicines, provision of health cards or other entitlement programs that increase children’s access to health care, public awareness campaigns, easing requirements for access (e.g., scratch the need for identity cards, family books or birth certificates), strengthened maternal and child health programs and other public health services, revamped disease surveillance, growth monitoring systems and capacity to design, implement and administer health services. (There can also be an increase in the use of traditional health service provider). In short, free health services for mothers and children through public clinics with maintained immunisation programs and provision of micronutrient supplement, as well as engaging in monitoring health outcomes appear to be reasonably effective first line interventions in helping alleviate the impacts of the crisis on the majority of children. (5) On the more indirect side, interventions are needed in income generation (especially to address children’s needs), family income support schemes, support mechanisms for children without family support (orphanages, refuges/safe houses), general social supports (e.g., for domestic violence mitigation) and child protection intervention (e.g., programs against child exploitation). (5) Box 4: For the rising prices crisis, it is fitting and important to keep in mind some key recommendations the recent WHO Commission on the Social Determinants of Health Report made, namely: - The Commission warns us about volatility and unpredictability of aid flows. - It warns us that Globalisation is intensifying the commodification and commercialisation of water, health care, and electrical power is severely diminishing the role of the public sector in the regulation of health; it is also increasing the availability and consumption of health-damaging products and encouraging unhealthy diets. - It warns us to be aware that the global financial architecture may have more influence on health than international assistance for health care and points out that it is not clear that any country has yet demonstrated that private health services can be regulated in ways that increase health equity and protects the human right to health. - Thereafter, recognising the failure of markets to supply vital goods and services equitably, the Commission calls for increased public financing of programs and policies to tackle the social determinants of health, including child development, education, improved living and working conditions and health care. It also calls for a fair allocation of the total resources for actions that address the social determinants of health, both geographically and across social groups. For this, progressive taxation at the national level, a major increase in aid for health, improved quality of that aid and greater debt cancellation are considered indispensable. - It also calls on aid-recipient governments to ensure that increases in aid and debt relief support coherent policy-making and action to address the social determinants of health. - It calls for supporting renewed government leadership to balance public and to regulate private sector interests. - It calls for more widespread use of health impact assessments and for mitigating the negative impacts on children’s health and on health equity. - It calls for greater representation of public health in domestic and international economic policy negotiations and for the public sector to take a leadership role in national and international negotiations to protect health and reduce health inequities. - It closes by emphasising the need to adopt health equity as a core global development goal, with appropriate indicators to monitor progress both within and between countries, and the need for the MDGs to be reconsidered so that they amore specifically advance equity as a core marker of achievement. (9) A final reflection Would it help for UNICEF to consider setting up a Recovery Information Centre, to assist governments in: – gathering information and indicators for planning and monitoring programs for children? –enhancing information flows between key players, including community groups and NGOs, thereby improving coordination of responses to strengthen the delivery of social services to children? – providing examples of best practices in programs delivering services to children and in decentralisation of these programs? - building capacity at the local level, in both government units and community based groups, to ensure quality outcomes in the design and delivery of services for children? - quantifying the outcomes for children in order to assess the magnitude of the threats created by the crisis? - exploring the mechanisms by which the threats are created in order to improve the response? - sharing experiences on approaches (best practice and what can go wrong)? and - building capacity in policy makers through access to training opportunities and exposure to best practice examples? (5) Epilogue Since the main issue is to improve the welfare of children, particularly in the poorest segments, we need to be clear that the social impacts of the food price crisis are still unfolding, and that our challenge is not only about ensuring greater efficiency and more effective targeting in the delivery of services. Our continued engagement is needed in the implementation of a structural reform agenda that promotes what is ultimately needed: a sustained social, economic and politically decisive response. Only the latter will, in turn, lead to substantially and sustainably fulfilling the human rights of children and their families. (5) ...and you all can help here with your proactive advocacy by, back home, insisting that remedies are implemented as appropriate since rising food prices are already a fait accompli of contemporary history. References (1) IFPRI Forum, March 2008. (2) International Herald Tribune, Editorial Page, Aug.2-3, 2008. (3) IFPRI Forum, July 2008. (4) Declaration of the High Level Conference on World Food Security: The Challenges of Climate Change and Bioenergy, Rome, June 5, 2008. (5) Impact of the Asia crisis on children: Issues for social safety nets. A report sponsored by the Australian Government for APEC, August 1999. (6) Human Rights Council Special Session on the rising food prices situation, May 22, 2008. (7) IMF, Food and Fuel Prices - Recent Developments, Macroeconomic Impact, and Policy Responses. Prepared by the Fiscal Affairs, Policy Development and Review, and Research Departments, June 30, 2008. (8)Adapted from J. Escobal, IFPRI, 2020 Focus Brief, December 2007 and N. Jones et al, Qsquare Working Paper No 46, University of Toronto, 2007. (9)Commission of the Social Determinants of Health Report, WHO, August 2008. Key Terms Acknowledgement and request Readers are invited please to respond. Please use the response facility below. Readers may make use of the material in this editorial if acknowledgement is given to the Association, and WN is cited Please cite as: Schuftan C. Rising food prices and children: Nutrition and health implications. [Commentary] World Nutrition, April 2011, 2, 4: ???-???. 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. The author states: Thanks to Geoffrey Cannon for his crisp editorial guidance. 2011 April. WN4. Commentary: