1. Long centuries of poverty and injustice have accumulated too many insatisfactions, too much misery and too much indignity, as well as a heavy load of preventable ill-health, malnutrition and deaths that have all been buried in time.
2. That is why, in the human rights-based framework (HRBF), it is the structural problems that cause poverty and underdevelopment that we try to get at. That is also why the HRBF does not endorse individual targeting of the poor. Focusing only on the poorest of the poor is so restrictive (and actually blames the victims) that little or no impact will be seen in the population at large. In that case, geographic targeting is to be preferred. (We note that the HRBF is also sympathetic to the idea that poverty reduction should start with children).
3. Instead, the HRBF strives, among other, to give voice and influence to most beneficiaries in relation to the services delivered (or not delivered) to them (including health). It thus frames poverty reduction as a matter of the meeting of obligations rather than as acts of benevolence or as acts geared at achieving greater administrative expediency. This is why we always have to keep in mind that many of the decision-makers and duty bearers we have to deal with, yes, do think the poor have to be respected and helped…but ‘from the far’.
4. Meeting the above obligations unavoidably passes through creating productive employment. But we note that employment gets no mention in the MDGs. With others, we contend that without more jobs, all other goals (including the health-related) stand on a shaky foundation.
5. Moreover, wages worldwide have lagged behind economic growth actually causing some of the problems the MDGs set out to address to begin with. (Keep in mind that, due to the law of supply and demand, mass unemployment worldwide means that higher wages cannot generally be expected in the run-away course of globalization). Instead, the MDGs overwhelmingly focus on transfer payments, but not on newly created employment that would make such transfers less necessary.
6. It may well be we need to focus less on poverty reduction and more on employment generation policies. After all, there are valid entitlements for able-bodied, healthy individuals to have access to productive work –and, as we know well, labor is the poor wo/man’s most important asset.
7. Decent work for all thus needs to become a global objective –one that needs to set a time-bound goal (‘a la MDG’) to effectively reduce current unemployment levels. (We admit that this is easier said than done, but without a concrete objective and a plan, it is much less likely to become a reality).
8. Mind you that the IMF and the World Bank have also pretty much ignored employment matters and have not taken on the issue frontally (or have mentioned it only to ignore it later)… But then, it does not cost the Bank anything when their solutions or non-action-in-some-areas (such as employment) prove to be wrong. They simply see it as a hiccup –not a reason to call the neoliberal paradigm into question. Recipients, who may not even be aware that the Bank exists, are the ones to pay for the bad advice. (A. Traore) This is profoundly unjust and raises many fundamental and disturbing concerns.
Let us take two examples
9. The Bank mothered the DALYs (Disability Adjusted Life Years). DALYs measure quantity of ill-health so as to set priorities. But DALY’s have many detractors. Some are of the opinion that, for instance, weighing a-year-lived-at-age-70 half the value of a-year-lived-at-age-25 is ethically untenable. Others think DALYs are biased against individuals with permanent disabilities since ‘burden of disease’ does not capture the individuals’ different ability to cope with those burdens. More accepted is the objection that ‘burden’ actually means ‘burden of disease and of poverty and of underdevelopment’ –and not that of disease alone.
Bottom line: The widespread use of DALYs has for years siphoned off the attention of health economists away from giving greater priority to actions that tackle the social determinants of health. …So recipients pay for the bad advice.
10. Poverty Reduction Strategy Papers (PRSPs), of which there were 52 by March 2006, are nothing more than another of the Bank’s top-down approach to poverty reduction. In them, country ownership is illusory. Conspicuously absent in their preparation have been, parliaments, trade unions, women’s groups and civil society organizations out of favor with the government. The Bank actually never specified what constitutes an acceptable-participatory-PRSP-process and this raises questions about the intentions of the Bank for ensuring participation by the poor and by civil society. (P. Kamruzzaman) To be made democratically legitimate instruments, the PRSPs preparation and monitoring process has to be opened up to the conspicuously absent groups mentioned above.
Bottom line: For all the rhetoric of community participation and of addressing the priority needs of the poor, PRSPs are replete with top-down prescriptions and many of us are left quite convinced they will not deliver the poverty reduction expected. …So recipients pay for the bad advice.
11. We all know the World Bank is staffed by (some) well-meaning planners and bankers who see poverty as a technical engineering problem that their answers will solve. (William Easterly) As is well known too, the Bank’s culture is primarily analytic and focuses mostly on macro-economic issues. The question we are left with is: Are we to believe that there is such a thing as socially responsible macro-economics? As it seems the answer to this is no, …people who are poor pay for the bad advice.
12. A closing note: Promoting an ethos that people who are poor are lucky, because they will be the first to enter Heaven, has led to the political position that ‘we-the-rich’ have something we should give to ‘them-the-poor’. (Be reminded that, as opposed to rights, charity is given mostly when convenient). In the HR context, charity is to be seen as nothing but the escape valve of guilt feelings that having money brings on. (Guilermo Cabrera Infante)
13. [And on a more sarcastic note perhaps, Mark Twain was of the opinion that a banker is someone who lends you an umbrella on a sunny day and wants it back immediately when it starts raining…].
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org