CLAUDIO SCHUFTAN
schuftan@gmail.com
When pushed to its limits, nature fights back by dying.
When pushed to its limits, how should society fight back?
(Simonis, U., 1989)
Our work in development is about change. And change brings conflict, pain, confusion. Only out of this emerges a new understanding.
This being so, we might as well face change straight-on and, in our case, this means for us to start deconstructing the whole existing development delusion which has led us to the unwarranted situation in which people have come to accept scarcity and poverty as inextricable facts of life.
But the universe does not have unmovable laws that lead to poverty (!); it has habits -and habits can be broken. (Anand, A., 1988; Morehouse, W., 1988; Robbins, T., 1985)
The greatest risk for us in this is to be deluded into thinking that palliative approaches (in our case in health and nutrition) and socioeconomic tinkering can bring about the long term stability needed for sustainable economic take-off.
It is an all-pervasive feeling of helplessness that leads poor people to accept political realities they might otherwise dismiss and fight. If poverty is a function of powerlessness, how can extreme poverty at the base of so much of ill-health and malnutrition be attacked? Whatever the response, one thing is clear: One does not have to wait until big changes are in place; otherwise, the process would never start. The poor can begin to empower themselves, in groups and in their own minds, even while the government is still saying ‘no’ to political changes…and this is where we can play a catalyst role.
Because of this, all existing grassroots organized groups we come across matter: their voices matter. Unions matter; self-help projects matter, women’s and youth organizations matter: they raise the level of pride and courage. The fact is that alternative political organizations and community groups speaking out do have the legitimacy to do so (a legitimacy that many of us may think we do not have). Working with and through them increases our legitimacy.
The alleviation of poverty should and can be made a cost-effective component of development plans. But central to it becoming that, is the need to build a wider consensus on a new, more militant ‘global ethics’ built on the principles of equity, accountability and international grassroots solidarity. We all can and should become more active in fostering a genuine dialogue on these matters wherever it be that we work. In doing so, we need to become experimenters, calculated risk takers, innovators, intensifiers and diversifiers, pioneers, digesters of new information, practitioners of common sense, and more social, political and economically rational and fair human beings. (Rhoades)
An environment that fosters a political climate supportive of innovation and social change is the first thing to fight for starting in our own work as health and nutrition professionals. Hence, we need to be proactive in expanding the social safety net for the poor to organize effectively around health and nutrition issues, striking a balance between pragmatism and idealism.
For this, we need to constantly point our fingers at the set of social causes that are behind poverty, ill-health and malnutrition -causes that are not the fault of individuals (!). We should nevertheless reject outright scape-goating and should avoid victimizing: it only leads to a passive blaming of the system. We should rather encourage people to look for and find -and to look with them- the underlying sociopolitical causes determining their state of (de)privation and disempowerment.
Real empowerment requires understanding the larger social forces that shape individual situations to then learn how to join with others in taking, not individual, but collective responsibility and action for reshaping situations of oppression and exploitation.
Therefore, our main individual responsibility may often be to join with others -not to solve the problems on our own. What is most people-empowering is a shared vision of collective responsibility, i.e. that only by working together on an intolerable social reality can individual lives ultimately be improved.
The role of progressive forces working in health and nutrition is thus to help develop such a rational understanding of the underlying forces at play. Only if we speak the truth about the ultimate (often hidden) interests of the actors in the non-sustainable development game -our own private motives included- will people have grounds to trust us. But, in all honesty, we have simply been too narrow in the focus of our own thinking when interacting with communities and their leaders and have failed to address the foundations of the problems of underdevelopment underlying the ill-health and malnutrition we posit to be addressing. It is high time for us to use all our intellectual strength to repair the damage inflicted by our Western-biased social order and by our insensitivity and, most of all, our lack of outspokenness about that order not having laid the foundations for a sustainable development.
In the process, instead of ineffectually denouncing approaches as reactionary or programs as non-performing and insincere, we must rather first understand ourselves the underlying psychological needs that these ideologies and programs gratify. We then ought to start developing alternative programs that somehow also speak to the same psychological needs, at least during a transition period. To do so now, calls for a serious rethinking on our part of the fundamentals of what we do and how this contributes (or not) to sustainable development. (Lerner, M., 1987)
Let us not forget that we are more irrational than rational; our emotions control us more than our ‘ratio’. Therefore, appealing to our reason only is inefficient. Take, for example, totalitarian ideologies: they have always liked to wear a mask of ‘reason’, but have also skilfully exploited the emotional inclinations of their subjects. (Friedrich Durrenmatt, Swiss playwright) From the psychological perspective then -and in a truthful and not a mischievous manner- we ought to do likewise: we have to appeal to people’s reason and emotions.
Society is said to evolve as a (bloody) pendulum: a conservative cycle/a liberal cycle; action and reaction; back and forth like the tides, always taking a toll of death (some of it from hunger and disease). As long as we are trapped in these cycles and do not actively try to break their passive succession, we cannot expect much in the way of liberation; we cannot even expect fundamental change, except the awful slow variety where each step takes two generations or more. (Robbins, T., 1985)
The battle against poverty, ill-health and malnutrition calls for liberation, empowerment, self-reliance and partnership instead of mostly only integrity, operational effectiveness and administrative accountability – the latter three being an often touted Northern recipe for development success.
If government policies do not enable the population to receive a minimum income compatible with good health, nutrition and safe shelter now, those below that minimum income level will be unhealthy, will be malnourished and will be shanty dwellers. It is as simple as that. To combat this process of immiseration, welfare states choose to transfer payments and handouts. But what is needed is a transfer of assets and power. And for this to happen, the poor will have to fight for it by themselves(!). The welfare ethics does not provide for this transfer and has too often been merely translated into a form of ‘punitive welfare’ towards the poor. (Shepperdson, M., undated)
Not surprisingly, the long-term trend in gross numbers of poor people worldwide has been relentlessly upwards. The average annual growth in the number of poor has almost equalled global growth in GNP and has exceeded population growth. The puzzling aspect is that often mortality rates have, at the same time, in many places declined -despite the increase in numbers of the poor. In welfare terms, though, numbers matter more than percentages or rates (!). The analysis of poverty should thus, by necessity, focus on numbers -but not to make it into a ‘numbers game’ as is too often being done by academicians, bureaucrats and politicians. In fact, what is operationally needed, apart from a Poverty Line, is at least two parallel threshold indicators: an Ill-Health Line and a Hunger Line. For many, inequality somehow seems less relevant to ill-health and malnutrition than to poverty itself. But it clearly is at least as relevant to these direct consequences of poverty, and we have to keep making this point(!). (Shepperdson, M., undated))
Since we normally look at the effects of underdevelopment on just two broad income groups -the poor and the non-poor- a more operationally relevant poverty line needs to be defined, not as a mere cut-off point, but specifically to set measurable Poverty-Redressal Objectives over time. Here is a point where we can concretely contribute by helping define a Critical Consumption Level that will sustain good health and nutrition. Such an indicator needs then to be expressed as a fraction of the per capita income.
(Note that the list of today’s basic needs is so extensive that very little of a poor man’s income is likely to be spent on non-basic needs…). Persons below this Critical Consumption Level will be potentially eligible for consumption subsidies, and persons above this line, potentially eligible for higher, progressive taxes. Such poverty redressal measures can perfectly well still promote economic growth and need not be administered as welfare measures. (Ray, A., 1989)
What all this boils down to is that without taking on the ‘big picture’ of sustainable development, its problems are merely displaced by patchy interventions (in some of which we are often involved). We cannot continue to separate the struggle for sustainable development from harsh structural sociopolitical realities that are relentlessly discriminating against the poor. The ill-health and malnutrition we are left to deal with are but outcomes of such realities. Insisting on the need to address the ‘big picture’ -and critiquing (maybe) well-meaning, but ineffective programs and projects- does not have to relegate us to being inactive otherwise. Obviously, we need to involve ourselves in some short-term measures, but these must contribute to a process that takes us toward long-term structural changes rather than throwing us off the track..
We must forge a new agenda that not only allows us to work with the people on their more immediate problems, but also to jointly come up with a revised sustainable social order. Such an order calls for alternatives that eventually lead to political actions that foster the needed structural changes that will eventually revert the underlying poverty.
As part of this new focus, Northern NGOs should more decisively support local efforts to address these larger structural issues in an open way letting people’s movements, not elites, define the partners they want to work with and the causes they want to embark on. (Barton, C., 1989)
As said, something is terribly wrong with the framework from which we have been choosing our options when pursuing what we do in health and nutrition. A more political analytical framework is thus needed. In it, multiple social objectives have to be taken into account -distributional concerns taking center stage. It is up to us to bring these concerns more into the heart of what we stand for (our ideology) and what we do (our praxis). Mind that distributional judgements are already at play in existing policies(!). But these judgements must now be biased more towards equity concerns and thus towards the poor. The alleviation of poverty must be kept at the center of what we do professionally beyond mere lip service (the latter a place where it mostly still is). (Ray, A., 1989) (*)
(*): There are three commonly used poverty-redressing indicators in development work that we should definitely use more often:
The first, relates to the Share of Project Benefits that Accrue to the Poor: the requirement should be that this share be greater than a specified number, say 75%. The use of this indicator assumes that the population can be divided simply with reference to a predetermined poverty line. This indicator should help us in biasing our selection of projects in favor of those that have a greater consumption benefit for the poor.
The second indicator, is the Number of Real Target Group Beneficiaries as a Percentage of the Total Number of People who Benefit from the Project. This head count of the number of beneficiaries helps, but has unfortunately nothing to do with the absolute amount or the value of benefits being enjoyed by the poorest.
The third indicator, is the Employment Impact of Projects: this is used to make sure that the income generated due to project activities will exceed what the poor would earn if engaged in alternative activities. (Ray, A., 1989)
In summary, I do not overlook the fact that reconceptualizing is a difficult undertaking which tampers with values, power structures and social structures built-up with great labor by special interests over many decades. Nevertheless, current changing circumstances require that we more-than-think about new approaches to the role health and nutrition should play in fostering a sustainable development: only the future will tell whether such new approaches are going to be more realistic. (Note that no words are more treasured by preservers of the status-quo than ‘realistic’, ‘pragmatic’ and ‘programmatic’; these, of course, are relative terms, for one wo/man’s realism is another wo/man’s radicalism). At this juncture, then, we need people who can rescue themselves from their own modest objectives; we need development thinkers (and practitioners) of consequence. (Jaffe, E.D., 1987; Robbins, T., 1985; Korten, D. C., 1991-92)
The goal of ‘redistribution with growth’ can be achieved, as long as it emphasizes an increase in the productive capacity of the poor. In this context, project choice per-se has a lesser potential effect on income redistribution than the adoption of direct redistributive measures such as tax reform with a deliberate antipoverty focus. For example, in Latin-American countries, the poorest 50% of the population receives about 15% of the national income. This means that a project would only pass the income redistribution test if more than 15% of the net income it generates were distributed to the poor. This also means that, if a project is chosen, the net income share generated by it for the poor should be no less than the proportion of the poor in the total population. (Bacha, E.L., 1989)
References:
Anand, A. (1988), Repetition or innovation? Development Forum, XVI: , pp. 23-24, Sept.-Oct.
Bacha, E.L. (1989), Views and review, Chapter 4 in: The Impact of Development Projects on Poverty, Dev. Centre, OECD, pp. 81 + 84.
Barton, C. (1989), Swaps are counterproductive, Development Forum, XVII: 4, p.13, July-Aug.
Jaffe, E.D. (1987), The crisis in Jewish philanthropy, Tikkun, 2:4, p.30, Sept.-Oct.
Korten, D. C. (1991-92), Sustainable development: A review essay, World Pol. J., pp. 159-190, Winter.
Lerner, M. (1987), A new paradigm for liberals: The primacy of ethics and emotions, Tikkun, 2:1, pp. 22-28 and 132-136.
Morehouse, W. (1988), Soul searching, Development Forum, XVI: 4, p.15, July-Aug.
Ray, A. (1989), Perfecting tools to measure the alleviation of poverty, Chapter 2 in: The Impact of Development Projects on Poverty, Dev. Centre, OECD, pp. 42-49.
Robbins, T. (1985), Jitterbug Perfume, Bantam Books, N. York, 1985.
Shepperdson, M. (undated), The Political Economy of Health in India, Chapter 16, pp. 304-370, Centre for Dev. Studies, Univ. College of Swansea, UK.
Simonis, U. (1989), IFDA Dossier 73, p.58, Sept.-Oct.
Claudio Schuftan
Saigon, Vietnam.