Claudio Schuftan
cschuftan@phmovement.org
I would like to think that you -as me- often ask yourself what we could
all do better to achieve greater equity in what we do given that we most
often work in countries with appalling social inequities. Allow me to share
with you some of my thoughts on this.
I see our role in helping put in place the needed social processes and
mechanisms that will drive sustainable policies in health and nutrition
as being inseparable from us helping to re-establish a will and intent to
change underlying structural inequalities in society. To achieve the latter,
you can -as individuals- come to this will from either of 2 backgrounds:
you can either come to it from a primarily ethical or from a political
motivation.
These two motivational approaches that can drive us to become more
involved in lessening social inequities represent, not packages of universal
solutions, but rather paths to follow to get things that need to be done done,
and the latter by whom and with whom (and against whom).
Living as we do in a mean, unfair and selfish world, I see the challenge we
face as being one to graduate from the first into the second approach.
Let me explain why.
THE PRIMARILY ETHICS-LED PROCESS TO SUSTAINABLE DEVELOPMENT IN HEALTH AND NUTRITION
As is true for slavery, there are
ethical limits to tolerating extreme
poverty.
The growing new development ethics that calls for working with the poor
as protagonists and not merely as recipients has, so far, itself
unfortunately remained mostly a top-down approach. It represents mostly
the view of academicians, of intellectuals, of church leaders, of
international bureaucrats and of a few politicians (mostly in
the opposition). Beneficiaries have remained mostly passive in this
approach, merely being counted as the ‘object’ of the process. This
ethics-led process is mostly ethically motivated and assigns a key role
to ‘moral advocates’ who are to advance the following cascading
process:
– NEEDS (Entails assessing needs requiring fulfillment using
“objective”(?) field research techniques)
|
– ENTITLEMENTS (Entails granting selected identified needs the status of
entitlements to be honored by society)
|
– RIGHTS (Entails translating accepted entitlements into actual rights)*
|
– LAWS (Entails delegating to members of Parliament the
legitimization of selected rights by promulgating them
into laws)
|
– LAW ENFORCEMENT (Entails assuring/securing that the laws get
enforced by government institutions)**
_________________________________________________________
* : Promoting these rights is not, by itself, a progressive political
act.
**: Often very weak or non-existent and without the people getting involved
directly in it.
The inherent weakness of this process is that to have rights ultimately
respected, someone other than the poor takes the responsibility at each
step to steer the process from entitlement to enforcement.
THE PRIMARILY POLITICALLY-LED PROCESS TO SUSTAINABLE DEVELOPMENT IN HEALTH AND NUTRITION
This more bottom-up political approach (in which commitments are needed
beyond ethics) better accommodates and represents the perceptions of
needed development actions as seen from the perspective of development’s
beneficiaries. In this approach, beneficiaries are clearly the protagonists of
the process; the process is mostly politically motivated and assigns a key role
to ‘social activists and political advocates’ who are to advance the following
cascading process:
– FELT NEEDS (As freely and spontaneously expressed by organized
communities)
|
[Consciousness raising]
|
– CONCRETE DEMANDS (Felt needs are articulated into concrete
demands each tackling perceived causes)
|
[Social learning]
|
– CLAIMS/EFFECTIVE DEMANDS (Based on concrete demands, people
make claims* and exert an effective
demand**)
|
[Social Mobilization/Empowerment]
|
[Acquisition of Social Power]
|
– ORGANIZED PEOPLE’S ACTIONS (Initial mobilization of own and
other available resources)
|
[Gains in self-confidence]
|
DE-FACTO EXERCISE OF POWER (Within or challenging the law;
bringing in, using and progressively
controlling needed external resources)
|
[Networking]
|
[Acquisition of Political Power]
|
– CONSOLIDATION OF NEW POWER (Coalition building)
|
[Leads to new felt needs and the cycle restarts]
________________________________________________________
* : Claims correspond to entitlements in the previous diagram.
**: When people are willing to invest their own resources to fulfill
their felt needs.
Although the ethically and politically led approaches, as simplified in
these two diagrams, represent different paths, both can contribute
-through their own merits- to sustainable changes in the health and
nutrition of the poor. The two approaches complement each other, but would be
even more synergistic if the ethically led process gets more proactive civil
society inputs and gets more politically savvy.
It is in the realm of the second diagram that I see us ever getting a chance to
influence the choice of needed investments in health and nutrition, as well as
influencing the redistributive and social protection measures/priorities that
will concomitantly address the poverty underlying the ill-health and
malnutrition we (as professionals) are left to deal with.
It is in the realm of the second diagram as well -with the added strength
coming from an organized community- that I see us ever effectively influencing
how the public sector allocates its resources and chooses geographic/
socioeconomic/ethnic targets, and how, in the process, the government favors
programs that are under strong community control.
Finally, it is also in the realm of the second diagram that I see us succeeding
in re-establishing a will and an intent to change structural inequalities
underlying ill-health and malnutrition; our strength will come from building
the new constituencies that do have a vested interest in pushing for the
unpostponable changes in the system that basically reproduces the existing
structural inequalities and determines the parameters within which we
(as professionals) are “allowed” to intervene.
Claudio Schuftan, Ho Chi Minh City.