1. Am I tired of going to such conferences? Sort of.
2. It is just that, in them, we hear about so many things that need doing and have so long been overdue (…achieving the health MDGs, strengthening health delivery systems, organizing and empowering beneficiaries to demand changes ….and on-and-on…). One gets the impression that it is in times of crisis that we finally will bring to the fore what really needs doing and has long been overdue… But not even in such circumstance does the needed happen in our meetings of the learned; almost nothing substantial, beyond a passing comment, is heard about taking actions to address the ‘condition of poverty’, about disparity reduction, about addressing the widespread and numerous violations of the human right to health and to nutrition; nothing substantial and really deep-felt is heard about empowering claim holders –or worse: the concept of empowerment is repeatedly hijacked by making it mean giving women greater self-esteem, providing them with health education and nutritional knowledge and skills and/or ‘empowering’ them to better take care of their children.
3. Empowering claim holders a) to exert growing social counter-power to the power that keeps them in poverty; b) to fight the often flagrant health and nutrition rights violations they are subjected to; and c) to fight for greater equity and access to the services they need, all still seems to be a taboo topic at the conferences I attend. A shame.
4. One gets the feeling that, after so many years of struggle to combat preventable ill-health and preventable malnutrition, we are, over and again, back to square one. Presenters in time-scarce crammed parallel sessions* do not seem to be aware at all of (or decide to overlook) the fact that there has been significant criticism of, for instance, World Bank-funded projects and the recommendations they make to ministries of health –a criticism rooted in objecting to the fact that these ignore the social, economic, political and human rights dimension and determinants of the problems at hand –beyond a window-dressing/passing-by mention.**
*: In these sessions, questions and discussions are quelled when the chairperson says: “Sorry we have run out of time” and all of us in the audience are left boiling when some of what was said from the podium is sheer nonsense –as many others attending feel these are the take-home-messages from the gurus up there.
**: Also lately ignored are the objections many of us have voiced over and over about the ‘ten top solutions’ proposed by the Copenhagen Consensus of Eminent Economists.
5. In these conferences, we are further repeatedly asked to believe the dogma that pointedly investing-in and improving health and nutrition per-se improves equity. Well, by themselves, they do not! Rebalancing the power equation does!… In the spirit of the interrelated and interdependent right to health and to nutrition, that calls for mobilizing claim holders to actively demand changes, and making duty bearers accountable. [The prescriptions we hear in the conference rooms (maybe not in the corridors –the better part of these conferences) do not heed this call; the presentations we hear in the closing session, not as a surprise, only pay lip service to the processes really needed for the realization of these inalienable human rights.
6. We do not need more ‘pro-poor interventions’ that target and victimize poor people’s groups. We may target poor geographical areas, but at the same time –and never missing– we need to proactively move to sustainably reduce disparities beyond mere poverty alleviation; only that will take care of the violations we see in both health and nutrition (and will actually make mainly technical interventions ultimately irrelevant once and for all).
7. I am personally tired of our colleagues alluding to ‘the need for structural changes’ with impunity, i.e., without really meaning (or understanding) what they say.
8. The ‘window of opportunity’ for disparity reduction has been open for 3,000 years… And what do we get at these meetings? More of the same, i.e., ultimately not taking advantage of the window of opportunity…
9. What we get is not necessarily unimportant, but it is INSUFFICIENT. Is now the time to act? Yes! But with more than what we usually hear at these gatherings of, so often, scientists that sadly seem to still not having climbed down from their ivory towers.
10. Only some lonely and committed souls mention the need of using the human right framework as a basis for action, as the basis for plans to tackle the major right to health and to nutrition violations –as the People’s Health Movement is doing (www.phmovement.org). The message of applying the human rights-based approach as an avenue to empower claim holders, to work with duty bearers to help them comply with their human rights obligations is hardly ever heard.
11. The power to act is different from the ability to act; thinking we can achieve quicker results, we have often given the role to individuals and institutions with the ability to (and not the ones with the power to) act. This has led to the status-quo so many of us refuse to live with.
12. Am I too harsh in my analysis? I do not think so; I just call a spade a spade. We have to stop the infamous practice of speaking about these things in whispers.
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org