9. How nutrition improves

I was in Rome in early September. Not to see the Pope or the Piazza d’Espagna. But rather to contribute to our global efforts to bring the struggle for food sovereignty eventually a step closer to reality. The occasion was a meeting called by civil society, spearheaded by FIAN (a WPHNA member), to consolidate a civil society position towards the call by FAO’s Committee on World Food Security (CFS) to launch a Global Strategic Framework for Food Security and Nutrition (GSF) by October 2012. The GSF is meant become the framework to coordinate and guide joint actions by a wide range of actors regarding food policies at the global, regional and national levels.
Civil Society Organizations have consistently maintained that this GSF must be at the centre of joint action and see it as a much-needed global reference for policy-makers. For civil society organizations though, the GFS is above all about ensuring that policies are significantly more people-centred.

The result of our discussions were included in the first draft of the joint civil society political statement on the Global Strategic Framework and compiled by a civil society drafting team (of which I was part). The statement contains the vision and the demand of civil society that people who produce, distribute and need food must be in the centre of policies. The key role of food providers and consumers is highlighted in the draft, including that of social actors such as social movements and smallholder organizations of fisher folks, peasants, pastoralist, indigenous people and other. Finally, the Civil Society Statement stresses the need of setting clear accountability and monitoring responsibilities as a priority issue.

Most important for WPHNA was a back-to-back meeting to the above. It was about organising a Global Right to Food Network to strengthen worldwide efforts to end hunger and malnutrition by promoting better cooperation between likeminded partners and to voice our demands louder for the fulfilment of the right to nutrition. The call is for civil society to more proactively demand accountability through empowering its cadres to foster active community mobilization. The seed for the network was planted and we will certainly hear more about it in the future.
You will ask: Did you get to see the Coliseum and the Fontana di Trevi? Barely and passing by only. It was an intense 3 days…

Women! Don’t let that old trickle-down black magic get you in its spell! Nourish your community from your land. Women farmers in Africa, India

Impoverished countries
Some reflections on how nutrition improves

Here is a quick summary of some actions that have been deemed relevant to nutrition in impoverished countries around the world:

• Equitable economic development is positively related to nutritional improvement, by way of its impact on poverty, equity, household food security and social expenditures. A threshold exists at around an average of $US 500 per capita income; above this, social expenditures rise significantly with rising income.
• Equitable growth strategies are a more efficient long-term means of alleviating poverty and indirectly improving nutrition, than are compensatory (targeted) poverty alleviation programmes (as I said in my August column).
• Quantity, quality and distribution of social expenditures are central for the above to happen.
• Mutually reinforcing long-term effects on nutrition can be had by investing in women’s health and in their education, as well as in other women’s issues.
• Social discrimination against women is common in countries where nutrition has not improved as much as would be predicted by their economic growth.
• Nutrition programmes give visibility to nutrition, but may only promote broader awareness which is not the ultimate goal. Participatory processes in these programmes are as important as their activities as such.
• A mix of top-down and bottom-up interventions is the most pragmatic and effective approach often generating synergies.
• The most successful and sustainable nutrition programmes have strong community ownership. Decentralised decision-making power is crucial.
• Nutrition issues can and have influenced broader development policies. The availability of relevant disaggregated information, of democracy, and of a free press, do contribute to this.
• Development of an explicit nutrition policy is a vital prerequisite to the mobilisation of sectoral awareness and support.
• A synthesis of the recent lessons learned (pertaining to reasons behind real nutritional improvements) still leaves us with some apprehensions, because, when malnutrition (an outcome indicator) improves, it leaves no explicit track or trail of why it did so. It basically is still left to us to sort out the reasons.

Finally, I do not think the Road Map for Scaling Up Nutrition (SUN) represents a set of nutrition-relevant actions that fulfils several, let alone many, of the criteria above. See my July column for why I think this.

‘Detective work’ done by honest and qualified researchers should sharpen our wits and improve our capacity to bring together all relevant elements of observed and sometimes puzzling ‘realities’. Only then can we decisively choose which nutrition-relevant actions are best in any given setting. Armed with this information, we can also oppose and even confront nutrition-irrelevant or anti-nutrition actions.
I have for long been convinced that people will feed themselves well, if their environments enable them to do so. The nature of enabling environments varies, of course. Governments and agencies – including non-governmental organisations – do not always foster enabling environments. They are usually either part of the problem, or else are neutral.

Sharing a common conceptual analytical framework has proven to be crucial to understand the causality of malnutrition, and to develop at least some beginnings of a shared political view. We have tried to do this since the 1980 UNICEF conceptual framework for nutrition as agreed and published by UNICEF. But this is only the first step. Creating political awareness of the problems of malnutrition is no longer enough. Our goal has to be to mobilise resources and people for action for nutrition-relevant actions.

The first requirement is a correct analysis of the relevant causes. Only then is it possible to intervene effectively. Engaging communities actively in service delivery, in capacity building and in their own empowerment, becomes central to the creation of enabling environments. What needs to come first is local. National or global environments are just as important, but are more remote to communities.
Fostering effective local democracy may well be a move to tackle the ominous health and nutrition consequences of non-enabling environments, and also to engage people in policy and political issues.

Outside agencies and agents can support effective local democracy. Governments – and other organisations – that say they respect and protect impoverished people’s entitlement to food, care and health, but do not positively and actively fulfil these obligations, should be openly confronted. Needed actions, include ensuring household food security, food sovereignty, the care of women and children, and the provision of basic health services, as well as environmental sanitation. Governments must be pressed to make needed interventions in these fields.
With encouragement, communities will be able to take on responsibilities. They will also be able to engage the resources they control in making their entitlements more attainable. Also, they will be better able to mobilise and to fight for resources that they do not control (This assumes that their government is not so repressive as to make this impossible). The key twin issues are community mobilisation and community empowerment. This is what creates an enabling environment, which is ultimately linked to the underlying and basic determinants of ill-health and malnutrition.

Women! Work for independence and empowerment and for your rights! Women generating income on their farms in the Ukraine, the US, Malawi

Here are two scenarios. The first is more down-to-earth:
Economic development is positively related to nutritional improvements. Economic growth – only if and when it trickles down – is said to help to prevent and control ill-health and malnutrition in poor countries. But the effects of such aggregate economic growth are not immediate (nor automatic) on poor households’ disposable income. This is thus an illusion. We should not be deceived.
A good road towards empowerment now, I believe, is a wide movement to promote education and income generation activities for women.

Income generation for women can short-cut the ‘waiting-for-trickle-down’ syndrome emptily promised by structural adjustment and by conventional donors. Income generation activities can generate more immediate needed additional modest household income – a true bottom-up solution.
In the poorest households, women’s income generation can result in sometimes quite significant increases in disposable household income, even if the total income is low.
As an intervention, income generation by women attempts to blend the technical with the political in the battle against malnutrition. It more directly deals with the basic causes underlying the ill-health and malnutrition that characterise poverty worldwide.

Income earned by women is, to a much higher degree than that of men, used for family well-being expenditures –nutrition included. Women’s modest, frequent income more directly affects the proportion of every increase in income that goes to consumables, including food and also basic services
Income generation by women does not of itself correct the immiserating impact of unfair political and economic systems. But women’s income generation can target some key determinants of ill-health and malnutrition. Also, it can organise and empower women in a way that prepares them for taking more active roles in participating in decisions and actions concerning food and nutrition in their families and in their communities.

Here is my more dreamy scenario:
Some of us have for too long lived surrounded by four walls, in an immutable environment, with the line of our professional horizon barely perceptible. Have we thus grown up inside an impenetrable armour of good manners and conventionality?

We have been trained to please and serve and, I’d say, have ended up limited by our own routines, the prevailing social norms and our hidden fears. Has, for too long, fear been our companion? Fear of authority and of what people will say, fear of the unknown and of what is different, fear of the unpredictability of social justice, fear of leaving the protected cocoon of our guild, fear of facing the dangers of the real world out there, fear of our own fragility and of the ultimate truth?

Could it be that our truth has been made up from omissions, courteous silences, well kept secrets, order and discipline? While masses of the impoverished share the same space and time with us, yet it is as if they existed separate from us. And under such circumstances, have our aspirations really been more to achieve virtuosity and recognition?

We do not know in what turn of the road traveled we lost the person we used to be. We are not sure any more, which of the causes we championed were meaningful, which we won and which we lost. If we made some mistakes and had uncertainties and fears about the future, we feel we have paid dearly for them already.

But also, I want to believe that we feel suddenly empowered. A new mood allowing us to make meaningful decisions in our professional lives is infusing us. We are willing to pay the consequences for it. We do not owe an explanation to anyone for these changes.

This sense of optimism and commitment invades some of us, particularly in preparation for our upcoming Rio2012 congress. Our fears have dissolved as we have lost our fear of fear. We now find new strengths as we face new risks. We are finding new forces within ourselves that we always had, but did not know we had, because we had never used them. We are ready to join the growing number of explorer-doers seeking new ways out to the problems of the world. We feel pride as women and men who are reinventing equity in our work.

Some of us walk victorious, while others still carry disillusions mostly having suffered early defeats. But we feel we own our destinies, our future, and our irrevocable newly acquired dignity. We finally understand talk about liberation, about rights and empowerment, and about freedom from want in new ways and yearn to discuss with others what we see and feel about each of them.

We can now live each day without necessarily making worthless plans. We feel we have a blank sheet in front of us where we can write our new plans and, in the process, become whoever we want to become, without anybody judging our past. In short, we can be reborn. (1)

And then I woke up. Will post-Rio shatter this dream? It is up to us all! Dreaming is OK, but being naïf is not.

Yet, I hope I have here advanced some ideas that might provoke you to contribute to this movement, to get closer to the time when real democracy and the respect of human rights are no longer a dream.

Reference:

1. Allende I., The Daughter of Fortune, Plaza y Janes Editores SA, Barcelona,
1999, pp 296-301.

Acknowledgement and request

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Schuftan C. Some reflections on how nutrition improves [Column] Website of the World Public Health Nutrition Association, October 2011. 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.

cschuftan@phmovement.org
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