Eleanor Roosevelt, one of the team that drafted the Universal Declaration of Human Rights at the foundation of the United Nations. This vision now more than ever needs to be affirmed and renewed

What mainly determines population well-being, health, and disease?

I am committed to the concept of the social determination of well-being, health, and disease. Social factors determine the incidence of preventable diseases, including deaths from all types of malnutrition. ‘Social determinants’ is a generic term. It includes cultural, economic, political and environmental determinants as well. Until 15-20 years ago, these were generally overlooked or denied. Now they are belatedly accepted as crucial – for no longer can arguments be found to deny their causal role! But the frustration all of us in public health and nutrition must surely feel is that close to nothing is being really done to address these determinants. Health and nutrition ‘experts’ so often have tunnel vision that shuts out the big picture. Very sadly, young nutritionists are still being taught from and mystified by narrow, restricted and outdated technical curricula. This, plus the stubborn resistance of the representatives of powerful countries in global negotiations (as is happening as I write during the preparation for this month’s International Conference on Nutrition) reduces resolutions to technical actions bordering on charity that perpetuate poverty and misery. The Chinese proverb says: give hungry people fish and you feed them for a day; show them how to fish and you feed them for life. But it has always been more than that. The pond is privately owned with ‘no trespassing’ signs, and the waters are polluted by chemicals…and in the case of oceans, fish stocks are dwindling and dying out. You get my point. I rest my case.

What mainly determines good population nutritional status?

Following what I say above, I am equally committed to the social determination of nutrition, as well as to the conceptual framework of the causes of malnutrition introduced by the UN Children’s Fund (UNICEF) in 1990. This sees malnutrition as an outcome, with clear immediate, underlying and basic (or structural) causes. In 1983, I participated in the workshop in Tanzania where the concept was discussed, agreed and framed. All three levels of cause must be addressed at the same time. But before and after the Tanzania workshop, and publication of the concept by UNICEF, the basic or root causes of malnutrition continue to be overlooked or ignored. This is why the rates and prevalence of undernutrition have not changed much, and why those of new forms of malnutrition such as obesity and diabetes, notably in impoverished populations, have soared. Women’s and children’s rights, crucial to protect against malnutrition in all its forms, remain as abused as ever. Women in their lives and work as food producers, mothers, breastfeeders, housekeepers, cooks, and fetchers and carriers, have rights that must be once and for all affirmed and ensured. Similarly, the rights of family farmers, peasants, fisherfolk and of all those who live and work at or close to subsistence level, must be respected, protected and fulfilled, not just in speeches and writing, but in real life, all the time, constantly. It is a first duty of governments to yield to their vulnerable populations now becoming empowered to protect themselves. The same applies to the rights of all humans. Conscious public health nutrition work is political. It must be so.

How useful are the current nutritional sciences?

Yes, ‘standard’ work is needed. Yes, clinical nutrition applied to communities is needed. Yes, we do need our colleagues to do what they are doing. But colleagues must not leave the social determinants of health and nutrition to ‘others’ (what others?), because they feel they have inappropriate public health ‘tools’ in their ‘tool-boxes’ (what are these tool-boxes?). Please, no more Lancet series of spectacular statistical analyses that carefully evade almost all the big issues.

Are enough governments and official agencies making real progress?

A better question is why they are not making real progress? The main reason is the entrenched arrogant top-down approach to malnutrition. Have commensurate grassroots initiatives to combat malnutrition been sufficiently supported and strengthened? No, they have not. Has massive human rights learning taken place? No. Are claim holders demanding the changes they see as a priority to strengthen their food sovereignty? Many yes, but far fewer than would be doing so with greater political awareness and support. We professionals have a duty to fight in equal partnership with people rendered poor by an unfair system, for access to land and agricultural inputs, for the empowerment of women in agriculture, for sustainable agro-ecological practices, and for artisanal fishermen and nomadic groups. Yes, a duty! Moreover, we have the added duty openly to indict greedy transnational corporations, corrupt governments, and autocratic donors.

Are current dietary guidelines and nutrition education programmes, effective?

Are you kidding me? ‘Food groups’? ‘Healthy’ food pyramids? ‘Recommended dietary allowances’, or ‘daily amounts’? Give me a break! What? To teach poor
people to choose and eat what they cannot afford? So they can respond to a quick
quiz set by the teaching ‘health worker’? All of these are nutrient-based, and not based on what people eat, which is meals! Many millions of dollars have been spent by well–meaning colleagues working for different agencies doing this useless nutrition education. Who are they deceiving? There is a role for nutrition education, yes, but only in the context of and in support of the right to nutrition, of food sovereignty, and of empowerment of claim holders, above all, women. A final thought: Does conventional nutrition education think it can rival the enormous advertising power of Big Food and Big Drink? I’ll let you figure that one out.

What types of civil society groups are most responsive to the big issues?

First, reject the concept of ‘non-state actors’ which like ‘stakeholders’, is a manipulation meant to merge conflicted industry with genuine public interest groups. Next, please distinguish between the two main types of genuine non-governmental organisation. One is international NGOs funded by big traditional donors that have to protect their funding. The other is a mixture of ‘public interest civil society groups’ and ‘social movements’, both of which are clearly most responsive to claim holders’ demands. Think here of La Via Campesina, the People’s Health Movement (PHM), indigenous people’s movements, and many others. In the last decade, many international non-government organisations have become more proactive, but when it comes to call a spade a spade, they usually act cautiously to avoid offending their funders. True, there are a rapidly growing number of small local groups that see the big picture and are becoming more vocal and militant. Latin America has many, especially in the Andean region. Grass-roots organisations are the most committed. Increasingly, people understand that their misery has national and global determinants. This is a good omen. Here, I will deliberately say nothing about the Scaling Up Nutrition (SUN) initiative.

Name up to three inspiring leaders likely to be active to 2030, with reasons
I have just completed a piece on this topic for WN in December. Please wait!

Identify up to three of your greatest fears, with reasons
On my dark days I sense doom. Why should we be different from the Egyptians, the Romans, or the Easter Islanders? Greed, status, folly, consumerism, burgers and television (the modern bread and circuses) obsess or absorb most people. But I cannot and do not give up. Top of my fear list is the growing power of transnational corporations that are usurping national sovereignty. The consequent growth of religious and other ideological fundamentalism is my second great fear. The third fear is certainly climate change. Through PHM and otherwise, I do engage with these three topics. I also abhor the global monster of ultra-processed products, and of the transnational and national corporations and industries that produce and peddle them.

Identify up to three of your greatest hopes, with reasons
Hope #1: Human rights learning becoming a global reality. People need to know that they have rights and then to fight for them, not as beggars, but as claim-holders. The challenge is to find the resources to implement a massive global human rights learning campaign. This is an endeavour whose time has come. Hope #2: Countries really and truly adopting the human rights framework in confronting, preventing and controlling malnutrition, thus claim-holders taking up the space they are entitled to to actively demand their rights. Hope #3: All multilateral and bilateral development agencies really and truly adopting the human rights framework, including extra-territorial obligations that will scrutinise and regulate particularly transnational corporations. All this may sound hopelessly idealistic. But the menace of climate change alone, requires a revolution in the ways societies are shaped and governed. Not surprisingly, the greater the menace, the greater the need to place human rights at the centre, and thus fulfil the vision of great public servants such as Eleanor Roosevelt (pictured above),who built the United Nations 70 years ago on the foundation of human rights.
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Make any other remarks as you may wish
I chose public health nutrition as my life’s work 40 years ago, after qualifying as a physician in my native Chile. In the early 1970s, socially conscious people became politicised there, because of the changes occurring in the country. For me, then, nutrition blended science, medicine and politics. Undernutrition and related infections, and high infant and young child mortality were endemic in Chile at that time, as now in Asia and Africa and among other populations rendered impoverished and marginalised. Nutrition work made me an activist. It still does.