10. MDGs: for whom? and for what?

At the two-thirds point between 2000 and 2015, at a summit at UN headquarters in New York, the United Nations has just completed its assessment and review of the Millennium Development Goals. The Lancet has taken this opportunity to publish an appraisal of the MDGs, now and for the future, prepared by a distinguished group of London-based academics (1). The latter is critical of what it sees as the somewhat slow progress that has been made towards the achievement of the Goals, and also to some extent is critical of the Goals themselves.

We, at the Peoples’ Health Movement, have been for long saying that the MDGs, and the thinking behind them, are problematic. While this month’s column is by me, it also expresses the considered views of the PHM which, I believe, has more than any other organisation earned the right to speak for the people who are most affected by the MDGs, and by all aid and development programmes.

Reference and footnote

1Waage J and the London International Development Centre Commission.
The Millennium Development Goals: a cross-sectional analysis and principles for goal-setting after 2015. Available on-line at: www.the lancet.com/mdgcommission. Editor’s note: please also see the news item on the home page of the October 2010 Association website.

THE MILLENNIUM DEVELOPMENT GOALS EMBODY A CONTRADICTION. POOR COUNTRIES ARE EXPECTED TO MEET THE GOALS WHILE AT THE SAME TIME CONTINUING TO SUBMIT TO THE NEO-LIBERAL POLICIES THAT HAVE LARGELY CAUSED THE VERY PROBLEMS THAT THE GOALS ARE SUPPOSED TO RESOLVE.

The Peoples’ Health Movement, as its name indicates, is a network of networks of civil society and grassroots organisations, health professionals and academics, with very many sympathisers within international institutions, UN agencies, and national governments and their agencies. PHM has a presence in over 70 countries. Its focus is on communities and citizens especially in impoverished countries – the people who the MDGs are or should be all about.

Six shortcomings

For long now, PHM has been raising awareness of the MDGs’ limitations, namely denouncing that the Goals suffer from:

• Donor over-influence.
• Technical over-emphasis.
• Inattention to action on underlying social and economic inequities.
• Lack of systematic long-term financial commitment.
• Predominant focus on health and education.
• Overlooking of the entire political and economic economy.

Five points you may not know

Our denunciations are further based on the following facts and observations, which also seem to be generally overlooked:

• The obligations of the rich countries are not quantified in the MDGs paradigm, whereas the obligations of the poor countries are. This evidently assumes that poverty is a problem of poor people only.
• Poverty is defined in the MDGs as a state in which people have to live in the equivalent of less than $US 1 a day. But inflation is likely to make the one dollar in 2000 worth around 60 cents by 2015.
• Official responses to the nutrition-related MDGs seem to be more concerned with quelling or preventing food riots than with addressing the underlying and basic deeper causes of chronic malnutrition.
• If current trends continue, by 2015, 3.7 million more children in Africa will suffer from malnutrition than are today.
• China, Cuba, and Vietnam (where, by the way, I live, so I am in a position to know), have long focused on core development concerns, but have not labeled them as ‘Millennium Development Goals’, i.e., not wanting to play the MDGs game.

Not to forget: 1. Malnutrition is a big human rights issue

Above all, even if the MDGs as currently conceived were ever achieved, this only could result in a modest improvement in global health and nutrition …if at all. In any event, the Goals cannot be approached, let alone achieved, without adequate input from civil society, and this cannot mean simply a blind acquiescence with the assumptions and approaches proposed by the experts.

Therefore, it is a fallacy to suppose that health and nutrition programmes addressing the urgent needs of women and children implicitly address equality and human rights. In the human rights-based approach, to which we are committed, nothing is left implicit!

The MDGs operate too much using a ‘deficit-filling approach’ in addressing poverty and preventable ill-health, preventable malnutrition and preventable premature deaths. ‘Filling the last bit of the cup’ will not work. What is needed is re-filling the cup from the bottom.

Poverty, ill-health and malnutrition are the result of the ongoing process of social exclusion. The human rights-based approach specifically explores the exclusionary mechanisms that need to be dismantled – now! Consequently, concrete demands need to be placed on duty bearers – now! Where someone has a right, someone else has a duty. Gone are the days of us ‘working with beneficiaries’: We now need to act, to mobilise rights holders’ (claim holders) so that they demand their rights.

21 problems

Here are 21 more specific problems with the MDGs. (Yes, there are more!):

MDGs:

• Perpetuate a focus on communicable diseases.
• Encourage quick-fix technical approaches.
• Offer too little too late and are not really new, but rather rehashed versions from earlier goals set by international policy-makers.
• Emphasise average outcomes across an undifferentiated population; moreover, they focus on outcomes, disregarding the processes through which we are to achieve them.
• Provide mostly a ‘template of targets’ for the bureaucratic mind.
• Ignore the fact that poverty is a function of human rights violations.
• See housing, health care, and access to food and water not as non-negotiable and universal human rights, but as ‘needs’ to be met.
• Infuse neo-liberal priorities into development policies, often using just the language of human rights; ultimately, they attempt to ‘wash the face’ of neo-liberalism by emphasising what is possible and do-able …for donors and the market.
• Fail to represent a development paradigm break. Instead, they are a set of indicators embedded in a paradigm –the neoliberal paradigm.
• Come from the outside, in the North, resulting in what some consider ‘the ghettoisation of the problems of development’.
• Call for change, but not for creating the conditions to make real needed structural change possible.
• Overlook the roots of inequality.
• Seek to ‘eradicate extreme poverty and hunger’ (Goal 1), but rely on the discredited notion that economic growth at the national level (GNP) can eliminate poverty.
• Avoid denunciation of the bad governance of the rich ‘G8’ countries and of the international financial institutions.
• Represent a set of international obligations, and are not a real expression of local governmental goodwill.
• Fail to provide a real sense of ownership either by poor countries’ governments or their civil society actors.
• Place all responsibility on the separate national governments, with no real global authority in charge of their enforcement.
• Pretend to be a moral compass with a set of yardsticks to measure some types of progress, but are mostly a counting and accounting exercise.
• Disregard the effect of trade policies on malnutrition (the negative consequences of current unfair international trade policies are one of their major oversights).
• Fail to even mention women’s labour and property rights, or violence against women, which is one of the most fundamental obstacles to ensuring women’s rights.
• Assume that privatisation of services is a strategy for, rather than an obstacle to, economic development and improved nutrition.

Not to forget: 2. Malnutrition is a political issue

The implications of all the above are clear. Political forces cannot be fought with moral attitudes and technical fixes. What is needed is determined and sustained political action, from the ground up.

Seen from another angle, the MDGs miss what most matters to people who happen to be poor, who are also known as ‘the bottom billion’; they overlook or ignore issues of risk, security, respect, status, dignity, voice, and vulnerability. All of these are as important to impoverished populations as issues of income and consumption.

Also, none of the Goals can be achieved without empowering women and without recognising the centrality of decent employment, which also is a human right.

Furthermore, debt relief is a precondition for even keeping up the hope of meeting the MDGs. In addition, market liberalisation strategies have been oblivious to the ideas behind the MDGs. Whatever their rhetoric may claim, transnational corporations are certainly not geared to invest in helping achieve the Goals. .

The human rights philosophy

A radical rethink needed

For all these many reasons the MDG approach badly needs rethinking. We need post-MDG policies, based on human rights principles. These need to be worked on and put into practice now, to minimise harm and disenchantment come 2015.

When all is said and done, it is human rights violations that are the raison d’etre of all the Goals. Therefore, applying the internationally agreed human rights framework to them, or perhaps better, replacing the MDGs approach altogether, will reveal the discrimination, social exclusion, and other human rights gaps in the Goals as currently framed and applied.

A call to action

So far, most civil society organisations are failing to challenge the system that constantly and continually recreates the condition of poverty. It is time for duty-bearers to be held to account. Are more members of the World Public Health Nutrition Association prepared to do this? We cannot, in good faith, remain aloof from politics.

At the Peoples’ Health Movement, we fear that, after 2015, what will have been achieved is no more than islands of progress in an ocean of remaining grievances and persisting human rights violations. By sticking to the MDGs paradigm, inequalities are staring us in the face now, but will be shouting at us after 2015.
The MDGs need not only to be attained, but also sustained long term – post 2015. As now framed, the Goals would enable halving the hunger of all under 5s in the world on 1 January 2015, simply by distributing a few hundred million sandwiches to hungry children the night before. That is why I say: Poverty reduction without redistribution is only to be seen as flimsy rhetoric. Political power is a crucial precondition for a country to rise out of the poverty trap once and for all.

We need to focus on the processes that will lead to overcoming malnutrition (or to achieving any of the other Goals). These processes have to be bottom-centered. Without the proper participatory processes, MDGs as outcomes may mean nothing – they will be like a Christmas toy car … batteries not included. The process must ‘pull’ needed changes, and not be the conduit for ‘pushed’, often packaged, solutions.

Walking the walk

It’s not enough for aid and development agencies, and non-governmental organisations of any type, simply to start inserting human rights language into their discourse. We hear a lot these days about a human rights ‘lens’, or adding a ‘human rights perspective’, or having ‘human rights projects’, or ‘mainstreaming human rights’. What is needed is to walk the walk. Policy-makers and decision-takers of all types at all levels have to embark in human rights-compatible programming, using the human rights-based approach, which is by now well delineated. We, in the Peoples’ Health Movement, feel there is now no other rational choice.

Non-governmental organisations (NGOs) have to decide what, now and when to move in this direction. Governments must be pushed to take up their international responsibilities towards nutrition. One thing this means is that NGOs need to shift their work from a welfare perspective to an economic justice perspective. This entails getting involved, hands-on, in the transformation of the current political and economic orthodoxy into systems that are fair for all. It will also involve engagement in authentic human rights dialogues between claim holders and duty bearers.

As surely we must all know now, what goes on in the world is increasingly shaped by powerful transnational forces. Many of these have dire consequences for the right to nutrition. Local and national level efforts to influence the determinants of malnutrition can have only a limited impact. It is easy to see why health professionals in the public sector so often feel powerless. What therefore is needed, is collective action – thus the Peoples’ Health Movement. What, then, about the World Public Health Nutrition Association…?

Seven final thoughts

I end this month with seven thoughts:

• Real life is more complex than Millennium Development Goal slogans.
• The poor and the marginalised are not where they are by chance.
• The objectives we should strive for are not to stabilise malnutrition, but to make it disappear by addressing its roots.
• Granted, not all the problems of malnutrition are structural. But if structural issues are not addressed, the chances of the MDGs sustaining a global improvement of health and nutrition are nil.
• We have to avoid ‘othering’ people as ‘poor’ and thus as inferior to the non poor. This is what the MDGs implicitly do a bit – or a lot.
• The specific, general and structural failings of the MDGs should be denounced publicly, to demystify the ‘silver bullet’ aura of just going-for and achieving the eight Goals.
• The MDGs cannot be achieved without respect for human rights overall and in particular for minority and women’s rights. Nor can they be achieved without redistribution of wealth from the rich to the poor.

So, in the name of the wretched of the earth, are we to change the world? Or are we the victims of those who have the power to change the world?

If the second is the case, is what we usually discuss in our professional meetings as public health nutritionists going to change things? Did you attend and participate in the Porto world public health nutrition congress that has just ended? Think back please. Did you sense a growing insistence that our profession must now take effective action to empower impoverished populations? I hope you did. But were most discussions in effect critical or did they support the current aid and development paradigms and programmes? I fear they were. As professionals and as part of this association, we all can do much better.

Request and acknowledgement

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. The MDGs: who for, and what for? [Column] Website of the World Public Health Nutrition Association, October 2010. 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.

This column is reviewed by Geoffrey Cannon. Special thanks to: The Broker, issues 14 and 15, June and Aug. 2009; Development and Cooperation, issues 31:11, Nov 2004; 31:12, Dec 2004; 32:1, Jan 2005; 32:2, Feb 2005; 32:4, April 2005; 32:5, May 2005, 32:6, June 2005, 32:7, July 2005, and 32:8/9, Aug/Sep 2005. Finance and Development, 41:3, Sept 2004. SCN News No.29, late 2004-early 2005. ‘Human Rights, Health and Poverty Reduction Strategies’, draft, WHO/HDP/PRSP/05.1, 2005. and Yifat Susskind, www.madre.org/articles/int/mdgcritique.html. Also to George Kent and Vicente Navarro.

cschuftan@phmovement.org
www.phmovement.org