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SCALING UP NUTRITION (SUN): Is it really going to put nutrition at the centre of development?

I have to admit my columns are not always calming.

I here now ask questions and make comments about the rather big SUN (Scaling Up Nutrition) worldwide initiative endorsed by the World Bank and the pertinent UN agencies plus some international NGOs.

Our colleagues who are driving and steering SUN, some of whom I have known well for many years, call once again for nutrition to be mainstreamed in development work. This time the energy, declared commitment, and stated engagement of powerful players, looks stronger than ever before. I applaud this. All public-spirited professionals concerned with malnutrition should respect SUN; we should continue to engage with its process, make clear proposals for improvement and press for these, as well as be constructively critical when needed. A friend who is nothing more than a yes-person is not a true friend. Those who are driving SUN deserve respect; my column this month is written in that spirit.

I consider myself a nutrition activist. As such, I try to have my practical experience influence my theory. Our engagement in nutrition work should lead to a praxis in which profession, empathy, concern and political solidarity become one and the same. Without these bearings I fear that we will just go in circles. I fear that the SUN initiative does not – at least yet – have these bearings. In any case, we need to discuss it, as between colleagues and friends. Here, I call for us to build up our capacities as nutrition activists to motivate others to be equally constructively critical.

Box 1

SUN

The Scaling Up Nutrition (SUN) Initiative is, in one way or another, steadily engaging more and more public health nutrition and allied professionals throughout the world.  It is the most ambitious, highly-geared, integrated multi-actor programme of its type ever attempted.  Its vision is once and for all effectively to address undernutrition, food and nutrition insecurity, and their consequences, particularly in the most highly burdened countries. A recent issue   of the Food and Nutrition Bulletin linked here summarises some of SUN’s purposes and ambitions.

One of the concerns is that any programme initiated at top level may well not succeed in achieving the lasting results that only active community engagement  can make possible. There are other concerns too, like the state of the most vulnerable in many parts of the world. They also include concerns about the heavy external debt burdens, rapidly increasing inequity between and within nations, the collapse of public health services, and rising and volatile food prices, all suffered by the most vulnerable populations, any of which are liable to vitiate any form of development initiative. These oppressions are not  necessarily the responsibility of those who have devised SUN, granted. But they cannot be overlooked.

Now I proceed to ask some general questions, and also some questions addressed to the leaders of the SUN initiative. I hope this will generate a dialogue.

Here is my first question. Can we now at last, begin to shift our attention away from merely ‘reaching the poor with nutrition interventions’, towards deep understanding of the fundamental drivers of poverty and inequality, as these affect nutrition?  What ultimately counts, I contend, is our social and political accountability, and also carrying out our work in true partnership with populations and communities that happen to be impoverished.

It is political processes and issues of power that determine the content, direction and implementation of food and nutrition policies and programmes. As nutrition activists we can be strong political players, instead of – implicitly or by default – merely protecting narrow group interests. But we have to be mindful of the fact that we mostly work under the wings of governments, industry, or international agencies that are often unmindful of the real interests of those who are impoverished, despite their public statements to the contrary. We all know that the people who have the power are not the people who have the problems.

Our networked influence as public health nutritionists can and must contribute to realisation of the human right to nutrition; and also, to the reversing of violations of this right in all domains. So my second question to the SUN leaders is: Does the SUN initiative also mean and intend this? So far the drafters of its documents seem to skip the human rights dimension –at least explicitly. Is this my misunderstanding?

The processes that make people poor and malnourished are becoming more ingrained every day. So my next question is: Is the SUN Initiative fostering ‘survival’,  or sustained ‘better living’  Poverty changes people’s incentives and the constraints under which they operate; it causes a chronic sense of helplessness. Impoverished people are excluded from a share of their nation’s resources. That is why, to end protein-energy malnutrition, the distribution of wealth is as important, if not more important, as its creation. I am not sure that the World Bank, a backer of SUN, fully understands or accepts this point. Perhaps in pronouncements, but in practice?

People experience poverty and the violation of their right to nutrition differently, according to their gender, age, caste, class and ethnicity. For us, in nutrition work, poverty is multi-dimensional. It relates to powerlessness, to exclusion, to exploitation, to victimisation and to violence. It is also related to migration, to forced displacement, to rising urbanisation and to loss of livelihoods. Do the leaders of the SUN initiative see this at par value?

Let’s face a hard fact. Much of our work, such as that which involves micronutrients, remains a ‘nutrition repair industry’ of damage done by impoverishment. A sustainable approach to poverty reduction is complex. It requires three types of measure. These are to ensure that the ‘improving poor people’ continue to improve; that the ‘coping poor people’ graduate out of their precarious state; and that the ‘declining poor people’ have an opportunity to reverse their condition. I ask: How much of this do we really do in our nutrition work?

Poverty that is forced on individuals and on families who have no other choice, is unequivocally linked to injustice – and potentially to rebellion, uprising, and even wars. It is a denial of human rights on a massive scale. Should this fact not make a difference in our day-to-day work?  And so, to my next question is: Do those shaping the SUN Initiative, in their call for nutrition to be placed more at the centre of development, accept this, with all its implications? We need to engage in sincere dialogue on this and the other questions asked here.

The gap in policy processes towards better food security and nutrition interventions is not mainly a gap between knowledge and action. Food and nutrition issues generally have had little policy attention from decision-makers. The lack of action this entails is not due to a lack of knowledge. Ignorance is not the issue. It is more a matter of a deliberate choice not to attend to food and nutrition matters.

Crucial partners in the SUN initiative are food and nutrition research organisations, such as those associated with the UN and World Bank funded CGIAR consortium, originally named the Consultative Group on International Agricultural Research, These employ and engage thousands of highly trained and committed professionals. But as far as I can see, they have hardly engaged in the needed consciousness-raising about the structural causes of malnutrition.

If I am wrong in this, let’s have a response please. Most such organisations seem to think that if decision-makers have, or are given, more and better knowledge that they will indeed take the urgently needed decisions. But this is not how the political world works. People in power rarely go against their own interests. What is missing is something that SUN, by its nature, is not supplying. This is organised methodical intelligent, informed and energetic pressure from below, from empowered claim-holders.

I will now explore this somewhat further here, in a point-counterpoint fashion.

Point 1

Most nutrition colleagues will, I think, agree that the right food and nutrition policy decisions are not being made, in a world where malnutrition is still a serious public health nutrition problem, and where a host of options for action exist. Why is this? Why do decision-makers overall pay little attention to food and nutrition issues?

Counterpoint 1

Some researchers in the food and nutrition community are indeed looking for ways to reduce the gap between knowledge and action. As said above, the issue is deliberate overlooking and ignoring of the food and nutrition problem, as long as this does not get to the stage of social and political unrest and uprising, and thus jeopardising the stability of the system controlled by those who hold the power. Knowledge gaps most decidedly exist, but are of little significance. Policy is only minimally affected by knowledge alone. It is political factors that determine the policies that get priority. It is power politics that drive policy choices.

The communities most affected by impoverishment are usually not being engaged in the policy making process. They do not have a voice; they do not influence policy. They need to be empowered to do so in order to claim this right.  And thus another question: Will the SUN Initiative embark on this?

The more militant civil society organisations have indeed contributed to some real changes. There is much to be learned from them. We need to help budding civil society organisations to achieve the power to demand needed changes and to monitor their implementation.

Point 2

Existing food and nutrition research organisations like the CGIAR consortium often engage in attempts to influence policy-makers by communicating their findings to them and by contributing new information at conferences and other policy fora.

Counterpoint 2

But merely communicating and contributing new information to decision-makers will not achieve needed changes, unless this information addresses political issues. Furthermore, new information and ideas need to come not just from discussion with professional peers, but with the claim-holders themselves.  Just how often does this actually happen? Perhaps more often than I think, so examples please, from knowledgeable readers.

Point 3

These organisations claim there is a disconnect between the sphere of policy-making and the sphere of science-and-knowledge; that the need is to break ground methodologically, to engage policy-makers for decisions to be made.

Counterpoint 3

This has been one of the problems of these food and nutrition research organisations all the time. They try to connect policy with science-and-knowledge, and not with politics. Does any knowledgeable professional in these fields really still think that if decision-makers have more and better knowledge, they will make decisions that are against their political interests? In their guts, politicians already know what scientists want to tell them. They may not have quantified information, but they know. The need is not to break new methodological ground. The need is to break through politically.

Point 4

These organisations still often call for more interdisciplinary research.

Counterpoint 4

However, almost all the hurdles are ideological. Multidisciplinary teams of conservative researchers will produce conservative, ‘focused’ (meaning narrow) results and recommendations that merely tinker with the immediate and, perhaps, underlying causes, strictly consistent with the established order – or disorder.

What is needed, above all, are structural changes that address the basic causes of preventable hunger and malnutrition. It is definitely not a dearth of multi- or interdisciplinary work that has hampered progress. ‘Selling’ research findings to decision-makers is, I think, likely to bring more of the same disappointments. Policy makers tend not to listen, unless claim-holders put pressure on them.

Point 5

Many of these organisations call for setting up social protection and safety nets.

Counterpoint 5

Let us now, once and for all, stop talking about safety nets! This is what leads to mere tinkering within the system. The ongoing casino capitalism with its global restructuring, creates the problems, and food and nutrition professionals are supposed to pick up the pieces? Just so that poor and marginalised people do not revolt? Who is cheating whom here? We need to stop victimising poor people and them throwing them bread-crumbs. What about changing the system that makes safety nets for poor people necessary to begin with?

Point 6

The CGIAR and similar organisations have proven their ability to communicate effectively, to bring relevant actors together to promote action.

Counterpoint 6

True, but what are they communicating? Rice with added iron or vitamin A? The horrible impact of AIDS on agriculture, economies and social stability? The need for improved agro-forestry? Super new strains of staple foods? None of this is enough. In any case, do such proposals lead to policy-makers listening, acting, and going on to make structural changes? I think not.

Food and nutrition issues appear on the public policy agenda almost always only when it is in the interest of the decision-makers, or when international pressures become unbearable. Is the SUN initiative a response to such a pressure?

Only occasionally do leaders have a clear mind and determination about the importance of food and nutrition, in a genuine equitable and sustainable development process. But we need to remember that some governments do place a high priority on reducing hunger and malnutrition. Take Vietnam, China, Brazil, Costa Rica, Cuba, and Kerala state in India. The common denominator among them is political determination at the highest level, in some cases spurred by engagement and partnership with strong civil society organisations.

Ultimately, the crucial factor is organised pressure from below; thus the importance of empowering and mobilising beneficiaries. Current legislation and legal systems do not affect action to reduce hunger and malnutrition to any great degree. Laws may be passed, but are often not enforced. National leaderships often feel content with having made the laws, and do not care much about their enforcement. Legislation is also frequently in response to international pressures and not to a real felt need. So a similar question to the last one is: Is the SUN initiative a response to such pressure?

So how can all the actors allied and working together within the SUN initiative, create the conditions for actions that really will effectively reduce hunger and malnutrition in impoverished countries? In my view and that of many experienced colleagues, they will first need to go through a deep process of revising and redefining their vision and their mission. Above all, they need to incorporate the human right to nutrition in their policies and actions. Will the SUN initiative mark the end of the donor-driven, philanthropic and charitable approach to what actually are human rights? I hope so. I pause, for a reply.

Please cite as: Schuftan C. Let us hope that the SUN Initiative can really put nutrition at the centre of development. [Column]. Website of the World Public Health Nutrition Association, January 2012. Obtainable at www.wphna.org

cschuftan@phmovement.org

www.phmovement.org

www.humaninfo.org/aviva

HUMAN RIGHTS-PROOFING DEVELOPMENT PLANS.

Food for a neglected yet needed thought

Human Rights Reader 280

-Good economic times are especially conducive to the illusion that bad times will never return.  (A. Dixit)

-There is a long, long tradition of development professionals offering development recipes that do not work. Not being facetious, in ongoing development work, the main cause of the problems encountered is the solutions so far applied; wouldn’t you agree? Remember: Neither charity nor a romantic sense of ‘social responsibility’ are sustainable.

1. We have a tremendous underutilized accumulated knowledge on the past and ongoing ‘development processes’ that, for the most part, have been human rights-blind. Allow me just a few examples. For instance, we know that:

• When roughly 80% of the world’s population has no access to social security, a commonly prevailing myth is that economic growth does automatically imply an extension of social protection. It does not!

Economic growth strategies have no regard for distributional and  environmental consequences. Period.

• The Northern-led (or pushed?) development drive has never distributed resources and wealth evenly, and has taken our finite environment for granted. But it became even more uneven with the advent of capitalism as the latter:
  • extended private property relations,
  • further skewed the distribution of income and the systems of social, economic and political power and authority,
  • gave free reign to the market system with negative consequences for the environment,
  • limited the capacity of the State to restrict markets,
  • reduced regulation, taxation and public expenditures, as well as

unfairly opened-up national economies to international

operators (D. Tarantola), and

• relentlessly pursued self-interest and profit which gets in the way of serving the poorer groups in society. (M. Yunus)
• Although achieving real bottom-centered development requires justice and equality, the commitment to human rights (HR) is merely rhetorical on the part of the Bretton Woods institutions and of other external lenders and donors.* (Development in Practice) [On the other hand, we also have to be aware that it is easier to bitch against the demon of the North than to mobilize the interests of the South… (A. Gomez)]

*: Let me ask you: From a HR perspective, does not our failure to proactively denounce:

• World Bank country policy advice and influence that has led and leads to the destruction of the livelihoods of millions,
• the non-regulation of destructive operations of transnational corporations, and
• the signature and implementation of international trade agreements that inhibit/restrict access to food, to health and to needed resources for vulnerable groups

make us, to some extent, accessory to these consequences?

• Most poor communities have various levels of poverty, even if they all look relatively poor to the uninitiated outsider. People in them are often overwhelmed-by and suffer the consequences of both local and global economic designs. Nevertheless, they still seek ways to engage-with and act-upon the issues that concern them most directly. True, people prefer visible development realizations over invisible operating mechanisms and policies. But they are, without a doubt, motivated to act as protagonists for positive social change. Let us not forget this! (L. Schultz)
• Somehow, academics and more traditional development practitioners do forget this. They have problems more seriously considering the power relations that ultimately influence outcomes in the development process. Development is just not party to the ‘neutrality principle’ these colleagues purport regulates the same process; rather, there is always a political objective. In that sense, the social sciences/scientists can only open up possibilities for development; social action at the community level is indispensable to eventually accomplish fair and just development objectives. **

**: The intellectual development worker in her/his ivory tower does not interest us for what s/he does, but for what s/he does for us [--for HR]! (S. Carmichael)  Intellectuals ought to commit suicide as a group if they avoid confronting the social reality that is all around them. (Che Guevara)  The qualities of leaders are not irrelevant for the desired results, but they are also not the sole and decisive factor. (Trotsky)

2. But to HR-proof development plans, we also know what we need-to and are-not doing. Allow me just a few examples here too. For instance:

• We do not distinguish between what is branded ‘complex’ and what, in reality, is not wanted by the (powerful) Establishment. (A. Katz)
• We do not make sure that development policies address both interests and values –in equal measure!
• We do not formulate our development challenges as HR issues, thus ensuring development is people-focused.
• We do not make sure that human development is complemented by a conceptual framework that shares similar underlying motivations, even if these have different emphases, but ultimately add to the respect and fulfillment of HR. (S. Alkire)
• We do not shift development from service-delivery-as-a-primary-focus to building-the-people’s-capacity-to-actively-claim.
• We do not make sure that every relevant decision is taken at the lowest possible level (subsidiarity principle).
• We do not involve local officials in decision making; they do not only have a more objective understanding of matters local, but they are also more used than us to think in local terms.
• We do not pay more attention to the processes of how outputs, outcomes and impacts are achieved, and
• We do not, once-and-for-all, make sure a shared vision of the centrality of HR in development work ‘sinks-in’ by implementing much bolder HR learning measures at all levels.

3. Although these lists are just an arbitrary sampler from my end, two special additional issues fall in the realm of ‘need-to-do’, namely:

Accountability

Bureaucratizing morality  gives us a sense that we are exerting close control….this really is nothing but a superstition. (D. Weinberger)

4. Since the issue of accountability is the key to effective development, getting it right can and will unlock progress that is otherwise stalling. Too often, accountability is seen solely as a set of complex tools for auditing and incrementally improving development in its current configuration within the old paradigm. (A. Litovsky)  But in HR work, accountability is really to settle about-nothing-less than renegotiating the global social contract, i.e., to‘civilize power’! *** (T. Burgis) With HR violations well assessed, we have to mobilize claim holders to demand duty bearers are kept accountable.

***: A caveat here: When accountability is built on myths of precision (becoming rather too picky), the important systemic, structural failures are missed; this has been called  ‘accountabilism’.

Development budgets

In a way, government budgets and their execution are a truer measure of their commitment to the realization of human rights than are its (on paper only) policies and plans.

5. The role of government budgets in causing and potentially resolving an issue is considered crucial in HR work. Budgetary items relating to economic, social and cultural rights should be (and more often are not) prioritized in all government budgets.

6. The UN Convention of Economic, Social and Cultural Rights (CESCR) prohibits the diversion of resources that ought to be devoted to HR covenant-related issues. Also of UN concern, is the non-utilization of budgetary items earmarked for social expenditures since these funds should be fully spent.

7. Governments have the obligation to ensure people participate in defining the problems and the solutions related to access to social services that governments seek to resolve through their budgets. The problem is not the budget figures themselves, but people’s exclusion from the budgeting process and from full access to budget execution information.****

****: Never forget: When fifteen things need to be done, doing three of them is not going to get you 20% of the way there. It is going to get you much less. You will need to get 15, or at least 13 or 12 of them done, before you start to see any big effect; we call this strategic complementarities –and the budget implications of this should be clear.

8. How the budget discriminates can be easily spotted by calculating per capita allocations or, better even, per capita expenditures, for example, for ethnic minority groups; or, by checking whether the government has allocated adequate funding to allow HR regulatory bodies or agencies to operate in an effective way.

9. Let us remember here that States are obliged to ask for international cooperation if domestic resources are insufficient to assure the fulfillment of HR.

Which then are the HR-in-development priority challenges?

10. The response to this question depends on which HR are unfulfilled or being violated and on the causes of the local development failures that have been collectively identified; it also depends on who selects the priority challenges.  But beware, defining development challenges as a lack of something here and something there risks focusing on overly simplistic solutions that prevent further analysis of the structural causes of the problems at hand. When searching for the linkages between levels of causality, the key cascading question to be asked over and over in the causality analysis is: Yes, but Why? After every answer, we have to keep asking this until we get to the bottom-of-the-bottom causes. (D. Werner)

11. If everything in the current approach to development was bad, solutions would be easier. The difficulty is in identifying and countering the bad which has been based on way-too-much ‘professional knowledge’ and endless failures in  application. For instance, we see failures when providing support to groups of population that do not need it so badly while withholding the same support from people who need it more badly; costly errors are generally made when  doing so. Conversely, fostering the HR framework makes development most-vulnerable-people-centered. (A. Mulley)

12. Bottom line, the human rights-based approach rights-proofs development plans by struggling for social justice through all-inclusive, participatory development policies.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

____________________

Adapted from D+C  36:9, Sept. 2009; D+C, 36:12, Dec. 2009; D+C 37:9, Sept. 2010; D+C, 37:10, Oct. 2010; D+C 37:12, Dec. 2010; F+D, 47:2, June 2010, F+D 47:4, Dec. 2010; The Broker, Issue 24, Feb/March 2011, Development in Practice, 19:8, 2009; FAO: Budget work to advance the right to food 2009; and UNFPA  A HRBA to Programming: Practical implementation manual and training materials, 2010.

Postscript: It is rightly said that we are what we do. But we should add that we also are what we do not do, what we say and what we choose not to say. (A. Gomez)

Nutrition and sustainable development

This month, I look forward to a world conference being held next June, in Rio de Janeiro. This is the ‘Rio+20’ Conference on Sustainable Development, whose website is at http://www.uncsd2012.org/rio20/

The overarching declared purpose of Rio+20 is once again, to raise consciousness of and arouse conscience on the environmental dimension, which until late last century was more or less forgotten. Veterans of world summits on any topic have reason for scepticism, but they are needed, and we must all do our best to see that Rio+20 really does mark a time when we all move towards living in ways that are fair and sane.

Adequate good nutrition is smack in the middle of sustainable development. Neither is possible without the other.  But as I consider these issues, like you, I am also reflecting on what has been and is happening this year in the streets all over the world. This year has been and is one of direct action, and I believe that the unrest, riots and uprisings that we see and that some of us have experienced, whatever their immediate and obvious cause, all have a core mood in common. This is awareness that we are living in a world whose political and economic governance – or rather lack of governance and surrender to corporate greed – has gone wrong and has broken down.

The prevailing governance structure of the globe ignores the several crises the planet is facing, as well as the social determinants behind them. Food insecurity (1), preventable child and maternal deaths (2), price Barriers to accessing  medicines (3), collapsing health systems (4) share the fact that we do have enough resources to provide for them, but these resources instead flow to over-consumption. Military expenditure  and obscene wealth for a small elite (5).

Food prices including those of staple foods all over the world remained stable from 1990 to 2007; since then, prices have rocketed and fluctuated wildly. One reason, as pointed out by Olivier De Schutter, the UN special rapporteur on the right to nutrition, is the recent vast increase of speculation in food commodity futures prices. The results, early this year, were food riots in many impoverished countries, leading to uprisings in North Africa that threatened and toppled governments.

My point here is that the triggers for the unrest that escalated very rapidly in a number of grossly unjust societies, were uncontrolled and chaotic food prices, in countries whose rulers had failed to protect their people by the use of regulations and controls that could have stabilised the cost of staple foods, as wise rulers throughout history have done.

The latest manifestation of this year’s phenomenal series of direct actions is the Occupy Movement, which includes the Occupy Wall Street movement. This began in the South in Kuala Lumpur, Malaysia on 30 July, spread to Zuccotti Park in New York on 17 September, and by early November had spread to 600 communities in the US and around 2,500 cities worldwide. Occupy is now supported or endorsed by political and other leaders even up to head of government level in many countries, including in the US and in the BRIC countries of Brazil, Russia, India and China.

The protests are against what is now often accurately termed ‘casino capitalism’. This monster has been created by what still remains the orthodox political and economic system known as ‘freeing the market’, which is technobabble for surrendering the responsibilities and duties of government, and letting transnational corporations use increasingly lenient laws they believe will increase their profits.

Until this abuse of governance is stopped and reversed, world summits on the environment, climate change, prevention of diabetes, cancer and heart disease, or the war on world poverty, are really hot air. They are also duplicitous, because the officials who organise them must surely be well aware of the big issue that is driving environmental wreckage, the melting of the Arctic and Antarctic ice-caps, and the outrageous combination of obesity, poverty and deficiency.

  Box 1

Sustainable development

Eating the planet and having it

Whether we are policy-makers, professionals, citizens or consumers, or any combination of these, we won’t make progress with the idea of ‘sustainable development’ until we think through what these terms mean and imply. ‘Sustainable’ is perhaps easy to define. It means something like ‘capable of being continued indefinitely’ and in our context, taking human, living and physical resources into account. Thus, to use a well-known example, recommendations that everybody should eat more fish are not sustainable – unless few people pay attention to the recommendation.

So what about ‘development’? People like us have been brought up to believe in ‘development’. The concept of ‘underdeveloped’ and ‘developed’ countries, later tactfully changed to ‘developing’ and ‘developed’, is embedded in all discourses concerning human progress, as are allied terms like ‘emerging market economies’. What ‘development’ conventionally means is economic development. And the metric for this type of development, applied to any country, is Gross National Product. What this measures is the total amount of money turned over within a country. The more money circulates, the more economic development, which usually is simply termed ‘development’.

Human rights, justice and equity don’t enter this picture. A country whose population was mainly made up from relatively self-sufficient family farmers, with a small ruling class that was not rapacious, would by definition be ‘developing’ – or if it preferred to stay that way, ‘undeveloped’. By contrast, a country with a  substantial number of vastly wealthy people and an economy based on money, whose public goods are privatised, and whose diseased population is mostly in a perpetual state of insecurity and even gross poverty if only because of the cost of health care, is ‘developed’. Another example would be a  country whose national turnover of money depended on vast stocks of weapons of mass destruction, used from time to time to invade other countries. Such a country is counted as most developed. Sounds familiar?

My point here is that in its current conventional sense, ‘development’ cannot be sustainable, because it depends on increasingly rapacious and senseless exploitation of human, living and physical resources. The concept of ‘sustainable development’ in this sense is a contradiction in terms, it is in effect imagining that we can eat the planet and have it. Unless the leaders of the Rio+20 summit being held next June get their collective heads round this basic point, and insist on a new concept of ‘development’ based on rights, equity and justice, decency, happiness and freedom, we all will continue to roll on to doom.

What does this matter to us?

These seismic events are the context for the work of all professionals who, like us, are committed to doing our best to improve conditions in areas where we are competent.

So one of my first questions is:  If we are trying to make nutrition interventions in impoverished countries more sustainable, why is most of what is said, written and done having so little effect? Here are some answers to this question:

• Our praxis, which is to say our application of principles and ideas, has become professionalised. In the process, we have devalued and demoted the proper role of popular knowledge in our teaching and practice.
• Our prevailing values and attitudes as researchers and practitioners are arrogant. They have impeded us from respecting and acting as equals with our national counterparts in the countries we work in.
• We still seek to control knowledge as part of an elite class. We thus fail to obtain a deeper understanding that will guide more appropriate actions which can only come from a process of genuine popular participation.
• The root of the problem is that real sustainable development involves process of popular enrichment, empowerment and participation which our technocratic project-orientated ideology by its nature fails to accommodate.
• Another reason for the irrelevance of many past and current approaches is that overall development education has continued to transmit societal values mostly as they are perceived in the North.

Those who teach or who taught us, inevitably teach us part of themselves and the frame of values that is part of their background. The context any teacher comes from has its own frame of assumptions about what is real, unshakeable and safe. These contexts can become cages.

Difficult problems tempt us to focus on their more manageable component parts. But this atomistic approach evades the more complex underlying and basic structural questions. This also prompts the ‘exclusion fallacy’, in which what we choose not to discuss is assumed to have no bearing on the issue (6). An uncritical, repetitive reliance on the same old shallow data in the interpretation of unresolved issues, which avoids seeing malnutrition as an outcome of complex social and political processes, will not and cannot do.

The predominant theories of development still see society largely as an organic whole that is normally in equilibrium. This view does not fit well with the facts. Instead, we need to view society as a complex of forces in tension and conflict, because of the divergence of interests that drive them. We should not assume that conflicts are resolvable within what is now the prevailing political, economic and social system (7).

There is now much talk about the need for ‘multidisciplinary approaches’. In principle these are needed. In practice they often assume that looking at problems from a ‘wider’ perspective will automatically lead to rational and equitable solutions. But the mere act of putting together disciplines, without taking into account where the ‘experts’ are coming from ethically, ideologically and politically, has not and will not by itself make a significant difference. This will be all the more so, if beneficiaries – who need to become de-facto claim-holders – are not fully involved in decision-making processes.

The Millennium Development Goals initiative will, we now know for sure, fail to halve the 1990 global hunger rate by 2015. This is more than just a wretched item of news. For far too long now there has been a block in the way of our realising that malnutrition in all its forms is in part driven by a model of development that is inherently unsustainable, as summarised in Box 1. The people in the streets may help us to become unblocked. But this calls for us being able to understand what they (and) we are seeking so that we are more likely to get where we need to be and, once there, to know what to do.

Vocally opposing and manifesting against old ways is not enough. The current movement needs a new conceptual framework, a new system of principles and values. These need to be concrete, cogent and compelling. Debates about past historical rights and wrongs should be mainly to guide us to come up with more coherent propositions for tomorrow. We need a vision firmly embedded in a practice. We must not walk away from these debates.

In our own work, we need to open new space to discuss and agree what now must come about. We need to take full account of all causal levels of malnutrition in impoverished countries and settings, i.e., social, economic and environmental, immediate, underlying and basic causes.  Vision must move to mission and to real work with tangible outcomes. A vision is not much good if it simply stays in the air as something devoutly to be desired. A vision of that sort is a mirage; it recedes as you approach it. To be of use, the vision has to point to a route, and to take into account a lot of unpleasant realities.

A vision is of no use unless it serves as a guide for effective actions. These will need to be biased towards the oppressed, because it is their rights that are being trampled. We ought to express and manifest solidarity towards the oppressed. Only then will our vision be shared with them and gain weight and credibility in its commitment to equity and justice. We can no longer abandon the have-nots to the dollar-dispensing Northern bilateral or multilateral agencies. The moment cries for us to press for more. Windows of opportunity have a way of slamming shut. (8)

It is hard for many of us to maintain political agility in a hostile environment. But the role of an avant-garde is to cause ferment. Let’s not assume that somebody else is going to take care of issues that engage and involve us. We have to get active. A strategic overhaul of our actions requires a crisis in our thinking. This I believe is why the Occupy Movement is encouraging.

The future of our work in nutrition cannot be a simple extension of the past. Business as usual is no longer an option and in the times we now live in, has little if any meaning. Tuning the engine won’t work; it needs to be taken apart and put together again, for new purposes (9).

For a start, we have to work towards checking the malign forces that propel us as professionals in the generally hopeless direction we are moving. The fundamental changes now needed, can be brought about only by organisations and people that have no vested interest in the survival of the non-sustainable development system as it operates now, and that oppresses dependent countries and their impoverished people (10, 11).

A new professionalism will emerge when we become explorers, always asking what and who will gain, or lose, from our choices and actions in our work in nutrition. New professionals ‘who put the last first’ already exist, but we remain a minority. Now we need to multiply, and interact, coalesce and organise dynamic networks among ourselves and between us and grassroots organisations.

A mere extension of what most of us have already been doing in public health and in nutrition is not strong enough to insert nutrition within sustainable development. Our big task now is not only to have conceptual breakthroughs, but also to design strategic plans that specify all necessary institutional changes.

What’s in store, and what’s to do?

So what should we do now? I have given this some thought. In one column here I can’t attempt much more than a wake-up call at a very significant time in history, when so many ordinary decent citizens are expressing their outrage on the streets. How can we all make progress towards genuine sustainable development, based on principles of justice and equity which is most likely to preserve Earth for our grandchildren and their grandchildren?  Here are some possibilities, which I regard very much as thoughts in progress, to be improved by discussion and exchanges:

• We need to de-professionalise our work. This will mean seeking, re-valuing and incorporating popular knowledge and know-how into planned actions.
• In this process, our local counterparts, and local civil society organisations, need to take a more visible lead, even at the cost of some possible mistakes.
• All relevant knowledge needs to be shared from the very start with the beneficiaries who in the process become claim-holders.
• We need to move away from the project-oriented approach and move towards processes of popular enrichment and empowerment.
• We now need to depend less on academicians, and professional practitioners, and listen more to the everyday sufferers from the prevalent inequitable system.
• They should define the changes that are needed. Action plans are thus to be negotiated and finalised in neighbourhoods and fields, not in our offices.
• Education has to be from the claim holders’ perspective with their choice of contents and priorities. We have to be more open to their needs and values.
• Our analyses need to incorporate the structural causes of malnutrition as part of the ‘big picture’. This includes changes made by economic globalisation.
• We will thus be forced to face the complex social and political forces of oppression that prevent populations and communities from improving their own nutrition.
• We have a duty to confront head-on and to expose the malign forces that oppose greater equity so as to neutralise them, from local to global levels.
• We need to use the internet to build networks of like-minded colleagues who can consolidate a strong worldwide solidarity movement.
• We have to confront the types of bilateral and multilateral aid – often no more than tinkering – that perpetuate inequitable and disempowered societies.
• We have to play a part in forcing institutional changes in aid agencies, the UN system included, so as to make them more democratic and transparent.
• We need a whole new curriculum for public health, nutrition and development professionals, to prepare a new generation of more enlightened professionals.

The processes that can lead to real sustainability, to the fulfilment of the human right to nutrition, and to equitable societies, can and should start with small direct actions that we can help bring about more easily.

Actions at grassroots level can take many forms. These should always include examination of who is losing and who is winning, and why. At higher levels, most of us have more experience on how to start discussions leading to change. We now have to follow through! We have to commit ourselves, in a more active and even militant way, to get and to keep the process of popular empowerment moving, always confronting the status-quo that gives the impression that nobody cares.

Examples where some of these elements have worked exist. Some of these, like the Indian state of Kerala, and Sri Lanka, Cuba, and Costa Rica, are well known. Others, like the primary health care work done in Iringa in Tanzania, and the Indian Jamkhed comprehensive rural health project in the state of Maharashtra, are also sources of insight and inspiration. They all have in common bottom-centred, gender-sensitive, empowering approaches and a political choice to tackle the underlying deep roots of poverty, injustice and ignorance.

The road to real development indicated here requires that we break with the old development paradigm, as summarised in Box 1. This will mean stepping on the toes of many powerful vested interests. It has always been like this, isn’t it?

I rejoice to see the people, especially the young people, now in the streets, sometimes passionately debating with courageous establishment figures who come to reason with them and learn from and sometimes join them.  The present moment is full of promise. The old ideas are broken. An era is ending. We are in for an exciting new era. We need all the courage we can muster. It’s time, I believe, that we all stopped being mere bystanders and become actors. Addressing issues like these will have to pave the way to Rio+20.

References

1          Holt-Gimenez E. The world food  crisis: What’s behind it and what we can do about

it, Food First 2008, Institute for Food and Development Policy, Oakland, California.

2          Hogan M C. Maternal mortality for 181 countries, 1980-2008: A systematic

analysis of progress  towards the Millennium Development Goals, The Lancet  2010, Early online. doi:10.1016/S0140-6736(10)60518-1

3          ‘t Hoen E F M.The global politics of pharmaceutical monopoly power, drug patents,

access, innovation anfd the application of he WT Doha Declaration on TRIPS and

public health. Dieman 2009, AMB Publishers.

4          WHO. Everybody’s business: Strengthening health systems to improve health

outcomes, WHO Framework for Action, 2007 Geneva.

5          Milanovic B. Global inequality recalculated: The effect of new 2005 PPP estimates

on global inequality, World Bank 2009 Washington DC.

6          McDermott W. The forbidden agenda, Transnational Perspectives 1989, 15:1, 6-8.

7          Langley W.  Liberation theology and the politics of transformation,

Transnational Perspectives 1989, 15:1, 23-29.

8          Gitlin T. After the thaw, Tikkun 1988, 3:6, 50-53.

9          Myers N. New Economics 1987, 1, 1, 8.

10        Harman W. Redefining global development, Development Forum 1989, 17:2, 21.

11        Bracho F. The common cause for worldwide sustainable development: A   Southern view, IFDA Dossier 1990, 63-67.

Please cite as: Schuftan C. Nutrition and sustainable development. [Column] Website of the World Public Health Nutrition Association, December 2011. Obtainable at www.wphna.org

cschuftan@phmovement.org

www.phmovement.org

                                                                                          www.humaninfo.org/aviva

People’s Power Breakfast and Speak-Out to Fix Health Care in Brooklyn: Wednesday January 11 at 7AM

Stephen Berger, Investment Banker & Chair of Cuomo's Medicaid Resign Work Group

Doctors for the 99% will be out on Wednesday morning (1/15/2012) at 7AM to provide a people’s answer to a $75-a-plate power breakfast inside the Brooklyn Marriott.  Health industry and Wall Street insiders will be guests of Crain’s NY (the local business publication whose readers ARE the 1%) to talk about how to “Solve Brooklyn’s Hospital Crisis”.

Why a demonstration?

This protest is a response to Gov. Cuomo’s special work group on Brooklyn hospitals (chaired by Stephen Berger a Wall St. financier) which has recommended changing NY law to allow investors to own or operate hospitals that are in financial trouble. They also recommend that the state be given power to dismiss hospitals’ management and boards. Together, these changes will allow Wall St. to take over health care even more than they already have.

It is amazing that in an attempt to save money, the State would turn Brooklyn hospitals over to for-profit companies.  There is extensive evidence that privatizing health services results in increased costs, poorer quality, and increased health disparities.  The people who will profit are the for-profit companies.  The people who will pay? The taxpayers of New York and the patients who will lose access to safety-net institutions.

Changes to our health care should be made transparently and democratically. These life and death decisions should be made by the communities who will be affected, not by the bankers who caused our problems in the first place.

This is a classic example of using a “crisis” to push through unpopular policies that will benefit only the rich.

What is the background?

• 20% of Brooklyn residents live in poverty. 40% of Brooklyn residents have Medicaid as their health insurance, and another 20% have no health insurance at all.
• One-third of all Brooklyn residents lack a regular doctor, so they use emergency rooms (ERs) when they get sick. 46% percent of all ER visits in Brooklyn could be better treated in the community.
• 6 of Brooklyn’s 14 hospitals are almost out of money and in danger of closing: Brookdale (Brownsville), Brooklyn Hospital (Ft. Greene), Interfaith (Bedford-Stuyvesant), Kingsbrook Jewish (East Flatbush), Long Island College (Cobble Hill), and Wyckoff (Bushwick). These hospitals serve low-income communities, where most people have Medicaid or no insurance, and many are immigrants and people of color.
• Gov. Cuomo appointed a special workgroup chaired by an investment banker to suggest fixes for Brooklyn’s troubled hospitals. They suggested letting private investors come in to “save” these hospitals.
• Brooklyn is fighting to keep hospitals open in low-income neighborhoods. Meanwhile, the wealthy east side of Manhattan is stuffed with well connected hospitals that grab public money, but give little care to low income communities of color.

What are the details of the demonstration?

We will be meeting Wednesday 11 January @ 7 am outside the Brooklyn Marriott, 333 Adams St (near Borough Hall / Jay St / MetroTech in downtown Brooklyn).

For more information visit: http://owshealthcare.wordpress.com or contact: owshealthcare@gmail.com

WE ARE SWARMED BY TOO MANY STATISTICS AND DATA THAT, AT THE END OF THE DAY, PROVIDE TOO LITTLE VALUABLE ACTIONABLE INFORMATION FOR HUMAN RIGHTS.

Food for changing and transforming a thought

Human Rights Reader 279

-These days, we do not say or do anything that does not have numbers attached (statistics); judgment comes from the latter (so this can be called the ‘politics of data’). More numbers, more graphs, more histograms with a % on the top and history thrusts forward defying anyone who contradicts…

-Beware: Indicators only indicate, they do not explain; they can be seen as snapshots of a small part of the reality.

1. Over millennia, we have progressed from hunter-gatherers to [uncritical?] information gatherers. (M. McLuhan) There has simply been an exponential increase in often profoundly disruptive information. Too bad, because right now, statistics have often become “human beings with the tears wiped off”. (I. Selikoff) Information may be power, but it is not knowledge, it certainly is not wisdom. (The Lancet)

2. One of the barriers to progress in our human rights (HR) work, I contend, has been that statistical agencies around the world are run by economists and statisticians… and they are not always people who are comfortable with human beings or with HR. The selected national measures they employ tell us a good deal about the economy, but almost nothing about the specific things in people’s lives that really matter to them. (A. Michalos). We thus have to stop acting as if just more/better ‘any-data’ will make a difference in HR.

3. As opposed to people’s direct testimonies, data represent people only to a certain degree. [Also, keep in mind that, occasionally, small numbers tell a big story. (M. Soussan)]. On the other hand, the plural of testimonial evidence is not ‘data’…but, I insist, live anecdotes indeed complement ‘tears-wiped-off’ statistics and, many times, we will have to do with just testimonies until  better information is available. This, because, as said, available information covers only a fraction of the relevant HR-related factors in any particular location.

4. What I am saying here is that one cannot expect quantitative indicators to tell the whole story. Moreover, even where we do have local data, we will always need an intelligent analysis of the broader context –and the perceptions of those directly affected is key for such an intelligent analysis!

5. As this Reader has insisted before, in HR work, we should actually use indicators in their negative connotation, i.e., what is the percentage of those whose indicators fall below the norm, i.e., whose HR are thus still being violated.* In other words, HR activists are not out there just to document impact, but impact pathways, impact processes and shortcomings.

*: For instance, when the vaccination coverage rate of <1s is 85%, we should say that the right to immunization of 15% of the <1s is till being violated.

6. So, the evolution of indicators-as-data is supposed to be monitored, right? Yes, but I argue that we too often fall into the trap of monitoring what-has-been-done (in HR parlance corresponding to equality of opportunity) when we should be monitoring what-has-been-achieved (corresponding to equality of results).

7. Setting verifiable and time-bound benchmarks of any kind may indeed be necessary, but not sufficient for the progressive realization of HR. That is because we really need benchmarks to monitor progress in disparity reduction (the more accurate HR term for poverty alleviation and for the fulfillment of the HR of all). Such monitoring is to be done in conjunction with, perhaps, already ongoing monitoring efforts.**

**: Let us further note that, during times of crises, monitoring efforts have to be redoubled.

8. It is widely considered best to have one body in charge of HR monitoring with a clear mandate. (FAO) Only then will monitoring processes help ensure the most marginalized groups get involved and contribute to a genuine HR programming process. The selection of indicators and their  monitoring must thus be participatory. As needed, existing indicators must be ‘tweaked’ to be first and foremost more disaggregated (gender, race, age. religion, etc), as well as HR-based.

Let us be clear: More data for the usufruct of the few does not help the human rights cause.

The root of the word evaluation is value! It is supposed to measure change –positive change– but what is considered positive is usually left to interpretation. (Not often enough considered in evaluations are questions like: Did the intervention(s) reach many or few of the right/intended people? Which social class benefited most and which the least…?).

9. An increase in the number of reported HR-violations-as-an-indicator will clearly indicate regression in the realization of HR. This is self-evident, isn’t it? –and additionally, regression is an absolute taboo for any state. (FAO) But such an indicator is rare if not inexistent: It is not in the interest of the powers-that-be. (Moreover, you and I know politicians always pick the data that suit them best).

10. In last instance, ‘what we measure affects what we do’, and better HR-based measurements will lead to better decisions, or at least different decisions. (J. Stiglitz) To begin with, gaps in HR-based indicators have to be established in each case so that their adoption can help direct information gathering activities and ultimately commensurate corrective actions.

11. It has been said that the right information and statistics are a powerful tool for creating a culture of accountability and for realigning HR (Human Development Report 2000). The question is: What information…? This flies in the face of the generic argument that (any) measurement will lead us to better decisions.

The ultimate challenge is to translate the power of numbers into the power of action in the direction of human rights.

12. Much of the academic and official research that generates statistics primarily focuses on excellence, on method, on reputation and on ranking and not on its social relevance. The challenge for us is to translate social research and surveys*** into appropriate HR measures, e.g., field-adapted, affordable and accessible models of health care, land reform, income generation activities for youth, etc.

***: Don’t surveys more often deform than really measure public opinion…? Think about it.

13. What this boils down-to is that we must use indicators that will provide us with evidence:

• of involvement of marginalized groups;
• of fair and equal representation of claim holders and duty bearers;
• of technical assistance that has been provided to traditionally excluded groups in building their capacity to participate in decision making;
• of the percentage of resources spent on making information accessible to excluded groups (e.g., money spent on translations to local languages);
• of public expenditure on the neediest groups; of strengthened capacity of claim holders to claim their rights and of them actually claiming them (same for duty bearers, in terms of their capacity to actually fulfill their duties).

14. Furthermore, what this boils down to is translating the sense of awareness and knowledge of people into them understanding the structural issues behind inequity and inequality, and then into them getting actively involved in claiming.

15. Bottom line, at  the risk of being accused of courting controversy, as you see, it is not about yet further interpreting the reality [we observe through statistics]; it is about changing and transforming it. (Marx)

Claudio Schuftan, Ho Chi  Minh City

cschuftan@phmovement.org

[You can find the HR Readers in a website at www.humaninfo.org/aviva under No. 69].

_____________________________

Adapted from D+C, 35:6, June 2008; D+C, 35:11, Nov. 2008; D+C 36:1, Jan. 2009; SCN News, No.36, Geneva, mid-2008; The Broker, Issue 9, Apr 2010; The Broker, Issue 15, Aug. 2009; The Broker, Issue 24, Feb/March 2011; Understanding Human Rights: Manual on HR Education, W. Benedek Ed., ETC, Graz, 2006; UNFPA, A HRBA to Programming: Practical implementation manual and training materials, 2010; and F+D, 47:4, Dec. 2010.

Postscript: To me, documentation work is always very important, not least than to be able to unmask those who knowingly lie (A. Gomez) and when lies become fact, compromise is compromised, neutralizing the truth. (J. Koenig)

About the Social Determinant of Health

This is a bit belated report from the Rio World Conference on the Social Determinants of Health. The conference was convened by the World Health Organization together with the government of Brazil, to whom many thanks, for their enabling many colleagues from the People’s Health Movement to attend.

The conference was billed as the way to advance the cause of Closing The Gap in a Generation (1), the report of the WHO Commission on the Social Determinants of Health. Cynics had a feeling that it would be nothing of the kind, and once again, the facts supported cynicism, I am sorry to say. Preparations for the conference turned out to be a case study of what is now amounting to a kind of ‘war of the words’. This is being fought between all those in the UN system and member states who believe in public health and public goods, and those who remain committed to ‘business as usual’ at the time when the world’s financial institutions and banks are collapsing under the weight of their own greed.

Successive drafts of the final conference’s Political Declaration were covered in crossed-out and bracketed clauses and phrases, as the wealthy nations got to work, ‘toning down’ and eliminating almost all traces of real quantifiable concrete measurable and accountable progress on behalf of the majority of people in the world whose suffering increases.

As battle-scarred public health warriors expected, the powerful nations won most of the battles. But not all.  We did not come or go quietly, and it became apparent in the conference that more and more key people in the UN system and national governments have also concluded that the current systems of political, financial and social governance are broken. In clear interventions, WHO director-general Margaret Chan indicated this almost in so many words. But UN agencies are choked with executives who believe in alliances with the transnational corporations that with its allies are wrecking our world. Some of these executives will perhaps be working for such corporations in due course. That’s where the stock options and nice pensions are.

The frustration in the conference halls was so intense that no less than three alternative declarations were circulated. One of them came from the organisation of which I am a member, the People’s Health Movement; one from the Latin American Association of Social Medicine (www.alames.org ); and one from the International Federation of Medical Students’ Associations (www.ifmsa.org ). Revealing too was the fact that the representative of civil society in the panel in the closing ceremony, our PHM colleague David Sanders, was the one person during the three days to receive a standing ovation from the floor. He made comments fully in line with what I say here below.

Sir Michael Marmot, chair of the WHO Social Determinants Commission, was at the centre of the Rio conference. We believe he is as frustrated as we are. Here is what he said in a recent issue of the WHO Bulletin (2). I insert my own comments.

‘Closing the Gap in a Generation is a rousing call. Did the World Health Organization’s Commission on Social Determinants of Health really believe it to be possible? Technically, certainly’. (This is a telling word. It’s code for saying that there is pressure to take the politics out of policy issues and reduce them to technical ‘fixes’)

‘Yes, there is a greater than 40-year spread in life expectancy among countries and dramatic social gradients in health within countries. But the evidence suggests that we can make great progress towards closing the health gap by improving, as the Commission put it, the conditions in which people are born, grow, live, work and age.  These include ensuring: equity for every child from the start, healthier environments, fair employment and decent work, social protection across the life course and universal health care. To make such progress, we must also deal with inequalities in power, money and resources – the social injustice that is killing on a grand scale. At a more fundamental level, our vision is to create the conditions so that every person may enjoy the freedoms that lead to improved health – what we call empowerment’. (And does he believe that this now is really happening? Read on…)

In the three years since Closing the Gap in a Generation was published, there is no question that there is much to make us gloomy: the global financial crisis and the steps put in place to deal with it have worse impacts on the poor and relatively disadvantaged; the persistence of bad governance nationally and globally; climate change and inequitable measures for mitigation and adaptation and, in many countries, an increase in health inequalities’. (Quite. Exactly. He then goes on to make some rather vague positive points. But the signal is clear. The only conference that could start to make a real difference in favour of rights, equity and justice would be one that resulted in a Declaration that acknowledged the outrageous misery and poverty that has been and is being accelerated by the present dominant systems of governance. Did that happen? No, it did not. Did Michael Marmot expect this would happen? I have not asked him).

The People’s Health Movement was invited by the WHO Commission on the Social Determinants of Health to give evidence, and to contribute to the Commission’s report which was published in 2008 (1).This we did. Since then it has become increasingly evident to us that the most powerful WHO member states – that is, national governments – are reluctant to redress, or even to discuss or acknowledge, the power politics that year in, year out, worsen health inequities.

Constantly, states of health and disease of populations are being reduced to technical issues, whereas in truth, these are political. This was understood during the Industrial Revolution, as the quotation from the great epidemiologist, pathologist and reformer Rudolf Virchow makes clear. Health inequities are determined by the social conditions in which people are born, grow, live, work, and age. This has always been well-known by those prepared to see what is in front of their eyes and to face these facts. Public health pioneers, such as Rudolf Virchow saw this. Robert Koch devoted a key part of his Nobel laureate speech in 1905 to the issue. Brock Chisholm, the first director-general of the World Health Organization, said in 1949 that ‘the death rate from pulmonary tuberculosis is now everywhere accepted as a sensitive index to the social state of a community’.

Margaret Chan, the current WHO director-general, also understands this, as well she might. In her opening address to the Rio conference she said: ‘Governments have responsibility towards people and their health… People are pushed into poverty due to catastrophic medical bills, and many governments are not preventing that. Progress in a civilised world should mean more than simply making more and more money. Globalisation was set to be the rising tide that would lift all boats, this never happened. It lifted the big boats but tended to sink many of the small ones. Globalisation creates benefits, sometimes big ones, but has no rules that ensure the distribution of those benefits. The world now is highly interconnected, but the prevailing goal remains to fulfil economic benefits and not to distribute them fairly or evenly. As a result differences in income, access to care, health outcomes are greater today than in any time in history’. Well said, but it would have been nice if  Dr Chan stayed until the last day when the Political Declaration was presented. Instead, she left the night before the Conference ended. Is there a hint here?

Public health is not technical, it is political

The social determinants of health cannot be addressed by fixes that address policy coherence and inter-sectoral action in health, as is being called for. Platitudes like ‘inter-sectoral action’ and ‘policy coherence across sectors’ do nothing to address the continuing violation of the right to health. It is not policy incoherence that causes the negative impact of dominant macro-economic policies on health. Actually there is significant policy coherence across sectors, including the health sector. But these policies have been greatly influenced by the currently dominant political and economic ideology. This is the issue. It has promoted a ‘market’ approach that in effect privatises public health.

Why is this continually glossed over? Why are the features of what is a reckless and ruthless not recognised? Corporations remaining free to do whatever they want to protect their bottom line. Capital flight, and a continued unfair regime of patents especially of medicines are all widening health inequities in health, across the world. This is why obesity and diabetes have become not merely epidemic, but pandemic.

For us at the People’s Health Movement, comprehensive primary health care is the backbone of any equitable health system, but it cannot be supported without active community involvement. The same is true for nutrition.

Primary health care needs publicly provided, publicly accountable health care services, working in partnership with the communities from which the people who become patients live. It involves working with community networks and organisations and engaging with communities. This can never be properly provided by private systems whether or not these are supported by health insurance schemes. Health care provision has been increasingly privatised over the last three decades. Indeed, Big Pharma has become less and less regulated. Poor social policies and programmes, unfair economic arrangements, and bad politics, are robbing an increasing proportion of populations all over the world of the opportunity to lead healthy lives. Reduction of public health and nutrition inequities depends on reform of the global economy and of geopolitics generally.

The evil of ‘trade-offs’

Taking an non-political approach to such issues by saying, as we constantly hear,  that conflicts and trade-offs between the interests of different sectors are inevitable, or that taking necessary actions will result in some negative impacts or costs for some groups, is mistaken. Differences among countries, between social classes, between men and women, between corporations and communities, can be reduced. These all are caused by the power politics that determine which actions will be taken and which will not, on the social determinants of health and nutrition. Willingness to transfer real power to communities is the key.

This is what we in the People’s Health Movement reminded delegates, in our own statements made before and during the Rio conference. But relentless pressures from the US and Europe continue to force governments of vulnerable and impoverished countries to sign up to basically unfair free trade agreements. These agreements force weak government to open their markets to – among many other items – the ultra-processed food and drink products that enrich and further empower transnational corporations. Reform of the global agricultural trade regime has continued to stall for years. Food systems thus become increasingly insecure and fragile.

The combination of the opening up of markets to the transnationals, massive subsidies to agribusiness in the North, and intellectual property rights that unfairly protect big business, gives increasing power to the transnational seeds, agribusiness and food and drink corporations, and undermines national food sovereignty. This process continues to accelerate. Thus between 1990 and 2001, foreign sales of the biggest food-related transnational corporations rose from $US 88.8 billion to $US 234.1 billion, with total foreign assets rising from $US 34.0 billion to $US 257.7 billion. These corporations increasingly dominate the global food supply system, which includes seeds, fertilisers and pesticides, the production, processing and manufacturing of food and drink products, and how these are marketed to consumers.

This trend, together with factors like speculation that creates chaos in food prices, the increasing proportion of US corn being used for bio-fuels, and the impact of industry-generated climate change, is primarily responsible for the recent critical food shortages in many impoverished countries. Food price increases and fluctuations in the last few years have done enormous damage to the reductions achieved in poverty and hunger in the past two decades. Such food insecurity has contributed to continuing widespread malnutrition, as evidenced by high stunting rates and micronutrient malnutrition, with an estimated 854 million undernourished people worldwide in 2001-2003. The UN Food and Agriculture Organizations estimates that food price rises alone have caused at least 50 million more people becoming hungry. At the same time, supplies of degraded ultra-processed snack products, sugared drinks and other degraded edible substances continue to erode and destroy previously established rational food systems, and are causing rocketing rates of obesity, diabetes and other chronic disease. Unless unfair social, economic and political regimes are successfully challenged, these pandemics will get worse. ESTIMATES THAT FOOD PRICE RISES HAVE RESULTED IN AT LEAST 50 Gender issues are not ‘one of those things’

The global distribution of child and maternal malnutrition and mortality illustrate the significance of unequal power relations. Unequal gender relations are not easy to change. An important first step is to acknowledge that these exist and that they are maintained by prevailing political and economic policies. Practical steps towards women’s equality and empowerment must be taken.

Examining of the processes that led to the Rio conference, it was hard to believe these steps were really serious. They mostly evaded analysis or even acknowledgement of the power relations which maintain health and gender inequalities. People are poor because they live within unjust societies.

Now, after the Rio conference, let me acknowledge and highlight the commitment of so many representatives of the Brazilian government and civil society, in supporting and inspiring us in the People’s Health Movement. Interventions in Rio, from that of the Minister of Health to those of Brazilian grassroots organisation representatives, resonated with us. Other ministers of health from Latin America resisted the dilution of statements in successive drafts of the Political Declaration. In the final Declaration it was evident that they had lost some, but also that they won some.

The corporations, governments and other institutions that perpetuate the new world must be confronted. The mandate of WHO includes assistance to member states in addressing the ‘causes of the causes’ of malnutrition in all its forms. The rights-based approach to health equity provides WHO with a strong mandate to direct and coordinate realisation of equitable universal primary health care coverage. The right to health is enshrined in the constitution of WHO and in that of over 130 national constitutions. This needs to be used as a powerful tool for legalisation, enforceability and implementation of policies very urgently needed to enhance equity between and within nations.

The planners of the Rio conference on the social determinants of health constantly stated that its emphasis should be on practical initiatives designed to address inequity. These are conspicuous by their absence in the conference’s final Political Declaration. 

Yet there are many practical examples of courageous countries and communities finding ways of managing national and international economic relations equitably. There is much to learn from such examples.

Confronting the power of transnational corporations in areas most relevant to global and national states of health is within the mandate of WHO. Thus, WHO has led the way in developing a global regulatory regime for tobacco control. After Big Tobacco, the next targets for rational and equitable regulation must be Big Booze and Big Snack.

Due to the economic crisis that impoverished countries did nothing to cause, there are now 200 million more people living on less than US$ 2 a day, existing in distress, malnutrition and ill-health. The international bankers and their representative organisations must be held accountable. They must contribute to addressing the vast resource gap in health, for example by paying a Tobin Tax on financial transactions. WHO member states should champion such an approach, which after all is in their own interests.

The danger now is that some countries may face the issues of the social determinants of health, but do so in a medicalised and individualistic way, by focusing on ‘risk factors’ and ‘individuals’ lifestyles’. But the real challenge is to renew relatively equitable politics and economics that truly will go towards ‘closing the gap’. We in the nutrition, public health and medical sectors are the professionals who patch up sick societies. There is ultimately not much we can do, unless we also engage politically.

The People’s Health Movement was present in force in Rio. We are thankful and feel this is a good sign. There, we were able to speak out what we believe in. We distributed our unofficial Political Declaration, which has been and evidently is being studied avidly by people in the UN system and national governments. And we have now launched our  fresh-off-the-press third report, Global Health Watch 3 (www.ghwatch.org ). We believe we are making our mark. The change will come. It must come.

References

1                Commission on the Social Determinants of Health. Closing the Gap in a

            Generation. Health Equity Through Action on the Social Determinants of Health.

            Geneva: WHO, 2008.

2                Marmot M. Closing the gap in a generation. Bulletin of the World Health

            Organization 2011; 89, 702.

Please cite as: Schuftan C. The Rio Social Determinants Conference [Column] Website of the World Public Health Nutrition Association, November 2011. Obtainable at www.wphna.org

cschuftan@phmovement.org

www.phmovement.org

www.humaninfo.org/aviva

JUSTICE, HUMAN RIGHTS AND THE STATE: TO HAVE A RIGHT IS TO HAVE SOMETHING WHICH SOCIETY OUGHT TO DEFEND ME FOR. (John Stuart Mill)

Food for a how-to-defend-ourselves thought

Human Rights Reader 278

-“Man is a social animal. Therefore he is a political animal as well”.

-Members of society who depend most upon an acceptable theory of justice are its poorer, marginalized and less powerful members. It is for them that a just society is most crucial.

1. Mind you, we have duties towards people we never know… and they have similar duties towards us. The human rights framework thus basically looks at people in societies with attention to claims they have on each other in the form of rights and duties, as well as with attention to their demands for justice * and equality.

*: Justice: The balance of public interest and individual rights, the fair sharing of the available goods of society and the fair restitution of victims.

2. As this Reader has said before, politics is in a continuum with morality; our political duties and obligations are thus often congruent with our moral duties and obligations. Human rights (HR)** are typically defended on the basis of moral principles although it may as well be on legal and political grounds. This is not to say that all politics or all politicians are moral; but it is to say that our politics are constrained and indeed determined by our sense of morality.

**: Rights: Demands that a member of society is entitled to make upon his society.

3. From the HR perspective, a person or a group may very well disrupt the smooth operations of the government if it is convincingly demonstrated these operations interfere with the overall public interest. There must always be a balance between the public interest, on the one hand, and private interests on the other. HR basically carry within themselves the power to bring individual interests in line with public interests. HR firmly contend that the function of the state is and has to be to protect the public interest, protect equity, protect equality and protect justice.

4. If a group of people or a social class have been historically deprived of their adequate share, because of their income, the color of their skin, their ethnicity, their religious beliefs, their sex or age, they should be given more than their proportionate share in compensation. This is not to be construed as an injustice to other people and/or groups. If the distribution of privileges and of power are equally important, why shouldn’t all members of society be able to expect equal treatment and respect, not only by the law, but in every conceivable social situation by every conceivable social institution?

All of the above are concerns of justice. But what is justice? Who decides? And how?

5. For us, in HR work, the elements of what is just is enshrined in a set of covenants. It is the practices applied primarily, but not only, by the state that are to be judged from the HR point of view as per said covenants and their corresponding General Comments.

6. Already for Plato, millennia ago, equality meant that all men and women are equal just by virtue of their being human. I do not need to tell you that this is not a belief that was always accepted by everyone since then. We stand with Plato and do believe everybody is equal.

7. Conservatives say people are to be equal in opportunities alone, without having any actual right to social services. Conversely, a just society considers the welfare of the worst-off members of society as an obligation.

For liberals, justice does not equate with a fair distribution, but with an equal distribution. The question this begs is: Is equality the primary concern of justice? In HR, we are compelled to set up systems of fair distribution.

If justice means equal then a legitimate state is bound to maximize equality. Conversely, if justice only means everyone in his or her proper place (a conservative outlook), the state will be legitimate if ‘harmony and working together’ are smooth.

8. Governments are legitimate only because their citizen agree (or have tacitly –or under duress– accepted) to be ruled by them. Often, an implicit or an explicit social contract exists in the form of an agreement among people to share certain interests and make certain compromises for the good of all people. But perhaps as often, no such social contract exists and the interests of a minority are imposed on a majority. This is where HR are most sorely needed.

Going back to the history of philosophy, much of the world is divided and ruled according to rival political  ideologies.

9. Marx’s emphasis on people’s rights hardly needs to be restated here. He reminded us that many people take more than they can use personally and use their excess possession merely as a means to manipulate other people. This, while many more people are still more concerned with putting food on the table and do not have enough protection under the law to prevent them from being grossly exploited and underpaid for unrewarding and painful labor.

10. For Marx, freedom of speech does not go together with freedom of economic exploitation, i.e., freedom to a decent dignified life. Marx also turned his attention from the supposed right to private property to the abuse of private property. He rejected the accumulation of wealth that someone has personally amassed when it serves only as a means for getting richer at the expense of other people, i.e., when treating workers as a commodity.

11. Freedom of speech, he said, is meaningless in the face of the minimum economic necessities that worry most people everyday. We need more than just freedom to speak out (a civil right). We need freedom from the economic exploitation that keeps workers in dire circumstances (an economic right). “People need freedom from material need. The means to achieve this are already at hand; what is needed is simply a more equitable form of  distribution”. For Marx, this meant no private property. The revolution he called-for was thus not so much a political revolution, but an economic one –a revolution he felt was inevitable and had/has been in the making since ancient times, sometimes hidden, sometimes in the form of an open struggle.

12. Freedom-from-want is as much a battle for freedom as the traditional liberal battles for freedom of speech have been, he tells us. When HR violations are condoned by political (and religious) authorities, such conditions of oppression bring about new forms of struggle, for instance, attacks against the instruments of exploitation used by these authorities who are part of the bourgeoisie. So, when pushed to the limit, popular agitation due to protracted HR violations becomes a distinguishing feature…and each step is accompanied by a corresponding political advance.

13. Numbers of protesters increase, mass movements strengthen, the interests of claim holders are made heard more and more; they form permanent associations and their struggles take more and more the character of collision-between-two-classes.*** Here and there, riots break out. Immediate results are not the important for Marx, but instead the ever expanding union of claim holders. He foresaw the expansion of the various local struggles into national struggles with groups in the bourgeoisie stepping over to the cause of the claim holders as they increase their social consciousness. We know how this panned out in later history…

***: Political power, for Marx, is merely the organized power of one class to oppress another. Claim holders, for him, are thus compelled to organize themselves as a class doing away with the old oppressive conditions.

14. What it all boils down to here is that we cannot serve the public interest at the intolerable expense of injustice. Serving every individual’s interest has to recognize a primary concern for justice — distributive justice, i.e., of everyone receiving his or her fair share.**** Public interest is important, but respect for every individual’s rights is even more important.

***: For instance, concerns over land ownership, over just wages and fair prices are all matters of distributional justice.

Bottom line, what is at issue for us is the concept of justice?

15. People ought to be treated equally since they have human rights that no one can take away from them. People ought to equally share the material goods of society (this is and has been the subject of constant debate and sometimes of wars and of revolutions). How much should the state serve the people and how much the people serve the state? (J. F. Kennedy) What constitutes a good state? And when, if ever, do people have the right to overthrow the state or a particular government, or a particular law? There is no way in which we can avoid asking these questions. The Spring Revolution and the Occupy Movement are budding “ought-to” movements. We now need to imbue them with HR principles and standards that go beyond mere protest and the expression of repressed anger!

Claudio Schuftan, Ho Chi  Minh City

cschuftan@phmovement.org

_____________________________

Adapted from R. C. Solomon, Introducing Philosophy: A Text with Integrated Readings, 4^th Edition, Harcourt Brace Jovanovich, 1989.

Postscript: I have always believed that activism pays off: Do the right thing, confront unfairness and selfishness, stay true to yourself…one day it all works out. I do not know if, so far, people who are wronged eventually get their justice because of our activism; it may not work all the time. But I do think one day we and they will get our/their reward. (adapted from A. Verghese)

AS WE ALL WELL KNOW, ETHICS IS ONE OF THE ROOTS OF HUMAN RIGHTS. WHAT DO PHILOSOPHERS HAVE HAD TO SAY?

Food for a thought beyond just believing

Human Rights Reader 277

Historically, it is actually the organized pressure from minorities and from women on ethical grounds that have often given us the equal rights and the non-discrimination we now take for granted.

[I will here attempt to bring-in the history of philosophy on ethics to support the concept and practice of human rights. I do not want to philosophize with you here, but to help you to consult your own moral inclinations by interpreting what you read below].

Good moral rules help us act in the most rational way possible.

1. Human rights  (HR) tell us we should take into account others and not only our own interests when deciding what we ought to do. The best way of satisfying everyone’s interests is through being consequent with ethics. HR are seen as needed in order to make us human.

2. HR appeal to principles that distinguish values (ought to do) from facts (what actually is). It is imperatives with a-moral-ought in them that are tied to what we do in HR work.*

*: Ought is the verb most often used to express moral duty or obligation; sometimes, perhaps more appropriately, must or have-to is used when HR enter the political arena.

3. In HR work we thus justify the morality of our actions by appealing to the good consequences our actions have for others (and for ourselves).

HR are about respect for living in society and about the promotion of the public good.

4. We remain convinced that applying moral rules achieves the greatest good for the greatest number of people. But the hitch here is: we actually choose our own morality. ‘Thou shalt, thou shalt not’ consists of commands that rule our decision making. Even if we can escape all punishment, we are absolutely forbidden to kill; we are indoctrinated by these moral ‘commands’. We can also be blamed if we have not done what we should have done, i.e., we stand under obligation to give our neighbors their due.

5. We thus have to decide for ourselves what laws of morality we are willing to accept. Is what our conscience commands us good? Consciousness is simply the internalization of the moral teachings of our parents and of society. So, should we accept or reject what we have been taught? Our conscience may disagree, but we must still decide whose conscience and which rules of conscience we ought to obey.

Morality is not just obedience though; it is doing what is right.

6. For Kant, morality was the ability to think and decide for oneself what is right and what is wrong; whom to obey and whom to ignore; what to do and what not to do. If we try to tie morality too closely to our society, it looks as if there is no room for autonomy, no way in which we could disagree. We actually have to be critical and admit that some of these sets of commands are or may be false. But if something is morally reprehensible to us, it should be true to us even if the society in question does not agree with that moral principle.

7. ‘Moral relativism’ has always been a threat to established morality (it has been said it is a result of the crumbling of belief in the dogmas of religion). It was Kant who said we have to agree to at least the basic principles of a universal morality. So that key moral principles hold for every society.

What is right is distinct from what people merely think is right; yet what is right is right everywhere, and is always the same, he argued.

8. In sum here, it is indeed possible (and necessary) for us to act in the interest of others and be concerned about their welfare. Altruism says that people ought to act with each other’s interests in mind. Only if actions are motivated by a concern for others’ interests do we call them truly moral actions.

We sometimes think that we are moral, just because we believe in moral principles. But believing is not enough; action is required.

9. There is a natural principle of benevolence in wo/man (gender correctness added) which is in some degree to society what self-love is to the individual. Some of our desires are desires to serve someone else’s interests. (The satisfaction that accompanies good acts is itself not the motivation of such acts though! As Kant said, moral worth of an action does not lie in the effect expected from it).

10. Plato, much earlier, told us that justice** is not a private good (as charity is). Charity just gives the giving individuals a sense of satisfaction and peace of mind. Charity makes the giver feel self-righteous (an act of psychological egoism?).

**: Justice here is meant as the need for lawful-and-fair treatment of other people (which does not mean equal treatment…).

11. Later, Aristotle went further and said that there is no real distinction between ethics and politics and that the proper end of ethics is politics. (Am I thus an Aristotelian…?) ***. For him, justice has much to do with one’s role in society –and ‘respect’ is an ingredient of it. “It is by our conduct in our intercourse with other wo/men that we become just or unjust”. *

***: I wonder if that is why Aristotle though that the passion of our youth is sometimes more virtuous than our rationality in established maturity.

[We note here a caveat: The morality for Aristotle depended upon rules embedded and learned in an elite society of privileged Greek males. Conversely, modern ethical conceptions are universal, not restricted to a particular society].

12. For Kant, every person can find for her/himself what acts are moral; there are thus individual, i.e., personal demands for morality. Not so for D. Hume for whom the end of all moral speculations is to teach us our duties and engage us to embrace them. Hume felt that what is morally ‘fair’ for all will animate us to embrace it and maintain it. “Render wo/men totally indifferent to morality and there will no longer be a chance to regulate our lives and actions”.

13. For J. J. Rousseau, the morality of our actions consisted entirely in the judgments we ourselves form with regard to them. The first reward of justice is the consciousness that we are acting justly. There are though wo/men insensible to all that is right, he posited; they bypass any notion of justice when it is to their own advantage.

In human rights work, we do not speak the voice of remorse, but the voice of outrage.

14. In HR, when we see any act of injustice, it stirs in us an instinctive anger which bids us to go to help the oppressed. But we are restrained by a duty to laws that often hamper our drive to protect those whose rights are being violated.**** Ultimately, what our consciousness decrees is based on our judgment and gut feelings. The power that moves us is consciousness –which is derived from the moral system we adopt in relation to our fellow wo/men. As soon as our reason perceives social injustice, our conscience impels us to pursue it with the voice of outrage that passes judgment on what is evil.

****: Basically, a HR violation occurs when a person treats another primarily as a means to his or her ends, making the violated an instrument of the violator’s purposes. Violators are thus those who pursue the fulfillment of their desires without a concern for any good but their own. In short, violators of HR are ultimately ‘consumers’ of persons ….and the violated persons are the consumed. (W. Gass)  That is why the piling up of violations reaffirms our every day struggle with the violators. Because it makes a difference in what context and in-the-service-of-what-particular-and-specific-interests the distinction is made between manipulative and non-manipulative social relationships, what we constantly seek is to distinguish between manipulative and non-manipulative social relations so as to decisively counter the former. (A. MacIntyre)

15. Kant rejected all attempts to base morality on feelings; it must be based solely on reason, he argued. For him, morality’s central concept is duty –and duty subjects itself to rational principles. He further argues that reason, by its very nature, must be universal. Kant insisted in the independence of morality from society. Morality, for him, consisted only of rational principles. He was concerned with what makes a person morally worthy. “Act as duty requires, but not because duty requires”; “to be beneficient when we can is a duty”. So, retain: Duty brings about the necessity of acting in HR work.

[We note here another caveat: It was conformity with the law what Kant used as the central notion of duty. Not so necessarily for us in HR work since laws often harbor HR violations].

16. Kant indirectly actually says that HR are necessary of-and-by themselves without reference to another end; “they are objectively necessary” he says.

He goes on to say that, as relates to moral imperatives, there are universal laws of reason that tell us what to do: “Imperatives of duty to others become imperatives of principle”. Talks of sympathy and good will betray the rights of wo/men and actually violate them. “Moral principles are necessary, essential to human nature and they hold for every human being”. The maintenance of our humanity-as-an-end in itself depends on respecting HR. One should contribute anything to the dignity of others. Therefore, acting according to universal laws of reason and morality is obeying rational principles. “Morality is a product of our rational will”.

17. For J. Bentham, the interest of the community is the most general expression in the realm of morals; nevertheless, this meaning is often lost. It is in vain to talk of the interest of a community without understanding that it reflects the interest of its individual members though. Bentham thus first looks at one person whose rights seem to be violated and then takes account of the number of persons whose rights are compromised…a methodology we can well use in HR work today.

18. For John Stuart Mill, morality was not a question of applying a law to an individual case. Morality must be deduced from principles even if they are scornfully rejected by some. Key for him was the sense of dignity which all human beings ought to possess in one form or another. For him, morality encases the rules and precepts of human conduct.

19. Friedrich Nietzsche was called the anti-moralist: To him, all people were to be judged by the same moral standards, the standards of duty; there are no elites, he argued. “What does your conscience say? “You should become  who you really are”. “Morality is the herd-instinct in the individual”.

He complained that the morality of the ruling classes is foreign and irritating to present-day taste in that it insists primarily that one has duties only to ones equals. Supposing that the abused and oppressed moralize, he went on, what will  the common element in their morality be? Probably a suspicion and a condemnation of man. “The slave has an unfavorable eye for the virtues of the powerful; he (rightly) has a skepticism and distrust”. Therefore, “power resides in the evil which does not know it is despised; The evil man thus arouses fear”. Moreover, the slave’s desire for freedom and of liberty also necessarily belong to her/his morality.

Knowing is creating, creating is law-giving; truth is power.

20. Under this guise, Nitzsche attacked absolute moral principles of reason that are the same for everyone. This point he made was maliciously taken up in the 20^th century in an attempt to destroy universal moral codes. In Sartre’s philosophy, the idea of universal morality is also completely rejected, because, for Sartre, our values are a question of personal commitment. In response to any question about morality, the only ultimate answer is “because I choose to accept these values; this is what I choose mankind to be”.

21. In J. P. Sartre’s writings, wo/man is responsible for what s/he is. Not only for her/his own, but for all wo/men. “Nothing can be better for us unless it is better for all; in fashioning myself, I fashion wo/man”. No rule of general morality can show you what you ought to do, he argued. To say that it does not matter what you choose is not correct.

What is not possible is not to choose.

22. Sartre went on to tell us “If I do not choose, that is still a choice”. “When I confront a real situation, I am obliged to choose my attitude towards it and, in every respect, I bear the responsibility of that choice. Wo/man makes her/himself by the choices of her/his morality and s/he cannot but choose a morality”.  “It is through my actions that I commit myself to values, not through principles I accept a priori or rules that are imposed on me by society; if you refuse to choose, you are coping out”. What counts is, therefore, simply our choice of actions and values together with their consequences –whatever they are. For Sartre, morality is those values we choose to follow through our actions: He basically thus exhorts our responsibility.

23. Where does all this put us, then?: What we want to know from ethics teachers is not only how people use the word, not even what kind of actions they approve. (G. E. Moore) Why? Because we can encourage and persuade one another to accept certain ethical positions, but the positions themselves are merely matters of personal attitude –rationally justified or not.

If statements of value are to be significant, it is indeed human rights’s business to pass judgments on what is right.

24. Human rights express, if not objective, at least impersonal ethical judgments; no question about that. But note that statements of value are unverifiable. It is notorious that what seems intuitively certain to one person may seem doubtful or false to another. The HR covenants are key to us since they provide some tested criteria of negotiated and agreed validity. In last instance, HR law is an objective rule that is binding whether we accept it or not so that implicit or explicit recognition of these judgments is at the center of every day HR practice.

25. Bottom line, what matters for HR is the construction of a civility that can be sustained. Moral decline gives and has given justification to worrisome misjudgments, policies, actions and HR violations. The barbarians are not waiting beyond the frontiers; they have already been governing us for quite some time!

26. Commitment can be said to be a freely chosen adoption of moral principles which one thereby vows to defend and apply in practice. Our commitment defines what we are morally bound to do. What are you bound to do?

Claudio Schuftan, Ho Chi  Minh City

cschuftan@phmovement.org

_____________________________

Adapted from R. C. Solomon, Introducing Philosophy: A Text with Integrated Readings, 4^th Edition, Harcourt Brace Jovanovich, 1989.

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