equity and social justice
DESCRIPTION
Equity and social justice. . The global context of extreme poverty and hunger Proximate ultimate causes & how hunger will become history. Allan J Davison PhD, Professor, Biochemist, Faculty of Sciences, Simon Fraser University Department of Biomedical Sciences & Kinesiology June 2011. - PowerPoint PPT PresentationTRANSCRIPT
Equity and social justice.
Prepared as part of an education project of the Global Health Education Consortium & collaborating partners
Allan J Davison PhD, Professor, Biochemist,Faculty of Sciences, Simon Fraser University
Department of Biomedical Sciences & KinesiologyJune 2011
The global context of extreme poverty and hungerProximate ultimate causes & how hunger will become history
Page 2
Objectives
On completing this module you will be able to:
1. Describe the extent of malnutrition & its impact on people of the planet, and understand how MDGs depend on nutrition
2. Analyze the factors that determine nutritional health3. Identify nutritional problems among individuals & populations, identify causes &
appropriate solutions4. Assess risks at various stages of the life cycle & recommend strategies for
diminishing risk5. Compare competing theories accounting for the inequities6. Predict outcomes by projecting current trends into the future
& foresee a pathway toward a world without hunger
Section Break 6
1.Malnutrition: prevalence, causes, consequences 42.Major categories & measures of nutritional status4 3.Nutrition & crucial periods in the life-cycle; 4 4.Determinants of nutrition, dietary patterns & culture2 5.Nutrition and its relationship to disease4 6.Making hunger history - breaking the poverty-trap37.Trends in nutrition, food security & globalization3
Page 3
6 Making hunger history breaking the poverty-trap cycle
To find the remedy, we must know the causesPoverty trapResource trap
Then we’ll understand what “remedies” don’t workwhat is working dramaticallywhy hunger will become history in this century
Page 4
Page 5
Worldwide distribution of malnutritionOver 20 million children suffer from acute malnutrition WHO.
Page 6
Scientific American, Sept 2007
“The bottom billion” (title of a book by Paul Collier )
“The poorest of the poor” - Public health nutritionists identify a subclass of the hungry - those who try to survive on resources worth less than $1 per day
• We define this subclass as people who don't get enough to meet the ordinary demands of life
• They lack the resources to earn a living, or obtain what’s needed for normal, growth, maintenance & reproduction
• It goes without saying that they are unable to provide the necessities for those who depend on them
Page 7
“The bottom billion” (title of a book by Paul Collier )
•Their lack of access to resources is such that a significant fraction will be unable to stay alive
•They live mostly in isolated rural areas and most are subsistence farmers
This means that what they eat this month is what they can take out of the ground from last month's planting
Page 8
7 Malnutrition & MDGs: cause, effect, cure3 slides: 1. Trends in nutrition, food security & globalization2. Agricultural trends3. Nutritional inequities - Cause & consequence4. Food security; Prospects for having enough food
Page 9
4 Determinants of nutrition, diet & culture2 slides: 1.
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Worldwide, nutritional inequities follow poverty
(as do health inequities & life expectancy)• Globally, there is plenty of food for everyone but …those who
have more than they need find reasons not to share• The result – in the time you spend on this module over 1000
children will have died of hunger• Each day 1500 children go forever blind from lack of vitamin A• The poorest are 50-200x more likely to die in pregnancy (more
than half these deaths are attributable to iron deficiency). • About 2 billion people (56% of pregnant women) have iron
deficiency. Their babies have low birth-weight, & mortality
Page 11
Note D
Sub-determinants of nutritional sufficiency
Page 12
Each factor has its own contingencies. Here are a few more:
Stability includes freedom from disruptive forces• war (revolts, invasion, political upheaval, social disruption)
• exploitation from outside – unequal trading practices
• corruption externally – multinational corporations offer bribes and rich nations tolerate this because it benefits them
• corruption internally – where some developed nations set a poor example e.g. non-transparent procurement policies
Note O
Determinants of population nutrition
Page 13
Any broken link can nutritional inequities.
(think about how …)
The mechanisms of hunger – many paths
Page 14
“Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action
”
Notice how one path can feed-back to affect others
As diagrammed by WHO
in
Sub-determinants of nutritional sufficiency
Page 15
Each factor has its own contingencies. Here are a few:
Economic development depends on agricultural sustainability• irrigation & soil maintenance (crop rotation, contour plowing)• seeds, fertilizers, appropriate insecticides
Agricultural productivity depends on good harvests• climatic: drought and floods• drought - and frost-resistant crops• hybrid seeds and related biotechnology• market for any excess crop, non-exploitative trade
Sub-determinants of nutritional sufficiency
Page 16
Each factor has its own contingencies. Here are a few more:
Stability includes freedom from disruptive forces• war (revolts, invasion, political upheaval, social disruption)
• exploitation from outside – unequal trading practices
• corruption externally – multinational corporations offer bribes and rich nations tolerate this because it benefits them
• corruption internally – where some developed nations set a poor example e.g. non-transparent procurement policies
Note O
Poverty - greatest cause of malnutrition(hunger, blindness, disease, birth defects, maternal/neonatal
death)
Page 17
The causes of poverty are disputed – no one wants to be part of the cause. What we know is….
• Poverty doesn't just happen, it is caused by economic, political, social & geographical circumstances & decisions
• Usually these decisions are made outside the groups of people most affected by it!
Note P
Poverty - greatest cause of malnutrition(hunger, blindness, disease, birth defects, maternal/neonatal death)
Page 18
• Old people, women and under-supported children are most likely to be impacted by poverty
• Uneven distribution: 2/3 of undernourished people live in Asia
• Hunger is growing fastest in Sudan, Rwanda, Burundi, Chad D.R. Congo, Sierra Leone, Zimbabwe, Somalia
Dietary patterns across cultures
1. Hunter gatherers – the earliest category
Benefits: mixed diet, well nourished in good times
Risks: famine or drought, warfare & plunder, resource- depletion through population pressure
Prevalent problems: starvation, thirst, life-expectancy
Page 19
Note I
Poverty - greatest cause of malnutrition(hunger, blindness, disease, birth defects, maternal/neonatal
death)
Page 20
The causes of poverty are disputed – no one wants to be part of the cause. What we know is….
• Poverty doesn't just happen, it is caused by economic, political, social & geographical circumstances & decisions
• Usually these decisions are made outside the groups of people most affected by it!
Note P
Poverty - greatest cause of malnutrition(hunger, blindness, disease, birth defects, maternal/neonatal death)
Page 21
• Old people, women and under-supported children are most likely to be impacted by poverty
• Uneven distribution: 2/3 of undernourished people live in Asia
• Hunger is growing fastest in Sudan, Rwanda, Burundi, Chad D.R. Congo, Sierra Leone, Zimbabwe, Somalia
Page 22Page 22
Fundamentals and emphasis
– As we consider cause and effect we must ask: How & why have such inequities come to be?Who and what factors impede solutions?
What current initiatives will bring the resolution?
– To help answer these, we must will emphasize:Immediate causes - scarcity of specific
nutrients Primary and secondary preventionPublic health approaches to solutions
World% undernourished
231970 1980 1990 2000 201015
33%
17%same data22%
14%
1970 2010 2015 target 2030 FAO est
0
2000
4000
6000
8000 FedMalnourished
Number fed & under-nourished worldwide
24
14%
Prediction
6%11%
Target
33%
2424
millions
A vicious cycle for malnutritionpoverty, health, economic deprivation
Page 25
Development:Marginalization
inability to provide for self or family
Access to the ladder of development
Poverty: Diminished access to agricultural & food
resources malnutritionhigh birth rate
Health: Physical & cognitive impairment,
susceptibility to disease, early death inability to
earn an incomenutrition
Routes to famine
Discovering resources
Externally initiated armed conflict
Uncertain rainfall & drought
Being landlocked
Bad governance
Israel, Afghanistan
So.Africa Nigeria, Iraq
Lesotho
Being on a trade or pipeline route
Zimbabwe, Italy, USA
Sudan, Afghanistan
Sahel, Palestine
Blaming the bonsai tree...
Yunus:
1 Malnutrition & MDGs: cause, effect, cure3 slides: 1. Trends in nutrition, food security & globalization2. Agricultural trends3. Nutritional inequities - Cause & consequence4. Food security; Prospects for having enough food
Page 27
28
Paying for total strangers to eat?
Not us, not if it goes to corrupt
dictators” }
28
29
http://www.globalissues.org/article/35/foreign-aid-development-assistance#GovernmentsCuttingBackonPromisedResponsibilities
“Development aid”, not spent on poverty or development
Clawed back by unfair tradeEmergency aid Debt relief Refugee, Tied to benefit rich
“Phantom aid”, the wasted 47%Refers toODA, not
MDGs
The Millennium Development Goals
Page 30
At a UN Millennium (2002) summit, the nations of the world set eight MDGs to be achieved by 2015
• The world's main development challenges were identified• Specific actions and targets (the MDGs)• A commitment to provide the means was made by
189 nations & signed by 147 heads of stateThe MDGs break down into • 21 quantifiable targets • Targets are measured by 60 time-lined indicators
Some nations have kept their trust. But some of the richest in the world have announced that they will not meet their commitments
Nutrition & Millennium Development Goals
Page 31
Primary goal is to eradicate extreme poverty & hunger
Nutrition – direct prerequisite to goals1, 3, 4, 5 & 6; indirectly to 7 & 8
see next 2 slides
1
maternalhealth
Child mortality
Gender equity Empower ♀ Achieve universal
primary education
HIV, malaria, other diseases
Environmentalsustainability
Global partnershipfor development
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1. Eradicate extreme poverty & hunger. Poverty is the main determinant of hunger. In turn, malnutrition irreversibly compromises physical & cognitive development & thus transmits poverty & hunger to future generations.
2. Achieve universal primary education. Malnutrition diminishes the chance that a child will go to school, stay in school, or perform well in school
3. Promote gender equality, empower women. Women’s malnutrition impairs the whole family’s health & nutrition
Centrality of nutrition to MDGs 1, 2, & 3
Centrality of nutrition to MDGs 4, 5, & 6
4. Reduce child mortality. Delivery of a live healthy child is dependent, above all, on a well nourished mother. Protein & folic acid are critical here
5. Improve maternal health. Malnutrition accentuates all major risk factors for maternal mortality, e.g., inadequate protein, iron, iodine, vitamin A & calcium
6. Combat serious infectious diseases. Malnutrition aggravates infections, immune competence, transmission & mortality in HIV, malaria, tuberculosisAdapted from Gillespie and Haddad (2003) http://web.worldbank.org/
Page 33
2 Categories & measures of nutritional status
4 slides: • Malnutrition, undernutrition, • Overnutrition / Overweight, Obesity• Energy requirements: calories, carboh, proteins, fats • macronutrients, micronutrients
Page 34
Categories of nutritional statusNutritional status is assessed as one of four
categories 1. Good nutritional status: All nutrients (right quantities, time &
place) allow optimal, growth, maintenance, & reproduction
2. Overnutrition: An excess of a nutrients (usually calories) is being consumed, so that health is negatively impacted
3. Undernutrition: Insufficient food is consumed to allow for the energy needs of the individual. Inevitably dietary (& then body) protein is burned for energy. A secondary protein deficiency ensues – thus: "protein-energy-malnutrition"
4. Malnutrition: Energy consumption is adequate, but there is an imbalance among constituents of the diet and health is impacted
Page 35
Note C
Worldwide distribution of malnutritionOver 20 million children suffer from acute malnutrition WHO.
Page 36
Scientific American, Sept 2007
Worldwide, nutritional inequities follow poverty
(as do health inequities & life expectancy)• Globally, there is plenty of food for everyone but …those who
have more than they need find reasons not to share• The result – in the time you spend on this module over 1000
children will have died of hunger• Each day 1500 children go forever blind from lack of vitamin A• The poorest are 50-200x more likely to die in pregnancy (more
than half these deaths are attributable to iron deficiency). • About 2 billion people (56% of pregnant women) have iron
deficiency. Their babies have low birth-weight, & mortality
Page 37
Note D
“The bottom billion” (title of a book by Paul Collier )
“The poorest of the poor,” Public health nutritionists identify a subclass of the hungry - those who try to survive on resources worth less than $1 per day
• We define this subclass as people who don't get enough to meet the ordinary demands of life
• They lack the resources to earn a living, or obtain what‘s needed for normal, growth, maintenance & reproduction
• It goes without saying that they are unable to provide the necessities for those who depend on them
Page 38
“The bottom billion” (title of a book by Paul Collier )
• Their lack of access to resources is such that a significant fraction will be unable to stay alive
• They live mostly in isolated rural areas and most are subsistence farmers
This means that what they eat this month is what they can take out of the ground from last month's planting
Page 39
40
http://www.who.int/mediacentre/factsheets/fs290/en/index.html
http://www.fao.org/mdg/en/http://www.un.org/millenniumgoals/reports.shtml#mdgs
41
http://www.who.int/mediacentre/factsheets/fs290/en/index.html
http://www.fao.org/mdg/en/http://www.un.org/millenniumgoals/reports.shtml#mdgs
42
http://www.unicef.org/media/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf
http://ije.oxfordjournals.org/content/32/4/518.full.pdf
Percentage stunted
60%
40%
20%
AfricaAsia
Latin Am
Last 2 or 3 points are projections
1980 & every 5 years
Unhelpful misconceptions about aid
Page 43
False: “Most aid money goes into the Swiss bank accounts of corrupt African dictators”
“Aid creates dependence & impedes self-sufficiency”“Despite all the aid $, the problems are only getting worse”
The truth is: Overwhelmingly African leaders are not corrupt. When they are, most bribes come from the West
Well planned aid builds capacity & self-sufficiency
Overall, hunger worldwide is diminishing. MDGs go forward because of the countries that honour their pledges!
Note E
Page 44
6 Making hunger history - breaking the vicious cycle of the poverty-trap3 slides: • Worldwide distribution of malnutrition
& its relation to poverty• Societal costs of malnutrition
including effects on young children
Page 45
We now know what works!Widespread agreement at conferences! Tool-kits for
elimination of extreme poverty & hunger exist
MDGs, change agents, Grameen, Millennium Village, Agencies & foundations for development. CIGHR, GHEC, Supercourse, Universities, Spokespersons
for the developing nationsWe know what we can do to help right now.
We know we can do it better! New knowledge production, dissemination, data
mining, knowledge brokering & application
Resources, personnel, sharing what works, time needed to get on development ladder
Need govt action!
Need info & research
Money? No way to get it & useless!
• No one to employ anyone, no one to sell things to• No shops to spend money in• What they eat this month is what they can take out of
the ground from last month's planting• Hungry & stunted kids tiny unmarked graves• Hospital, dispensary, emergency > 1 day walk
More immediate than money – (1) to SURVIVE We don’t need studies to learn what’s needed
Page 47
The poorest - don’t give them money
Jeffrey Sachs
What do they need?
The greatest nutritional problems are well known:Protein energy malnutritionVitamin AIronIodine
What do they need?Short term – “Give a man a fish ...”
Emergency rations, safe water, first aid, antibiotics,public health – vaccinations, drugs, etc
In conflict zones, shelter, safety to live, plant, harvest
In drought “safe-water straws”
Page 49oral rehydration solution ready to use foods
Millions saved
“Phantom aid”: 47% is “wasted”
• Evaporating aid - promises … broken as soon as cameras turn elsewhere
• $ flow benefits the rich nations – tilted trade• Aid with strings attached, contingent on UN votes,
WB loans, unfair trade• Dumped food surplus local farm economy• Money given by corrupt rich people to
“corrupt dictators”
50
UK banks in Nigerian
corruptionPaul Collier: The bottom billion50
Emergency aid isn’t intended for development
http://www.globalissues.org/article/35/foreign-aid-development-assistance#GovernmentsCuttingBackonPromisedResponsibilities
To become self-sufficient - obviously:good seeds, fertilizer, drinkable water, sanitation, low technology agricultural info & resources, drip-irrigation, ARVs mosquito nets, dispensaries, hospitals
Emergency aid – beyond Survival at the same time (2) Sustainablity
Long term – (3) To thriveScaling up production - factories
“... teach a man to fish”
development ladder
To become self-sufficient - obviously:good seeds, fertilizer, drinkable water, sanitation, low technology agricultural info & resources, drip-irrigation, ARVs mosquito nets, dispensaries, hospitals
Emergency aid then beyond (1) Survival & implementedat the same time (2) Sustainablity
Long term – (3) To thriveScaling up production - factories
“... teach a man to fish”
development ladder
7 Malnutrition & MDGs: cause, effect, cure3 slides: 1. Trends in nutrition, food security & globalization2. Agricultural trends3. Nutritional inequities - Cause & consequence4. Food security; Prospects for having enough food
Page 54
We know what works•Transparent & accountable , open bids•Partnerships not paternalism•Goals, objectives, timed milestones•Strategies revised annually by both partners•Externally monitored. No political pressure•Sustainable emphasis on poverty, agriculture•Serves recipient needs, not donor / ideology•Firm long-term commitments: MV, Grameen
Unrealistic? Let’s see ...55
• Grameen Family of social enterprises
• Billionaire philanthropists & foundations
• The Millennium Village project
• Passionate & influential voices for change
• Scientists & students bring energy to future
• Instant spread of innovations: agric, educ, &c
Beyond MDGs: amazing changes
56 www.sfu.ca/global-nutrition
Microfinancing successes
Donkey carts ($200) repay in
2.5 mos
4 Factories for treadle pumps. 2y later there are 75
Drip irrigation allows winter cukes @ 3x price. 1A farm profit
$100 $550 / yr
Business Week
Grameen Impacthttp://www.grameenfoundation.org/our-impact
9.4 million poor have been helped1,000,000 microloans have been generated
http://www.youtube.com/watch?v=kW-4gJmXy5M
http://www.youtube.com/watch?v=1UugpcDjjJU
Grameen village phone10M subscribers300k cell-phone ladies
Innovations that make a differenceBarefoot agriculturistsSoil conservation, don’t burn
contour farming, irrigation, crop rotationDrip irrigation
Pump installation
Burkina Faso: planting-pits & stone furrows land food for 500,000
Phillipines: Tilapia in protein for 30,000,000China: Hybrid rice in – enough for 60,000,000Bangladesh: Market liberalization in rice yield 3x
Link to Millions fed
Appropriate technologyInnovations that make a difference
$25 pump irrigates ½ acre $100/y net
Watering can irrigation
rainwater collection pitsvalve
sub-surface drip irrigation
Zero-tillage wheat-seeder drill - $100?
Labour goes further. Earlier planting yield
Doubled yield govt subsidy
Farmer buys & rents to pay off
2 factories 100 in Haryana & Punjab
Millennium Village Project
Farm production
Gender equity
Nutritional services
Energy & environment Health services
Water
Prevent malaria & TB
Environment
$3m x 5yrsfunded in advance
Initiatives making a differenceGrameen Family of social enterprisesThe Kings of Philanthropy & 100s of foundations
The Millennium Village project
Influential voices for changeScientists & students are making a difference
The Millennium Development Goals – for the poorest
You! ...amplify with others @ SFU &?
VoteSpeak, write, telephone
International internship
DonateLive
against 99.7% of tax on ourselvesOxfam, IDRF (Can Revenue charities)
to leave enough for everyoneconsider study abroad
Page 64
Supplementary note to the preceding slide
Every day, 1500 women die from pregnancy- or childbirth-related complications. In 2005, there were an estimated 536 000 maternal deaths worldwide. Most of these deaths occurred in developing countries, and most were avoidable. (1) Improving maternal health is one of the eight Millennium Development Goals adopted by the international community at the United Nations Millennium Summit in 2000. In Millennium Development Goal 5 (MDG5), countries have committed to reducing the maternal mortality ratio by three quarters between 1990 and 2015. However, between 1990 and 2005 the maternal mortality ratio declined by only 5%. Achieving Millennium Development Goal 5 requires accelerating progress.
Maternal mortality in 2005: estimates developed by WHO, UNICEF,
UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.
who.int/reproductive-health/publications/maternal_mortality_2005/index.html,
accessed 14 August 2008).
Source: http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/index.html
Photo credits
Page 65
Supplementary note to the preceding slide
Source: http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/index.html
Page 66
Supplementary note to a preceding slide
Why do mothers die?Women die from a wide range of complications in pregnancy, childbirth or the postpartum period. Most of these complications develop because of their pregnant status and some because pregnancy aggravated an existing disease. The four major killers are: severe bleeding (mostly bleeding postpartum), infections (also mostly soon after delivery), hypertensive disorders in pregnancy (eclampsia) and obstructed labour. Complications after unsafe abortion cause 13% of maternal deaths. Globally, about 80% of maternal deaths are due to these causes. Among the indirect causes (20%) of maternal death are diseases that complicate pregnancy or are aggravated by pregnancy, such as malaria, anaemia and HIV.(2) Women also die because of poor health at conception and a lack of adequate care needed for the healthy outcome of the pregnancy for themselves and their babies.
67
Passionate renegades
67
Take home message• Catastrophic inequities in distribution of
foods
• Kinds of nutritional status & health impact
• We’ve faced causes, know there are cures
• As we face the future we are ...
water, protein, iron, vitamin A, iodine
Not by accident? Who’s responsible? What’s needed perinatal - women and children
not just across nations – increasingly within
Impatient Optimistic
http://www.sfu.ca/global-nutrition