Human Rights and Nutrition Practice
As we approach the next millennium, food and nutrition professionals and others searching for solutions to the worlds widespread undernutrition and hunger find themselves within a new post-Cold War development era. With the diminution and conclusion of the Cold War as a global conflict over the last quarter century, the international development environment changed profoundly while hundreds of millions still remain undernourished.
The year 1989 marked the end of the Cold War and of the development environment which was shaped by the Bretton Woods institutions and the Marshall Plan. The Cold War era was characterized by a political stalemate of the eastern and western blocs that dominated foreign assistance and stifled economic and social change everywhere, especially in developing countries. However, illusions that the triumph of the west would automatically lead to the widespread rectification of the worlds injustices, such as persistent hunger and malnutrition, have been dispelled over the past nine years. Much work remains to be done.
The post-Cold War development era is characterized by five trends:
Human rights are key to the new era. This has been long delayed. At the end of World War II, the horror of the violation of human rights that occurred during the war was clear, leading to, among other actions, the establishment of the United Nations and the ratification of the Declaration of Human Rights.
Despite this promising beginning for humans and their rights, Cold War ideological conflict severely retarded the development of human rights. The human rights approach to improving human welfare was greatly weakened by the division of rights between the two blocs. The West, particularly the United States, promoted civil and political rights while rejecting the concept of economic rights, and the East, particularly the Soviet bloc, espoused economic rights to the exclusion of political rights. In the interest of maintaining political control, both sides-- especially the Soviet bloc and, for the United States, in many Third World countries-- were capable of violating both the rights they didn't champion and those they did.
Table 1. Ratification of Five International Human Rights Instruments Pertaining to the Right to Food as of September 1998
In response to the Cold War, human rights institutions have established their importance, essentially through grassroots organizations, opposing major human rights violations occurring in both blocs.
We in the United States are now free to join with our allies to not only focus on political rights, but to integrate economic rights, and a reasonable approach to achieving them, into our conception of human rights, which had been distorted by the politics of the Cold War.
The right to food is related to a variety of rights which affect the ability of groups and individuals to achieve food and nutritional security for themselves (Marchione, 1996). By the end of 1995, the majority of the countries of the world had ratified the 10 international conventions most closely related to the right to food and nutrition. These include rights of children to the highest attainable standard of health, rights of women to be free of discrimination, and economic rights, including food and shelter in peace as well as war. As table 1 indicates for five important human rights instruments, world ratification of human rights treaties has been good, especially for developed countries. Unfortunately, as table 1 also shows the U.S. record on ratification has not been as good as other developed countries. From 1989 to 1996, the ratification of international rights instruments accelerated, and no less than seven international conferences have reshaped and articulated these human rights, culminating in the World Food Summit in 1996, where world leaders committed to reduce world hunger as a matter of human rights:
Thus, the end of the Cold War provides the opportunity for reuniting the two fundamentally inseparable bodies of rights. Using this body of rights, nutritionists can join the front lines of a reinvigorated effort by NGOs, civil society and the international community to end world hunger.
The Human Rights Approach to Nutrition Practice
The post-Cold War potential of universal human rights merged with the practice of public nutrition provides a potent approach to effectively end world hunger. In contrast to clinical and laboratory nutrition, which are essentially bio-technical endeavors, public nutrition deals with problems of social groups and the public policies and programs used to address them (Mason et al., 1996).
Public nutrition has two fundamental tasks:
Human rights are essential to both tasks. Human rights inform the standards for policy and project goals. They also provide the guidance for freely involving individuals and the community in nutrition program development and functioning.
Application of such a human rights approach to nutrition practice and hunger reduction demands a response to each of the post-Cold War trends.
Better Knowledge of Human Rights
Nutrition programmers in this new era must become better informed about the local manifestations of basic economic, social, political and civil rights in the countries and communities where they work. Have international conventions been ratified? How do these international rights articulate with local law and cultural practices? Are women's or minority rights respected in peace and in conflict and population displacement situations? Nutrition programs must increasingly be viewed as ethical processes, where basic rights form the framework for food security goals and program implementation.
Universal rights as they are stated in international instruments and declarations should inspire the specification of nutrition goals and policies not only by governments, but also by NGOs, communities, and private investors. The state should be expected to fulfill needs only in the last resort after all reasonable steps have been taken to respect existing food preferences and other unique aspects of a peoples food system, to protect the means of food procurement (food entitlements) that do exist, and to facilitate new means for universal food and nutrition security. Equally important is a civil and political rights approach to nutrition programming that enables communities to shape programs that affect their lives. If given full play, this approach should empower the community to eventually realize the interrelated web of basic human rights, including economic rights, such as the right to food. On ethical grounds, the goal of nutritional security for all is not to be compromised, but the route to its achievement must be particular, iterative, and situationally determined.
Adapting to Democratic Environments
Democratization challenges nutrition practice to better incorporate community knowledge of nutrition problems in their analyses and to apply adaptive process approaches to their programs. It opens routes to nutrition policy advocacy and scaling up activities by means of political decisions. On the negative side, nutrition issues become more open to exploitation by unscrupulous politicians, commercial distortion, and unskilled action organizations. NGOs can represent local elites and though well meaning, are not always committed to public purposes.
Civil freedoms require nutrition practitioners to better understand and use the local culture. Participation and empowerment privileges community members perceptions and indigenous knowledge of nutrition problems. For example, the U.S. Department of Agriculture, Food and Nutrition Service uses a household self-assessment to determine the degree of food insecurity in the United States, as well as objective nutrition assessments. Practitioners should use anthropological skills to take advantage of opportunities to learn from communities, respecting and applying the lessons of how communities cope with food insecurity and how they perceive the causes of growth failure and nutritional deficiencies. This will inevitably lead to more variable and flexible programs that stretch the envelope of standard nutrition program designs. A major challenge is to empower communities and local organizations without sacrificing objective evaluation of results, taking care to not let the program process overtake the development outcome.
Active civil societies provide more opportunities to cooperate intersectorally and to advocate at all levels for specific interventions and better policy environments and resources for local programs. The new development environment permits a shift in the balance away from top-down scientific, central programming toward bottom-up advocacy for communities in need.
The new era nutritionist must be self-critical. Hierarchy and dominance do not always derive from central government or from wealthy classes or corporations; they can derive from professionals who will not identify with the plight of people at the grassroots.
Protecting Nutrition Rights within Free Markets
In the new era, nutrition programmers and policy makers have to come to terms with functioning in economies which are "liberalizing," which means deregulation, reduced government spending, and substantial opening to market forces. Food, employment, information, and services essential for nutrition security will be subject to the forces of open markets, not necessarily with beneficial outcomes for poor people, as we have recently seen in Indonesia and other nations in southeast Asia.
In open economies nutrition problems may be caused or solved in distant markets affecting food prices, food choices, a farmer's agricultural sales, or employment income. Practitioners are required to have a greater understanding of how markets can be used to create sustainable enterprises and income for the poor, and, if necessary, know how to act in the public interest against unfavorable market consequences. For example, codes of conduct, such as those created for the marketing of breast milk substitutes, may become increasingly necessary to regulate commercial nutrition "education" and protect nutritional status. Similarly, large private enterprises and macro-economic policy planners have greater responsibilities to protect and promote nutrition security.
Practitioners, both public and private sector, must avoid a "neo-liberal" attitude, that the market will solve the nutrition problem. The role of the practitioner should be one of vigilance, cooperation, and advocacy as necessary. The market can be a powerful ally for promoting goods and ideas of nutritional benefit, but an equally powerful foe, requiring practitioners at times to develop strategies to cope with price volatility and to promote countervailing citizen action and scientific information.
Practitioners must also know the economic development implications of poor nutrition, its impact on mortality, mental development, productivity, and morbidity. For the new approach, conditions such as blindness and mortality due to vitamin A deficiency, or mental retardation induced by iodine deficiency are essentially ethical violations and not merely factors in an economic growth equation.
Coping with Scarce Development Resources
At the end of World War II, the public opportunity and challenge to rebuild from the ashes of war was vigorously taken on. In contrast, after the Cold War, the response has been to cut official development resources. In this era of resource scarcity the challenge is how to better target administered food and nutrition programs, seeking sustainable low cost solutions, even while preserving human rights, including the right to food.
Practitioners need to be aware that development investments tend to migrate to sectors and populations with high potential for market development and away from the marginal areas where nutrition insecurity and the demand for expensive administrated nutrition programs is great. Neglect of such areas increases their vulnerability to crises caused by natural disasters or civil disturbances, triggering massive suffering, costly emergency food aid, and widespread violations of the right to food.
The challenge is to more efficiently and ethically use diminishing development resources. For example programs may use more efficient area-based strategies that focus on underlying conditions, such as sustained improvements in household income and public health infrastructure and nutrition support programs, rather than on costly, facility-based nutrition rehabilitation triggered after hunger has become a reality. Understanding local cultural behaviors, such as breastfeeding and complementary feeding practices, can lead to lasting low cost and preventative solutions. UNICEF has found that solutions involving communities in nutrition surveillance reduce cost and increase effectiveness.
The recent spread of micronutrient programs is not only a result of their new found efficacy, such as the mortality and morbidity impact of vitamin A, but also their cost effectiveness. However, micronutrient supplementation can not replace programs that seek sustainable solutions to widespread general malnutrition, food insecurity, and poverty. Even mild underweight in children contributes to the 55 percent of children who die each year of diseases in association with low weight for age (UNICEF, 1997).
Targeting food aid to the most needy countries and regions and targeting supplementation at the most vulnerable early stages of growth are more efficient for long-term nutrition improvement, a strategy being adopted by the World Food Program. Monetization of food aid within a country enabling nutrition service providers to purchase nutrition inputs unavailable from other sources may be another resource to be tapped. Since the later 1980s, while cash assistance has declined, a growing portion of program needs are raised from the sale of food aid in recipient countries. In fiscal year 1997, nearly 40 percent of U.S. project food aid provided for development purposes was sold by international NGOs to raise currency for implementing high quality programs, a useful approach where negative effects on local food production and food preference are respected and protected.
Collaboration between local government, non-governmental organizations, and communities can lead to cost-sharing in cash and kind, more innovation, and more sustainability.
Upholding Rights in Civil Wars
The universal right to food applies in both stable and disrupted societies. Practitioners are obligated to address not only the consequences of natural disasters, but also complex emergencies where food security may be undermined intentionally or unintentionally as a consequence of larger political and military objectives. This requires a willingness to grapple with the consequences of ethical stance of the right to food, such as monitoring food assistance to see that it is used for the hungry rather than the military.
Practice requires application of nutrition skills under dangerous and awkward conditions. In emergency response situations, nutrition practitioners must work in unsecured areas with the arcane problems of food aid procurement, logistics and international cooperation in relief camps. They must be able to apply rapid methods of assessment, management, and intervention. They should be aware of methods for situation analysis using considerations of how the interventions may exacerbate conflict between ethnic or other groups or hurt local capacities, such as local food production or breastfeeding practices. Their nutrition interventions should include ways to facilitate return to normal development conditions.
Food and nutrition professionals and all those concerned with chronic and transient forms of hunger face new opportunities and challenges for hungers eradication in the post-Cold War development era.
Commitment to eliminating world hunger will not happen in the normal course of the political life of rich nations because the cause lacks a critical mass of powerful constituencies. Effective action to eliminate hunger will not happen in the normal course of the political life of poor nations because of their economic limitations, and because poor nations, despite their independence, often lack governments where the poor and undernourished have a real political voice.
Effective action, therefore, will happen only with purposeful leadership, cooperation based on universal human rights norms, and creative partnerships within and between developed and developing countries. Food and nutrition professionals are confronted with the choice of remaining secure in their technical domain, refining the understanding of the causes and the varieties of suffering of undernourished people, or taking an active role in partnerships and human rights promotion. This new role requires the courage to advocate as well as analyze, to respect peoples knowledge about nourishing themselves, to energize and support indigenous food security initiatives rather than dictating them, to hold the private sector as well as the public sector accountable for the protection and facilitation of universal human rights, and to be skilled at targeting limited resources to the best and more sustainable approaches to fulfill the right to food.
Nutrition practitioners and all concerned with world hunger have the knowledge and the legal human rights tools to make hunger an insignificant problem. The alternative is to be confronted with the faces of hunger in greater frequency and detail from the comfort of our ever-better-wired and well-fed homes.
Resources and References Used
Tom Marchione, Ph.D., anthropologist, serves as an Evaluation Officer and Nutrition Advisor to the Bureau for Humanitarian Response at USAID, where he evaluates assistance programs, and advises on aspects of nutrition and food security. This article is based on his forthcoming book, Scaling Up, Scaling Down: Overcoming Malnutrition in Developing Countries, New Jersey: Gordon and Breach Publishers. The opinions in this article are those of the author and are not intended to represent the views of the United States Agency for International Development.