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Egypt gives agricultural aid to central and southern africa
Module 41b: Nutrition in Global Health
Roadmap toward a world without hunger
Prepared as part of an education project of the Global Health Education Consortium & collaborating partners – 1 Sept 2009
What is the nutritional status of our planet?How does it impact the health of populations?How did we get here? What’s to be done?Where are we going?
Allan J Davison PhDFaculty of Sciences, Simon Fraser UniversityDepartment of Biomedical Sciences & Kinesiology
3
3 www.sfu.ca/global-nutritionplease disturb!
Allan Davison
Making hunger history?
Page 4Page 4
Nutrition fundamentals for global health
• This module deals with catastrophic inequities in the global distribution of foods
• Almost a billion of us are too hungry to live a productive life, while an equal number are adversely affected by overweight
• Nutrient deficiencies impact health throughout the life cycle: Water, protein, iron, vitamin A, iodine.
• Childbearing women and children are hardest hit• What nutritional principles allow us to understand &cope with
this• We will not avoid difficult questions about cause and effect:
“How & why has this come to be?”; “Who is responsible?”
Other modules contribute to our understanding of nutrition in global health
Page 5
Modules dealing specifically with nutritionModule 41b World nutrition - What builds a better future & what doesn'tModule 48 Acute malnutrition – Clinical aspects
Modules dealing with mitigation of poverty – the most important cause of hunger
Page 6
Pre-quiz
(remember to erase this box after reading) Use the separate GHEC Quiz template to create your quiz. Place this Quiz reference slide before the next continuing slide.
• As a reality check as you begin this module, and to create “teachable moments” for what follows, we invite you to take a 5-minute quiz before you start.
• You will be offered 10 true-or-false questions on common misconceptions that can mislead the unwary. Clearing up fog is essential if we are to understand nutrition in a world where some people deliberately mislead us
• After completing the pre-quiz, we expect you to continue this module with greater interest and renewed clarity
1.TF In the poor nations almost everyone is hungry; in the remainder almost everyone gets an adequate diet
2.TF Worldwide, more people have their lives shortened by overeating than by starvation
3.TF When poor nations now find a place on the ladder of development, they develop slower than rich nations did when they enjoyed their phase of development?
4.TF Most Canadian specialists in global health understand how the distribution of poverty & hunger are changing?
5.TF Health & nutrition benefits are possible only after economic development occurs
6.TF People in regions of extreme hunger & poverty desperately need money
7.TF 50% of children in the US rely on charity for their meals at some time in their lives?
Quick guess quiz – 2 of following are T
Quick answers
1. F In some nations hunger is the norm; in the remainder, an adequate diet is the norm
2. T Worldwide, more people have their lives shortened by overeating than by starvation
3. F In the present era, when poor nations find a place on the ladder of development, they develop slowly compared with the rich nations in their phase of development?
4. F Most Canadian specialists in global health understand the how the distribution of poverty and hunger are changing?
5. F Health & nutrition benefits inevitably occurs after economic development rather than before
6. F People in regions of extreme hunger & poverty desperately need money
7. T 50% of children in the US must rely on charity for their meals at some time in their lives?
Page 9Page 9
Learning objectives
1. What works & what doesn’t?toward evidence-based solutions
After completing this module the user should be able to
How to get the most out of this module
If you are …• a nutritionist or
student of nutrition• a student in public
health• planning a project in
regions with severe nutritional problems
• a public health practitioner
• Pay attention to global & public health & policy implications.
• Pay attention to perspectives & realities in desperate situations
• Emphasize check-lists to prepare for field work & gather information to recommend & advocate for intervention.
• Use slides & resources in your information / teaching sessions
Page 10
We recommend that you …
Core concepts and skill-set
• Why nutrition is relevant to global health?
• Socio-economic determinants of nutrition & health
• Nutritional principles that govern the distribution of problems across populations, & across the life-cycle
• Nutrition as a determinant in global health & MDGs
• Competing theories for how we came to this point
• Prognosis: Given no change, where are we heading?
Page 11
Page 12
Nutrition in Global Health:Roadmap to a world without
hunger
1. Understanding the problem (else can’t solve)2. Myths are roadblocks to making hunger history
Making hunger history?
13
Where are we?
Where are we going?
Much better since the MDGs, but far from making hunger history
Hunger on a global scale will disappear, in 2 or 3 more 15y plans. New initiatives
Only 5-10 nations of 23 will reach 0.7% of GDP. None will forgo unfair trade rules
What’s working, what’s not?
“Let’s put hunger in the museums”Yunus Muhammad
Hans Rosling Global Health statistician Talk to US State Department 2009
Above $1 per day microcredit, below $1 emergency aid
Is this just a pipe-dream?
the evidence using gapminder
1974: 1,600,000,000extreme poverty
& hunger 2008: 800,000,000
HD
The situation? Bad but improving
• Graph
Page 15
Why nutrition in relation to global health?
• Of the immediately modifiable factors that affect individual & public health … nutrition is the most important
• Nutrition at every stage of life lays a foundation for health in the ensuing stage
• For all nations, rich & poor, nutrition determines physical health / development through the life-cycle, including:
Success in childbearing, cognitive function, socio-economic independence, educational achievement, & employability …
... now and on into the ensuing generations
Health & economic development are contingent on provision of adequate nutritional resources & support
Page 16
Where are we? Can we find a better way?
About 55,000 people die of hunger each day - 2/3 are children
• Each year 3 million newborns die in the first week of life• Almost an equal number in EU&USA are dying of over-nutrition • The world produces enough food to feed everyone but somehow
we lack the political will to distribute it as needed• One person in 5 in the developing world (1/3 of world's children)
are undernourished & will never lead a productive, active life. • To feed them for a year, & start them on the development ladder
would cost less than the world spends on armaments in 30 days
Page 17
Can it be very difficult to improve on this?
1. The 50% (actually 49.2%) is US children that will require food-aid some time during childhood
2. Infant mortality in Washington DC
3. China and India differences growing – rich -> richer
“This is a problem we can solve at a fraction the cost of ignoring it” (Senator Geo McGovern: US Ambassador to UN Food & Ag Org)
Does it matter ...Do we care? Should we care?the world produces enough food for everyone, yet some have much less than they need while others have much more than they need
food wasteSouthern Africa as a microcosm
George W Bush: “Terrorism is rooted in the frustration of people pushed by suffering
beyond the point of endurance”
We should have compassion for those who find no cause for their lives to count. We are ethical beings Click for more (Yunus)
Yunus: Blaming the poor for their poverty
• “Poor people are like a bonsai tree. You take the seed of the tallest tree in the forest and plant it in a flower pot. All you see is a tree this high. It looks exactly like the tree that you saw in the forest, but a scaled-down version. You wonder what happened. ‘Is there something wrong with the seed? No, we selected the best seed.’ The problem was it was not given space to grow. Poor people are bonsai people. There is nothing wrong with their seed. Simply, society never allowed them the space to grow, so they remain stunted and we pity them. If you had provided them the space, they would be as tall as anybody else”.
Poverty as an imposition: Mohammad Yunus (Nobel Prize 2006)
Page 20
J Sachs: “Exploitation is the result of poverty”
Page 21
“Affluent nations have plundered and exploited poor countries through slavery, colonial rule & unfair trade practices. Yet … exploitation is the result of poverty (which left impoverished countries vulnerable to abuse) rather than the cause”
“Poverty is generally the result of low productivity per worker, which reflects poor health, lack of job-skills, patchiness of infrastructure, chronic malnutrition etc. Exploitation played a role in producing some of these conditions, but deeper factors –(geographic isolation, endemic disease, ecological destruction, challenging conditions for food production) tend to be more important and difficult to overcome without external help”.
Here is the basic paradox – stuffed & starved in a world that produces enough for everyone. It raises the questions: What is the connection between those that have less than they need to survive and those who have so much that they are injuring themselves with the surplus? How can otherwise compassionate people be so indifferent to the suffering their lifestyles cause.
Given the paucity of information in text & reference books, where can we learn what we will need in order to understand where we are and where we are going?
Lets turn to the agents of change, those who are making the future
Creating the future – agents of change
Yunus Muhammad - Creating a world without poverty
Jeffrey Sachs - The end of poverty
Dambisa Moyo - Dead Aid (she’s against aid to the poor)
Frances Moore Lappé - Diet for a Small Planet
Raj Patel - Stuffed & Starved
Paul Collier - Bottom Billion
Loaned $76 to poor– Nobel Prize in 2006
Voice for poorest of poor. Prev World Bank trouble-shooter
“Creates dependence” Goldman-Sachs 2001-)
Economist: discovery of resources is the worst!
If any game of chance such unequal results
Rules of economics rob the most needy of food
Page 25
Nutrition in Global Health:Roadmap to a world without
hunger
1. Understanding the problem (else can’t solve)2. Myths as roadblocks to making hunger history3. How we will make hunger history – 6 initiatives
More misconceptions, mostly deliberately chosen to whitewash governments and agencies like WTO, World Bank, etc.
Very successful. Average US citizen thinks the US is giving about 30x as much in development is the case. Is not told that the greatest amount of US aid is military rather than development. Nor that most goes countries the US wants to coopt, invade, destabilize, or shore up. Most goes to Israel. US aid began in the 1950s as a way to dispose of surplus agricultural production.
Dambisa Moyo is right about some kinds of aid – the kind that disempowers.
More misconceptions about aid ...
Page 27
False: “Most of the aid money goes into the Swiss bank a/c’s of corrupt African dictators”
“Aid creates dependence & impedes self-sufficiency”“Despite all the aid money their problems are getting
worse” & “It’s their own fault”The truth: Very few leaders are corrupt by (say) ...
Well planned aid targets capacity & self-sufficiency
Most MDGs are being met, to the extent that rich countries honour their commitments. Blaming the bonsai tree.
Note that the people hate both the foreigners who bribe & their own leaders who take the bribes. Nigeria’s oil rich yet its people are among the poorest in Africa
Ottawa, Washington, World Bank, WTO, free traders
Myth: Aid isn’t workingTrade for profit instead
Trade barriers. Fair trade & aid
Population outstrips food supply
… we give more than anyone!
Trillions wasted! - 1 b still starving
MDGs won’t be achieved
Most aid corrupt dictators Corrupt multinationals
2008 recession
Never promised 0.7% and anyway …
“Trade not aid”
Broken promises
Malthus is wrong
28
V little is wasted
½ what EU gives!
Truth: Profit motive doesn’t work -
sustainable development aid
works
“They” didn’t cause it
You did so!
Roadmap to a world without hunger
The big lie: “Aid doesn’t work”20 nations pledged 1974 to donate 0.7% of GNP
to Aid. “No benefit! 1 billion are still starving”
4+2 nations did meet pledge: 800m now starving
Truth: can you guess?
was 1600m ⇒ 800m spared!!
Only 4 nations delivered!
22 renewed pledge 2001 Broke it again in 2002
:^( US pays < ¼ of promise
Canada < ½
Well done? No!
To a few: “well done”. To many: “800m still to go”
Myth: Aid isn’t workingTrade for profit instead
Trade barriers. Fair trade & aid
Population outstrips food supply
… we give more than anyone!
Trillions wasted! - 1 b still starving
MDGs won’t be achieved
Most aid corrupt dictators Corrupt multinationals
2008 recession
Never promised 0.7% and anyway …
“Trade not aid”
Broken promises
Malthus is wrong
30
V little is wasted
½ what EU gives!
Truth: Profit motive doesn’t work -
sustainable development aid
works
“They” didn’t cause it
You did so!
Worl
d G
DP
$P
PP
per
cap
(e
st)
15
00
-21
00
1500 2000$0
$5,000
$10,000
India to 1500
China + Indiato 1850
WesternEuropeto 1945
USA + WestEurope
since 1945
http://ers.usda.gov/Data/Macroeconomics/
Manifest destiny of world - wealth
China +India 2040?
31
Number of malnourished world-wide
321970 1980 1990 2000 20100
100
200
300
400
500
600
700
800
900
1000M
illio
ns
un
der
-no
uri
shed
(FA
O k
cal /
ho
use
ho
ld)
FAO data
water-carrier
See also: WHO, UN, WB, USDA, CIA, OECD, IFPRI
UNICEF 2009
http://www.unicef.org/media/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf
kcal per household surveyed
World% undernourished
331970 1980 1990 2000 201015
33%
17%same data
22%
14%
1970 2010 2015 target 2030 FAO est
0
2000
4000
6000
8000Fed
Malnourished
Number fed & under-nourished worldwide
34
14%
Prediction
6%11%
Target
33%
3434
millions
35
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%
Africa
Asia
Latin Am
Last 2 or 3 points are projections
1980 & every 5 years
36
http://www.who.int/mediacentre/factsheets/fs290/en/index.html
http://www.fao.org/mdg/en/http://www.un.org/millenniumgoals/reports.shtml#mdgs
Number stunted
200m
100m
0
Africa
Asia
Latin Am
1980 & every 5 years
37
Paying for total strangers to eat?
Not us, not if it goes to corrupt
dictators” }
37
38
http://www.globalissues.org/article/35/foreign-aid-development-assistance#GovernmentsCuttingBackonPromisedResponsibilities
“Development aid”, not spent on poverty or development
Lost to: InefficiencyUnfair tradeEmergency aid RefugeesTied to benefit rich & Debt relief
“Phantom aid”, the wasted 47%
Refers toODA, not
MDGs
Real aid53%
Corrupt Dictators? Rich...
Series1
-600
-400
-200
0
200
400
600
Accept “bribes” to give trade concessions that impoverish their people
Accept personal & campaign “contributions” peddling influence. Could stop bribery at home & abroad by abolishing secret a/c
... & Poor
39
100s
bu
reau
crat
s
200s
MN
Cs
10s
corr
up
t d
icta
tors
1000
s p
resi
den
ts,
PM
s, b
ure
aucr
ats
in r
ich
wikipedia Lockheed
SwissAir
Misconceptions about aid ...
Page 40
False: “Most of the aid money goes into the Swiss bank a/c’s of corrupt African dictators”
“Aid creates dependence & impedes self-sufficiency”
“Despite all the aid $, problems are getting worse” &
“It’s their own fault”The truth: Very few leaders are corrupt by ...
Well planned aid targets capacity-building & self-sufficiency
Most MDGs are being met, to the extent that rich countries honour their commitments. Blaming the bonsai tree.
...US standards: when they are, bribes come from where?
Ottawa, Washington, World Bank, WTO, free traders
Who gives 0.7% of GNP? Myths, truth, & omissions
$57.5: given by the EU’s 20 most developed countries$22.74: given by USA with about the same population
US aid goes mostly to nations it can use
Kuwait gives 8.2% of GNO, Saudi Arabia 4% in 2002Cuba may gives the highest % of GNP. China & India??
Myth:In absolute terms the USA gives more than anyone else
Truth:
Omissions:
CorruptionThe truth: NAm politicians, police?Very few African leaders are corrupt by
(say) ... NAm standards.
Who’s rips them off? Company who pays bribe? CIA that props up a puppet government? Local brokers who take the bribes?
A country is oil rich; its people are hungry
Surely all are the enemies of the Nigerian people!
Roadblocks to a world without hunger
The big lie: “Aid doesn’t work”20 nations pledged 1974 to donate 0.7% of GNP
to Aid. “No benefit! 1 billion are still starving”
4 nations did meet pledge: 800m now starving
Truth: can you guess?
was 1600m ⇒ 800m spared!!
Only 4 nations delivered!
22 renewed pledge 2001 Broke it again in 2002
US pays < ¼ of promise
Canada < ½Well done?
To a few: “well done”. To many: “800m still to go”
Page 44
http://go.worldbank.org/K7LWQUT9L0
Predicted progress - % of people living in poverty
Is the situation hopeless? Let’s see …
Page 45
Extreme poverty is decreasing, worldwide. Failures in the Sahel are outweighed by successes in Asia - Africa needs attention
MDGs will mostly be mostly met - not in the promised time frame; unless NAm & EU follow through on their commitments
• Only 4 countries give the 0.7% of GDP agreed to in 1970. Denmark, Norway, Netherlands, Sweden
“Does development aid do more harm than good?” Only, if wrongly delivered - We know what works & doesn’t
• Science, not polemics or ideologies point the wayArgument about strategies is counter-productive. The situation
demands multiple approaches!
Page 46
Nutrition in Global Health:Roadmap to a world without
hunger
1. Understanding the problem (else can’t solve)2. Myths as roadblocks to making hunger history3. How we will make hunger history – 6 initiatives4. What will we / should we choose?
Where do we choose to go from here?
Page 47
What the future holds depends on who you talk to!What options we have for the future, what we are
choosing, what works and what doesn’t ...... these topics will take up most of Module 41b
The next few slides will provide a preview.• Some see the MDGs as viable & forsee dramatic
decreases in poverty, hunger, & the burden of disease • Others write off the developing world as doomed, by
corrupt dictators, HIV, and civil warsLet’s see what those who follow the evidence agree on
Food prospects in an uncertain economic future
Page 48
The World Bank report Dec 2008: Food Crisis - Global Economic Prospects 2009http://www.worldbank.org/html/extdr/foodprices/
• Food production is likely to maintain pace with demand over the next few years.
• While the economic collapse can diminish demand for fuels (thus moderating prices), people still have to eat, and there will be no decrease in demand for, or the price of, food.
• The price of foods will devastate those who currently cannot afford even a minimally adequate diet.
• As LMICs strengthen their economies, consumption of foods increases most in poorer countries: by 6% vs 1 or 2% in the rich.
• As oil prices rise above $50 per barrel, it becomes increasingly profitable to convert food to fuel. Fuel costs impact food costs
• Climate change, too has an unsettling effect.
Factors limiting future food availability
Page 49
Increasing cost-burden of food & food production• New priorities for spending - the war on terrorism • Resource depletion - increasing energy costs• Increasing cost of oil - chemical fertilizers, food diverted to fuel• Globalization & the increasing power of the food conglomerates • The global economic melt-down; differential impact on the poorPreoccupation of rich nations with their own problems• Debt crisis & borrowing by the rich countries → inflation• Printing money → inflation• Mega-dollars spent on the war on terror• Decreased government revenues → increased taxes
All these lead to revocation of previous aid promises Uncertainties around climate change & many others
War and instability are incompatible with good nutrition
Page 50
“The U.S. has just established a new military command in Africa, declaring Africa to pose new security threats to the U.S. But even as the U.S. spends more than $600 billion on the military, and even as U.S. counterinsurgency forces spread out across the impoverished stretches of the Sahel, the U.S. will never achieve peace if it continues to spend less than one hundredth of the military budget on Africa's economic development. An army can never pacify a hungry, disease ridden, and impoverished population”.
Economic Solidarity for a Crowded Planet2007 Reith Lectures Jeffrey Sachs
Hunger is incompatible with peace
Page 51
“I firmly believe that we can create a poverty-free world if we collectively believe in it. In a poverty-free world, the only place you would be able to see poverty is in the poverty museums. When school children take a tour of the poverty museums, they would be horrified to see the misery and indignity that some human beings had to go through. They would blame their forefathers for tolerating this inhuman condition, which existed for so long, for so many people”. Muhammad Yunus Nobel Prize address 2006
Poverty is a Threat to Peace
Harbingers of change ...
Page 52
... new credible voices call for a better world• Philanthropists: Bill Gates, Warren Buffet, George Soros &c• Microcredit: Muhammad Yunus (Nobel Prize 2006), Danone• Writers who speak for the dispossessed: Chang, Clapp, Collier,
Curtis, Lappe, Maxwell, Naidoo, Patel, Sachs, Stiglitz, others • Young people: Two new graduate programs in Global Health in
Canada, received over 1500 applicants from all over the world. • From direct contact, the students were spectacular: brilliant, well
prepared, strongly motivated to become agents of change• Zinn’s Global Values 101 discovered a similar enthusiasm• Social Business: Beyond belief, the Grameen wellspring of
innovation, hope, & faith in humanity towers above all
We now know what works & what doesn’t
Page 53
• All nations agreed to accept & work toward the Millennium Development Goals for the elimination of poverty
• An unrestrained marketplace has failed to bring prosperity to either rich or poor countries
• Strident voices allege that aid does no good. However, the problems with misdirected aid are easily overcome
Unless we alleviate hunger, we cannot create a world without unrest. Neither can we pacify the hungry for long with bombs
Kinds of aid that don’t work
Page 54
http://www.starvedforattention.org/#/stories/usa
To see an example of wasteful government aid, view on the MSF website:
(start from part 2, half-way through the video)
Page 55
Nutrition in Global Health:Roadmap to a world without
hunger
1. Understanding the problem (else can’t solve)2. Myths as roadblocks to making hunger history3. How we will make hunger history – 6 initiatives4. Wild-cards and unknowns
A vicious cycle for malnutritionpoverty, health, economic deprivation
Page 56
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.AfricaNigeria, Iraq
Lesotho
Being on a trade or pipeline route ...
Zimbabwe [USA]
Sudan, Afghanistan
Sahel, Palestine
Blaming the bonsai tree...
Yunus:
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 nations
We 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 59
The poorest - don’t give them moneyJeffrey Sachs
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
Page 60oral rehydration solution
ready to use foodsMillions saved
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
Innovations that makes a difference
Grameen family of social enterprises
The Kings of Philanthropy
The Millennium Village project
Influential voices for change …
Scientists & students who are making a difference
The Millennium Development Goals
You! ...
$7 can deliver an insecticide treated mosquito net
Don’t believe 1 person can make a difference …
MGH students
Web resources & GHEC
Social enterprises for those who are surviving – Grameen family
Grameen family of Social Businesses
1 Grameen Community Development Bank for the poor (p)2 Grameen Trust (np) 37 countries 3 Grameen Fund (np) Risk capital for small-med business4 Grameen Telecom (np) poor to profit from a cell phone5 Grameen Phone (p) 50% of all telephones in Bangladesh6 Grameen Solutions (p) fast-growing software company7 Grameen Communicns (np) soft & hardware networking8 Grameen Fish & Livestock (np) village aquaculture & dairy9 Grameen Shakti (np) renewable energy in remote regions10 Grameen Shikkha (np) educational loans literacy & tech11 Grameen Byabosa Bikash (np) supp for microcredit12 Grameen Danone Foods (p&np) nutritious food near cost13 Grameen America (p) alleviate poverty in working poor
http://en.wikipedia.org/wiki/Grameen_family_of_organizations
http://www.grameenfoundation.org/Bangladesh rocks
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
Grameen Impact
http://www.grameenfoundation.org/our-impact
9.4 million poor have been helped1,000,000 microloans have been generated
http://www.youtube.com/watch?v=1UugpcDjjJU
http://www.youtube.com/watch?v=kW-4gJmXy5M
Page 68
Nutrition in Global Health:Roadmap to a world without
hunger1. Understanding the problem (else can’t solve)2. Myths & lies: roadblocks to making hunger history3. The roots of hunger4. How we will make hunger history – 6 initiatives5. New tools that are changing the world6. Indicators of progress7. Wild-cards and unknowns
Innovations that make a difference
Barefoot agriculturistsSoil conservation, don’t burncontour farming, irrigation, crop rotationDrip irrigation
Pump installation
Burkina Faso: planting-pits & stone furrows land food for 500,000
Phillipines: Tilapia in protein for 30,000,000
China: Hybrid rice in – enough for 60,000,000
Bangladesh: Market liberalization in rice yield 3x
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 difference
Grameen Family of social enterprisesThe Kings of Philanthropy & 100s of foundations
The Millennium Village project
Influential voices for change
Scientists & students are making a difference
The Millennium Development Goals – for the poorest
You! ...amplify with others @ SFU &?
Vote
Speak, write, telephone
International internship
Donate
Live
against 99.7% of tax on ourselves
Oxfam, IDRF (Can Revenue charities)
to leave enough for everyone
consider study abroad
What kinds of aid don’t work?
Aid designed to benefit the donor, not the recipient
Not billions given to buy favours
Vandana Shiva
Read /google J Perkins “Confessions of an economic hit-man”
... donor countries insist that recipient open their markets
... farmers in all rich countries lobby for barriers
... food must be bought, processed, shipped by donor
WTO? IMF? World bank?
... food aid 1950s surplus dumping
... who speak from a dogmatic ideology ...
... with a strong self-interest
... with history of lying, bribing, or cheating
How to tell who’s lying to you ...
follow the money
... who’s generosity extends only to their borders ...
... who allow no voice for the dispossessed
small ears
... who can’t admit a mistake
... who can’t accept that there are multiple paths ...
professors
Canada
Be suspicious of those ...
They’re not all lying - maybe it’s 5 blind men & an elephant
Don’t expect to agree with any one person
Keep an open mind: free enterprise, free trade, GM seeds, globalization
birth control / condoms? ...
Yunus
... look for common good
... look for unbiased datanext slide
Pitfalls problems & roadblocks•Financial melt-down
•National scale land purchases•Food fuel ...•War on terror ...•Nations in crippling debt to IMF & World Bank
•Unfair trade practices•Climate change•Globalization of food economics•Clean water & air have become commodities
Vandana Shiva on globalization
Vandana Shiva on Food Laws
Diverts development & aid $ Increases the price of foods
Also displaced persons & Destroys the local economy
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
Long term village needstools for sustainable development
Health & perinatal services
Dispensary & emergency nurse within 7 miles
Hospital within 50 miles
Transport system
Bicycle or motor-cycle ambulance
Every village has a cell phone, & very truck-driver
Steady-ish progress toward MDGs
Page 80
Goal Sub-targets likely to be achieved
Action still needed
1. Eradicate extreme poverty & hunger
reduce poverty by ½ developing countries’ export earnings devoted to servicing external debt fell by ~50%
Eradicate hunger: ½ those in sub-Saharan Africa may still live on < $1/d; ¼ of all children are underweight. Fairer trade unlikely
2 Universal primary education
Primary school enrolment of at least 90%
Promising progress
3 Promote gender equality, empower women
The gender parity index in primary education > 95%
Of 113 countries 18 may achieve parity in 2o ed; Parity in employment & politics seems unlikely
4 Reduce child mortality
Measles deaths 89% of children receive vaccinations
Child mortality has dropped by ½ but still too high
5 maternal health Some progress, 500,000 pregnant women still die of complications
6 infectious disease & safe water
Malaria prevention tripled, AIDS: deaths new infections, tuberculosis 1.6b people have gained access to safe drinking water
Some 2.5 billion people, ½ developing world, live without approved sanitation
7 Global partnership for development
Unprecedented verbal agreement & generous promises
In reality, aid expenditures declined for 2 years. Few meet 0.7% of GNP
Only goal #2 is fully within reach!At half-way, most MDGs are partly met.
Who gives 0.7% of GNP? Myths, truth, & omissions
$57.5: given by the EU’s 20 most developed countries$22.74: given by USA with about the same population
US aid goes mostly to nations it can use militarily
Kuwait gives 8.2% of GNO, Saudi Arabia 4% in 2002Cuba may give the highest % of GNP. China & India??
Myth:“In absolute terms the USA gives more than anyone else”
Truth:
Omissions: Canada is in bottom 1/4 of rich nations
Web links to a world without hunger
Clinton Global Initiative
Bill & Melinda Gates Foundation
Grameen Family of Social Businesses
Millennium Village Project (WHO, UN, Jeffrey Sachs)
Official Development Aid
The Cuba, China model for bootstrap development
University Global Health initiatives
http://www.clintonglobalinitiative.org
http://www.gatesfoundation.org/Pages/home.aspx
http://en.wikipedia.org/wiki/Grameen_family_of_organizations
http://www.unmillenniumproject.org/
Sweden, Luxenbourg, Norway, Netherlands, Denmark
spreading in Africa, Latin America, Middle East
Spreading in Latin America, Africa, USA, Australia, Canada, Switzerland – through student power, and top administration, not ...
Population growth & nutrition
World population growth
World under 5 mortality
Google Public Data (from World Bank)A new tool to learn what’s happening
Wildcards and unknowns
Page 84
Economic meltdown; will it bring more sympathy & help for the hungry, or less when demand for food is increasing?
Will the richest continue to redirect development aid to spreading a “war on terror”? The worlds richest nation now has a president with vision. Will he be allowed to “change”?
In Africa, for whatever reasons, most nations are turning to China. Will they be made the theatre for a new cold war?
Will the eastern nations, on whom the sun is now rising, be better global corporate citizens than those who went before?
Cuba has done a spectacular job in providing excellent nutritional health for itself & others. Will we use its example?
Climate change, will we find a fairer globalization, trade barriers
China & India - future role in development 1 of 3
Page 85
In the ensuing 50 years, the combined GDP of two Asian countries will likely be more than double the total of their nearest 3 rivals. Clearly that has implications for development aid & relief of hunger, particularly in Africa
China & India - future role in development 1 of 3
Page 86
The situation in complex, & only hindsight is 20-20Nevertheless, the present & its prevailing trends are clear China has been forthright in its motives – to develop good relations with resource-rich Africa, & to take advantage of political and strategic blunders of its rivals on that continentIn the economic climate prevailing in 2009 African economies are in strong decline. Simultaneously OECD investment is decreasing
Chinese investment, aid, and loans have been increasing dramatically since 200
Hope for Africa ... from China & Indiaaccording to the Government of Canada
Page 87
Mr. Obhrai insisted that the government understands Canada's obligations in this regard and is committed to increasing ODA. He thought it more useful to focus on dollar values than ODA percentages. He empha-sized that Canadian ODA is going up and now totals $4.4 billion, “a lot of money," he pointed out. It is twice what Canada was spending a few years ago andrepresents an extremely strong commitment by this government to development assistance. A more important question, Mr. Obhrai suggested, is how this money is being spent. Aid has to be effective and, to this end, the government is narrowing its focus from 107 to 25 countries. Unfortunately, recipient countries do not always have the capacity to absorb the money available. There is no lack of money, especially now that China and India have joined the ODA game; the challenge is to make effective use of it. India and China have already succeeded in moving large numbers of people out of poverty and this is what will happen in Africa. Mr. Obhrai underlined the necessity of investing in capacity to make a difference. The Gov-ernment has significantly increased spending in defence and development with a view to Canada reassuming its position of leadership in the world.
There has seldom been a more pivotal time
Page 88
An upwelling of energy for action
Review your pre-quiz to confirm that you have advanced your knowledge.
As we move now to think of the future, here is part of the pre-quiz for
module 41b
Page 89
Does globalization promote nutritional health? For whom?Is free enterprize good for everyone? If not, for whom?Are African leaders dictators?Does most aid to Africa end up in their Swiss bank accounts?Does food aid do more harm than good?
Academics argue fiercely about what should be done. Does that mean that we don’t know what to do?
Page 90Page 90
Summary: What you’ve learned & its applicationsNutritional health is not equitably distributed worldwide
Correcting nutritional inequities is crucial to a viable futureWe've reviewed nutritional principles in global context
Nutritional health, public health, & economics are inseparableWorst nutritional risks: water, protein, iron, vitamin A, iodine.
This helps us know what to look for and what to recommendAcross the life cycle, kids & mothers are at greatest risk
So we know priorities & best practices for risk mitigationWe have seen setbacks, slow progress toward the MDGs
We have substantial agreement about what needs to be doneWe see powerful signs of hope: fortunes given away, crazy ideas, lending money to the poorest & getting it back, fresh voices We join those working for a better world with new clarity & energy
Innovations that make a difference
Barefoot agriculturistsSoil conservation, don’t burncontour farming, irrigation, crop rotationDrip irrigation
Pump installation
Burkina Faso: planting-pits & stone furrows land food for 500,000
Phillipines: Tilapia in protein for 30,000,000
China: Hybrid rice in – enough for 60,000,000
Bangladesh: Market liberalization in rice yield 3x
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 difference
Grameen Family of social enterprisesThe Kings of Philanthropy & 100s of foundations
The Millennium Village project
Influential voices for change
Scientists & students are making a difference
The Millennium Development Goals – for the poorest
You! ...amplify with others @ SFU &?
Vote
Speak, write, telephone
International internship
Donate
Live
against 99.7% of tax on ourselves
Oxfam, IDRF (Can Revenue charities)
to leave enough for everyone
consider study abroad
What kinds of aid don’t work?
Aid designed to benefit the donor, not the recipient
Not billions given to buy favours
Vandana Shiva
Read /google J Perkins “Confessions of an economic hit-man”
... donor countries insist that recipient open their markets
... farmers in all rich countries lobby for barriers
... food must be bought, processed, shipped by donor
WTO? IMF? World bank?
... food aid 1950s surplus dumping
... who speak from a dogmatic ideology ...
... with a strong self-interest
... with history of lying, bribing, or cheating
How to tell who’s lying to you ...
follow the money
... who’s generosity extends only to their borders ...
... who allow no voice for the dispossessed
small ears
... who can’t admit a mistake
... who can’t accept that there are multiple paths ...
professors
Canada
Be suspicious of those ...
They’re not all lying - maybe it’s 5 blind men & an elephant
Don’t expect to agree with any one person
Keep an open mind: free enterprise, free trade, GM seeds, globalization
birth control / condoms? ...
Yunus
... look for common good
... look for unbiased datanext slide
Pitfalls problems & roadblocks•Financial melt-down
•National scale land purchases•Food fuel ...•War on terror ...•Nations in crippling debt to IMF & World Bank
•Unfair trade practices•Climate change•Globalization of food economics•Clean water & air have become commodities
Vandana Shiva on globalization
Vandana Shiva on Food Laws
Diverts development & aid $ Increases the price of foods
Also displaced persons & Destroys the local economy
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
Long term village needstools for sustainable development
Health & perinatal services
Dispensary & emergency nurse within 7 miles
Hospital within 50 miles
Transport system
Bicycle or motor-cycle ambulance
Every village has a cell phone, & very truck-driver
Steady-ish progress toward MDGs
Page 102
Goal Sub-targets likely to be achieved
Action still needed
1. Eradicate extreme poverty & hunger
reduce poverty by ½ developing countries’ export earnings devoted to servicing external debt fell by ~50%
Eradicate hunger: ½ those in sub-Saharan Africa may still live on < $1/d; ¼ of all children are underweight. Fairer trade unlikely
2 Universal primary education
Primary school enrolment of at least 90%
Promising progress
3 Promote gender equality, empower women
The gender parity index in primary education > 95%
Of 113 countries 18 may achieve parity in 2o ed; Parity in employment & politics seems unlikely
4 Reduce child mortality
Measles deaths 89% of children receive vaccinations
Child mortality has dropped by ½ but still too high
5 maternal health Some progress, 500,000 pregnant women still die of complications
6 infectious disease & safe water
Malaria prevention tripled, AIDS: deaths new infections, tuberculosis 1.6b people have gained access to safe drinking water
Some 2.5 billion people, ½ developing world, live without approved sanitation
7 Global partnership for development
Unprecedented verbal agreement & generous promises
In reality, aid expenditures declined for 2 years. Few meet 0.7% of GNP
Only goal #2 is fully within reach!At half-way, most MDGs are partly met.
Who gives 0.7% of GNP? Myths, truth, & omissions
$57.5: given by the EU’s 20 most developed countries$22.74: given by USA with about the same population
US aid goes mostly to nations it can use militarily
Kuwait gives 8.2% of GNO, Saudi Arabia 4% in 2002Cuba may give the highest % of GNP. China & India??
Myth:“In absolute terms the USA gives more than anyone else”
Truth:
Omissions: Canada is in bottom 1/4 of rich nations
Myth: Aid isn’t workingTrade for profit instead
Trade barriers. Fair trade & aid
Population outstrips food supply
… we give more than anyone!
Trillions wasted! - 1 b still starving
MDGs won’t be achieved
Most aid corrupt dictators Corrupt multinationals
2008 recession
Never promised 0.7% and anyway …
“Trade not aid”
Broken promises
Malthus is wrong
104
V little is wasted
½ what EU gives!
Truth: Profit motive doesn’t work -
sustainable development aid
works
“They” didn’t cause it
You did so!
Worl
d G
DP
$P
PP
per
cap
(e
st)
15
00
-21
00
1500 2000$0
$5,000
$10,000
India to 1500
China + Indiato 1850
WesternEuropeto 1945
USA + WestEurope
since 1945
http://ers.usda.gov/Data/Macroeconomics/
Manifest destiny of world - wealth
China +India 2040?
105
Number of malnourished world-wide
1061970 1980 1990 2000 20100
100
200
300
400
500
600
700
800
900
1000M
illio
ns
un
der
-no
uri
shed
(FA
O k
cal /
ho
use
ho
ld)
FAO data
water-carrier
See also: WHO, UN, WB, USDA, CIA, OECD, IFPRI
UNICEF 2009
http://www.unicef.org/media/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf
kcal per household surveyed
World% undernourished
1071970 1980 1990 2000 201015
33%
17%same data
22%
14%
1970 2010 2015 target 2030 FAO est
0
2000
4000
6000
8000Fed
Malnourished
Number fed & under-nourished worldwide
108
14%
Prediction
6%11%
Target
33%
108
108
millions
109
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%
Africa
Asia
Latin Am
Last 2 or 3 points are projections
1980 & every 5 years
110
http://www.who.int/mediacentre/factsheets/fs290/en/index.html
http://www.fao.org/mdg/en/http://www.un.org/millenniumgoals/reports.shtml#mdgs
Number stunted
200m
100m
0
Africa
Asia
Latin Am
1980 & every 5 years
111
Paying for total strangers to eat?
Not us, not if it goes to corrupt
dictators” }
111
112
http://www.globalissues.org/article/35/foreign-aid-development-assistance#GovernmentsCuttingBackonPromisedResponsibilities
“Development aid”, not spent on poverty or development
Lost to: InefficiencyUnfair tradeEmergency aid RefugeesTied to benefit rich & Debt relief
“Phantom aid”, the wasted 47%
Refers toODA, not
MDGs
Real aid53%
Corrupt Dictators? Rich...
Series1
-600
-400
-200
0
200
400
600
Accept “bribes” to give trade concessions that impoverish their people
Accept personal & campaign “contributions” peddling influence. Could stop bribery at home & abroad by abolishing secret a/c
... & Poor
113
100s
bu
reau
crat
s
200s
MN
Cs
10s
corr
up
t d
icta
tors
1000
s p
resi
den
ts,
PM
s, b
ure
aucr
ats
in r
ich
wikipedia Lockheed
SwissAir
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 ...114
• 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
115
www.sfu.ca/global-nutrition
116
Passionate renegades
116
Web links to a world without hunger
Clinton Global Initiative
Bill & Melinda Gates Foundation
Grameen Family of Social Businesses
Millennium Village Project (WHO, UN, Jeffrey Sachs)
Official Development Aid
The Cuba, China model for bootstrap development
University Global Health initiatives
http://www.clintonglobalinitiative.org
http://www.gatesfoundation.org/Pages/home.aspx
http://en.wikipedia.org/wiki/Grameen_family_of_organizations
http://www.unmillenniumproject.org/
Sweden, Luxenbourg, Norway, Netherlands, Denmark
spreading in Africa, Latin America, Middle East
Spreading in Latin America, Africa, USA, Australia, Canada, Switzerland – through student power, and top administration, not ...
Population growth & nutrition
World population growth
World under 5 mortality
Google Public Data (from World Bank)A new tool to learn what’s happening
Page 120
Credits
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