| ESSAYS
ON FOOD, NUTRITION, HEALTH CARE AND DEVELOPMENT
Claudio Schuftan MD
[All these essays are available free of
charge from the author at
, Fax: 84 4 9710802, or IPO Box 369, Hanoi, Vietnam].
Titles and Table of Contents:
1. THE CAUSES OF HUNGER AND
MALNUTRITION: MACRO AND MICRO DETERMINANTS
Macro and micro causes
of malnutrition
Diagnosing the causes
of hunger and malnutrition
Proposing solutions
The role of ideology
A critical look at
nutrition planning
Working with the
community
2. TECHNICAL, ETHICAL AND IDEOLOGICAL
RESPONSIBILITIES IN NUTRITION
Introduction
Science: Its political,
ideological and ethical implications
The scientist as a
promoter of status quo or social change
Economic power,
political power and poverty
Where do liberal food
and nutrition workers stand_
A critical look at our
profession and ourselves
The future challenge
3. DE-WESTERNIZING HEALTH PLANNING AND
HEALTH CARE DELIVERY:A POLITICAL PERSPECTIVE
Understanding the roots
of the problem: Western medicine and its hierarchy:
The participation
issue:
Decentralization
Steps towards
de-westernization
4. BOOK REVIEW:
Susan George. A FATE WORSE THAN
DEBT: A RADICAL NEW ANALYSIS OF THE THIRD WORLD DEBT CRISIS (OR, THE
WORLD FINANCIAL CRISIS AND THE POOR)
5. VIEWPOINT - ETHICS, IDEOLOGY AND
NUTRITION
Ethos
Ideology
Liberals
Radicals
Political naivete_
Social consciousness
What can I do_
Tool
Establish links
6. ETHICS AND IDEOLOGY IN THE BATTLE
AGAINST MALNUTRITION
How is our ethos
formed_
How is ideology formed_
Liberals and radicals -
a typology
How relevant is our
work_
Are we politically
naif_
Are we afraid of
speaking-up in political terms_
Nutritionists in the
Third World
A new direction_ - Some
possible conclusions
An attempt to know who
we are
7. THE CHALLENGE OF FEEDING THE
PEOPLE:CHILE UNDER ALLENDE AND TANZANIA UNDER NYERERE
The conceptualization
of malnutrition as a problem and its effects on nutrition policy
formulation: A review of the literature
The challenge of
feeding the people: How it has been addressed
Nutrition intervention
in Chile and Tanzania: Two perspectives of a shared commitment
Tanzania and Chile: A
review in perspective
8. THE ROLE OF HEALTH AND NUTRITION IN
DEVELOPMENT
The role of health and nutrition in
development
Capacity of the current system to
alleviate hunger and malnutrition
9. MULTIDISCIPLINARITY, PARADIGMS AND
IDEOLOGY IN DEVELOPMENT WORK
Setting the focus
An attempt to define the concepts
A development paradigm_
A missing paradigm in our analysis_
Paradigms and the ruling elite
Multidisciplinarity
The role of conceptual frameworks
Ideology
Ideology and legitimacy
Ethos and norms
Conflicts in the terminology_
Subjectivity of the sciences
The social and the classical sciences
in development work
Science and its environment – The
real world around us
Does a universality and pluralism of
theories exist that makes multidisciplinary work realistic_
Transcending narrow paradigms
Crisis - The battle of
the paradigms
The dilemmas in choosing new paradigms
Who are the real innovators_
Tackling the causes of maldevelopment
A critical look at what we do
The limits of traditional development
project evaluation
"We should" -
Our inherent obligations and the challenges ahead
Conclusions
10. SURVEY ON ATTITUDES TO NUTRITION
PLANNING
11. "HOUSEHOLD PURCHASING-POWER
DEFICIT" – A MORE OPERATIONAL; INDICATOR TO EXPRESS MALNUTRITION
The indicator
Uses and potential abuses of the
proposed indicator
Income generation
Income redistribution
Food consumption subsidies –
rationing systems
Conclusions
12. FOREIGN AID AND ITS ROLE IN
MAINTAINING THE EXPLOITATION OF THE AGRICULTURAL SECTOR:EVIDENCE FROM A
CASE STUDY IN AFRICA
Evidence of the
exploitation: A preamble and five exhibits
Sources, uses, and
sectoral distribution of foreign aid: A preamble and four exhibits
Putting it all
together: A final balance sheet
Postscript
13. LOW SCHOOL PERFORMANCE:MALNUTRITION
OR CULTURAL DEPRIVATION_
14. HUNGER AND MALNUTRITION:OUTLOOK FOR
CHANGES IN THE THIRD WORLD
15. VIEWPOINT: NUTRITION PLANNING -
WHAT RELEVANCE TO HUNGER_
The general issues
North-South conflict
The response of the rich
Aid and funding agencies
The international bureaucracy
The basic questions
The planners and the people
Research
A Third World perspective.
16. ROSALIA, a poem by ORLANDO LEON
17. THE POLITICAL ECONOMY
OF ILL HEALTH AND MALNUTRITION.
The situation: The
macro and micro levels
The actors:
institutions, social groups and individuals
The methods and
solutions
Epilog
18. COMMENTARY - THE MARKETS
OF HUNGER: QUESTIONING FOOD AID (Non-emergency/Long-term)
Introduction
The politics of food
aid: in the donor countries – in the recipient countries
Not just any kind of
aid
Concluding remarks
19. ACTIVISM TO FACE WORLD HUNGER:
EXPLORING NEW NEEDED COMMITMENTS
The problem(s) of hunger and its
(their) solutions
Looking at ourselves and the other
actors in the battle against hunger and malnutrition (individuals,
institutions and social groups)
Organizing ourselves and
others(participation. Raising political consciousness, mobilization and
consolidation of movements)
Keeping our eyes open and constantly
learning more about the issues at stake
Speaking up!
20. THE CHILD SURVIVAL REVOLUTION: A
CRITIQUE or HEALTH
STILL ONLY FOR SOME BY THE YEAR 2000_
Background
The key questions
Do people have choices_
A critical look at GOBI and the Child
Survival Revolution
The efficiency of GOBI
The implementation of GOBI
Health still only for some by the year
2000_
21. DEVELOPMENT NEMESIS
or BEYOND MALDEVELOPMENT IN
AFRICA
PART ONE: Development
and today's reality
Introduction
Western development past and present
A critique of outdated development
theories
Third World development as seen by the
North
The oversold technological approach in
Western development
Myth and reality in development
ideology, paradigms and models
Ideology and development models
Paradigms and new theories
The irrelevance of current development
studies
The myth of objectivity and of
apoliticism
The issue of social power
Epilogue to part I
PART TWO: The actors
and the future of development - The era of empowerment
Introduction
The actors in today’s development
drama (or rather farce_…)
From liberals to progressives: a
typology of modern secular missionaries and development workers
Liberal beliefs
Liberals and development
Liberals and ethics
Liberals and politics
What liberals need to – the normative
dimension
The non-actors in today’s development
Issues on participation
Genuine participation: what it is and
what it isn’t
A liberating participation: why needed_
Participation: what it takes
Internal organization for participation
Participation: The future
Development: The future
What is needed to overcome stale Third
World development policies: a fresh (or not so fresh…) set of
prescriptions
The need for a more critical and
visionary attitude
Paradigms and science: the needed
breakthroughs
Politics, ideology and new global
values: the keys to unlock underdevelopment
Epilogue to part 2
22. LOOKING BEYOND THE DOABLE:
RESOLUTIONS FOR A NEW DEVELOPMENT DECADE
23. EGOS/ALTER EGOS OF THE MAIN ACTORS
IN DEVELOPMENT PROJECTS
The "expert"
The consultancy's
management
The donor agency
officer
The civil servant
24. POSITIVE DEVIANCE IN CHILD
NUTRITION: A DISCUSSION
Positive deviance in context
Positive deviance: the difference
between coping and adapting
Positive deviance in situations of
failure to thrive as opposed to situations of hunger and malnutrition
Positive deviance and poverty
Gaining weight by behaving in a
positively deviant manner
What is behind positive deviant
attitudes_
Conclusion
25. THE PROJECT APPROACH IN DEVELOPMENT
ASSISTANCE
26. TRIAGE MANAGEMENT IN THIRD WORLD
HEALTH MINISTRIES
27. ON BEHALF OF THE AFRICAN CHILD:
CHALLENGES AND WINDOWS OF OPPORTUNITY FOR THE DONOR COMMUNITY
The nine panels
Windows of opportunity
Challenges
1. The empowerment factor
2. A national commitment to health and
nutrition: Does everything start with a sound causal analysis_
3. Breaking out of the poverty cycle
4. An enhanced role for the caring of
children
5. The right to know
6. The population/PHC/nutrition link
7. Never be sorry to be too late
8. Pressures imposed to address the
economy: Do the people matter_
9. Other factors to reckon with in the
90s
28. THE HOUSEHOLD ENTITLEMENTS
REVOLUTION, OR A WOMEN-CENTERED APPROACH TO FAMILY SECURITY
29. BRAVE NEW WORLD: A POLITICAL
PENDULUM IN SEARCH OF ITS BALANCE
30. MALNUTRITION AND INCOME: ARE WE
BEING MISLED_ (A
DISSENTING VIEW WITH A CONFUSING LITERATURE)
The issue of
malnutrition and income as presented in the literature
The thesis: (A
counter-argument)
What to do then_
31. A PATH FOR THE 1990s_:
GOVERNMENT-DONOR PARTNERSHIP TO FINANCE PHC IN THE THIRD WORLD
32. DOWNSIZING THE CIVIL SERVICE IN
DEVELOPING COUNTRIES:THE GOLDEN HANDSHAKE OPTION REVISITED
Setting the empirical and conceptual
scene
Why downsize_
Why a golden handshake_
Possible new approaches and their
limitations
How much to downsize_ Determining the
magnitude of the downsizing
How to downsize_
To set preconditions or not
What to do with the wages saved from
downsizing_
The Kenya example
The golden handshake: a grant or a loan
to departing civil servants_
To give incentives or to dismiss
Other implementation issues
How to redeploy public servants to the
private sector_
Conclusions
33. THE WORLD DECLARATION ON NUTRITION
AND THE 1992 INTERNATIONAL CONFERENCE ON NUTRITION (ICN) PLAN OF ACTION:
THE CUTTING EDGE OF CONVENTIONAL THINKING
Do international conferences solve
world problems_
Do international declarations change
the course of history_
Do international conferences overlap in
their purposes_
Do international conferences bring out
the best in the process of their preparation_
Where are we left after ICN_
34. INCOME GENERATION
ACTIVITIES FOR WOMEN,THE NINTH ESSENTIAL ELEMENT
OF PRIMARY HEALTH CARE_: AN IDEA WHOSE
TIME HAS COME!
35. SOME REFLECTIONS ON ACC/SCN'S
"HOW NUTRITION IMPROVES"
36. NUTRITIONAL GOALS FOR THE
MID-NINETIES: A CALL FOR ADVOCACY AND ACTION
37. THE EMERGING SUSTAINABLE
DEVELOPMENT PARADIGM: A GLOBAL FORUM ON THE CUTTING EDGE OF PROGRESSIVE
THINKING
A development paradigm in need of
replacement
Windows of opportunity to take
advantage of (normative htmlects)
The three pillars of an emerging
sustainable development paradigm
Getting from the old to the new
paradigm
The time for consolidating a transition
is now!
Reevaluating the major development
objectives in the late 90s
Should social gains justify economic
sacrifice_
37 A. SUSTAINABLE DEVELOPMENT BEYOND
ETHICAL PRONOUNCEMENTS:THE ROLE OF CIVIL SOCIETY AND NETWORKING
The context
The background
What commitments are needed beyond
ethics_ From the normative to the operational in sustainable development
The primarily ethics-led process in
sustainable development
The primarily politically-led process
in sustainable development
Networking
Leadership
38. FOREIGN AID: GIVING
CONDITIONALITIES A GOOD NAME or
CONDITIONALITIES: THE LAUNCHING OF A
SOUTH-SOUTH COUNTER-OFFENSIVE
39. THE COMMUNITY DEVELOPMENT DILEMMA:
WHEN ARE SERVICE DELIVERY, CAPACITY BUILDING, ADVOCACY AND SOCIAL
MOBILISATION REALLY EMPOWERING_
In
service delivery, empowering means…
In capacity building, empowering means…
In advocacy, empowering means…
In social mobilization, empowering
means…
40. DEVELOPMENT IN THE MID 1990S:
REFLECTIONS OF AN OLD SOCIALIST
41. BOOK REVIEW: D. Werner, D. Sanders,
et al -- QUESTIONING THE SOLUTION:
THE POLITICS OF PRIMARY HEALTH CARE AND
CHILD SURVIVAL with an in-depth critique of oral rehydration therapy
42. EQUITY IN HEALTH AND NUTRITION AND
THE GLOBALIZATION OF THE WORLD’S ECONOMY
43. THE DIFFERENT CHALLENGES IN
COMBATING MICRONUTRIENT DEFICIENCIES AND COMBATING PROTEIN ENERGY
MALNUTRITION or THE
GAP BETWEEN NUTRITION ENGINEERS AND NUTRITION ACTIVISTS
43 A. MICRONUTRIENT DEFICIENCIES AND
PROTEIN-ENERGY MALNUTRITION
44. NORTHERN-LED DEVELOPMENT: IS IT
SELLING TECHNICAL FIXES TO SOLVE THE PROBLEMS OF ILL-HEALTH AND
MALNUTRITION_
The foreign aid scenario under a
technical fix approach
Endnote
45. ACTIONS AND ACTIVISM IN FOSTERING
GENUINE GRASSROOTS PARTICIPATION IN HEALTH AND NUTRITION
46. HEALTH, NUTRITION AND SUSTAINABLE
DEVELOPMENT.
The need for a more critical and
visionary attitude
Endnote
Pstscript
47. NEW PERSPECTIVES, OLD RISKS: OUR
NEED TO CHANGE AND TO RECONCEPTUALIZE or REEMPHASIZING THE NEED TO
TACKLE THE CAUSES OF POVERTY IN THE BATTLE AGAINST ILL-HEALTH AND
MALNUTRITION
48. HEALTH SECTOR REFORM MEASURES: ARE
THEY WORKING_…AND WHERE
DO WE GO FROM HERE_
Shortcomings of HSRs
So what would be more effective and
sustainable_
Equity oriented measures to be
implemented from the central level
49. ON DEVELOPMENT, THE
REAL WORLD, POWER GAMES AND THE UGLY FACES OF GREED
[Variations on a theme by the Danish writer Peter Hoeg].
50. SO WHAT... (IN SEARCH OF THE 'BIG
PICTURE' IN DEVELOPMENT)
51. CAN SIGNIFICANTLY GREATER EQUITY BE
ACHIEVED THROUGH TARGETING_: AN ESSAY ON POVERTY, EQUITY AND TARGETING
IN HEALTH AND NUTRITION
Poverty, equity and social justice
Equity and health for all
Equity, structural adjustment and
safety nets for the poor
Who are the poor and how do we find
them_
Equity and the public/private
allocation of resources
Avenues and dead-end streets to equity
Equity and targetry
Equity and participation
Equity an prepayment schemes
Equity and social security
Where to go from here_
52. GLOBALIZATION, OR
THE FABLE OF THE MONGOOSE AND THE SNAKE
Globalization and its negative
consequences
A dearth of workable solutions_
The equity/equality approach
The human rights approach
Bolder steps are needed
Three caveats
In closing
53. ELEMENTS FOR A
NUTRITION ACTIVISM COURSE AND CURRICULUM
54. THE ROLE OF HUMAN RIGHTS IN
POLITICIZING DEVELOPMENT ETHICS,
DEVELOPMENT ASSISTANCE AND DEVELOPMENT
PRAXIS
55. A LETTER TO THE STUDENT ERICA WHO
IS PLANNING TO SPECIALIZE
IN INTERNATIONAL NUTRITION
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