Global Nutrition Part 2

1. Global Nutrition Part 2 The ugly Where are we now? Stuffed & starved The good Where are we headed? The bad What works? How did we get here? Whatdoesn’t? It wasn’t an accident Can anything help? Most of you will see hunger in museums! Roadmap to a world without hunger

2. Roadmap to a world without hunger Who to ask what’s happening?Where are we now, really ? http://www.sfu.ca/global-nutrition What works & what doesn’t?

3. Evidence-based analysis & solutions • Questions that need qualifying • The 50% (actually 49.2%) is children that will require food-aid at some time during childhood • Pct % of people hungry is declining dramatically Who’s lying? Be deeply suspicious of follow the money • Those with a strong self interest ... • Those with history of lying or cheating • Those who speak from dogmatic idealism Keep an open mind: free enterprise, free trade, GM seeds, globalization? ... Yunus - yes if it helps the poor

4. When experts disagree ... • ... don’t expect to agree with anyone? • Do we believe in globalization? Look for common ground • Do we believe in free enterprise? • Do we believe in free trade? Be deeply suspicious of ... Follow the money • Those with a strong self interest • Those with history of bribery, lying, or cheating • Beware of those with small ears, ideologues, those who allow no voice for the dispossessed

5. What kinds of aid don’t work Teams of publish or perish “anthropologists” “Another needs assessment? … Look around. Ask people” “We have noticed that Americans have very tiny ears” ... ... & very large mouths. But we would prefer it to be the other way around Aid that designed to benefit the donor, not the recipient Advocates for the poor rate the World Bank, IMF, & WTO fail! Vandana Shiva Not billions given to buy loyalty of corrupt leaders

6. Who tilts the playing field ... We do: Our tax dollars, the leaders we elect Harper? Ignatieff? Layton? Development begins at independence Discovery of natural resources  impoverishment! Donor countries insist that recipient open their markets ... farmer’s lobby in rich countries get barriers Food must be bought from US farmers, processed in US mills, shipped in US ships WTO? World bank? Read: Confessions of an economic hit-man

7. The poorest of the poor Have resources worth less than $1 per day Jeffrey Sachs video If you give a cell phone, battery will run down! a significant fraction will be unable to stay alive they live mostly in isolated rural areas most are subsistence farmers what they eat this month is what they can take out of the ground from last month's planting who to call in an emergency? ... Page 7

8. Don’t give them money … Money? Useless • Unless one has seen remote villages, it’s hard to imagine a community without commerce • No shops to spend money in, no one to employ anyone, no one to sell things to • Hungry & stunted children are all too visible. Those who didn’t survive are in tiny unmarked graves • Hospital, dispensary, emergency services > 1 day walk Their needs are much more immediate than money. We don’t need studies to learn what they need - read on!

9. What’s more important than $? Everything Short term – need to survive emergency rations, safe water, first aid, antibiotics, public health – vaccinations, drugs, &cIn conflict zones, shelter, safety to live, plant, harvest Medium term - need is to become self-sufficient :good seeds, fertilizer, usable water, sanitation, low technology agricultural info & resources, drip-irrigation, mosquito nets, Page 9

10. Long term village needs tools for sustainable development health services, Dispensary pharmaceuticals, emergency nurse within 7 miles Hospital within 50 miles Transport system bicycle ambulance Every village has a cell phone, a motor-cycle Every truck-driver has a cell phone Kidsneed perinatal & long term nutritional support

11. Pitfalls problems & roadblocks Diverts development & aid $ Increases the price of foods • Financial melt-down • National scale land purchases • Food  fuel ... • War on terror ... • Nations in bondage to IMF debt • Unfair trade practices • Climate change • Globalization of food economics • Clean water & air have become commodities Also  displaced persons & Destroys the local economy Vandana Shiva on globalization Vandana Shiva on Food Laws

12. Routes to famine Being landlocked – no one to trade with ... Lesotho Discovering resources ... South Africa Being on a trade or pipeline route ... Afghanistan Bad governance ... Zimbabwe Armed conflict … Everywhere Uncertain rainfall & drought ... Sahel, Palestine Out of a tiny acorn the mighty oak doth grow ... ... or a tiny bonsai tree Let’s try to avoid blaming the victim, the people Yunus:

13. A vicious cycle: economics, hunger, health Poverty  diminished access to agricultural & food resources  malnutrition Physical & cognitive impairment, susceptibility to disease, early death  inability to earn an income nutrition Economic marginalization  inability to provide for self or family

14. Initiatives making a difference The Millennium Development Goals Grameen Family of social enterprises The Millennium Village project The Kings of Philanthropy Influential voices for change Scientists & students who are making a difference If you believe 1 person can’t make a difference, you’ve never been in a tent with a mosquito You! ... $7 can deliver an insecticide treated mosquito net MGH students

15. Innovations that make a difference Barefoot agiculturists Soil conservation, don’t burncontour farming, irrigation, crop rotation Pump installation Burkina Faso planting-pits & stone furrows  land food for 500,000 Tilapia in Phillipines for 30,000,000 Hybrid rice in China – enough for 60,000,000 Market liberalization in Bangladesh  rice yield 3x x Millions fed x Truck-drivers

16. Zero-tillage wheat-seeder drill - $100? Doubled yield  govt subsidy Farmer buys & rents to pay off 2 factories 100 in Haryana & Punjab Labour goes further. Earlier planting  yield 

18. Innovations that make a difference Appropriate technology Watering can irrigation $25 pump irrigates ½ acre  $100/y net sub-surface drip irrigation rainwater collection pits valve

19. The Millennium Development Goals • World’s nations committed to meet 8 goals by 2015 • The development challenges were identified • Specific actions & targets (the MDGs) • A pledge to provide the means was made by 189 nations & signed by 147 heads of state • The MDGs break down into: 21 quantifiable targets • with 60 time-lined indicators. Some of the richest now say they will not meet their commitments ... but those who keep faith &Arab states, Cuba, China &? will turn the tide

20. Nutrition & Millennium Development Goals Primary goal is to eradicate extreme poverty & hunger  Gender equity Empower ♀ see next 2 slides Achieve universalprimary education 1 HIV, malaria, other diseases  Child mortality  Environmentalsustainability Global partnershipfor development Nutrition – direct prerequisite to goals 1, 3, 4, 5 & 6; indirectly to 7 & 8  maternalhealth

21. Centrality of nutrition to MDGs 1, 2, & 3 1. Eradicate extreme poverty & hunger. Poverty is the main determinant of hunger. Malnutrition irreversibly compromises physical & cognitive development & 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

22. 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. NB protein, iron, iodine, vitamin A & calcium 6. Combat serious infectious diseases. Malnutrition aggravates infections, immune competence, transmission & mortality in HIV, malaria, tuberculosis Adapted from Gillespie and Haddad (2003) http://web.worldbank.org

23. Solutions to global hunger are within our reach - IFPRI • "Successes in agricultural development need to be recognised ... so that others can learn lessons from them“ • "The need to invest in agriculture is more important and urgent than ever before."

24. Progress toward elimination of poverty Millennium Development Goals Report • Panel of experts July 2009 Many factors complicate interpretation BRIC countries (Brazil, Russia, India, China) break the curve Sub-Sahara Africa has not done as well Experts agree that the situation has worsened since 2008 – food prices remedy is urgent

25. Slow progress toward the MDGs At half-way, most MDGs are partly met. Only goal #2 is fully within reach!

26. Who gives 0.7% of GNP? Myths, truth, & omissions Myth: In absolute terms the USA gives more than anyone else Truth: $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 Omissions: Kuwait gives 8.2% of GNO, Saudi Arabia 4% in 2002 Cuba may give the highest % of GNP. China & India??

27. Social enterprizes – Grameen family

28. 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 business 4 Grameen Telecom (np)  poor to profit from a cell phone 5 Grameen Phone (p) 50% of all telephones in Bangladesh 6 Grameen Solutions (p) fast-growing software company 7 Grameen Communicns (np) soft & hardware networking 8 Grameen Fish & Livestock (np) village aquaculture & dairy 9 Grameen Shakti (np) renewable energy in remote regions 10 Grameen Shikkha (np) educational loans literacy & tech 11 Grameen Byabosa Bikash (np) supp services for microcr. 12 Grameen Danone Foods (p&np) nutritious food near cost 13 Grameen America (p) alleviate poverty in working poor http://www.grameenfoundation.org/ http://en.wikipedia.org/wiki/Grameen_family_of_organizations

29. Microfinancing successes Drip irrigation allows winter cukes @ 3x price. 1A farm profit$100  $550 / yr Donkey carts for$200 repay in 2.5 mos 4 Factories for treadle pumps. Now there are 75 Business Week

30. Grameen Impact http://www.grameenfoundation.org/our-impact Grameen village phone 10M subscribers 300k cell-phone ladies http://www.youtube.com/watch?v=1UugpcDjjJU http://www.youtube.com/watch?v=kW-4gJmXy5M 9.4 million poor have been helped 1,000,000 microloans have been generated

33. Farm production Nutritional services Millennium Village Project Water Environment Energy & environment Gender equity Prevent malaria & TB Health services

34. The GOBI prescription: doesn’t have to be big $ Oral rehydration therapy Growth monitoring Child health – low-cost solutions Immunization Breast-feeding $14 can save a child’s life (2 mosquito nets@$7)

35. Eliminate hunger & malnutrition in the village increase production of nutritious foods improve nutritional status of pregnant & nursing mothers & infants < 2 micronutrient supplementation Provide equipment for a safe supply of drinking water Train local community health workers for home-based care Renovate or construct a local clinic & dispensary Equip kitchens with improved stoves outfitted with a chimney

36. Access to clean water & sanitation Explore and cost options technologies (e.g. boreholes, dug wells) for increasing water supply at the household level at each village Rainfall pits Drip irrigation Install and train community in rainwater harvesting and collection from rooftops and storage tanks in schools, medical facilities and other appropriate buildings in the area Provide material and training to filter and/or disinfect all collected water depending on the raw water quality Promote the creation of ventilation improved pit latrines

37. Improve livelihoods & increase incomes for agricultural workers Provide technical expertise and required inputs to diversify parts of farmland to higher value products after food security is achieved focus on improving nutritional status of pregnant women, nursing mothers and infants under two Provide equipment for water harvesting techniques for small-scale irrigation Provide training to develop new village businesses (e.g. agro-based processing, small livestock cooperatives, small-scale artisans) Assist farmers and entrepreneurs to partner with larger food processors, supermarkets and export-oriented distributors Provide all-weather vehicle access road and village vehicle Develop organized systems for selling products to more distant markets and purchasing farm inputs

38. CBC Ideas 2009 The Kings of Philanthropy Bill Gates $28b + Warren Buffet $37b ($10b to B&M Gates) George Soros $6b Gave $1b to start world's largest social entrepreneurship foundation Omidyar ebay owner $10b http://www.omidyar.com/ a conversation with the world to discuss the direction of their philanthropy Ashoka http://www.ashoka.org/ Bill Drayton CEO, Lecturer at Harvard & Stanford "In US people are very down on foreign aid, because its just not working! University in a box Rider Sahel Jeffrey Skoll $1b ebay ceo http://www.businessweek.com/magazine/content/04_48/b3910407.htm President Obama proposed $50-million for the Serve America Act Jim Brockerman Benetec Silicon valley deliberately non-profit  Ben Kingsley balancing the planet Ted Turner $1b to UN programs EU gov money will follow Rockefeller Philanthropy advisors President Melissa Berman has guided $1b in private resources for public benefit  The person giving the $ away has a hard time getting honest criticism There's a need in philanthropy to set very high goals Need for a critique

39. Resources for a world without hunger 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 ... 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

40. What can we do?

41. Take home message A billion overweight - a billion hungry • Catastrophic inequities in distribution of foods • Kinds of nutritional status & health impact • Through the life cycle, the hardest hit are • We’ve faced difficult questions re inequities As we face the future we are ... not just across nations – increasingly within water, protein, iron, vitamin A, iodine childbearing women and children “Not by accident?”; “Who’s responsible?” Impatient Optimistic

42. America is well covered in text, Canada gets a nod - world is ignored! Roadmap to the next 2 lectures Where are we, the world, now? How did we get here? Where are we going? What is working and isn’t Compare your mindset with evidence-dataset Indignation at inequities & the causes Realistic optimism re a world without hunger Impatience at slow progress & cost in lives

43. Next lecture Nutritional concerns in Canada and in LMICs

44. Do we need to know? We live in an interconnected world We ignore our compassionate impulses at our peril

45. Nutrition in relation to global health • For all nations, rich & poor, among the immediately modifiable factors that affect individual & public health … nutrition is of prime importance • nutrition determines physical health & development through the life-cycle, including: • Success in childbearing, cognitive function, socio-economic independence, education, disease resistance & employability • Health & economic development are contingent on provision of adequate food, nutritional resources & support at every stage of life lays a foundation for the ensuing stage

48. Nutrition in Global HealthCauses, mechanisms, solutions Why nutrition is crucial to global health & MDGs Overview of nutrition across humankind Human nutrition fundamentals in global context Top five world nutrition problems, & their solutions Nutrition across the life cycle & in rich and poor nations Cause & effect: Determinants in population nutrition Roadmap to a world without hunger: Nutrition Part II Page 48

49. Worldwide distribution of malnutrition Over 20 million children suffer from acute malnutrition WHO Scientific American, Sept 2007

50. 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 don’t want to share • The result – in the time we spend on this module over 1000 children will have died of hunger • Each day 1500 children go forever blind from lack vitamin A • The poorest are 50-200x more likely to die in pregnancy • About 2 billion people (56% of pregnant women) have iron deficiency. Their babies have low birth-weight, &  mortality