San Jose, California. Since I am back in the Americas for holidays, I start this month by quoting some views of the prominent Uruguayan journalist and essayist Eduardo Galeano, written some 40 years ago, but still salient today. Yes, it is not me, but him pictured above. He is well known among many of us for his always sharp-as-a-whistle incisive social commentary.

Reviewing his reflections prompted me to ask myself what our role as ‘nutritionists-helping to-shape-society’ ought to be. In rather strong terms, I here argue for what our obligations should be, beyond liberalism: I call for a greater engagement in political action as the true test of our values as nutrition professionals.

As you may know, I am originally from Chile, and I am indebted to my fellow Latin American Eduardo Galeano and his book The Open Veins of Latin America, for the eight reflections that follow. The book was banned in the 1970s by the military dictatorships in Argentina, Brazil, Chile and Uruguay.

One. The international labour division consists of some countries specialising in winning, and others in losing. The latter continue to work as servants of the former.

Two. The defeat of the have-nots has always been implicit in the victory of the haves. The labour of the have-nots has always generated their own poverty, since it has fed the wealth of the haves.

Three. The strength of the globalised system rests on the necessary inequity of the parties that make it up. This inequity assumes ever more dramatic proportions. The dominant classes in poor countries have no interest in finding out whether patriotism could be more profitable than treason, or if begging and dependence are the only possible way for their countries’ international politics. Countries thus end up mortgaging their sovereignty, because, we are told: ‘There is no other way’.

Four. The globalised system is very rational from the point of view of their foreign owners and of our ‘hamburgeoisies’ that have sold their soul to the devil.

Five. The globalised system has a thorn in its side. We have too many people. And people reproduce. They make love with enthusiasm and without precautions. More and more, people are left on the verge of the road, jobless. So the empire gets worried: unable to produce more bread, it does what it can to get rid of those sitting around the table. ‘Fight poverty! Kill a beggar!’ a master of black humour wrote on a wall in the city of La Paz.

Six. The globalised system thus convinces poor people that poverty is the result of not avoiding having children. So it now proposes, in panic, measures to resolve the problem. Population control measures are the preferred policy.

Seven. We have social classes, and the oppression of one class by another. The system calls that ‘adopting a Western lifestyle’.

Eight. Poverty is not written in the stars. Underdevelopment is not the result of an obscure will of God. People are waking up, and are demanding changes.

Are nutritionists as intellectuals a class apart, responsible only to their own inner urges, and to their own vision of human needs? Are we not duty-bound to immerse ourselves in our respective societies to foster a higher level of social consciousness? Are we assuming our role as natural leaders, destined not only to provide key ideas that can reshape society, but also to make sure that these ideas become actions?

The public health nutrition congress held in Porto last September was a gathering of such selected intellectuals. But did they act as ‘a class apart’ or as bona-fide duty-bearers? There was some criticism reported on the Porto meeting on the home page of this website earlier, so I add no more. A reason for hope is our Association’s promise of a totally different type of meeting in Rio 2012.

So what role should we all play, in our troubled early 21st century world?

Intellectuals too often do bend the rules of discourse to suit their own interests; too often they do argue for what they want to believe. Their theories do end up justifying the status-quo. Nutritionists in higher education too often do not question the privileges of certain groups in society -privileges that ultimately end up perpetuating hunger and malnutrition.

Intellectuals are part of the system

But scholar intellectuals do not float somewhere above the economic system; they – meaning we – are part of it. Few scholars can resist the pressure of the scholarly tradition in which they work. Only by expunging that tradition’s false preconceptions can they break from its grip. This is possible only by challenging the ideology behind that tradition that many of us find abhorrent. Are we thus guilty of perpetuating passivity – the ‘passivist’ position of Geoffrey Cannon’s November column? An intellectual rebellion is difficult to achieve; many of us are prisoners of our own past training and other peoples’ thoughts (1).

We often use statistical illusions palatable to our own academic elites that do not really reflect the real world. Measuring poverty in detail can often be a substitute or an excuse for not acting in response to clearly visible needs (2).

To avoid discord or conflict, too many of our peers and too many international organisations take the politics out of the political economy of hunger and malnutrition in their daily decision making process. Using the economists’ yardstick only leads to a non-political bias… The abolition of slavery, or child labour laws, never would have passed a cost-benefit test (3).

Separating nutritional from political analyses, results in a reluctance to call a bean a bean. There is a tendency to stop the analysis where ‘politics’ begins, with formulations like: ‘This, however, is a political question’. But that is where the analysis should very often start. Our task is not merely to reflect the world, but to do something about it! Recognising trends and acting promptly at the right time, differentiates the politician from the theoretician (4).

The complex nature of the problems of hunger and malnutrition complicate our policy making. The essence of the problem transcends looking at it from an interdisciplinary view. A new world view, and a set of values into which all the determinants of hunger and malnutrition blend, is needed. The development of such a philosophy has been avoided by too many of our peers, because it raises larger issues and challenges the current system. We need effective tactics, yes, but first we need innovative strategies.

We need to move from our perennial critique to actual concrete actions. We need to plan for positive alternatives. These need to go beyond the expedient goal of obtaining the type of lowest common denominator results whose real purpose too often is to alleviate guilt feelings (5).

Our inherent obligations

We must not retreat into helpless passivity, watching the biological, ecological and social systems around us deteriorate. We can alter trends and avert catastrophes if we recognise and exercise our own power to make a difference. (6).

The greatest challenge we face today is to meet the inalienable human rights of poor and marginalised people. Past and present nutrition research too often has little or no relevance to our concern for the right to nutrition of the people. Furthermore, international and national nutrition conferences too often become exercises in futility, organised and orchestrated by the same conservative groups, year after year (7, 8).

Meeting the right to nutrition of the people will, in most countries, require political solutions that are likely to need technical inputs. But the political solutions are not dependent on first making the technical inputs available (9). Devoid of a clear ideological orientation, the right to nutrition does not clarify, but mystifies; it does not mobilise, but manipulates.

Not everyone who says ‘human rights’ supports human rights principles. These include: empowering participation in decision-making, social inclusion, rule of law, non-discrimination, dignity and accountability. The Roman emperors provided ‘bread and circuses’ for the masses. Authoritarian regimes present modern variants, such as beans and football stadia. Human rights defined in material terms, planned by an elite and delivered by a bureaucracy, create client groups, demobilise mass organisations, and create new patterns of dependency.

Technocratic models, like those proposed in The Lancet Series on Nutrition (to be found at.http://www-tc.iaea.org/tcweb/abouttc/tcseminar/Sem6-ExeSum.pdf) assume that the problems are largely scientific, and can be solved by closing management gaps found in decision-making groups (10).

There is no easy or short-term solution to the syndrome of underdevelopment, of which nutritional status is an important indicator. Too many non-solutions are proposed as answers. For instance, the provision of primary health care alone will not bring about better nutrition. Primary health care is necessary, but not sufficient. Ultimately, levels of health, nutritional status and living standards are determined by national development strategies and the international economic order. Straight public health and nutrition programmes, while aiming for greater equity, do not contain interventions that move towards more egalitarian societies (11).

Many of us are content to take life as it comes when things go reasonably well, preferring to evade the troublesome question of life’s purpose or meaning. In times of trouble, however, problems force themselves on our awareness and our consciousness. (12).

As scientists, technicians and intellectuals we are restless, often dissatisfied and critical, and in urgent need of an ideology. At the same time we are doing quite nicely: we have a vested interest in the status quo. And what is the ideology to be? Just a vague consensus for equal opportunity? We are good at exposing unintended consequences of well-meant measures. But this can be downright dangerous. This position threatens to give legitimacy to conditions set by corporate elites, where gross inequities are rationalised as a fact of life (13).

With a liberal ideology, we are committed more to stability than to justice and to fairness. As liberals, we have connections in the Establishment. We do not address fundamental questions. We are experts (technocrats). We think we are ‘reform professionals’, but more often actually are ‘stability professionals’ (13). We may make powerful diagnoses, but then offer feeble therapies.

Positive-sum games’, in which everybody or almost everybody wins something, are next to impossible when applying the radical therapies needed. That is why we now speak of disparity reduction instead of poverty alleviation. The rich simply have to give up some of their privileges! They are good at allocating gains, but horrible at sharing out losses. Honest rationality and self-interest frequently clash. Can we then stall indefinitely on needed policies and changes (14)?

Much of what has been called liberalism in the last half century has been merely an accommodation to historical change --to circumstances. It represents a triumph of circumstance over ideology. Liberals make a virtue of adjustment, of a kind of adaptive pragmatism. The disparity between what liberals say in public and what they do in private, is why it is so easy for young people to unmask the hypocrisy of their parents (15).

In the world that liberalism finally made, the world of the welfare state and the transnational corporation, liberalism itself has become politically and intellectually bankrupt. The welfare state of liberalism absolves individuals of moral responsibility, and treats poor and malnourished people as victims of ‘social circumstances’. It still condemns the lower class to a second rate education, yes even in the USA, and thus perpetuates the inequities it is supposed to abolish (16).

In the liberal tradition of the West, individual rights are valued more than social rights, and civil and political rights are deemed more important than economic, social and cultural rights. In socialism, on the other hand, the right to work, and to acceptable levels of nutrition and education, outweigh the importance of personal freedoms. To socialists, freedom from hunger, from ignorance and from disease is more important than freedom of expression (3).

It is no surprise that liberals believe in the globalised ‘free market’ and in competition. Liberals now seldom see trades unions as valid actors in the market or as institutions to be backed. Liberalism has no operational political economy at its core. It expunges any real perception of the nature of political and economic conflict perceived in terms of interest groups or of class.

Socialists espouse equality as an absolute, and measure injustice by distribution of wealth. But the right and the left do not occupy two extremes with a middle made up of liberals. Liberalism is another dimension altogether. It is empty of standards (17). It is often easy to see what liberal groups are opposed to or worried about. But what do they stand for? This is often an unresolved puzzle (13).

The core issues

So, here comes the question modern liberalism has always ducked. Why is the wealth of any self-proclaimed ‘egalitarian’ nation distributed so unjustly? The long march of liberal solutions to social injustice evades the more fundamental questions about wealth and its gross maldistribution.

The liberal mindset, well-intended as it may be, avoids confronting harsh realities. One of these is that in the final balance, welfare states care most for the prosperous, not the poor (18).

For a long time now, including in countries not really committed to genuine social development, health and nutrition programmes have become popular. These suggest a political adherence to the ‘ideals of health and nutrition’, without real commitment to deal with the deep-rooted social problems behind them (19).

Do liberal planners, programme officers, administrators and advisors really have anything relevant to offer in this world in 2011? The technocrats among us dodge the political issues behind undernutrition: “We are afraid to confront the hard-nosed reality of nutritional issues, because they come down to political questions and are non-scientific and hard to grapple with – so we shy away from them” (20).

Our predilection for nutrition education interventions comes from our believing in a concept of society in which there are ‘practical difficulties’ and ‘obstacles to desirable changes’, but ‘fortunately there are also various services or facilities available to overcome them, so in the end everything will be fine’.

But the way the world is going now, everything will in the end not be fine. We now need to analyse and expose the impact of systemic barriers to good health and nutrition. For instance, in the US, where I am now writing this column from, the strategy of ‘life-style policies’ for correcting deficits and imbalances in the diets of the population, by individually changing the food consumption patterns of individuals, avoids the political question of why those individuals consume that diet as they do. It ignores the enormous power and the economic interests of the gigantic corporations that determine food systems and thus dietary patterns (19).

We are in for a period of agonising reappraisal if we are to contribute to a world that is changing with remarkable speed. We need to make governments conscious that health and agricultural production interventions alone do not solve nutritional problems, and that the answer is not to be found in small projects, or with a few experts running around (20)

References

1. Ul Haq. M.: The fault is ours. New Internationalist, No. 32, Oct., p. 19 (1975).
2. Lehman-Haupt. C. reviewing The Mismeasure of Man by Stephen Jay Gould. International Herald Tribune, Oct. 31/Nov. 1 (1981).
3. Exact reference to these quotes lost to the author.
4. Galtung, J.: What is a strategy? IFDA Dossier 6, April (1979).
5. Hetzel, N.: A sustainable development strategy. IFDA Dossier 9, July (1979).
6. West. M: Washington Post, Jan. 14: E-2 (1979).
7. Mattis. A.: Science and technology for self-reliant development. IFDA Dossier 4, Feb.(1979).
8. Schuftan, C.: Do international conferences solve world problems? PHP, vol. 7, No. 11, Tokyo 1976
9. Adapted from Kirkpatrick, J.: De-westernizing medicine: concepts and issues in the literature, mimeo. Proceedings of the 10th International Congress of Anthropology and Ethnographical Sciences, Pune, 1978.
10. Green, RH.: Basic human needs: a strategic conceptualization toward another development. IFDA Dossier 2, Nov. (1978).
11. Mangahas, M.: Why are we reluctant to set numerical equity targets?. Nutrition Planning, 3: 102 (1980).
12. Adapted from Bettelheim, B.: Surviving and Other Essays. (Knopf, New York 1979).
13. Adapted from Geyelin, P.: Book review of The neo-conservatives by Peter Steinfels. Book World, Washington Post, April 27(1980).
14. Adapted from Lekachman, R.: Book review of The Zero-Sum Society by Lester Thurow. Book World, Washington Post, April 27 (1980).
15. McWilliams, W.C: Liberal dialogue: Do you want to talk about it? Book World. Washington Post, Dec 21: 9 (1980).
16. Lasch, C.: The Culture of Narcissism: American Life in an Age of Diminishing Expectations, as reviewed by William McPherson, Washington Post Feb. 4: E-1 (1979).
17. Lowi, T.J.: Where is liberalism, now that we really need it? Washington Post, Oct. 31: C-8 (1982)
18. Greider, W.: A radical idea as old as Lincoln. Washington Post, March 11: C-3 (1979).
19. Bantje, H.: Constraint mechanisms and social theory in nutrition education, mimeo. BRALUP, University of Dar Es Salaam. Tanzania. Proceedings of the 11th International Congress of the IUNS, Rio de Janeiro 1978.
20. Navarro, V.: The industrialization of fetishism or, the fetishism of industrialization: a critique of Ivan Illich. Social Science and Medicine, 9: 360 (1975).

Acknowledgement and request

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Schuftan C. Globalisation. It’s the rich that get the gravy, and other items. [Column]. Website of the World Public Health Nutrition Association, January 2011. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column is reviewed by Geoffrey Cannon.