Access pdf of February commentary here
Access pdf of March correspondencehere
Access pdf of April correspondence here

Sir: We have carefully read the response to our letter by the authors of the commentary in the February issue of WN (l-3). At first everything was going quite well. They now recognise a good number of the points we made in our March letter, and, as a proof, pointed us to their 'full' article through a link. [Ed: This is now posted under 'Professional affairs' on the Association's home page].

All this was fine… until we read towards the end of their letter: 'Public health nutrition is our business and our responsibility. We need to make sure that it works well, and when it doesn't, we need to know how and to be able to fix it. We need to collaborate and work collectively with many different groups and organisations, but the sign of a mature profession is that the buck stops with us. We need to agree and enact competencies, in order to fulfil our roles and responsibilities appropriately. If we don't do this, who will?'

Once again, it's all top-down, it is 'us' who are giving to 'them'. This still is, and down the ages has been, the mentality of philanthropists and of those with a paternalistic approach to development, including 'enlightened' colonialists. How many times does it need to be repeated that charity perpetuates and too often increases misery? Notice the 'our', 'our', 'we', 'we',' 'us', 'we', 'our' and 'we' pronouns in the text above. Nothing is said about those suffering or those responsible for the consequences of malnutrition (claim holders and duty bearers) – or even anything about participation with public health nutritionists in decision making.

'Collaborate and work collectively with many different groups' in their paragraph is, for sure, not meant in the sense our March letter brought out. We said that it is crucial and fundamental to inculcate in the training of our upcoming colleagues the issue of 'us' not being the ultimate key to succeeding in our endeavours. To this end, we actually called on using the human rights-based framework to train public health nutritionists.

Let us focus here on the 'we - them' issue implicit in the above paragraph. Such a position is in conflict with basic human rights principles. The 'we - them' attitude is still too common among 'aid workers'. It reflects a deep belief that 'we', 'who know', will 'save the poor', and that 'we' have the solutions. If 'we' did, why are inequity, poverty, insecurity, immiseration, and starvation increasing?

Two of my major experiences are relevant here (writes Urban Jonsson). Long ago, in the late 1970s, when Claudio and I met at a nutrition planning conference in San Francisco, we agreed that: 'People who live in poverty should be recognised as key actors of their development, rather than the passive beneficiaries of transfers of commodities and services'. This reflects a correct view of poverty and poverty reduction. It is not a new idea. We were simply confirming and underlining in our own field what most professionals with real experience of working and living among impoverished communities know, or sooner or later come to know. The great German philosopher Immanuel Kant stated: 'Charity is obscene in a human rights perspective'.

Thus in my own work on community mobilisation in Iringa, Tanzania, in the early to mid-1980s, I learnt that 'participation' should not be interpreted as 'they participate with us' (that is, programme staff), but rather that 'we' behave in such a way that we have the privilege of participating with them.

It is not only our personal experiences that clash with the 'we have the solution' or the 'we need to make sure that [public health nutrition] works well' attitude. United Nations agencies and many non-government organisations share our concern (4-7). The wider consensus is already with us. Perhaps the signatories of the letter we are reacting to even agree with us. But the paragraph we criticise is at best foolish, thoughtless and misleading.

This also brings us back to the SUN Initiative's approach, which we have already criticised (8,9). The Initiative is full of what industry, foundations and the social marketeers call 'low hanging fruits', implying that we ought to 'develop packages to be delivered to the poor, particularly to those in the poorest 10th percentile'. Of course, such an attitude is totally opposite to the human rights-based approach (4), in which communities living in poverty are empowered to become aware of their rights and are thus capable to claim them. This must be made clear to our young trainees, who many of us teach. Otherwise we all will be in for a couple more decades of pat solutions just to keep the status-quo going, with plenty of employment opportunities for expat aid directors, managers and workers.

When agency people refer to 'we need to do this and that, so that we can help them' this is a clear manifestation of an authoritarian, paternalistic approach – and such people even seem to be unaware of the meaning of what they are saying, and worse, doing.

We remind all readers here again that the SUN Initiative's approach precisely means that 'we' should scale up the nutrition programmes for 'them'. Isn't this a horrible pathway to present to our students as the option for the decade?

Please cite as: Schuftan C, Jonsson U. Competence: who for, and where from? [Letter] World Nutrition, May 2012,3, 4: 347-350. Obtainable at www.wphna.org

References

1. Hughes R, Shrimpton R, Recine E, Margetts B. Competence: what for, and why. [Letter] World Nutrition, April 2012,3, 4: 164-167. Obtainable at www.wphna.org
2. Schuftan C, Jonsson U. Competence: for what, and so what? [Letter] World Nutrition, March 2012, 3, 3,: 81-84. Obtainable at www.wphna.org
3. Hughes R, Shrimpton R, Recine E, Margetts B. Empowering our profession. [Commentary] World Nutrition, February 2012; 3, 2, 33-56. Obtainable at www.wphna.org
4. UNICEF: Human rights based approach: Statement of common understanding. http://www.unicef.org/sowc04/files/AnnexB.pdf
5. UNICEF: Global study of child poverty and disparities. www.unicefglobalstudy.blogspot.com/
6. IFAD: Manual for Bottom-Up-Approach in Food Security Interventions. www.ifad.org/hfs/tools/hfs/bsfpub/manual_toc.htm
7. Panda B. Top Down or Bottom Up? A Study of Grassroots NGOs' Approaches. 2007. www.jhm.sagepub.com/content/9/2/257.full.pdf
8. Schuftan, C. The Millennium Development Goals, and the Scaling Up Nutrition Initiative [Column]. Website of the World Public Health Nutrition Association, July 2011. Obtainable at www.wphna.org
9. Schuftan, C. Let us hope that the SUN Initiative can really put nutrition at the centre of development. [Column]. Website of the World Public Health Nutrition Association, January 2012. Obtainable at www.wphna.org