New stuff
Egypt gives agricultural aid to central and southern africa
http://english.aljazeera.net/news/africa/2010/02/201022318030794713.html
Page 1
Module 41b: Nutrition in Global Health
Roadmap toward a world without hunger
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 PhD
Faculty of Sciences, Simon Fraser University
Department of Biomedical Sciences & Kinesiology
Prepared as part of an education project of the
Global Health Education Consortium & collaborating partners – 1 Sept 2009
Allan Davison
Making hunger history?
adavison@sfu.ca
please disturb!
www.sfu.ca/global-nutrition
3
3
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?”
Page 4
Other modules contribute to our understanding of
nutrition in global health
Modules dealing specifically with nutrition
Module 41b World nutrition - What builds a better future & what doesn't
Module 48 Acute malnutrition – Clinical aspects
Modules dealing with mitigation of poverty – the most important cause of hunger
Page 5
Pre-quiz
• 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
(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.
Page 6
Quick guess quiz – 2 of following are T
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 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?
Learning objectives
After completing this module the user should be able to
1. What works & what doesn’t?
toward evidence-based solutions
Page 9
How to get the most out of this module
If you are …
We recommend that you …
• a nutritionist or
• Pay attention to global & public
student of nutrition
health & policy implications.
• a student in public
• Pay attention to perspectives &
health
realities in desperate situations
• planning a project in • Emphasize check-lists to
regions with severe
prepare for field work & gather
nutritional problems
information to recommend &
advocate for intervention.
• a public health
• Use slides & resources in your
practitioner
information / teaching sessions
Page 10
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
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
Page 12
Making hunger history?
Where are we?
Much better since the MDGs, but far from
making hunger history
What’s working, what’s not?
Only 5-10 nations of 23 will reach 0.7% of
GDP. None will forgo unfair trade rules
Where are we going?
Hunger on a global scale will disappear,
in 2 or 3 more 15y plans. New initiatives13
“Let’s put hunger in the museums”
Is this just a pipe-dream?
extreme poverty
& hunger
Yunus Muhammad
1974: 1,600,000,000
2008: 800,000,000
Hans Rosling Global Health statistician
Talk to US State Department 2009
the evidence using gapminder
Above $1 per day microcredit,
below $1 emergency aid
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
Can it be very difficult to improve on this?
Page 17
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
George W Bush: “Terrorism is rooted in the
frustration of people pushed by suffering
beyond the point of endurance”
Southern Africa as a microcosm
food waste
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”
“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”.
Page 21
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
Loaned $76 to poor– Nobel Prize in 2006
Jeffrey Sachs - The end of poverty
Voice for poorest of poor. Prev World Bank trouble-shooter
Dambisa Moyo - Dead Aid (she’s against aid to the poor)
“Creates dependence” Goldman-Sachs 2001-)
Frances Moore Lappé - Diet for a Small Planet
If any game of chance  such unequal results
Raj Patel - Stuffed & Starved
Rules of economics rob the most needy of food
Paul Collier - Bottom Billion
Economist: discovery of resources is the worst!
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 history
3. How we will make hunger history – 6 initiatives
Page 25
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 ...
Ottawa, Washington, World Bank, WTO, free traders
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.
Page 27
Myth: Aid isn’t
working
Trade for profit
instead
Truth: Profit motive
doesn’t work sustainable
development aid
Trillions wasted! - 1 b still starving works
V little is wasted
Population outstrips food supply
Most aid corrupt dictators
MDGs won’t be achieved
Malthus is wrong
Corrupt multinationals
Broken promises
Never promised 0.7% and anyway …
… we give more than anyone!
“Trade not aid”
2008 recession
28
You did so!
½ what EU gives!
Trade barriers. Fair trade & aid
“They” didn’t cause it
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”
Truth: can you guess? Only 4 nations delivered!
22 renewed pledge 2001 Broke it again in 2002
4+2 nations did meet pledge: 800m now starving
was 1600m ⇒ 800m spared!!
Well done? No!
:^( US pays < ¼ of promise
Canada < ½
To a few: “well done”. To many: “800m still to go”
Myth: Aid isn’t
working
Trade for profit
instead
Truth: Profit motive
doesn’t work sustainable
development aid
Trillions wasted! - 1 b still starving works
V little is wasted
Population outstrips food supply
Most aid corrupt dictators
MDGs won’t be achieved
Malthus is wrong
Corrupt multinationals
Broken promises
Never promised 0.7% and anyway …
… we give more than anyone!
“Trade not aid”
2008 recession
30
You did so!
½ what EU gives!
Trade barriers. Fair trade & aid
“They” didn’t cause it
World GDP $PPP per cap
(est) 1500-2100
$10,000
3
Manifest destiny of
world - wealth
China +
India 2040?
USA + West
Europe
since 1945
Western
Europe
to 1945
China + India
to 1850
$5,000
India to 1500
$0
1500
2000
http://ers.usda.gov/Data/Macroeconomics/
Number of malnourished world-wide
See also: WHO, UN, WB, USDA, CIA, OECD, IFPRI
1000
UNICEF 2009
Millions under-nourished
(FAO kcal / household)
900
800
kcal per household
water-carrier
surveyed
700
600
500
FAO data
400
300
200
http://www.unicef.org/media/files/Tra
cking_Progress_on_Child_and_Mat
ernal_Nutrition_EN_110309.pdf
100
0
1970
32
1980
1990
2000
2010
33%
World
% undernourished
22%
17%
same data
15
1970
14%
1980
1990
2000
2010
33
Number fed & under-nourished
worldwide
Prediction
millions
8000
Target
Fed
Malnourished
6000
4000
2000
33%
14%
11%
6%
0
1970
3
2010
2015 target 2030 FAO
est
34
Percentage stunted
http://www.unicef.org/media/files/Tracking_Progress_on_
Child_and_Maternal_Nutrition_EN_110309.pdf
60%
http://ije.oxfordjournals.org/content/32/4/518.full.pdf
Africa
40%
Asia
Latin
Am
20%
1980 & every 5 years
Last 2 or 3 points are projections
35
200m
Number
stunted
http://www.who.int/mediacentre/factsheets/
fs290/en/index.html
http://www.fao.org/mdg/en/
http://www.un.org/millenniumgoals/reports.
shtml#mdgs
Asia
100m
Africa
Latin
Am
1980 & every 5 years
0
36
}
Paying for total strangers to eat?
Not us, not if it
goes to corrupt
dictators”
37
3
“Phantom aid”, the wasted 47%
“Development
aid”, not spent
on poverty or
development
Lost to:
Inefficiency
Unfair trade
Emergency aid
Refugees
Tied to benefit
rich & Debt relief
http://www.globalissues.org/articl
e/35/foreign-aid-developmentassistance#GovernmentsCutting
BackonPromisedResponsibilities
Refers to
ODA, not
MDGs
Real aid
53%
38
Rich...
Corrupt Dictators?
Accept personal & campaign “contributions”
peddling influence. Could stop bribery at
home & abroad by abolishing secret a/c
wikipedia
Swiss
Air
600
Lockheed
400
200
0
-200
... & Poor
Accept “bribes” to give
trade concessions that
impoverish their people
-400
-600
39
Misconceptions about aid ...
Ottawa, Washington, World Bank, WTO, free traders
False: “Most of the aid money goes into the
Swiss bank a/c’s of corrupt African
dictators”
“Aid creates dependence & impedes selfsufficiency”
“Despite all the aid $, problems are getting worse”
& standards: when they are, bribes come from where?
...US
“It’s their own fault”
The truth: Very few leaders are corrupt by ...
Page 40
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 gives the highest % of GNP. China & India??
rruption
The truth: NAm politicians, police?
Very few African leaders are corrupt by
(say) ...
NAm standards.
A country is oil rich; its people are hungry
Who’s rips them off? Company who pays bribe?
CIA that props up a puppet government?
Local brokers who take the bribes?
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”
Truth: can you guess? Only 4 nations delivered!
22 renewed pledge 2001 Broke it again in 2002
4 nations did meet pledge: 800m now starving
was 1600m ⇒ 800m spared!!
US pays < ¼ of promise
Well done?
Canada < ½
To a few: “well done”. To many: “800m still to go”
Predicted progress - % of people living in poverty
http://go.worldbank.org/K7LWQUT9L0
Page 44
Is the situation hopeless? Let’s see …
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 way
Argument about strategies is counter-productive. The situation
demands multiple approaches!
Page 45
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 history
3. How we will make hunger history – 6 initiatives
4. What will we / should we choose?
Page 46
Where do we choose to go from here?
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 wars
Let’s see what those who follow the evidence agree on
Page 47
Food prospects in an uncertain economic future
The World Bank report Dec 2008: Food Crisis - Global Economic Prospects 2009
http://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.
Page 48
Factors limiting future food availability
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 poor
Preoccupation 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
Page 49
War and instability are incompatible with
good nutrition
“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 Planet
2007 Reith Lectures Jeffrey Sachs
Page 50
Hunger is incompatible with peace
“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
Page 51
Harbingers of change ...
... 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
Page 52
We now know what works & what doesn’t
• 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
Page 53
Kinds of aid that don’t work
To see an example of wasteful government aid, view on the MSF website:
http://www.starvedforattention.org/#/stories/usa
(start from part 2, half-way through the video)
Page 54
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 history
3. How we will make hunger history – 6 initiatives
4. Wild-cards and unknowns
Page 55
A vicious cycle for malnutrition
poverty, health, economic deprivation
Poverty:  Diminished
access to agricultural & food
resources  malnutrition
high birth rate
nutrition
Health: Physical &
cognitive impairment,
susceptibility to disease,
early death  inability to
earn an income
Development:
Marginalization 
inability to provide for
self or family
Access to the ladder
of development
Page 56
Routes to
famine
Being landlocked ...
Lesotho
So.Africa
Discovering resources Nigeria, Iraq
Being on a trade or pipeline route ...
Bad governance ...
Israel, Afghanistan
Zimbabwe [USA]
Externally initiated armed conflict
…
Uncertain rainfall & drought ...
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. Need govt action!
Resources, personnel, sharing what works, time
needed to get on development ladder
We know we can do it better!
Need info & research
New knowledge production, dissemination, data
mining, knowledge brokering & application
The poorest - don’t give them
Money? No way to get it &
money
Jeffrey Sachs
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
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
Millions saved
oral rehydration solution
ready to use foods
Page 60
Emergency aid – beyond Survival
at the same time (2) Sustainablity
“... teach a man to fish”
To become self-sufficient - obviously:
good seeds, fertilizer, drinkable water,
sanitation, low technology agricultural
info & resources, drip-irrigation, ARVs
mosquito nets, dispensaries, hospitals
Long term – (3) To thrive
Scaling up production - factories
development ladder
Innovations that makes a difference
The Millennium Development Goals
Grameen family of social enterprises
The Millennium Village project
The Kings of Philanthropy
Influential voices for change …
Web resources & GHEC
Scientists & students who are making a difference
You! ...
Don’t believe 1 person can make a difference …
$7 can deliver an insecticide treated mosquito net
MGH students
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 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 for microcredit
12 Grameen Danone Foods (p&np) nutritious food near cost
13 Grameen America (p) alleviate poverty in working poor
Bangladesh
rocks
http://www.grameenfoundation.org/
http://en.wikipedia.org/wiki/Grameen_family_of_organizations
Microfinancing successes
Drip irrigation allows
winter cukes @ 3x
price. 1A farm profit
$100  $550 / yr
Donkey carts
($200) repay in
2.5 mos
Business Week
4 Factories for
treadle pumps. 2y
later there are 75
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
Grameen Impact
9.4 million poor have been helped
1,000,000 microloans have been generated
http://www.grameenfoundation.org/our-impact
http://www.youtube.com/watch?v=1UugpcDjjJU
http://www.youtube.com/watch?v=kW-4gJmXy5M
Nutrition in Global Health:
Roadmap to a world without hunger
1. Understanding the problem (else can’t solve)
2.
3.
4.
5.
6.
7.
Myths & lies: roadblocks to making hunger history
The roots of hunger
How we will make hunger history – 6 initiatives
New tools that are changing the world
Indicators of progress
Wild-cards and unknowns
Page 68
Innovations that make a difference
Barefoot agriculturists Soil conservation, don’t burn
contour farming, irrigation,
Drip irrigation
crop rotation
Pump installation
Millions fed
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
Innovations that make a difference
Appropriate technology
Watering can irrigation
$25 pump irrigates ½
acre  $100/y net
sub-surface drip irrigation
valve
rainwater collection pits
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 
Farm production
Nutritional services
Millennium
Village
Project
Water
Environment
$3m x 5yrs
funded in
advance
Gender equity
Energy &
environment
Health services
Prevent malaria
& TB
Initiatives making a
difference
The Millennium Development Goals – for the poorest
The Millennium Village project
Grameen Family of social enterprises
The Kings of Philanthropy & 100s of foundations
Influential voices for change
Scientists & students are making a difference
You! ...
Speak, write, telephone amplify with others @ SFU &?
against 99.7% of tax on ourselves
Vote
Oxfam, IDRF (Can Revenue charities)
Donate
to leave enough for everyone
Live
International internship consider study abroad
What kinds of aid don’t work?
Aid designed to benefit the donor, not the recipient
... food aid 1950s surplus dumping
... food must be bought, processed, shipped by donor
... donor countries insist that recipient open their markets
... farmers in all rich countries lobby for barriers
Not billions given to buy favours
WTO? IMF? World bank?
Read /google J Perkins “Confessions of an economic hit-man”
Vandana Shiva
How to tell who’s lying to you ...
Be suspicious of those ...
... with a strong self-interest
follow the money
... with history of lying, bribing, or cheating
Canada
... who’s generosity extends only to their borders ...
... who speak from a dogmatic ideology ...
small ears
... who allow no voice for the dispossessed
... who can’t admit a mistake
... who can’t accept that there are multiple paths ...
professors
They’re not all lying - maybe
it’s 5 blind men & an elephant
Don’t expect to agree with any one person
... look for common good
Keep an open mind: free enterprise, free trade,
GM seeds, globalization
birth control / condoms? ...
... look for unbiased data
next slide
Yunus
Pitfalls problems &
roadblocks
•Financial melt-down Diverts development & aid $
Increases the price of foods
•National scale land purchases
•Food  fuel ...
Also  displaced persons &
•War on terror ...
Destroys the local economy
•Nations in crippling debt to IMF & World
Bank
Vandana Shiva on
Vandana Shiva on
•Unfair trade practices
globalization
Food Laws
•Climate change
•Globalization of food economics
Take home message
•Catastrophic inequities in distribution of
not just across nations – increasingly within
foods
water, status
protein, iron,
vitamin A,
iodine
•Kinds of nutritional
& health
impact
perinatal - women and children
by accident?
Who’s
responsible?
needed
•We’ve Not
faced
causes,
know
there What’s
are cures
Optimistic
•As we face the future
we are ... Impatient
http://www.sfu.ca/global-nutrition
Long term village needs
tools 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
Goal
Sub-targets likely to be
achieved
1. Eradicate
reduce poverty by ½
extreme poverty & developing countries’ export
hunger
earnings devoted to servicing
external debt fell by ~50%
2 Universal primary Primary school enrolment of
education
at least 90%
3 Promote gender
The gender parity index in
equality, empower primary education > 95%
women
4 Reduce child
 Measles deaths 89% of
mortality
children receive vaccinations
5  maternal health
6 infectious
disease & safe
water
7 Global
partnership for
development
Malaria prevention tripled,
AIDS: deaths new
infections, tuberculosis
1.6b people have gained
access to safe drinking water
Unprecedented verbal
agreement & generous
promises
At half-way, most MDGs are partly met.
Action still needed
Eradicate hunger: ½ those in subSaharan Africa may still live on <
$1/d; ¼ of all children are
underweight. Fairer trade unlikely
Promising progress
Of 113 countries 18 may achieve
parity in 2o ed; Parity in employment
& politics seems unlikely
Child mortality has dropped by ½ but
still too high
Some progress, 500,000 pregnant
women still die of complications
Some 2.5 billion people, ½
developing world, live without
approved sanitation
In reality, aid expenditures declined
for 2 years. Few meet 0.7% of GNP
Only goal #2 is fully within reach!
Page 80
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 militarily
Omissions:
Canada is in bottom 1/4 of rich nations
Kuwait gives 8.2% of GNO, Saudi Arabia 4% in 2002
Cuba may give the highest % of GNP. China & India??
Web links to a world without hunger
Clinton Global Initiative
http://www.clintonglobalinitiative.org
Bill & Melinda Gates Foundation
http://www.gatesfoundation.org/Pages/home.aspx
Grameen Family of Social Businesses
http://en.wikipedia.org/wiki/Grameen_family_of_organizations
Millennium Village Project (WHO, UN, Jeffrey Sachs)
http://www.unmillenniumproject.org/
Official Development Aid
Sweden, Luxenbourg, Norway, Netherlands, Denmark
The Cuba, China model for bootstrap development
spreading in Africa, Latin America, Middle East
University Global Health initiatives
Spreading in Latin America, Africa, USA, Australia, Canada, Switzerland – through
student power, and top administration, not ...
Population growth &
nutrition
Google Public Data (from World Bank)
A new tool to learn what’s happening
World population growth
World under 5 mortality
Wildcards and unknowns
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
Page 84
China & India - future role in development 1 of 3
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
Page 85
China & India - future role in development 1 of 3
The situation in complex, & only hindsight is 20-20
Nevertheless, 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 continent
In 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
Page 86
Hope for Africa ... from China & India
according to the Government of Canada
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 emphasized 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 and
represents 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 Government has significantly increased spending in defence
and development with a view to Canada reassuming its
position of leadership in the world.
Page 87
There has seldom been a more pivotal time
An upwelling of energy for action
Page 88
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
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 89
Summary: What you’ve learned & its applications
Nutritional health is not equitably distributed worldwide
Correcting nutritional inequities is crucial to a viable future
We've reviewed nutritional principles in global context
Nutritional health, public health, & economics are inseparable
Worst nutritional risks: water, protein, iron, vitamin A, iodine.
This helps us know what to look for and what to recommend
Across the life cycle, kids & mothers are at greatest risk
So we know priorities & best practices for risk mitigation
We have seen setbacks, slow progress toward the MDGs
We have substantial agreement about what needs to be done
We 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
Page 90
Innovations that make a difference
Barefoot agriculturists Soil conservation, don’t burn
contour farming, irrigation,
Drip irrigation
crop rotation
Pump installation
Millions fed
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
Innovations that make a difference
Appropriate technology
Watering can irrigation
$25 pump irrigates ½
acre  $100/y net
sub-surface drip irrigation
valve
rainwater collection pits
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 
Farm production
Nutritional services
Millennium
Village
Project
Water
Environment
$3m x 5yrs
funded in
advance
Gender equity
Energy &
environment
Health services
Prevent malaria
& TB
Initiatives making a
difference
The Millennium Development Goals – for the poorest
The Millennium Village project
Grameen Family of social enterprises
The Kings of Philanthropy & 100s of foundations
Influential voices for change
Scientists & students are making a difference
You! ...
Speak, write, telephone amplify with others @ SFU &?
against 99.7% of tax on ourselves
Vote
Oxfam, IDRF (Can Revenue charities)
Donate
to leave enough for everyone
Live
International internship consider study abroad
What kinds of aid don’t work?
Aid designed to benefit the donor, not the recipient
... food aid 1950s surplus dumping
... food must be bought, processed, shipped by donor
... donor countries insist that recipient open their markets
... farmers in all rich countries lobby for barriers
Not billions given to buy favours
WTO? IMF? World bank?
Read /google J Perkins “Confessions of an economic hit-man”
Vandana Shiva
How to tell who’s lying to you ...
Be suspicious of those ...
... with a strong self-interest
follow the money
... with history of lying, bribing, or cheating
Canada
... who’s generosity extends only to their borders ...
... who speak from a dogmatic ideology ...
small ears
... who allow no voice for the dispossessed
... who can’t admit a mistake
... who can’t accept that there are multiple paths ...
professors
They’re not all lying - maybe
it’s 5 blind men & an elephant
Don’t expect to agree with any one person
... look for common good
Keep an open mind: free enterprise, free trade,
GM seeds, globalization
birth control / condoms? ...
... look for unbiased data
next slide
Yunus
Pitfalls problems &
roadblocks
•Financial melt-down Diverts development & aid $
Increases the price of foods
•National scale land purchases
•Food  fuel ...
Also  displaced persons &
•War on terror ...
Destroys the local economy
•Nations in crippling debt to IMF & World
Bank
Vandana Shiva on
Vandana Shiva on
•Unfair trade practices
globalization
Food Laws
•Climate change
•Globalization of food economics
Take home message
•Catastrophic inequities in distribution of
not just across nations – increasingly within
foods
water, status
protein, iron,
vitamin A,
iodine
•Kinds of nutritional
& health
impact
perinatal - women and children
by accident?
Who’s
responsible?
needed
•We’ve Not
faced
causes,
know
there What’s
are cures
Optimistic
•As we face the future
we are ... Impatient
http://www.sfu.ca/global-nutrition
Long term village needs
tools 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
Goal
Sub-targets likely to be
achieved
1. Eradicate
reduce poverty by ½
extreme poverty & developing countries’ export
hunger
earnings devoted to servicing
external debt fell by ~50%
2 Universal primary Primary school enrolment of
education
at least 90%
3 Promote gender
The gender parity index in
equality, empower primary education > 95%
women
4 Reduce child
 Measles deaths 89% of
mortality
children receive vaccinations
5  maternal health
6 infectious
disease & safe
water
7 Global
partnership for
development
Malaria prevention tripled,
AIDS: deaths new
infections, tuberculosis
1.6b people have gained
access to safe drinking water
Unprecedented verbal
agreement & generous
promises
At half-way, most MDGs are partly met.
Action still needed
Eradicate hunger: ½ those in subSaharan Africa may still live on <
$1/d; ¼ of all children are
underweight. Fairer trade unlikely
Promising progress
Of 113 countries 18 may achieve
parity in 2o ed; Parity in employment
& politics seems unlikely
Child mortality has dropped by ½ but
still too high
Some progress, 500,000 pregnant
women still die of complications
Some 2.5 billion people, ½
developing world, live without
approved sanitation
In reality, aid expenditures declined
for 2 years. Few meet 0.7% of GNP
Only goal #2 is fully within reach!
Page
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 militarily
Omissions:
Canada is in bottom 1/4 of rich nations
Kuwait gives 8.2% of GNO, Saudi Arabia 4% in 2002
Cuba may give the highest % of GNP. China & India??
Myth: Aid isn’t
working
Trade for profit
instead
Truth: Profit motive
doesn’t work sustainable
development aid
Trillions wasted! - 1 b still starving works
V little is wasted
Population outstrips food supply
Most aid corrupt dictators
MDGs won’t be achieved
Malthus is wrong
Corrupt multinationals
Broken promises
Never promised 0.7% and anyway …
… we give more than anyone!
“Trade not aid”
2008 recession
10
You did so!
½ what EU gives!
Trade barriers. Fair trade & aid
“They” didn’t cause it
World GDP $PPP per cap
(est) 1500-2100
$10,000
1
Manifest destiny of
world - wealth
China +
India 2040?
USA + West
Europe
since 1945
Western
Europe
to 1945
China + India
to 1850
$5,000
India to 1500
$0
1500
2000
http://ers.usda.gov/Data/Macroeconomics/
Number of malnourished world-wide
See also: WHO, UN, WB, USDA, CIA, OECD, IFPRI
1000
UNICEF 2009
Millions under-nourished
(FAO kcal / household)
900
800
kcal per household
water-carrier
surveyed
700
600
500
FAO data
400
300
200
http://www.unicef.org/media/files/Tra
cking_Progress_on_Child_and_Mat
ernal_Nutrition_EN_110309.pdf
100
0
1970
106
1980
1990
2000
2010
33%
World
% undernourished
22%
17%
same data
15
1970
14%
1980
1990
2000
107
2010
Number fed & under-nourished
worldwide
Prediction
millions
8000
Target
Fed
Malnourished
6000
4000
2000
33%
14%
11%
6%
0
1970
1
2010
2015 target 2030 FAO
108
est
Percentage stunted
http://www.unicef.org/media/files/Tracking_Progress_on_
Child_and_Maternal_Nutrition_EN_110309.pdf
60%
http://ije.oxfordjournals.org/content/32/4/518.full.pdf
Africa
40%
Asia
Latin
Am
20%
1980 & every 5 years
Last 2 or 3 points are projections
109
200m
Number
stunted
http://www.who.int/mediacentre/factsheets/
fs290/en/index.html
http://www.fao.org/mdg/en/
http://www.un.org/millenniumgoals/reports.
shtml#mdgs
Asia
100m
Africa
Latin
Am
1980 & every 5 years
0
110
}
Paying for total strangers to eat?
Not us, not if it
goes to corrupt
dictators”
111
1
“Phantom aid”, the wasted 47%
“Development
aid”, not spent
on poverty or
development
Lost to:
Inefficiency
Unfair trade
Emergency aid
Refugees
Tied to benefit
rich & Debt relief
http://www.globalissues.org/articl
e/35/foreign-aid-developmentassistance#GovernmentsCutting
BackonPromisedResponsibilities
Refers to
ODA, not
MDGs
Real aid
53%
112
Rich...
Corrupt Dictators?
Accept personal & campaign “contributions”
peddling influence. Could stop bribery at
home & abroad by abolishing secret a/c
wikipedia
Swiss
Air
600
Lockheed
400
200
0
-200
... & Poor
Accept “bribes” to give
trade concessions that
impoverish their people
-400
-600
11
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
11
Unrealistic? Let’s see ...
Beyond MDGs: amazing changes
•The Millennium Village project
•Grameen Family of social enterprises
•Billionaire philanthropists & foundations
•Instant spread of innovations: agric, educ, &c
•Passionate & influential voices for change
•Scientists & students bring energy to future
11
www.sfu.ca/global-nutrition
Passionate renegades
116
11
The End
adavison@sfu.ca
www.sfu.ca/global-hunger
adavison@sfu.ca
www.sfu.ca/global-hunger
117
11
Web links to a world without hunger
Clinton Global Initiative
http://www.clintonglobalinitiative.org
Bill & Melinda Gates Foundation
http://www.gatesfoundation.org/Pages/home.aspx
Grameen Family of Social Businesses
http://en.wikipedia.org/wiki/Grameen_family_of_organizations
Millennium Village Project (WHO, UN, Jeffrey Sachs)
http://www.unmillenniumproject.org/
Official Development Aid
Sweden, Luxenbourg, Norway, Netherlands, Denmark
The Cuba, China model for bootstrap development
spreading in Africa, Latin America, Middle East
University Global Health initiatives
Spreading in Latin America, Africa, USA, Australia, Canada, Switzerland – through
student power, and top administration, not ...
Population growth &
nutrition
Google Public Data (from World Bank)
A new tool to learn what’s happening
World population growth
World under 5 mortality
Credits
• [Add author 1 information]
• [Add author 2 information]
• [Add … ]
Slide instructions
Place this Credits slide before the End of module slide.
Please erase this box after its reading.
Page 120
End of module
Please refer to the supplementary contents
for more information about this module.
[Reserved for GHEC notes]