Good day
I welcome this opp to be with you from the far..
You are seniors getting ready to face the world out there in not too long.
You took this intl hlth course probably out of a mix of curiosity and interest
You have found out by now that Int hlth is not about a collection of tech
probs and sols …nor about just ‘doing good’ in the world.
I will offer you yet another alternative view.
I have chosen the MDGs to do so. I am sure you have heard about them and
you have some handouts from me on it already.
I will offer you food for thought for a change in perspective.
In the next 20 mins I will challenge you.
So here I go:
MDGS D+C 37:12, Dec 2010.
1. It is pertinent to take stock of our chances of actually meeting the MDGs
by 2015.
2. I have to say upront I find it difficult to square the optimistic statistical
constructs of the MDGs with my personal observation in rural areas the
world over.
3. MDGs data alone simply do not give us a full picture of the social
consequences of poor countries’ development moving at a snail’s pace.
4. The MDGs debate has indeed gained momentum in the past 10 years.
5. Like it or not, the MDGs agenda has had a major influence on the
development debate. Rightly or wrongly, the MDGs have become a frame of
reference for international development.
6. But the mistaken belief persists that the MDGs are more successful than
any development agenda tried before. Actually, the general public of rich
nations tends to think that the MDGs apply only to Africa, to Asia and to
Latinamerica.
7. Let’s face it, development under MDGs policies has neither lived up to its promises
nor has it covered key areas.
8. In the year 2000, when the Millennium Declaration launched the MDGs, the MDGs
agenda failed, for example, to address peace and democracy, disarmament and security;
consensus on these proved to be impossible then. The rich countries spend billions on
weapons and do not want to give up this prerogative: what a waste of resources!
9. Otherwise, of the eight MDGs, MDG7 (on sustainable development) and MDG8 (on
partnership for development) still remain vague…Why? Because they are goals that
apply to changes of behavior the global North is expected to undertake!
10. It is really unacceptable that while the G8 have failed to change these matters,
hundreds of billions of dollars are funneled to tax havens every year.
11. Overseas Development Assistance doubled in the last decade to $100bn, but a good
part of the increase was/is not new money, but rather debt relief and fund going to
humanitarian assistance… and the least developed countries only get 1/3 of all ODA. In
reality, the MDGs are seriously under-funded. Needed are $120bn and only $1.5bn have
been pledged. This is why I ask, is political commitment best measured in funding levels?
12. But do not take me wrong, it remains a fallacy that tangible development results in
the realm of the MDGs will be achieved simply by spending more money.
13. The sustainability of results depends not on money, but on political circumstances,
i.e., development goals can only be achieved by political means. Structural changes is
what makes the difference in the long run, and this does not become evident in short term
MDG-type indicators.
14. Reform must originate within a given society, i.e., individuals must manage their
health, their education and their economic issues themselves.
15. After 10 years of MDGs, we still have high Infant and Maternal Mortality rates and
major deficits in sanitation.
16. MDG1 aimed at eradicating poverty and hunger has fared poorly. Towards the end of
the decade, the number of hungry and malnourished people rose once again. 925 million
affected human beings is a scandalously high level for malnutrition….and it has to be
halved by 2015….
17. I contend that the ‘MDGs-hype’ is, in part, a carefully cultivated hard-sell by the
neoliberal system to give the impression of a hefty impact on poverty.
18. Data from rural Kenya suggest that poverty is actually getting worse. If this is what it
means to be on track with the MDGs, then perhaps these goals were not ambitious
enough.
19. Conversely, Brasil has enforced targeted social policies with success and poverty
there has fallen significantly; economic growth has also led to more economic equality.
20. The private sector has been called ‘a prerequisite for poverty reduction’, but the
contributions made by private business have been simply oversold. There is no
demonstrable widespread ‘trickle down’ effect.
Other shortcomings:
21. In the real world, there is a need for the strengthening of social protection systems.
The MDGs do not tackle this.
22. Civil society organizations must be involved. The MDGs only timidly do so.
23. Human Rights must be protected. The MDGs do not look at preventable ill-health,
preventable malnutrition and preventable mortality as blatant HR violations.
24. TheMDGs are geared to people’s needs, but are executed by government agencies.
25. The MDGs focus is on people, but holding the state accountable, which is a
precondition for the respect of HR, is not part of the MDGs agenda.
26. The MDGs aim to fight abject poverty, i.e., that of incomes < $1.25/day. I ask: Is $2
or $3/day much better?
27.The MDGs must always go along with debates on the underlying values and interests
of people. Which it has not.
28. It is better to address diverging views than to hush them up (which the MDGs have) –
because the exchange of political and ethical arguments does matter.
29. The fostering of equal opportunities and of an ending of discrimination must be part
of any development effort. The MDGs do not tackle these two explicitly.
30. If one focuses on the agenda beyond 2015, still major challenges remain. We risk just
extending the MDGs and then carry on with business as usual. Actually, a document
along these lines has already been in circulation: ‘Global Development Goals 2030’.
31. But it would be insufficient and immoral to simply extend the MDGs another 15 yrs. - by 2015, in Sub Saharan Africa, the poverty rate (<$1.25) will still be 38%.
32. With the global financial crisis, we have seen substantial setbacks on several indices,
mainly in poverty, health, nutrition and education. Up to 250 million more people will be
living in extreme poverty in 2015. Actually the full implications of the 2008 global
financial crisis on the MDGs has not yet been quantified.
33. You see, then, where I am coming from? Paying too much attention to individual
MDGs indicators leads us to a kind of ‘anxious disaster relief’ mentality, namely applied
in haste, geared to immediate results and revocable when funds run short.
34. The impression that it only takes quantifiable goals to ensure sustainable development
is thus unrealistic and the idea that most governments of poor countries are now centered
on the MDGs is simply false: Donors are.
35. What I am driving at here is that it is simply counterproductive to elevate the MDGs
to an end in themselves. It is therefore misleading and not enough to look at MDGs
statistics.
36. The MDGs relate to the dynamics of the process of globalization --something all to
often not taken into account. But even under globalization, many people today are calling
for greater global social justice. Such an idea is fascinating, but one must never assume
that all development partners around the world share them.
37. Considering goals narrowly, in a one-sided manner, also disregards the
interrelatedness with, for instance, the perennially unfair world trade. It is no news that
the international trade system still fails to serve the interests of poor countries and of poor
people in them.
In short: The MDGs are not a welfare scheme.
38. Target 1B of MDG1 (achieving full and productive employment and decent work for
all) is ultimately the most important target. Poverty will not be reduced without near full
employment and decent work. Little progress in MDG1B has been achieved and not
much is talked about it in MDGs corridors. (Mind you, it is very difficult to collect
unemployment figures, mainly because of the great importance of the informal sector).
39. Achieving the MDGs must be understood as an issue of ethics, of HR and of politics
(and this is way beyond of what the MDGs ask for). Otherwise, the implementation of
MDGs actions risks being mechanical, anonymous and purely quantitative.
40. Participation by legitimate representatives of socially, economically and
geographically marginalized groups (and not by groups acting on their behalf!) must not
become an empty rhetoric. Ultimately, what needs to be pursued is a shift in the balance
of power, to be understood as better access and usufruct of economic resources by rights
holders and their participation in social and political decision making. We therefore must
boost the self-organization capacities of marginalized groups.
41. Involvement of the marginalized should actually be institutionalized and legally
enshrined. This is essential (and any form of surrogate participation must be prevented).
42. Finally, the international community must reconsider the conventional approaches to
development and come up with a truly internationally agreed plan that covers issues like
universal access to health care and to primary education, guaranteed state allowances for
children, basic pensions for senior citizens and for disabled people, guaranteed
unemployment benefits, compulsory education beyond primary education, clear goals for
climate change and many other burning issues.
43. In conclusion, the MDGs have led to narrowing the development discourse. We must
return to a more holistic, human rights-based understanding.
44. In short, the link between the sustainability discourse and the MDGs agenda is
missing. That is where we have to start. We must not wait until 2015 comes along.