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Saucy with the Gods: nutrition and food security speak to poverty
Food Policy, Vol. 23, No. 3/4, pp. 215–230, 1998 1998 Elsevier Science Ltd. All rights reserved Printed in Great Britain 0306-9192/98/$ - see front matter
Pergamon
PII: S0306-9192(98)00038-4
VIEWPOINT Saucy with the Gods: nutrition and food security speak to poverty Simon Maxwell Overseas Development Institute, Portland House, Stag Place, London SW1E 5DP, UK Poverty reduction has become the dominant paradigm of the 1990s, but poverty planners have had to re-learn many hard-won lessons from the earlier experience of nutrition and food security. Poverty planners can also learn from the current struggles of these related disciplines: for example, on how to discriminate between competing narratives, on the problems consequent on nutrition transitions, on managing international targets, and on questions of accountability. In general, this example of poor communication between disciplines emphasises the need for institutional learning and for management of knowledge. Development organisations need networks that cut across disciplines and sectors, which build cooperation in the field, and which develop new forms of partnership with poor people. 1998 Elsevier Science Ltd. All rights reserved. Keywords: poverty, food security, planning, rights
Introduction My title is taken from Shakespeare’s Julius Caesar. The story I have to tell is of dynastic rivalry and dynastic succession, set between Julius Caesar’s crossing of the Rubicon and his defeat of Pompey in 49 BC, and the final defeat of Mark Antony by the young Octavian, later the Emperor Augustus, at the battle of Actium in 31 BC. The theme of the paper is dynastic succession. Nutrition, prominent in the late 1970s and early 1980s, was displaced in the 1980s by food security. Food security, in turn, was displaced in the 1990s by poverty. Along the way, there appears to have been a failure to learn lessons in the process of dynastic succession. Many lessons were taken by Caesar to his grave; many more by Brutus. Have those lessons been re-learned by Mark Antony and Augustus? It is important to be clear here that my mission is not to bury poverty but to praise it. There is no question that the new emphasis on poverty reduction has re-energised and re-focused development policy. However, there are lessons to learn from history. Equally, there may well be lessons for poverty in the current intellectual and programmatic struggles of nutrition and food security. The wider issue is what it means for development agencies to be learning organisations. In developing these ideas, I begin with a review of the lessons forgotten, or perhaps the lessons re-learned by poverty planners in the 1990s. There are at least a dozen of these. I then 215
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review current struggles in food security and nutrition, to see whether there are further lessons for poverty planners. There are five main areas of possible synergy. Finally, I turn to the future and propose guidelines for a new Augustan age. There are four of these.
The lessons that poverty forgot, 1990–97 International work on poverty has evolved significantly since the landmark publication of the 1990 World Development Report on poverty (World Bank, 1990). There has been creative thinking on policy, a large investment in poverty assessments at country level, and substantial programmatic experience. There is a great deal of agreement amongst us about the characteristics and causes of poverty, and about appropriate actions to reduce poverty. In particular, the 1997 UNDP Human Development Report sketched out a vision with which many can agree. Jim Wolfensohn’s speech to the World Bank Board of Governors in Hong Kong in September 1997, ‘The challenge of inclusion’, covered similar territory (Wolfensohn, 1997). What I want to show here is that much of the learning that has taken place in the 1990s can be traced back to the conventional wisdom of nutrition and food security in the 1980s. There are a dozen points grouped into four main categories. Fig. 1 provides a summary. What is poverty? In the 1990 WDR, poverty was discussed largely in income terms. The money metric measure, based on a poverty line of US$1 a day in 1985 purchasing power parity, has been a powerful tool of analysis in poverty assessments. However, the Bank has come to recognise that poverty is multi-dimensional and that it includes elements of self-esteem and social participation (Hanmer et al., 1996). The new thinking is reflected in the present emphasis on social exclusion and inclusion. Here, it closely parallels analysis in nutrition and food security, where concepts of cultural acceptability, autonomy, and self-reliance have been common currency (Oshaug, 1985; Barraclough and Utting, 1987; Barraclough, 1991; Maxwell, 1996a). Poverty planners can look to the literatures on nutrition and food security, not only to find definitions of poverty which incorporate their new ideas, but also to find ways of investigating and measuring these non-material aspects of poverty (see, for example, Frankenberger, 1992). By the same token, poverty planners have come to take much greater interest in the variability of income, and the impact of shocks. In poverty studies, the terminology of livelihood security has become pre-eminent, with its emphasis on vulnerability and management of variability as key components of welfare (Chambers, 1997). Again, this move was prefigured in the nutrition and food security literatures. Nutritionists have long been concerned with the impact of shocks on the growth and weight of children, and have developed this into models which trace the nutrition security of households over time (Oshaug, 1985). Similarly, the notion
Figure 1 Twelve lessons that poverty forgot
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of variability and vulnerability is central to the very definition of food security (‘secure access to enough food at all times for an active, healthy life’). Food security analysis is quintessentially about the management of variability and risk (Davies, 1996). Again, the conceptual models have spawned substantial literatures on measurement and monitoring (Frankenberger, 1992). Who, where, how many, why? Poverty analysis has been very much concerned with understanding the social and geographical distribution of poverty, though it has often been hampered by the absence of accurate data, both for cross-section and longitudinal analysis. There is a rising tide of interest in panel data for comparative purposes. In tackling this issue, a neglected source of data lies in anthropometry, where large scale national data sets are available, often going back to the 1970s. For example, the recent Review of the World Nutrition Situation, published by the ACC/SCN Secretariat in Geneva, has brought together data from 95 countries of which at least 61 had two or more surveys for the estimation of trends in stunting of young children (ACC/SCN, 1998). Anthropometric data on height and weight provide good omnibus indicators of both long-term and short-term nutrition stress. Substantively, they tell an important story about relative progress in different regions and over different time periods. It is notable, for example, that early work on adjustment with a human face, which drew attention in the mid-1980s to the adverse consequences of structural adjustment for the poor, relied largely on nutrition data (Cornia et al., 1987). Sometimes, the nutrition data tell a story which reinforces the story told by the available, usually less rich, data on poverty. Sometimes, they extend the story in interesting ways. A prime example is the contrast in nutrition and poverty data for Asia and sub-Saharan Africa, reproduced in Table 1. Why is it that income-poverty data show roughly comparable levels in the two regions, whereas anthropometric data show a significantly higher level of deprivation in South Asia? Are the poverty data missing something important about the situation in South Asia? In analysing poverty, an essential piece of the jigsaw is the analysis of underlying causes. Here, there is much common ground between nutrition and food security on the one hand, and poverty on the other. However, it is worth emphasising that the entitlement and capability analysis which now informs much discussion of poverty and human welfare (e.g. in the 1997 UNDP Human Development Report), has its origins in Sen’s work on famine, and before that in detailed work on the etiology of under-nutrition carried out by economists like Joy (Sen, 1981; Joy, 1973). Nutritionists in the 1970s expended a great deal of effort on mapping the causes of under-nutrition, not always, as they themselves would accept, productively (Field, 1987). Food security analysis in the 1980s attempted to learn lessons about the need for simplification, for example, in the wave of food security studies which followed the great famine of 1984/85 in sub-Saharan Africa (Maxwell, 1990, 1996b). Similarly, nutritionists simplified their Table 1 Poverty and under nutrition in sub-Saharan Africa and South Asia % Population consuming less than % Children underweight (1993)b US$1 per day (1993)a Sub-Saharan Africa South Asia
39 43
Source: aUNDP (1997a, p. 27); bACC/SCN.
27 49
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analysis of the problem, for example, in the well known UNICEF model of the causes of child under-nutrition (Fig. 2). Can similar simplifications be applied to poverty analysis? Interventions When it comes to identifying the most appropriate interventions to tackle under-nutrition, food insecurity or poverty, there is again a great deal of common ground. We would all recognise that growth is necessary, but not sufficient; that targeting is necessary, especially when resources are limited; and that interventions in different sectors reinforce each other. However, there are a number of themes in the nutrition and food security areas that are only now beginning to achieve prominence in the poverty area.
Figure 2 Causes of malnutrition and death. Source: UNICEF (1990)
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The first of these is the importance of safety nets, present almost as an after-thought in the 1990 WDR, where the strategy is often referred to as ‘two-and-a-half legs’, with labour intensive growth and human capital being the two main legs, and safety nets an inferior third. Because of the emphasis on vulnerability and variability, managing shocks has always been central to food security analysis especially. Thus, the World Bank’s own pioneering review of the subject in 1986, Poverty and Hunger: Issues and Options for Food Security, distinguished clearly between chronic and transitory food insecurity, and reviewed in some detail the measures needed to reduce transitory food insecurity, including stabilising domestic food supply, stabilising demand, and protecting vulnerable groups (World Bank, 1986). More generally, food security analysis has accorded greater prominence to the macro economic management of shocks than has traditionally been the case in poverty analysis; and, partly in consequence, to the question of linking relief and development. A recent publication by the World Bank itself illustrates the complexity of the linkages between drought and the macro economy (Benson and Clay, 1998). By the same token, rehabilitation after shocks has been a major feature of food security analysis (Green and Mavie, 1994; Harvey, 1997). In the food security arena, much of our work has been driven by the impact of conflict. Sometimes, this has been indirect, as in the link between the civil war in Ethiopia and the famine of 1984–85. More recently the link has been direct, with conflict now being the major cause of famine, especially in sub-Saharan Africa (de Waal, 1993). It is interesting that the powerful World Bank task force report on poverty in sub-Saharan Africa, published in 1996, also identified conflict as a critical factor (World Bank, 1996). A further point is the sudden interest in the late 1990s in social capital as an essential ingredient in anti-poverty work (Putnam, 1993; World Bank, 1997a). Poverty planners have come to see that social cohesion and social integration play an important part in enabling growth and in protecting individuals against shocks. It might be interesting for them to look back at the long trajectory of work on community development in the nutrition arena. Programmes like the child survival and development programme in Iringa in Tanzania, which began in the early 1980s, were based on the idea of full community participation. As summarised by UNICEF, Quarterly weighing sessions sparked the participation not only of fathers and mothers, but also of the whole community in analysing why children were malnourished and why some seemed to thrive while others did not. An improved understanding of the facts involved in the nutritional well-being of their children in turn helped the villagers to plan and initiate actions that would contribute to better growth and overall child health (UNICEF, 1997, p. 41).
Finally, under this head, the nutrition community in particular has taught us important lessons about the complexity of human development problems, by focusing not just on aggregate nutrition intake (for which read income), but also on specifics like micro nutrients (principally vitamin A, iron and iodine). The extraordinary impact of micro nutrient interventions – for example, vitamin A supplementation in areas of evident xeropthalmia can lead to a reduction in child mortality of 23% (Beaton et al., 1993) – has important lessons for the planning of poverty programmes. Planning Three final lessons from nutrition and food security are about the process of planning for poverty reduction. The first is that participation matters. The current wave of interest in participation (Gaventa, 1998) had a pedigree in many nutrition programmes in the 1970s, as the
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Iringa experience cited earlier demonstrates. Are there some lessons to be learned, for example from UNICEF’s triple A cycle of assessment, analysis and action? A second issue is about the problem of choosing interventions. As we have seen, poverty reduction, food security and nutrition security are all complex, multi-dimensional objectives, with strong subjective elements. Furthermore, interventions have to be chosen to achieve the objectives in situations of high variability. In these circumstances, quantitative methods, for example, based on social accounting matrices, are of little help. Nutrition and food security planners have developed alternative and more informal methods, often based on checklists. For example, in the late 1980s, FAO pioneered a multiple criteria, check-list approach to selecting food security interventions (Huddleston, 1990). This has proved to be robust. Finally, one of the features of the new wave of work on poverty has been the creation of poverty planning units in developing countries – and indeed in donor agencies. The new social exclusion unit created by Tony Blair in the UK is a prime example of the genre. Characteristically, poverty units find it extremely difficult to plan effectively across central ministries, which have their own agendas, sources of financing and power bases. These problems are very familiar from nutrition and food security, and have been extensively reviewed (e.g. Field, 1987; Levinson, 1995; Maxwell, 1996b). Some clear lessons have come out of this analysis (summarised in Fig. 3). I have been trying (not very hard) to resist the temptation to say ‘we told you so’. It is actually hard to resist the conclusion that the learning process on poverty could have been accelerated with more attention to the previous experience of nutrition and food security. It is common to talk of the 1980s as the wasted decade in development. There is at least a sense in which the period 1990–95 can be identified as a wasted half-decade in poverty analysis. Perhaps there is just a hint, as with Julius Caesar, that ‘wisdom is confused in confidence’
Current struggles in nutrition and food security I turn now to current debates in food security and nutrition, in the hope that these may inform the poverty debate.
Figure 3 Ten lessons on food security planning.
Source: Maxwell (1996b)
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Competing narratives about food insecurity My first point is an indirect one, about the importance of ‘getting the story right’ – or discriminating between competing narratives about the problem policy is supposed to tackle. ‘Policy narratives’ are simplifying stories which inform policy (Roe, 1991). In food security, the underlying narrative is highly contested (Maxwell, 1996c). I suspect the same is true of poverty. In the field of food security, the competing narratives relate to our understanding of the world food problem. One interpretation of the problem is that the main problem facing the world is a growing shortfall in aggregate supply, resulting from the interaction between rapid population growth and slowing increases in agricultural productivity. The competing narrative gives greater prominence to the short-term crisis of under-nutrition currently existing in the world. On FAO estimates presented to the World Food Summit in 1996 (admittedly highly dubious; Smith, 1997), some 840 million people in the world do not have enough to eat. Many millions more are exposed to the risk of food shortage, or to specific micro nutrient deficiencies, particularly vitamin A, iron and iodine. The point about these two competitive narratives is that they have different implications for policy. A narrative which focuses on aggregate supply shortfalls is likely to lead to policies which emphasise increased production, often in high potential areas. These areas may be in the North, even when the nominal shortfall is found in the South (Pretty, 1995). Alternatively, they may be in the flat, well-watered and well connected areas of the South. In either case, production may be remote from poor people, many of whom will live in mountainous, arid or other low potential areas in developing countries, or in growing urban slums. A policy narrative which focuses on the food and security of the poor is likely to give greater emphasis to problems affecting access to food, and therefore to focus on income-earning activities and social safety nets. Seen from this perspective, a food production strategy may help the poor indirectly, by leading to a reduction in the price of food, but will be insufficient on its own to tackle hunger. No one should think that adjudicating between these competing narratives is not important for the allocation of resources: to production or consumption; to North or South; and to high or low potential areas. I have argued elsewhere that both narratives contain elements of truth, and that neither can be ignored – but that priority must be given to meeting short term consumption needs, not least because the private sector in high potential areas is more capable of financing its own development. I have called this strategy ‘Walking on two legs, but with one leg longer than the other’ (Maxwell, 1996d). When we turn from food security to poverty, we find that narratives do not compete over the same terrain (though there are interesting points to make, to which I shall return, about the relative importance of poverty in North and South). There are, however, competing narratives. In the field of poverty, the main competing narratives are about ‘poverty’ on one side, and ‘human development’ on the other (Baulch, 1996). The first is associated with work in the World Bank (especially World Bank, 1990), the second with UNDP (especially UNDP, 1997a). The caricature is that ‘poverty’ is about income measured in money terms, usually at the level of US$1 per day; and that ‘human development’ is about multi-dimensional deprivation, in which subjective feelings play an important part, and for which social exclusion acts as a metaphor. The great divide between poverty and human development has been much exaggerated, and possibly reflects the need for product differentiation as much as it does a genuine intellectual dispute between the World Bank and UNDP (Askwith, 1994). For its part, the World Bank
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has recognised the need to extend the concept of poverty beyond money-metric measures (Hanmer et al., 1996); by the same token, UNDP has recognised the need for growth (UNDP, 1997a). On the ground, however, it is not so clear that harmony prevails. Different narratives do co-exist, and they can imply quite different policies. Table 2 gives an example of two alternative narratives of poverty in an African country, the first taken from World Bank documentation, and the second from UN material. It is clear that the two narratives would lead in different policy directions. Nutrition transitions My second case is of more direct relevance to the poverty community. It has to do with nutrition transitions, and the implications for public policy of the rapid increase in chronic dietary diseases. The size of the problem is undisputed. The forthcoming report of the Commission on Nutrition, established by the ACC/SCN, summarises the problem as follows: WHO produced for the 1997 Health Assembly new evidence demonstrating that the major global burden of dietary diseases in adult life affects the developing world more than the developed countries. Now WHO is publishing new evidence of an escalating epidemic of obesity which is becoming apparent throughout the urban communities of the developing world, bringing in its wake the closely linked problem of diabetes… Rising cancer rates, particularly of the colon, breast, pancreas and prostrate, and heart disease, can now be expected (SCN, 1998, p. 9).
Table 2
Narratives on poverty in Tanzania
A. A World Bank narrative Poverty is largely a question of low income, compounded by poor social indicators. In Tanzania, it is largely a rural problem, and is found principally among households without access to a cash crop economy. For practical purposes, this means largely in semi-arid or isolated areas. Poverty fell sharply in the 1980s and early 1990s, mainly as a result of the liberalisation of input and crop marketing. The momentum was checked when the government lost control of the macro-economic aggregates in the mid-1990s. However, control has been reestablished. The main route to poverty reduction is broad-based agricultural growth, principally in cash crop sectors, partly through bringing new land into production, but mainly by enhancing productivity. Infrastructure and social sector investment is also very important, within the limits of a tight fiscal regime. Safety nets will have to rely largely on private initiatives. If per capita growth of 3% p.a. can be sustained (equivalent to 6% p.a. gross), then poverty could be reduced to around 10% by 2010. B. An alternative narrative Poverty is a multi-dimensional phenomenon, in which low income, poor social indicators, and social exclusion all play a part. Vulnerability, to drought or macro-economic shocks, is a key dimension of poverty. Poverty needs to be understood as both chronic and transitory, including the impact of seasonal hardship. In Tanzania, income inequality within agro-ecological zones is an important feature, and the poor are found in both high and low potential areas. Resource poor households, with little land and few livestock, are particularly at risk: many femaleheaded households fall into this category. Liberalisation has led to improved incentives and increased revenues for some – but not all have benefited, directly or indirectly, and income distribution has worsened since the early 1980s. Growth is obviously essential, to lift the average income and enable social services to be provided. However, cash crop sectors and areas should largely provide their own finance. The concentration of government and donor funding should be on programmes to empower and support the livelihood strategies of poor households and communities, including by helping the poor to improve health and education status. State safety nets are essential to supplement private provision. Tanzania cannot hope to eliminate income poverty by 2010. But it can aim gradually to increase incomes, while simultaneously reducing vulnerability to shocks, and helping the poor to achieve greater control over their own lives. Source: Greeley and Maxwell (1997).
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There are two causes of obesity and the various problems associated with it. The first is rising prosperity. Recent data from India, cited in SCN 1998, show that middle class men in India are over 30 times as likely to be overweight as poor men. This is not surprising. More startlingly, perhaps, the other factor is that nutrition deficiencies in the womb or infancy can lead to the appearance of chronic dietary diseases in later life. As infectious diseases are controlled and people live longer, such diseases are more likely to become apparent. A muchquoted example is that a nutrition shortfall in pregnancy can produce an under-developed pancreas, which in turn is associated with the development of late-onset diabetes in middle age. It might be expected that rising general standards of nutrition will eliminate the inherited forms of chronic dietary disease. However, the same phenomena will produce an increase in obesity and other dietary diseases of affluence. This nutrition transition is likely to put health budgets under even greater strain, and intensify competition for health resources. It is a phenomenon not discussed in the recent World Bank health nutrition and population policy paper (World Bank, 1997b). Meaningful targets A third issue where poverty can learn from food security is in the area of targets. International targets have recently become very popular, not least because of the dissemination work of the Development Assistance Committee of the OECD. The DAC’s publication, Shaping the 21st Century: The Contribution of Development Cooperation, puts targets for 2015 at the heart of its strategy. The document has influenced national policy, as in the case of the recent UK White Paper on international development. The key target in the DAC document is a reduction in the proportion of people living in absolute poverty by half by 2015 (DAC, 1996). Targets are an innovation in the field of poverty, but have been well established in food security and nutrition, at least since the World Food Conference of 1974, which announced that Within a decade no child will go to bed hungry… no family will fear for its next day’s bread, …no human being’s future and capacities will be stunted by malnutrition (UN, 1975, p. 4).
Targets on nutrition and food security were also adopted by the World Food Council in 1989, by the World Summit for Children in 1990, by the International Conference on Nutrition in 1992 and by the World Food Summit in 1996. A selection of food security goals for the year 2000, adopted by the World Summit for Children and the International Conference on Nutrition is reproduced in Fig. 4. The World Food Summit made a general commitment to previous targets, but concentrated on a new target, reducing the absolute number of hungry people by half by 2015. This latter target is not included in the DAC list, which predates it. Experience in food security and nutrition shows that targets can be useful, particularly in providing political impetus and in generating additional funding. However, our experience also shows that a certain caution is in order. Summarising the argument against targets, I have suggested that the sceptical case may be summarised as follows: International targets over-simplify and over-generalise complex problems. They distort public expenditure priorities, both because they misrepresent the problem, and because they privilege some sectors at the expense of others. Monitoring progress is extremely expensive and detracts from action on the ground. And the political benefits, though appreciable at first, may rapidly be lost if targets are not achieved (Maxwell, 1998b, p. 2).
As we have already seen, this series of nutrition and food security targets has been adopted, without much regard as to whether previous targets were achieved, or to the consistency between them. More importantly, we have seen that targets raise many conceptual problems,
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Figure 4 Food security goals for the year 2000
for example, about the very concept of ‘under-nourishment’, about the balance between chronic and transitory food insecurity, and about problems of measurement. The latest under-nutrition target, based on FAO’s calculation that 840 million people were under-nourished in 1996, is decidedly problematic. Thus, Smith concluded that the FAO calculation of under-nourishment had limited practical use as an indicator of food security for planning and monitoring food security interventions. It should not be used, in particular … to make cross-country and regional comparisons of food insecurity…, to track changes in food insecurity over time…, and to understand the causes of food insecurity (Smith, 1997).
In thinking about this problem, I have been led to conclude that the answer lies in subsidiarity. The answer is to keep the international targets universal, unambiguous and simple, and not do too much to measure them. Instead, responsibility for definition and measurement can be devolved to lower levels, mainly national, but also sub-national: We should agree that international targets have almost no connections to the real world of national planning and national resource allocation. These activities need to be guided by quite a different
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epistemology, one which recognises the richness, diversity and complexity of real world situations, and which builds on the knowledge, insight and ideas of poor people themselves. There are narratives to be reported about poverty and food insecurity, and they will bear very little relation to the narratives implied by international targets (Maxwell, 1998b).
Accountability A fourth issue which is currently high on the agenda, especially in the nutrition community, has to do with implementing the right to food. It has wider implications for accountability for public performance. Both rights and accountability are relevant to the poverty debate. The question of the human right to food has long presented a paradox. On the one hand, the right is well-entrenched in international legislation, particularly in the Universal Declaration of Human Rights of 1948 and the International Covenant on Economic and Social and Cultural rights of 1966 (UN, 1948, 1966). There is a large literature on the obligation of the state to respect, protect and fulfil the human right to food, in peace and war. On the other hand, the right to food, along with other economic and social rights, largely remains aspirational rather than legally enforceable. Pinstrup-Andersen et al. (1995) noted that Countries have offered various justifications for not enacting the right to food as a legal right: enforcement would be prohibitively expensive to the state, it is impossible to define economic and social rights in legally enforceable terms, protecting these rights would involve redistribution of privately held resources, and such rights can be easily abused by repressive governments (PinstrupAndersen et al., 1995).
Recent debate has, however, advanced somewhat from this position. One entry point has been to devise Codes of Conduct. For example, the International Federation of Red Cross and Red Crescent Societies has produced a Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief (IFRCRCS, 1996). This has been endorsed by more than 100 agencies, and the possibility of creating an ombudsman to oversee implementation is now being discussed. A code of conduct on the right to adequate food is also being prepared (WANAHR, 1997). I believe it is possible to go further and work towards a charter on food security and nutrition, setting out the guarantees that states make to their citizens. Essentially, these reflect performance standards to which governments can be held accountable. A proposal for a charter on food security is in Fig. 5. I have similarly proposed a charter on poverty reduction (UNDP, 1997b). An international charter is problematic, of course. It leaves important questions unanswered about funding and about the appropriateness of universal standards. Nevertheless, it offers enticing possibilities to the poverty community. North–south linkages A final issue has to do with North–South linkages. This is an issue where there is a good deal of material both on poverty and food security. It has become prominent because of the rapid rise in levels of poverty in the North during the last decade and a half. For example, recent data show that one-third of children in the UK currently live in poverty – and that poverty on this scale has real consequences for child nutrition, growth and development (Dowler, 1998). Food poverty provides a powerful window on poverty in the North more generally. Thus, Dowler has traced the use of food and nutrition data as indicators of poverty, and also the impact of food poverty on individuals. In a discussion of the link between food poverty and social exclusion, she has also made important points about the social role of food:
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Figure 5 A charter for food security Those who cannot afford to eat in ways acceptable to society; who find food shopping a stressful or potentially humiliating experience because they might have insufficient money; whose children cannot have a packed lunch similar to their friends’; who do not call on others to avoid having to accommodate return calls – these are people excluded from the ‘minimum acceptable way of life’. Food is an expression of who a person is and what they are worth, and of their ability to provide their family’s basic needs; it is also a focus for social exchange. Food is, of course, a major contributor to health and well-being. But it is not just health that is compromised in foodpoor households: social behaviour is also at risk (Dowler, 1998).
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A related point which comes out of the northern discussion is that income inequality has a negative impact on life expectancy, irrespective of income level and living conditions. Wilkinson (1996), in particular, has brought together cross-country survey data, epidemiological evidence, and the results of animal research, in order to demonstrate that the psycho-social consequences of being at the bottom of the income distribution, particularly stress, have adverse consequences for life expectancy. Feelings of powerlessness and low self-esteem are not simply subjective dimensions of poverty and social exclusion, they also have explicit physical consequences. It is a legitimate question whether the discussion of poverty and social exclusion in the North has any consequences or implications for the South. In considering this question, I have asked whether there are lessons to be learned on three aspects: (a) the comparisons to be drawn between North and South; (b) the possible convergence between North and South; and (c) the connections between poverty in North and South. My conclusion is: The thesis is that the answer to each of these questions is ‘yes’: there are then exciting possibilities for a new ‘mono-economics’, in which the boundaries of development studies begin to dissolve. Perhaps the Third World really is no more than a ‘collective psychological delusion’. Or does globalisation now mean that we are all developing countries? (Maxwell, 1998a).
Guidelines for a new Augustan Age This brief review of the lessons that poverty forgot, and of current struggles in nutrition and food security, suggests that there are lessons to learn about how these different policy communities can work together in the future. There are wider implications, too, for agencies which claim a new mission as learning organisations and knowledge banks. Four conclusions in particular are worth emphasising. First, there is an obvious need for networks that work. On all the issues I have touched upon, we can see a need for better networking, within and between disciplines. A genuine commitment to multi-sectoral analysis implies the need to learn more systematically from the past experience and current preoccupations of other disciplines; and also to create teams that cut across disciplines and sectors. This, again, is a much studied subject in the food security and nutrition fields, as we have seen. Perhaps the most important lesson is to build cooperation from the bottom up, working together in a task culture. In my experience, joint field work is often the best way to achieve this, perhaps in the context of participatory appraisals. If we are to struggle with competing narratives, the best place to do it is out in the field, and in partnership with poor people themselves. The second lesson is about the importance of subsidiarity in setting targets. This is a highly relevant issue for the 1999 World Development Report, which will deal with international targets, and for the report on poverty in 2000. Global narratives are inevitably reductionist and misleading. The best work in any of our sectors, nutrition, food security or poverty, will be informed by local realities. This is much more than simply saying that countries should produce national action plans to implement the targets agreed internationally. As I have written elsewhere National action plans exhibit a top down approach, in which the international targets drive the policy agenda at country level… In fact the approach we recommend is much more open, participatory, subversive and potentially deviant than this. In a process planning approach, we can be
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sure that poverty and food insecurity will feature prominently, but there is no guarantee that the particular target set internationally will feature at all (Maxwell, 1998b).
Third, there is both real need and real scope to work together on performance standards that will implement economic and social rights. This exercise could take the form either of a code of conduct or of a charter. In either case, it would lay down a set of guarantees that poor people can expect from those who control the resources and policies that affect their lives. Finally, the issue of accountability raises separate questions about the nature of partnership between donors and recipients. This is another topic highlighted in the DAC 21st Century document, and one picked up in the British White Paper on international development, which places partnership at the heart of its programme for bilateral relationships (UK, 1997). Many questions arise, however, about what exactly partnership means. Is it in fact a form of conditionality, in which recipients are expected to conform to good government and poverty reduction criteria before being granted the privilege of an aid relationship? Or is it instead something more contractual, in which both parties commit themselves to the principles that will govern their relationship, and the particular forms it will take. Some aid relationships have taken this form. For example, the Lome´ Convention has traditionally provided both a set of guiding principles and a concrete commitment to aid flows. There is a strong analogy here with the idea of a ‘participation ladder’, with co-option on the bottom rung and full empowerment on the top rung. As developing countries talk to their donors about partnership, can they expect more than asymmetric accountability, in which they carry the main burden of accountability?
Acknowledgements This paper was presented as a keynote address to the World Bank Human Development Week, 2–6 March 1998. Special thanks to Judith McGuire and other colleagues. Responsibility is the author’s.
References ACC/SCN (1998) Third Report on the World Nutrition Situation. ACC/SCN, Geneva. Askwith, M. (1994) Poverty reduction and sustainable human development: semantics or substance? Discussion Paper No. 345. Institute of Development Studies, Brighton, UK. Barraclough, S. L. (1991) An End to Hunger? The Social Origins of Food Strategies. Zed Books, London. Barraclough, S. L. and Utting, P. (1987) Food security trends and prospects in Latin America. Working Paper No. 99. Helen Kellogg Institute for International Studies, University of Notre Dame, USA. Baulch, R. (1996) Neglected trade-offs in poverty measurement. Poverty, Policy and Aid, IDS Bulletin 27(1). Institute of Development Studies, Brighton, UK. Beaton, G. H., Martorell, R., Aronson, K. J., Edmonston, B., McCabe, G., Ross, A. C. and Harvey, B. (1993) Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. University of Toronto, Ontario. Benson, C. and Clay, E. (1998) The impact of drought on sub-Saharan African economies. A preliminary examination. Technical Paper No. 401. World Bank, Washington DC. Chambers, R. (1997) Whose Reality Counts? Putting the First Last. Intermediate Technology Publications, London. Cornia, G. A., Jolly, R. and Stewart, F. (eds) (1987) Adjustment with a Human Face. Clarendon Press, Oxford. DAC (1996) Shaping 21st Century: The Contribution of Development Cooperation. Development Assistance Committee, OECD, Paris. Davies, S. (1996) Adaptable Livelihoods: Coping with Food Insecurity in the Malian Sahel. Macmillan, London. Dowler, E. (1998) Food poverty and food policy. Poverty and Social Exclusion North and South, IDS Bulletin 29(1). Institute of Development Studies, Brighton, UK. Field, J. O. (1987) Multi-sectoral nutrition planning: a post-mortem. Food Policy February. Frankenberger, T. (1992) Indicators and data collection methods for assessing household food security. In Household Food Security: Concepts, Indicators, Measurements. A Technical Review, eds S. Maxwell and T. Frankenberger. UNICEF and IFAD, New York and Rome.
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Gaventa, J. (1998) Poverty, participation and social exclusion in north and south. Poverty and Social Exclusion North and South, IDS Bulletin 29(1). Institute of Development Studies, Brighton, UK. Greeley, M. and Maxwell, S. (1997) Poverty and human development in Tanzania. Report on a visit to Tanzania, 14–26 February 1997. Mimeo, Institute of Development Studies, Brighton, UK. Green, R. H. and Mavie, M. (1994) From survival to livelihood in Mozambique. Linking Relief and Development, IDS Bulletin 25(4). Institute of Development Studies, Brighton, UK. Hanmer, L., White, H. and Pyatt, P. (1996) Poverty in sub-Saharan Africa: what can we learn from the World Bank’s poverty assessments? Institute of Social Studies, The Hague, The Netherlands. Harvey, P. (1997) Rehabilitation: An Annotated Bibliography for the CARE, Rehabilitation and the Greater Horn Project. Institute of Development Studies, Brighton, UK. Huddleston, B. (1990) FAO’s overall approach and methodology for formulating national food security programmes in developing countries. IDS Bulletin 21(3). Institute of Development Studies, Brighton, UK. ICN (1992) International Conference on Nutrition. Final Report of the Conference, Rome, December 1992. Food and Agriculture Organization of the United Nations/World Health Organization. IFRCRCS (1996) Code of conduct for the International Red Cross and Red Crescent Movement and NGOs in disaster relief. In World Disasters Report. International Federation of Red Cross and Red Crescent Societies, Geneva. Joy, L. (1973) Food and nutrition planning. Journal of Agricultural Economics XXIV(January). Levinson, F. J. (1995) Multi-sectoral nutrition planning: a synthesis of experience. In Child Growth and Nutrition in Developing Countries: Priorities for Action, eds P. Pinstrup-Andersen, D. Pelletier and H. Alderman. Cornell University Press, Ithaca. Maxwell, S. (ed.) (1990) Food security in developing countries. IDS Bulletin 21(3). Maxwell, S. (1996a) Food security: a post-modern perspective. Food Policy 21(2). Maxwell, S. (1996b) Organisational issues in new forms of multi-sectoral planning. Working Paper No. 42. Institute of Development Studies, Brighton, UK. Maxwell, S. (1996c) Review article perspectives on a new world food crisis. Journal of International Development 8, 859–867. Maxwell, S. (1996d) Walking on two legs, but with one leg longer than the other: a strategy for the World Food Summit. In Forum Valutazione a Cura del CISP, ed. M. Viezzoli. CISP, Rome. Maxwell, S. (1996e) A food charter for the millennium. Appropriate Technology 23(2). Maxwell, S. (1998a) Comparison, convergence and connections: development studies in north and south. In Poverty and Social Exclusion in North and South, IDS Bulletin 29(1). Institute of Development Studies, Brighton, UK. Maxwell, S. (1998b) International targets for poverty reduction and food security: a (mildly) sceptical but resolutely pragmatic view, with a call for greater subsidiarity. Canadian Journal of Development Studies, October. Oshaug, A. (1985) The composite concept of food security. In Introducing Nutritional Considerations into Rural Development Programmes with Focus on Agricultural: A Theoretical Contribution, eds W. B. Eide et al. Development of Methodology for the Evaluation of Nutritional Impact of Development Programmes, Report No. 1. Institute of Nutrition Research, University of Oslo, Oslo. Pinstrup-Andersen, P., Nygaard, D. and Ratta, A. (1995) The right to food: widely acknowledged and poorly protected. 2020 Brief, No. 22. International Food Policy Research Institute, Washington, DC. Pretty, J. N. (1995) Regenerating Agriculture: Policies and Practice for Sustainability and Self-Reliance. Earthscan Publications, London. Putnam, D. (1993) Making Democracy Work: Civic Traditions in Modern Italy. Princeton University Press, Chichester. Roe, E. (1991) ‘Development narratives’ or making the best of blueprint development. World Development 23, 1065–1070. SCN (1998) Ending malnutrition by 2020: an agenda for change in the millennium. A draft for consideration by the ACC/SCN. United Nations Commission on Nutrition. Sen, A. K. (1981) Poverty and Famines: An Essay on Entitlement and Deprivation. Clarendon Press, Oxford. Smith, L. C. (1997) World Food Summit follow-up: how useful is the FAO measure of chronic undernourishment. Food Forum 37. UK (1997) Eliminating world poverty: a challenge for the 21st century. White Paper on International Development. United Nations (1948) Universal Declaration of Human Rights. Adopted and proclaimed by General Assembly Resolution 217 A (III) of 10 December 1948. United Nations, New York. United Nations (1966) International Covenant on Economic, Social and Cultural Rights. Adopted and opened for signature, ratifications and accession by General Assembly Resolution 2200 A (XXI) of 16 December 1966. United Nations, New York. United Nations (1975) Report of the World Food Conference, Rome. 5–16 November 1974, New York. United Nations Development Programme (1997a) Human Development Report 1997. Oxford University Press, New York. United Nations Development Programme (1997b) Rethinking the Eradication of Poverty. UNDP, New York. UNICEF (1990) Strategy for improved nutrition of children and women in development countries. A UNICEF Policy Review. UNICEF, New York. UNICEF (1991) The State of the World’s Children 1991. Oxford University Press for UNICEF, New York.
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UNICEF (1997) The State of the World’s Children 1997. Oxford University Press for UNICEF, New York. de Waal, A. (1993) War and famine in Africa. New Approaches to Famine, IDS Bulletin 24(4). Institute of Development Studies, Brighton, UK. WANAHR (1997) Note on the World Food Summit Commitment 7, Objective 7.4 of the Plan of Action and its Follow-up. World Alliance for Nutrition and Human Rights, Oslo. Wilkinson (1996) Unhealthy Societies: The Afflictions of Inequality. Routledge, London. Wolfensohn, J. D. (1997) The challenge of inclusion. Address to the Board of Governors, Hong Kong, China, 23 September 1997. World Bank (1986) Poverty and Hunger: Issues and Options for Food Security in Development Countries. World Bank Policy Study, Washington, DC. World Bank (1990) World Development Report. World Bank, Washington, DC. World Bank (1996) Taking Action to Reduce Poverty in Sub-Saharan Africa. An Overview. World Bank, Washington DC. World Bank (1997a) World Development Report 1997. World Bank, Washington DC. World Bank (1997b) Health, Nutrition and Population: Sector Strategy. World Bank, Washington DC.
Pergamon
PII: S0306-9192(98)00038-4
VIEWPOINT Saucy with the Gods: nutrition and food security speak to poverty Simon Maxwell Overseas Development Institute, Portland House, Stag Place, London SW1E 5DP, UK Poverty reduction has become the dominant paradigm of the 1990s, but poverty planners have had to re-learn many hard-won lessons from the earlier experience of nutrition and food security. Poverty planners can also learn from the current struggles of these related disciplines: for example, on how to discriminate between competing narratives, on the problems consequent on nutrition transitions, on managing international targets, and on questions of accountability. In general, this example of poor communication between disciplines emphasises the need for institutional learning and for management of knowledge. Development organisations need networks that cut across disciplines and sectors, which build cooperation in the field, and which develop new forms of partnership with poor people. 1998 Elsevier Science Ltd. All rights reserved. Keywords: poverty, food security, planning, rights
Introduction My title is taken from Shakespeare’s Julius Caesar. The story I have to tell is of dynastic rivalry and dynastic succession, set between Julius Caesar’s crossing of the Rubicon and his defeat of Pompey in 49 BC, and the final defeat of Mark Antony by the young Octavian, later the Emperor Augustus, at the battle of Actium in 31 BC. The theme of the paper is dynastic succession. Nutrition, prominent in the late 1970s and early 1980s, was displaced in the 1980s by food security. Food security, in turn, was displaced in the 1990s by poverty. Along the way, there appears to have been a failure to learn lessons in the process of dynastic succession. Many lessons were taken by Caesar to his grave; many more by Brutus. Have those lessons been re-learned by Mark Antony and Augustus? It is important to be clear here that my mission is not to bury poverty but to praise it. There is no question that the new emphasis on poverty reduction has re-energised and re-focused development policy. However, there are lessons to learn from history. Equally, there may well be lessons for poverty in the current intellectual and programmatic struggles of nutrition and food security. The wider issue is what it means for development agencies to be learning organisations. In developing these ideas, I begin with a review of the lessons forgotten, or perhaps the lessons re-learned by poverty planners in the 1990s. There are at least a dozen of these. I then 215
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review current struggles in food security and nutrition, to see whether there are further lessons for poverty planners. There are five main areas of possible synergy. Finally, I turn to the future and propose guidelines for a new Augustan age. There are four of these.
The lessons that poverty forgot, 1990–97 International work on poverty has evolved significantly since the landmark publication of the 1990 World Development Report on poverty (World Bank, 1990). There has been creative thinking on policy, a large investment in poverty assessments at country level, and substantial programmatic experience. There is a great deal of agreement amongst us about the characteristics and causes of poverty, and about appropriate actions to reduce poverty. In particular, the 1997 UNDP Human Development Report sketched out a vision with which many can agree. Jim Wolfensohn’s speech to the World Bank Board of Governors in Hong Kong in September 1997, ‘The challenge of inclusion’, covered similar territory (Wolfensohn, 1997). What I want to show here is that much of the learning that has taken place in the 1990s can be traced back to the conventional wisdom of nutrition and food security in the 1980s. There are a dozen points grouped into four main categories. Fig. 1 provides a summary. What is poverty? In the 1990 WDR, poverty was discussed largely in income terms. The money metric measure, based on a poverty line of US$1 a day in 1985 purchasing power parity, has been a powerful tool of analysis in poverty assessments. However, the Bank has come to recognise that poverty is multi-dimensional and that it includes elements of self-esteem and social participation (Hanmer et al., 1996). The new thinking is reflected in the present emphasis on social exclusion and inclusion. Here, it closely parallels analysis in nutrition and food security, where concepts of cultural acceptability, autonomy, and self-reliance have been common currency (Oshaug, 1985; Barraclough and Utting, 1987; Barraclough, 1991; Maxwell, 1996a). Poverty planners can look to the literatures on nutrition and food security, not only to find definitions of poverty which incorporate their new ideas, but also to find ways of investigating and measuring these non-material aspects of poverty (see, for example, Frankenberger, 1992). By the same token, poverty planners have come to take much greater interest in the variability of income, and the impact of shocks. In poverty studies, the terminology of livelihood security has become pre-eminent, with its emphasis on vulnerability and management of variability as key components of welfare (Chambers, 1997). Again, this move was prefigured in the nutrition and food security literatures. Nutritionists have long been concerned with the impact of shocks on the growth and weight of children, and have developed this into models which trace the nutrition security of households over time (Oshaug, 1985). Similarly, the notion
Figure 1 Twelve lessons that poverty forgot
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of variability and vulnerability is central to the very definition of food security (‘secure access to enough food at all times for an active, healthy life’). Food security analysis is quintessentially about the management of variability and risk (Davies, 1996). Again, the conceptual models have spawned substantial literatures on measurement and monitoring (Frankenberger, 1992). Who, where, how many, why? Poverty analysis has been very much concerned with understanding the social and geographical distribution of poverty, though it has often been hampered by the absence of accurate data, both for cross-section and longitudinal analysis. There is a rising tide of interest in panel data for comparative purposes. In tackling this issue, a neglected source of data lies in anthropometry, where large scale national data sets are available, often going back to the 1970s. For example, the recent Review of the World Nutrition Situation, published by the ACC/SCN Secretariat in Geneva, has brought together data from 95 countries of which at least 61 had two or more surveys for the estimation of trends in stunting of young children (ACC/SCN, 1998). Anthropometric data on height and weight provide good omnibus indicators of both long-term and short-term nutrition stress. Substantively, they tell an important story about relative progress in different regions and over different time periods. It is notable, for example, that early work on adjustment with a human face, which drew attention in the mid-1980s to the adverse consequences of structural adjustment for the poor, relied largely on nutrition data (Cornia et al., 1987). Sometimes, the nutrition data tell a story which reinforces the story told by the available, usually less rich, data on poverty. Sometimes, they extend the story in interesting ways. A prime example is the contrast in nutrition and poverty data for Asia and sub-Saharan Africa, reproduced in Table 1. Why is it that income-poverty data show roughly comparable levels in the two regions, whereas anthropometric data show a significantly higher level of deprivation in South Asia? Are the poverty data missing something important about the situation in South Asia? In analysing poverty, an essential piece of the jigsaw is the analysis of underlying causes. Here, there is much common ground between nutrition and food security on the one hand, and poverty on the other. However, it is worth emphasising that the entitlement and capability analysis which now informs much discussion of poverty and human welfare (e.g. in the 1997 UNDP Human Development Report), has its origins in Sen’s work on famine, and before that in detailed work on the etiology of under-nutrition carried out by economists like Joy (Sen, 1981; Joy, 1973). Nutritionists in the 1970s expended a great deal of effort on mapping the causes of under-nutrition, not always, as they themselves would accept, productively (Field, 1987). Food security analysis in the 1980s attempted to learn lessons about the need for simplification, for example, in the wave of food security studies which followed the great famine of 1984/85 in sub-Saharan Africa (Maxwell, 1990, 1996b). Similarly, nutritionists simplified their Table 1 Poverty and under nutrition in sub-Saharan Africa and South Asia % Population consuming less than % Children underweight (1993)b US$1 per day (1993)a Sub-Saharan Africa South Asia
39 43
Source: aUNDP (1997a, p. 27); bACC/SCN.
27 49
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analysis of the problem, for example, in the well known UNICEF model of the causes of child under-nutrition (Fig. 2). Can similar simplifications be applied to poverty analysis? Interventions When it comes to identifying the most appropriate interventions to tackle under-nutrition, food insecurity or poverty, there is again a great deal of common ground. We would all recognise that growth is necessary, but not sufficient; that targeting is necessary, especially when resources are limited; and that interventions in different sectors reinforce each other. However, there are a number of themes in the nutrition and food security areas that are only now beginning to achieve prominence in the poverty area.
Figure 2 Causes of malnutrition and death. Source: UNICEF (1990)
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The first of these is the importance of safety nets, present almost as an after-thought in the 1990 WDR, where the strategy is often referred to as ‘two-and-a-half legs’, with labour intensive growth and human capital being the two main legs, and safety nets an inferior third. Because of the emphasis on vulnerability and variability, managing shocks has always been central to food security analysis especially. Thus, the World Bank’s own pioneering review of the subject in 1986, Poverty and Hunger: Issues and Options for Food Security, distinguished clearly between chronic and transitory food insecurity, and reviewed in some detail the measures needed to reduce transitory food insecurity, including stabilising domestic food supply, stabilising demand, and protecting vulnerable groups (World Bank, 1986). More generally, food security analysis has accorded greater prominence to the macro economic management of shocks than has traditionally been the case in poverty analysis; and, partly in consequence, to the question of linking relief and development. A recent publication by the World Bank itself illustrates the complexity of the linkages between drought and the macro economy (Benson and Clay, 1998). By the same token, rehabilitation after shocks has been a major feature of food security analysis (Green and Mavie, 1994; Harvey, 1997). In the food security arena, much of our work has been driven by the impact of conflict. Sometimes, this has been indirect, as in the link between the civil war in Ethiopia and the famine of 1984–85. More recently the link has been direct, with conflict now being the major cause of famine, especially in sub-Saharan Africa (de Waal, 1993). It is interesting that the powerful World Bank task force report on poverty in sub-Saharan Africa, published in 1996, also identified conflict as a critical factor (World Bank, 1996). A further point is the sudden interest in the late 1990s in social capital as an essential ingredient in anti-poverty work (Putnam, 1993; World Bank, 1997a). Poverty planners have come to see that social cohesion and social integration play an important part in enabling growth and in protecting individuals against shocks. It might be interesting for them to look back at the long trajectory of work on community development in the nutrition arena. Programmes like the child survival and development programme in Iringa in Tanzania, which began in the early 1980s, were based on the idea of full community participation. As summarised by UNICEF, Quarterly weighing sessions sparked the participation not only of fathers and mothers, but also of the whole community in analysing why children were malnourished and why some seemed to thrive while others did not. An improved understanding of the facts involved in the nutritional well-being of their children in turn helped the villagers to plan and initiate actions that would contribute to better growth and overall child health (UNICEF, 1997, p. 41).
Finally, under this head, the nutrition community in particular has taught us important lessons about the complexity of human development problems, by focusing not just on aggregate nutrition intake (for which read income), but also on specifics like micro nutrients (principally vitamin A, iron and iodine). The extraordinary impact of micro nutrient interventions – for example, vitamin A supplementation in areas of evident xeropthalmia can lead to a reduction in child mortality of 23% (Beaton et al., 1993) – has important lessons for the planning of poverty programmes. Planning Three final lessons from nutrition and food security are about the process of planning for poverty reduction. The first is that participation matters. The current wave of interest in participation (Gaventa, 1998) had a pedigree in many nutrition programmes in the 1970s, as the
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Iringa experience cited earlier demonstrates. Are there some lessons to be learned, for example from UNICEF’s triple A cycle of assessment, analysis and action? A second issue is about the problem of choosing interventions. As we have seen, poverty reduction, food security and nutrition security are all complex, multi-dimensional objectives, with strong subjective elements. Furthermore, interventions have to be chosen to achieve the objectives in situations of high variability. In these circumstances, quantitative methods, for example, based on social accounting matrices, are of little help. Nutrition and food security planners have developed alternative and more informal methods, often based on checklists. For example, in the late 1980s, FAO pioneered a multiple criteria, check-list approach to selecting food security interventions (Huddleston, 1990). This has proved to be robust. Finally, one of the features of the new wave of work on poverty has been the creation of poverty planning units in developing countries – and indeed in donor agencies. The new social exclusion unit created by Tony Blair in the UK is a prime example of the genre. Characteristically, poverty units find it extremely difficult to plan effectively across central ministries, which have their own agendas, sources of financing and power bases. These problems are very familiar from nutrition and food security, and have been extensively reviewed (e.g. Field, 1987; Levinson, 1995; Maxwell, 1996b). Some clear lessons have come out of this analysis (summarised in Fig. 3). I have been trying (not very hard) to resist the temptation to say ‘we told you so’. It is actually hard to resist the conclusion that the learning process on poverty could have been accelerated with more attention to the previous experience of nutrition and food security. It is common to talk of the 1980s as the wasted decade in development. There is at least a sense in which the period 1990–95 can be identified as a wasted half-decade in poverty analysis. Perhaps there is just a hint, as with Julius Caesar, that ‘wisdom is confused in confidence’
Current struggles in nutrition and food security I turn now to current debates in food security and nutrition, in the hope that these may inform the poverty debate.
Figure 3 Ten lessons on food security planning.
Source: Maxwell (1996b)
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Competing narratives about food insecurity My first point is an indirect one, about the importance of ‘getting the story right’ – or discriminating between competing narratives about the problem policy is supposed to tackle. ‘Policy narratives’ are simplifying stories which inform policy (Roe, 1991). In food security, the underlying narrative is highly contested (Maxwell, 1996c). I suspect the same is true of poverty. In the field of food security, the competing narratives relate to our understanding of the world food problem. One interpretation of the problem is that the main problem facing the world is a growing shortfall in aggregate supply, resulting from the interaction between rapid population growth and slowing increases in agricultural productivity. The competing narrative gives greater prominence to the short-term crisis of under-nutrition currently existing in the world. On FAO estimates presented to the World Food Summit in 1996 (admittedly highly dubious; Smith, 1997), some 840 million people in the world do not have enough to eat. Many millions more are exposed to the risk of food shortage, or to specific micro nutrient deficiencies, particularly vitamin A, iron and iodine. The point about these two competitive narratives is that they have different implications for policy. A narrative which focuses on aggregate supply shortfalls is likely to lead to policies which emphasise increased production, often in high potential areas. These areas may be in the North, even when the nominal shortfall is found in the South (Pretty, 1995). Alternatively, they may be in the flat, well-watered and well connected areas of the South. In either case, production may be remote from poor people, many of whom will live in mountainous, arid or other low potential areas in developing countries, or in growing urban slums. A policy narrative which focuses on the food and security of the poor is likely to give greater emphasis to problems affecting access to food, and therefore to focus on income-earning activities and social safety nets. Seen from this perspective, a food production strategy may help the poor indirectly, by leading to a reduction in the price of food, but will be insufficient on its own to tackle hunger. No one should think that adjudicating between these competing narratives is not important for the allocation of resources: to production or consumption; to North or South; and to high or low potential areas. I have argued elsewhere that both narratives contain elements of truth, and that neither can be ignored – but that priority must be given to meeting short term consumption needs, not least because the private sector in high potential areas is more capable of financing its own development. I have called this strategy ‘Walking on two legs, but with one leg longer than the other’ (Maxwell, 1996d). When we turn from food security to poverty, we find that narratives do not compete over the same terrain (though there are interesting points to make, to which I shall return, about the relative importance of poverty in North and South). There are, however, competing narratives. In the field of poverty, the main competing narratives are about ‘poverty’ on one side, and ‘human development’ on the other (Baulch, 1996). The first is associated with work in the World Bank (especially World Bank, 1990), the second with UNDP (especially UNDP, 1997a). The caricature is that ‘poverty’ is about income measured in money terms, usually at the level of US$1 per day; and that ‘human development’ is about multi-dimensional deprivation, in which subjective feelings play an important part, and for which social exclusion acts as a metaphor. The great divide between poverty and human development has been much exaggerated, and possibly reflects the need for product differentiation as much as it does a genuine intellectual dispute between the World Bank and UNDP (Askwith, 1994). For its part, the World Bank
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has recognised the need to extend the concept of poverty beyond money-metric measures (Hanmer et al., 1996); by the same token, UNDP has recognised the need for growth (UNDP, 1997a). On the ground, however, it is not so clear that harmony prevails. Different narratives do co-exist, and they can imply quite different policies. Table 2 gives an example of two alternative narratives of poverty in an African country, the first taken from World Bank documentation, and the second from UN material. It is clear that the two narratives would lead in different policy directions. Nutrition transitions My second case is of more direct relevance to the poverty community. It has to do with nutrition transitions, and the implications for public policy of the rapid increase in chronic dietary diseases. The size of the problem is undisputed. The forthcoming report of the Commission on Nutrition, established by the ACC/SCN, summarises the problem as follows: WHO produced for the 1997 Health Assembly new evidence demonstrating that the major global burden of dietary diseases in adult life affects the developing world more than the developed countries. Now WHO is publishing new evidence of an escalating epidemic of obesity which is becoming apparent throughout the urban communities of the developing world, bringing in its wake the closely linked problem of diabetes… Rising cancer rates, particularly of the colon, breast, pancreas and prostrate, and heart disease, can now be expected (SCN, 1998, p. 9).
Table 2
Narratives on poverty in Tanzania
A. A World Bank narrative Poverty is largely a question of low income, compounded by poor social indicators. In Tanzania, it is largely a rural problem, and is found principally among households without access to a cash crop economy. For practical purposes, this means largely in semi-arid or isolated areas. Poverty fell sharply in the 1980s and early 1990s, mainly as a result of the liberalisation of input and crop marketing. The momentum was checked when the government lost control of the macro-economic aggregates in the mid-1990s. However, control has been reestablished. The main route to poverty reduction is broad-based agricultural growth, principally in cash crop sectors, partly through bringing new land into production, but mainly by enhancing productivity. Infrastructure and social sector investment is also very important, within the limits of a tight fiscal regime. Safety nets will have to rely largely on private initiatives. If per capita growth of 3% p.a. can be sustained (equivalent to 6% p.a. gross), then poverty could be reduced to around 10% by 2010. B. An alternative narrative Poverty is a multi-dimensional phenomenon, in which low income, poor social indicators, and social exclusion all play a part. Vulnerability, to drought or macro-economic shocks, is a key dimension of poverty. Poverty needs to be understood as both chronic and transitory, including the impact of seasonal hardship. In Tanzania, income inequality within agro-ecological zones is an important feature, and the poor are found in both high and low potential areas. Resource poor households, with little land and few livestock, are particularly at risk: many femaleheaded households fall into this category. Liberalisation has led to improved incentives and increased revenues for some – but not all have benefited, directly or indirectly, and income distribution has worsened since the early 1980s. Growth is obviously essential, to lift the average income and enable social services to be provided. However, cash crop sectors and areas should largely provide their own finance. The concentration of government and donor funding should be on programmes to empower and support the livelihood strategies of poor households and communities, including by helping the poor to improve health and education status. State safety nets are essential to supplement private provision. Tanzania cannot hope to eliminate income poverty by 2010. But it can aim gradually to increase incomes, while simultaneously reducing vulnerability to shocks, and helping the poor to achieve greater control over their own lives. Source: Greeley and Maxwell (1997).
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There are two causes of obesity and the various problems associated with it. The first is rising prosperity. Recent data from India, cited in SCN 1998, show that middle class men in India are over 30 times as likely to be overweight as poor men. This is not surprising. More startlingly, perhaps, the other factor is that nutrition deficiencies in the womb or infancy can lead to the appearance of chronic dietary diseases in later life. As infectious diseases are controlled and people live longer, such diseases are more likely to become apparent. A muchquoted example is that a nutrition shortfall in pregnancy can produce an under-developed pancreas, which in turn is associated with the development of late-onset diabetes in middle age. It might be expected that rising general standards of nutrition will eliminate the inherited forms of chronic dietary disease. However, the same phenomena will produce an increase in obesity and other dietary diseases of affluence. This nutrition transition is likely to put health budgets under even greater strain, and intensify competition for health resources. It is a phenomenon not discussed in the recent World Bank health nutrition and population policy paper (World Bank, 1997b). Meaningful targets A third issue where poverty can learn from food security is in the area of targets. International targets have recently become very popular, not least because of the dissemination work of the Development Assistance Committee of the OECD. The DAC’s publication, Shaping the 21st Century: The Contribution of Development Cooperation, puts targets for 2015 at the heart of its strategy. The document has influenced national policy, as in the case of the recent UK White Paper on international development. The key target in the DAC document is a reduction in the proportion of people living in absolute poverty by half by 2015 (DAC, 1996). Targets are an innovation in the field of poverty, but have been well established in food security and nutrition, at least since the World Food Conference of 1974, which announced that Within a decade no child will go to bed hungry… no family will fear for its next day’s bread, …no human being’s future and capacities will be stunted by malnutrition (UN, 1975, p. 4).
Targets on nutrition and food security were also adopted by the World Food Council in 1989, by the World Summit for Children in 1990, by the International Conference on Nutrition in 1992 and by the World Food Summit in 1996. A selection of food security goals for the year 2000, adopted by the World Summit for Children and the International Conference on Nutrition is reproduced in Fig. 4. The World Food Summit made a general commitment to previous targets, but concentrated on a new target, reducing the absolute number of hungry people by half by 2015. This latter target is not included in the DAC list, which predates it. Experience in food security and nutrition shows that targets can be useful, particularly in providing political impetus and in generating additional funding. However, our experience also shows that a certain caution is in order. Summarising the argument against targets, I have suggested that the sceptical case may be summarised as follows: International targets over-simplify and over-generalise complex problems. They distort public expenditure priorities, both because they misrepresent the problem, and because they privilege some sectors at the expense of others. Monitoring progress is extremely expensive and detracts from action on the ground. And the political benefits, though appreciable at first, may rapidly be lost if targets are not achieved (Maxwell, 1998b, p. 2).
As we have already seen, this series of nutrition and food security targets has been adopted, without much regard as to whether previous targets were achieved, or to the consistency between them. More importantly, we have seen that targets raise many conceptual problems,
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Figure 4 Food security goals for the year 2000
for example, about the very concept of ‘under-nourishment’, about the balance between chronic and transitory food insecurity, and about problems of measurement. The latest under-nutrition target, based on FAO’s calculation that 840 million people were under-nourished in 1996, is decidedly problematic. Thus, Smith concluded that the FAO calculation of under-nourishment had limited practical use as an indicator of food security for planning and monitoring food security interventions. It should not be used, in particular … to make cross-country and regional comparisons of food insecurity…, to track changes in food insecurity over time…, and to understand the causes of food insecurity (Smith, 1997).
In thinking about this problem, I have been led to conclude that the answer lies in subsidiarity. The answer is to keep the international targets universal, unambiguous and simple, and not do too much to measure them. Instead, responsibility for definition and measurement can be devolved to lower levels, mainly national, but also sub-national: We should agree that international targets have almost no connections to the real world of national planning and national resource allocation. These activities need to be guided by quite a different
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epistemology, one which recognises the richness, diversity and complexity of real world situations, and which builds on the knowledge, insight and ideas of poor people themselves. There are narratives to be reported about poverty and food insecurity, and they will bear very little relation to the narratives implied by international targets (Maxwell, 1998b).
Accountability A fourth issue which is currently high on the agenda, especially in the nutrition community, has to do with implementing the right to food. It has wider implications for accountability for public performance. Both rights and accountability are relevant to the poverty debate. The question of the human right to food has long presented a paradox. On the one hand, the right is well-entrenched in international legislation, particularly in the Universal Declaration of Human Rights of 1948 and the International Covenant on Economic and Social and Cultural rights of 1966 (UN, 1948, 1966). There is a large literature on the obligation of the state to respect, protect and fulfil the human right to food, in peace and war. On the other hand, the right to food, along with other economic and social rights, largely remains aspirational rather than legally enforceable. Pinstrup-Andersen et al. (1995) noted that Countries have offered various justifications for not enacting the right to food as a legal right: enforcement would be prohibitively expensive to the state, it is impossible to define economic and social rights in legally enforceable terms, protecting these rights would involve redistribution of privately held resources, and such rights can be easily abused by repressive governments (PinstrupAndersen et al., 1995).
Recent debate has, however, advanced somewhat from this position. One entry point has been to devise Codes of Conduct. For example, the International Federation of Red Cross and Red Crescent Societies has produced a Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief (IFRCRCS, 1996). This has been endorsed by more than 100 agencies, and the possibility of creating an ombudsman to oversee implementation is now being discussed. A code of conduct on the right to adequate food is also being prepared (WANAHR, 1997). I believe it is possible to go further and work towards a charter on food security and nutrition, setting out the guarantees that states make to their citizens. Essentially, these reflect performance standards to which governments can be held accountable. A proposal for a charter on food security is in Fig. 5. I have similarly proposed a charter on poverty reduction (UNDP, 1997b). An international charter is problematic, of course. It leaves important questions unanswered about funding and about the appropriateness of universal standards. Nevertheless, it offers enticing possibilities to the poverty community. North–south linkages A final issue has to do with North–South linkages. This is an issue where there is a good deal of material both on poverty and food security. It has become prominent because of the rapid rise in levels of poverty in the North during the last decade and a half. For example, recent data show that one-third of children in the UK currently live in poverty – and that poverty on this scale has real consequences for child nutrition, growth and development (Dowler, 1998). Food poverty provides a powerful window on poverty in the North more generally. Thus, Dowler has traced the use of food and nutrition data as indicators of poverty, and also the impact of food poverty on individuals. In a discussion of the link between food poverty and social exclusion, she has also made important points about the social role of food:
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Figure 5 A charter for food security Those who cannot afford to eat in ways acceptable to society; who find food shopping a stressful or potentially humiliating experience because they might have insufficient money; whose children cannot have a packed lunch similar to their friends’; who do not call on others to avoid having to accommodate return calls – these are people excluded from the ‘minimum acceptable way of life’. Food is an expression of who a person is and what they are worth, and of their ability to provide their family’s basic needs; it is also a focus for social exchange. Food is, of course, a major contributor to health and well-being. But it is not just health that is compromised in foodpoor households: social behaviour is also at risk (Dowler, 1998).
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A related point which comes out of the northern discussion is that income inequality has a negative impact on life expectancy, irrespective of income level and living conditions. Wilkinson (1996), in particular, has brought together cross-country survey data, epidemiological evidence, and the results of animal research, in order to demonstrate that the psycho-social consequences of being at the bottom of the income distribution, particularly stress, have adverse consequences for life expectancy. Feelings of powerlessness and low self-esteem are not simply subjective dimensions of poverty and social exclusion, they also have explicit physical consequences. It is a legitimate question whether the discussion of poverty and social exclusion in the North has any consequences or implications for the South. In considering this question, I have asked whether there are lessons to be learned on three aspects: (a) the comparisons to be drawn between North and South; (b) the possible convergence between North and South; and (c) the connections between poverty in North and South. My conclusion is: The thesis is that the answer to each of these questions is ‘yes’: there are then exciting possibilities for a new ‘mono-economics’, in which the boundaries of development studies begin to dissolve. Perhaps the Third World really is no more than a ‘collective psychological delusion’. Or does globalisation now mean that we are all developing countries? (Maxwell, 1998a).
Guidelines for a new Augustan Age This brief review of the lessons that poverty forgot, and of current struggles in nutrition and food security, suggests that there are lessons to learn about how these different policy communities can work together in the future. There are wider implications, too, for agencies which claim a new mission as learning organisations and knowledge banks. Four conclusions in particular are worth emphasising. First, there is an obvious need for networks that work. On all the issues I have touched upon, we can see a need for better networking, within and between disciplines. A genuine commitment to multi-sectoral analysis implies the need to learn more systematically from the past experience and current preoccupations of other disciplines; and also to create teams that cut across disciplines and sectors. This, again, is a much studied subject in the food security and nutrition fields, as we have seen. Perhaps the most important lesson is to build cooperation from the bottom up, working together in a task culture. In my experience, joint field work is often the best way to achieve this, perhaps in the context of participatory appraisals. If we are to struggle with competing narratives, the best place to do it is out in the field, and in partnership with poor people themselves. The second lesson is about the importance of subsidiarity in setting targets. This is a highly relevant issue for the 1999 World Development Report, which will deal with international targets, and for the report on poverty in 2000. Global narratives are inevitably reductionist and misleading. The best work in any of our sectors, nutrition, food security or poverty, will be informed by local realities. This is much more than simply saying that countries should produce national action plans to implement the targets agreed internationally. As I have written elsewhere National action plans exhibit a top down approach, in which the international targets drive the policy agenda at country level… In fact the approach we recommend is much more open, participatory, subversive and potentially deviant than this. In a process planning approach, we can be
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sure that poverty and food insecurity will feature prominently, but there is no guarantee that the particular target set internationally will feature at all (Maxwell, 1998b).
Third, there is both real need and real scope to work together on performance standards that will implement economic and social rights. This exercise could take the form either of a code of conduct or of a charter. In either case, it would lay down a set of guarantees that poor people can expect from those who control the resources and policies that affect their lives. Finally, the issue of accountability raises separate questions about the nature of partnership between donors and recipients. This is another topic highlighted in the DAC 21st Century document, and one picked up in the British White Paper on international development, which places partnership at the heart of its programme for bilateral relationships (UK, 1997). Many questions arise, however, about what exactly partnership means. Is it in fact a form of conditionality, in which recipients are expected to conform to good government and poverty reduction criteria before being granted the privilege of an aid relationship? Or is it instead something more contractual, in which both parties commit themselves to the principles that will govern their relationship, and the particular forms it will take. Some aid relationships have taken this form. For example, the Lome´ Convention has traditionally provided both a set of guiding principles and a concrete commitment to aid flows. There is a strong analogy here with the idea of a ‘participation ladder’, with co-option on the bottom rung and full empowerment on the top rung. As developing countries talk to their donors about partnership, can they expect more than asymmetric accountability, in which they carry the main burden of accountability?
Acknowledgements This paper was presented as a keynote address to the World Bank Human Development Week, 2–6 March 1998. Special thanks to Judith McGuire and other colleagues. Responsibility is the author’s.
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