I often like to make my points using bullets rather than flowing prose. I use the bullets to challenge your thinking and your reactions to what you agree with—and disagree with. Here, I zero in on the application of the Human Rights Framework—often referred to as the human rights-based approach. To make things easier to understand, I apply all this to the area of health and nutrition seen from the wider perspective of its structural determinants.

Historically, the Basic Needs Approach only offered promises; the human rights-based approach (HRBA) focuses on obligations that actually demand action from decision-makers (duty bearers in human rights lingo). The victims of human rights (HR) violations (claim holders in human rights lingo) thus no longer beg; they now demand based on countries having ratified UN HR covenants, so now claiming is under the realm of international HR law.

Why the HRBA?

  • Because poverty, ill health, and malnutrition represent a denial of human rights on a massive scale.

  • Because ill health and malnutrition among populations rendered poor are the biological translation of a social disease.

  • Because we all live in structurally unequal societies.

  • Because, as development workers, we all work in countries with appalling social inequalities.

  • Because, with counted exceptions (China among others), governments have failed to successfully tackle preventable ill health and malnutrition.

  • Because there is now ample recognition of the political roots of violations of the right to health and to food (the latter now rightly understood not in terms of a lack of food, but rather in terms of the vulnerability that powerlessness brings about).

  • Because efforts to reduce chronic ill health and hunger in developing countries—and overnutrition the world over—are not currently on track to meet the SDGs.

  • Because social and employment concerns are never brought to the forefront in the process of addressing ill health, malnutrition, and preventable deaths.

  • Because the bare fact is that people rendered poor are excluded from their share in the wealth they help to create. (That is why the distribution of wealth is more important than its creation).

  • Because the prevailing public health and public nutrition discourse is wrong, discussions and actions based on the wrong analyses will be like pouring water into a broken bucket; no amount of effort to fill it will be sufficient.

Apathy towards these issues indeed turns our work stagnant. We thus need to transform apathy into activism and struggle for negotiated social contracts between people (as claim-holders) and duty bearers for better health and nutrition. Therefore, to make health and nutrition services work for those rendered poor, claim holders need more control over those services.

This is because, if available at all, health and nutrition services are failing poor people, the main reason being that they are top-down and thus do not promote the protection and fulfillment of people’s rights per se.

As examples of apathy, classically, most of us doing work on nutrition and health get involved in:

  • Schemes providing incentives for food production or technical assistance to food producers (sometimes even for women…).

  • Promoting food storage and preservation.

  • Reorganizing food marketing chains.

  • Influencing food choices and food preparation,

  • Implementing all or some components of primary health care.

  • (Quite useless) health and nutrition education activities that end up teaching people to eat what they cannot afford and thus have only limited potential. It reflects an attitude such as, "Keep them poor, but teach them.

Foreign aid likes to fund all these. And NGOs are nothing but appendices, or the executing arms, of traditional Northern bilateral agencies. Furthermore, foreign aid creates dependency and consistently devalues and demotes the role of popular knowledge in our fields of expertise. (Many of us are even often being used in one way or another and are thus, knowingly or not, at the service of the status quo. We do get involved in pat solutions often, even beginning to believe in these solutions.

So, where does our analysis ought to start when applying the HRBA?

It starts with our analysis of the framework of the causes of ill health, malnutrition, and preventable deaths, i.e., looking for immediate, underlying, and basic (structural) causes.

You all know the Chinese proverb, ‘Give me a fish and you’ll have fed me for a day, and teach me how to use a net and you’ll feed me for life.’ Its fallacy is repeated over and over again. The real question is who owns the pond/lake/river/ocean stretch and what the rights of the poor are to fish there… (Access to the Commons is not to be taken for granted!) Moreover, the pond/lake/river/ocean is contaminated.

You can either be convinced to apply the HRBA from a primarily ethical or from a political motivation.

But what is needed is clearly identifying the paths to follow to get things that need to be done, and the latter by whom, with whom, and against whom. (I personally see the challenge we face as being one to graduate from the ethical into the political approach). Why? Because claim holders must become the protagonists of a politically motivated process that assigns a key role to 'social activists and political advocates' acting as agents of accountability. This means for them having to effectively demand and influence how the public sector allocates its resources to different geographic/gender/socioeconomic/ethnic groups and how, in the process, the government favors programs that are under strong community control.

Some HR activists have been systematically analyzing state or local governments' budgets to show where funds are or are not going).

Basically, the problem is that, in the absence of more profound structural changes, we end up, more often than not, providing pat solutions that have not made any dent on the more burning problems of health and nutrition—from the local to the global in equal measure.

Health and nutrition problems are further strongly linked to the problem of urban migration. Every urban-migrating young adult (mostly male) represents, at the same time, two fewer arms to produce food and one more mouth to feed in the city through the efforts of those who stayed behind (mostly women, children, and elderly men). Moreover, the cost of a minimum-cost diet for an average family of five members is often above the minimum wages of most unskilled workers in urban centers. Foreign debt is also a constant reminder of the neo-colonial relationships between the countries of the North and the South. Part of the borrowed money has been used to maintain consumption levels (mostly urban).

Bottom line

Those rendered poor and marginalized have legitimate claims in the struggle for the rights to health and nutrition. The question is: Are claim holders accommodating when they should be confronting duty bearers as is needed?

Land reform, small farmers' credit, price incentives to food producers, subsidization of agricultural inputs linked to labor-intensive agroecology with high priority for food crops, equitable food distribution schemes, participatory decision-making, and many others along the same line are at the heart of what really could make a difference to nutrition. In health, tax-based universal free health coverage, a halt to privatization, and strict regulation of what are predatory health insurance practices are among the many things claim holders have to fight for. Add to this the organization of a network of daycare centers and nurseries in the country and serious moves toward providing quality primary health care services and access to dependable water and sanitation.

What to do then?

Should we start by denouncing the state of affairs brought up by what has just been said and begin looking for global and local alternatives with the participation of those sectors for which the present system has failed to provide even minimum benefits? Work at the grassroots level would then have to be made a doubly called-for priority.

Health and nutrition can and should be ports of entry for structural changes. The hows of this is what we should explore in more depth. The discontent already exists. To repeat: Human rights-based policies must instill a new will and commitment to change preventable structural causes of inequalities in society.

The question is whether the government is really committed to this task. Probably not really, since most cannot tolerate empowerment and autonomy of communities. The main problem remains: poverty. But this is for another Meer piece.