🚀 go-pugleaf

The vulnerable years

These links between poverty's causes and effects lend special
weight to the case for doing what could now be done to protect
young children from the worst aspects of poverty.

There are many external causes of that poverty.  And the process
of development must address all of those causes, whether they be
rooted in accidental geographical circumstances or exploitative
economic relationships. But one of the most intractable of those
causes is the fact that the children of the poor do not usually
receive the kind of start in life which will enable them to take
advantage of the opportunities that do become available.  And one
of the main aims of development must be to break into this
insidious 'inner cycle' of malnutrition and disease leading to
poor mental and physical growth; leading to poor performance at
school and at work; leading to reduced adult capacity for earning
an income, initiating change, responding to new opportunities;
leading to poor and often large families which are vulnerable to
the malnutrition and disease that close the cycle and allow the
current of poverty to flow from one generation to the next.

The place at which to make that break is before the child is born
and during the early years of his or her life.  If the mental and
physical growth of the child can be afforded special protection
at this time, if families and communities and governments can
prevent the worst aspects of poverty from affecting the child's
normal growth and development, if special measures can be taken
to give those vulnerable months and years something of the
protection which is given to children fortunate enough to be born
into a higher socio-economic class, then a major contribution to
the breaking of the cycle will have been made.

This is the kind of protection for the vulnerable years which
millions of parents the world over make sacrifices to provide. 
From the point of view of those parents, it is special protection
given from love and common sense.  From the point of view of the
effects of poverty on growth and development, it is special
protection given in order to artificially and temporarily lift a
child to a higher socio-economic level, for the vulnerable early
years, so that the poverty into which that child is born will
not, as far as is possible, inflict long term damage.

To illustrate the thesis still further, this is also the kind of
special protection that nature itself tries to provide to those
vulnerable years in the form of breastmilk.  In almost all
circumstances, breastmilk means that during the first six months
of life a child is well nourished whether he or she is born into
the meanest slum or the most opulent mansion.  Nature, too, is
here attempting to neutralize the fortunes of birth by providing
a standard of nutrition that does not reflect, and is not
affected by, the socio-economic level of the family into which
that child is born.

The capacity for extending this special protection, and for
protecting the period of most rapid physical and mental growth
from the most damaging aspects of poverty, has now been vastly
increased by advances in knowledge and communications capacity. 
By such means as immunization, growth monitoring and
promotion,(fn#21) the proper management of diarrhoeal diseases
and respiratory infections, supplementing vitamin A and iodine,
targeted food subsidies, and low-cost water and sanitation
services, it is now possible to broaden and strengthen this basic
protection for the most vulnerable years of life.  With today's
knowledge and communications power, families, governments, and
the international community could now build a shield of basic
protection around the early years for all children.  And in so
doing, a major contribution could be made not only to meeting
immediate human needs but to breaking the 'inner cycle' of
poverty and underdevelopment.   

The present opportunity to meet the most basic and obvious needs
of children in the poorest quarter of the world must therefore
also be seen in the context of this profound relationship between
the physical and mental needs of children and the social and
economic development of their societies.  "I think it is time,"
says Professor Muhammad Yunus, founder of Bangladesh's Grameen
Bank Movement, "to come out boldly to insist that children should
be placed at the centre stage in all development
thinking."(fn#22)

Outreach capacity

To these arguments must be added two other reasons which add
weight to the idea that the time is now right for a decisive
advance against the worst aspects of poverty.

One of the most important common factors uniting today's means of
protecting lives and health and growth is that almost all of them
are able to be put at the disposal of families by a community
health worker with only a few months of training.  A
well-trained, well-supervised, and well-supported community
health worker can, for example, help to provide family planning
information and services; advise on prenatal care and safe birth
practices; inform families of the advantages of breastfeeding;
organize immunization and record-keeping services; diagnose acute
respiratory infections and prescribe antibiotics; teach oral
rehydration therapy and the proper management of diarrhoeal
diseases; promote home hygiene and disease prevention; organize
growth monitoring sessions; promote today's knowledge about the
special feeding needs of the young child; organize protection
against malaria; distribute the most essential drugs and
medicines; provide vitamin A, iodine, and iron supplements where
necessary; and refer more difficult health problems to more
qualified health professionals.  
In short, they can demystify today's basic health knowledge and
put it at the disposal of communities.  And if they are supported
in that task by the full range of today's communications
capacities, schools and teachers, religious leaders and local
government officials, the print and electronic media, retail
outlets and professional organizations, NGOs and women's groups,
then the trained health worker can be the central span of the
bridge between present knowledge and present need.

There are many problems involved in the deployment of large
numbers of community health workers - in their recruitment and
retention, in their career structure and motivation, in their
regular training and supervision, and especially in the
organization of the essential referral services.  But such
problems can be and have been overcome when the political
commitment has been sustained and when the financial resources
have been made available.(fn#23)      

Above all, it can no longer be claimed that putting a trained
health care worker within reach of every family is not a
practical and affordable proposition.  Assuming a ratio of one
health worker for every 200 families, for example, it would
require approximately 2 million such health workers to serve the
world's poorest 2 billion people (it is not possible, in
practice, to reach only the poorest 20%).  At an average cost of
approximately $1,000 per year, to cover salaries and regular
in-service retraining, the total cost would be in the region of
$2 billion dollars a year.  Such a sum represents approximately
2% of the amount the developing world now spends every year on
the salaries of its soldiers.(fn#24)

For a wider range of services, the point has been elaborated by
Amartya Sen, Lamont University Professor at Harvard and former
Drummond Professor of Political Economy at the University of
Oxford:
"The question must also be raised ... as to whether a poor
country should have to wait many decades before it has enough
resources generated by economic growth to undertake ambitious
public programmes of health care and education.  It is not
illegitimate to wonder whether a poor country can 'afford' to
spend so much on health and education.

"In answering this question we must not only note the empirical
reality that many poor countries - such as Sri Lanka, China,
Costa Rica, the Indian state of Kerala, and others - have done
precisely that with much success, but also understand the general
fact that delivering public health care and basic educational
facilities is enormously cheaper in a poor country than in a rich
one.  This is because both health and education are
labour-intensive activities and this makes them much cheaper in
poor countries because of lower wages.  Thus, even though a poor
country is tremendously constrained in expending money on health
and education because of general poverty, the money needed to pay
for these services is also significantly less when a country is
still quite poor."(fn#25)

Demographic change

Lastly, the great demographic change taking place in our times
also adds it weight to the idea that the time is now right for a
determined effort to overcome the worst aspects of poverty.

Fertility rates have fallen in almost every region of the world. 
In Latin America, the annual number of births has now begun to
decline; in Asia, births will reach a peak in the mid-1990s and
begin to fall; even in South Asia, a peak will be reached within
a decade.  Only in Africa will the annual number of births
continue to rise until well into the next century (fn#26).  A
turning-point in the modern era will therefore soon be reached. 
For once the annual number of births is stable or declining, any
further investment in such services as health and education can
be used to improve the quality of the services offered and to
increase the proportion of people reached.  In other words, the
task of providing such services will no longer be a case of
'running to stand still', and the goal of meeting basic human
needs will no longer be a target that is for ever moving away.

Twenty per cent for basics

As the end of the 20th century approaches, there is therefore an
accumulation of reasons for believing that ending the worst
aspects of poverty is an idea whose time may finally have come.

New strategies and low-cost technologies are available.  Specific
goals which reflect this potential have been agreed upon.  The
commitment to those goals bears the signatures of more Presidents
and Prime Ministers than any other document in history.  The
plans for achieving them have been or are being drawn up in most
nations.  And there is a growing acceptance of the idea that
targeting some of these worst effects of poverty, particularly as
they affect children, is an essential part of long-term
development strategy.

In the wider world, the ground being gained by democratic systems
means that the long-starved concerns of the poor may begin to put
on political weight; providing basic social services for poor
families with the vote is, after all, good politics.  At the same
time, economic reforms may also create the kind of environment in
which a new effort to meet basic human needs would have a much
greater chance of success.  Meanwhile, the powerful tide of
demographic change is also beginning to turn.

For all of these reasons, a new potential now exists for moving
towards a world in which the basic human needs of almost every
man, woman and child are met.  But it is equally clear that this
attempt will not gather the necessary momentum unless the
political commitment is sustained and the extra resources begin
to be made available.   
If advantage is to be taken of the political commitments that
have been made, and of the national programmes of action that
have been drawn up, then those extra resources must begin to
become available in the next 12 months to two years.

Some nations have already begun the process of finding the
necessary funds from their own resources.  In most cases, this is
almost certainly going to mean an increase in the proportion of
government expenditures allocated to nutrition, primary health
care, clean water, safe sanitation, basic education, and family
planning services.  UNICEF strongly supports the United Nations
Development Programme's suggestion that at least 20% of
government spending should be allocated to these direct methods
of meeting priority human needs.(fn#27)  If implemented, such a
restructuring of government budgets would enable the developing
nations as a whole to find several times the $25 billion a year
that is needed to achieve the agreed goals.

In practice, such a shift in present patterns of resource
allocation will not be easy to bring about.  All governments,
however well-intentioned, have limited room for manoeuvre as
political pressures push them against the walls of economic
constraint.  Currently, the governments of the developing world
as a whole are spending over one third of their combined budgets
on the repayment of debt and on the financing of the
military.(fn#28)  Such distortions do not happen by accident. 
And the internal and external forces which have shaped such
spending patterns will not disappear overnight.  Nor will the
pressure to devote disproportionate amounts of public resources
to more advanced and more expensive health and education services
for the wealthier and more influential sections of society.

But even in the face of all such pressures, it should be possible
to allocate 20% of government spending to the task of helping the
poor meet their needs for food, water, sanitation, basic health
care, family planning, and the education of their children.

Restructuring aid

There remains the question of whether the industrialized nations
are prepared to assist in this effort.  Following the commitment
made at the World Summit for Children, every developing country
which draws up a detailed programme of action for reaching the
agreed goals - no matter what label is attached to the process -
should now be able to expect that some proportion of the cost
will be met by increased or reallocated aid.  That proportion
will vary from less than a quarter in East Asia and Latin
America, to between a quarter and a half in South Asia, and up to
two thirds in the least developed countries and sub-Saharan
Africa.  For the developing world as a whole, the additional
external assistance required will be in the region of an
additional $8 billion a year.

So far there is no significant sign that the industrialized
nations will make additional resources available on this scale. 
Aid continues to stagnate.  And there have been few serious
attempts to restructure existing aid allocations. 
Government-to-government assistance cannot easily shuffle off the
coil of foreign policy considerations, economic vested interests,
and historical associations, which means that the richest 40% of
the developing world's population receives twice as much aid per
head as the poorest 40%,(fn#29) and that the nations which
account for two thirds of the world's child deaths receive only
one quarter of the world's aid.  More positively, it would be a
mistake to imply that all the aid not used for directly meeting
basic human needs is irrelevant to this cause.  Roads also help
to meet basic needs.  Jobs even more so.

But again, it is not too much to expect that 20% of development
aid should be allocated to directly helping people to meet their
most basic needs for food, water, health care, family planning
and primary education.  Such a restructuring of aid expenditures
would, on its own, make available the extra $8 billion a year
required.  It would be an increase in the kind of aid that the
majority of people in the developing world want to receive, and
in the kind of aid that the majority of people in the
industrialized world want to give.  And it is an increase which
should now be offered to any developing country that commits
itself to a programme of action to meet basic human needs.

The same commitment must also be expected from the multilateral
organizations which currently disburse approximately $12 billion
a year.  In particular, the United Nations could play an
increasingly central role in international efforts to achieve
agreed social goals and to lay a new foundation for human
development in the 21st century.  And it is a role that could
also provide a focus for the impending reform of the United
Nations system and lead to the kind of changes which would make
sense to, and meet with the approval of, a worldwide public.

The fading excuse

Above all, this is an opportunity that must not be allowed to
evaporate into the perennial atmosphere of pessimism about the
prospects for world development.  The necessary task of drawing
attention to human needs has unfortunately given rise to the
popular impression that the developing world is a stage upon
which no light falls and only tragedy is enacted.  But the fact
is that, for all the set-backs, more progress has been made in
the last 50 years than in the previous 2,000.  

Since the end of the Second World War, average real incomes in
the developing world have more than doubled; infant and child
death rates have been more than halved; average life expectancy
has increased by about a third; the proportion of the developing
world's children starting school has risen from less than half to
more than three quarters (despite a doubling of population); and
the percentage of rural families with access to safe water has
risen from less than 10% to almost 60%.  Yet even these
extraordinary statistics cannot capture the true dimensions of
the change that has occurred in only a few decades.  Much of the
world has also freed itself from colonialism, brought apartheid
in all its forms to the edge of extinction, and largely freed
itself from the iron grip of fascist and totalitarian regimes. 
And underlying all of these changes is the slow and even more
fundamental change from a world organized almost exclusively for
the benefit of a privileged 10% or 20%, in almost all societies,
to a world in which the needs and the rights of all people are
increasingly recognized.  Only a few decades ago, it did not seem
a matter of great concern that the poor majority had no right to
vote, no freedom of expression or religion, no right to due
process of law, or that their children were not educated or
immunized and received little or no benefit from advances in
hygiene and health care.  In many nations, it even seemed natural
that the children of the poor could be sold or bonded or made to
work 14 hours a day in field or mine or factory.  And almost
exactly 50 years ago, when more than a million people starved in
the Bengal famine, they died in a world which raised no murmur of
protest.(fn#30)  
Seen from this longer perspective, the fact that two thirds of
the world's people now have the right to vote, or that 80% of the
world's infants are immunized, or that there is such a thing as a
worldwide Convention on the Rights of the Child, is a symptom of
a remarkable change.  And in the face of such progress, pessimism
is a sign less of sagacity than of cynicism.  In the decade
ahead, a clear opportunity exists to make the breakthrough
against what might be called the last great obscenity - the
needless malnutrition, disease, and illiteracy that still casts a
shadow over the lives, and the futures, of the poorest quarter of
the world's children.

It is almost unthinkable that the opportunity to reach these
basic social goals should be missed because the political
commitment is lacking or because the developing world and the
donor nations cannot, together, find an extra $25 billion a year.

The technologies and strategies are available and affordable. 
The outreach and communications capacity are there to be
mobilized.  The political commitments have been made.  And the
broader context of political, economic, and demographic change is
probably as favourable at this time as it is ever likely to be. 
The difficulties are enormous.  But they shrink beside the
difficulties that can be and have been overcome in the course of
all the many great achievements of our times.

In the industrialized world, neither recession nor competing
claims on resources can justify the failure to find the extra $8
billion a year which would be required to support the developing
nations that decide to make meeting basic social goals into a
national priority.

In the developing world, underdevelopment is a fast-fading excuse
for failure to make that commitment and to begin mobilizing the
necessary financial and human resources.

It is time that the challenge replaced excuse.  If today's
obvious and affordable steps are not taken to protect the lives
and the health and the normal growth of many millions of young
children, then this will have less to do with the lack of
economic capacity than with the fact that the children concerned
are almost exclusively the sons and daughters of the poor - of
those who lack not only purchasing power but also political
influence and media attention.  And if the resources are not to
be made available, if the overcoming of the worst aspects of
poverty, malnutrition, illiteracy and disease is not to be
achieved in the years ahead, then let it now be clear that this
is not because it is not a possibility but because it is not a
priority.

* * * * *

II

A common cause

Part I of this report has advanced the case that an unprecedented
gap has been allowed to open up between what could now be done
and what is being done to overcome the worst aspects of poverty. 
In particular, advances in knowledge which could bring better
health, nutrition, and education to millions of families are
being denied to the poorest quarter of the world's people.  The
argument has also been made that, where this gap remains wide,
the cause is not primarily a deficiency in resources or in
outreach capacity but in commitment and priority.  The poor lack
both purchasing power and proportionate political influence;
therefore the gaps between knowledge and need will not easily be
closed either by the invisible hand of market forces or by the
visible processes of conventional politics.

In such circumstances, gaps between what is and what could be,
between knowledge and need, are not likely to be closed by any
automatic or inevitable process of socio-economic development;
they are closed, most often, by large and growing numbers of
people who begin bringing pressure to bear for change.  Whether
acting in defence of their own interests or in solidarity with
the rights of others, it is people's movements of many different
kinds which have in the past succeeded in giving priority to the
issues that were being ignored, in making available to the many
the benefits of progress that were confined to the few, and in
bringing about changes that are today recognized as steps forward
for civilization itself.

Several of the panels in this report document the contribution of
people's movements to this process of making the benefits of
progress more widely available.  They show that what today would
be called NGOs have been essential to such changes as the
transformation of public health through the provision of safe
water and sanitation, the control of iodine deficiency disorders
in Europe and the United State and the conscious bringing down of
infant mortality rates in the United Kingdom and the United
States in the early part of this century.

More recently, most countries of the world have witnessed two
outstanding examples of the power of people's movements to bring
change of a fundamental kind and on an international scale: they
are the movement for the protection of the environment and the
movement for the advancement of women.  These causes, too, lacked
priority.  These causes, too, were unlikely to be advanced,
especially in the vital early stages, by either market forces or
conventional political processes.  And these causes, too, only
began their long and unfinished advance when large numbers of
people began to know more and care more and do more about the
mistakes that were being made and the injustices that were being
committed.

It is therefore evident that the struggle to end preventable
malnutrition, disease, and illiteracy, the struggle to meet the
most basic of human needs and to allow the poorest quarter of
humanity to share in the most basic benefits of progress, must
also depend, in large measure, on whether or not large numbers of
people are prepared to march in this cause.  To maintain the
political momentum that has so far been generated, and to give
the goals that have been agreed a new priority, nothing less is
now required than a worldwide strengthening of the basic needs
movement to the point where it begins to exert the same kind of
pressure as is today being brought to bear for the protection of
the environment.

Part II of this report is therefore an appeal to individuals and
organizations in all countries to become involved in this
struggle.   

Redefining the acceptable 'People's movements' is a blanket term
that must cover many strange bedfellows.  Some are movements of
the less privileged who are acting in defence of their own
interests; others are movements of the more privileged who are
seeking to show solidarity with the disadvantaged.  Some operate
in the broad daylight of civil liberties and freedom of
expression; others operate in the dark confines of censorship and
repression.  Some work at great geographic and economic distance
from the causes they support; others have the dirt of daily
involvement under the fingernails of their concern.  Some advance
their cause through the accumulated impact of thousands of
small-scale projects, which demonstrate what can be achieved at
the same time as showing that public support exists for
achievement on a larger scale; others choose the route of
acquiring and publicizing the facts, mobilizing public support,
carrying their case to the media, lobbying business leaders, and
pressing for specific changes in legislation or policy.

By some combination of these methods, people's movements have not
infrequently succeeded in bringing about a change that is even
more profound and lasting than the sum total of their practical
or political achievements.  On occasion, they have succeeded,
also, in changing the ethical climate of an age, in redefining
public and political perception of that which is acceptable and
that which is not.   

It was such a change in ethical climate that helped to undermine
the edifices of slavery and colonialism.  It was such a change
that, in many nations of the world, brought factory legislation
and the ending of child labour.  It was such a change that, with
a slow and tidal strength, gave millions of working people the
right to vote and to be educated.  It is such a change that is
today pushing back the frontiers of racism and apartheid,
rendering unacceptable attitudes and actions which have endured
for unquestioned centuries.  It is such a change that is
beginning to slow the vast and careless momentum of environmental
exploitation which, unchecked, would crush the regenerative
capacity of the earth itself.  It is such a change that is at
last beginning to batter at the high and ancient walls which
still exclude most of the world's women from the citadels of
equality.  And it is just such a change that must now be sought
in the struggle to overcome the worst aspects of world poverty.

To succeed in that aim, a change will have to be wrought in the
ethical climate which shapes and conditions our response to
deprivation on today's scale.  In the years immediately ahead,
the unnecessary deaths of tens of thousands of children each day,
and the preventable ill health and persistent malnutrition of so
many millions more, must be made into an evil as repugnant and
unacceptable as slavery or colonialism was, racism is, and sexism
will become.   

Every advance in capacity makes a call on civilization to keep
step.  The narrowing of the gaps between new knowledge and need
is therefore a measure of the success of social organization, a
test of civilization in the conduct of national and international
affairs.  It was not an unacceptable disgrace to humanity for
large numbers of people to be dying from plagues and fevers when
the cause was not understood and the cure was not available.  It
is an unacceptable disgrace to humanity for millions of children
to be dying every year from diseases that can demonstrably be
prevented and treated at almost negligible cost.

The evils of mass malnutrition, preventable illness, and
widespread illiteracy are no longer inevitable.  They too must
therefore be rendered unacceptable.  And they too must now be
made to retreat from the high ground of domination which they
have occupied for so long over the lives of so many.