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III PANEL DISCUSSION
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PANEL DISCOSSION
DR. WATERLOW: I would like to react to what Dr.
Chafkin said about emergencies or disasters. I was not
trying to say the obvious, that a strategy is needed for
I had in mind the more serious
disasters and famines. ~
cases throughout the world, the most seriously deprived
families, which are at greatest risk of severe malnu-
trition, the disaster families. The reasons for the
problems of these families are different in different
areas. In Jamaica, for example, it is usually some kind
of family disruption, such as abandoned mothers. In one
group I read about in Kenya, it was most often because
the mother was unmarried--an unacceptable situation in
Kenya, as opposed to the Caribbean. In Nepal, the key
factor is lack of land. Although the conditions vary,
everywhere one finds the 10% that are in a very bad
state. That is what I was referring to in discussing an
emergency strategy; I am not thinking simply of the
famine situation in the Sahara.
DR. MAHLER: People have been emphasizing the devel-
opmental ideology--whether we are playing development by
proxy or not. Most of us who came into development work
some 35 years ago began as missionaries. The first
director general of WHO told me in Delhi in 1951: "The
trouble with you, Mahler, is that you have too much
sympathy for those poor Indians. What you need to de-
velop is empathy with their predicament. Then, perhaps,
you can start seeing what kinds of problems they can
tackle themselves." This is a very important thing in
nutrition, too. I was nearly fired from WHO because in
1956 I said, "It is not a question of amino acids; it is
a question of calories," and the nutrition adviser was
not there.
The emphasis should be on developing the capacities
of nations to solve their own problems and on develop-
ing the self-reliance to try to tackle these problems
through research. There is a lot of impatience in the
donor community. We provide countries in need with
preconceived development packages neatly contained in
envelopes--conventional envelopes. Development in my
language means getting out of envelopes; that is the
etymologic sense of the word "development." The devel-
opment technocrats are anxious to provide new kinds of
envelopes, so that they can bask in the sunshine. A
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lot of our demoralization has been with those envelopes,
and we will gradually have to give others the capacity,
rather than looking for our own catharsis. If we let the
nationals be themselves in dealing with their problems,
we have every reason to believe that it can be done.
I am grateful that somebody mentioned the Tropical-
Disease Research Program, the World Bank, and the United
Nations Development Programs, organizations that have
shown that one does not have to play it by proxy, but
that the first objective can be developing local
capacities. The second objective is developing, as fast
as possible, new solutions to old problems.
difficult, but an absolute sine qua non in the global
food and nutrition situation. There is no reason to
become disillusioned, cynical, or skeptical. The rich
man always has a tendency to say that the poor man should
be very rational; however, coming from a poor family, I
can say that it is difficult to be rational when you are
poor; and this is true for a poor country, too. It is
remarkably difficult to make rational decisions when you
cannot afford to take any risks, because, lacking the
money to learn through doing, you cannot learn.
~
DR. MELLOW I will go on directly from Dr. Mahler's
point, with which I agree.
are fighting against is an orthodox view generated in the
developed countries that systematically plays down the
human element. If one wants to raise money, it is not
respectable to talk about supporting food subsidies. I
am pleased to say that the World Bank has just released
or is about to release a document that disproves that
oversimplification. A country which is economically
squeezed cannot afford just any food subsidy. But well-
targeted food subsidies in the urban areas, as Dr. Lunven
has been stressing, are an essential component of poli-
cies that lead to high agricultural prices as a way of
stimulating agricultural production in rural areas. It
is a rational combination--one that was brought out
earlier here. Virtually every industrial country prac-
tices this policy in one way or another. At the moment.
the dominant international economic orthodoxy still
focuses on how to cope with debt, how to get a country
back on the right track so that it can seek financial
assistance. But the international good-financial-
housekeeping seal of approval is obtained by abandoning
In economic matters, what we
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these things. The international community has an
obligation to affirm that the human dimension is not just
a byproduct of the economy. It is both an end and a
means for reaching the very economic solutions that
people want. It is a parallel action to offset the
misleading view, particularly in the last 5 years, of
what good economic policy is. Leaders understand in a
very basic way that you cannot starve your people to pay
your debts.
DR. SAI: I would like to comment on the issue of
training. A question was asked earlier about training,
and I think the question was slightly off focus. It
appeared that the questioner was trying to say that
training could be done better in the more industrialized
countries. There are technical advances for which the
training needs to be done externally; however, linkages
have to be made to ensure that training facilities in
Africa have access to some of the technologies or the
scientific expertise needed for more comprehensive
training.
With respect to training, the international community
has refused to listen to us for about 10 years. We have
been trying to make people recognize that the training
issue is going to return to haunt us when money is
available for doing something; and if we do not obtain
funds rapidly, we are not likely to succeed, regardless
of how much money we start pouring into the field.
We are trying to develop African expertise in Africa
for African work. I do not think getting a lot of
international experts to concentrate on Africa will do
the job. In fact, it often creates an unhealthy com-
petition that leads to the demise of African programs.
When we talk about training, the time is now. Richard
Jolly has mentioned that in Ghana and elsewhere the core
of trained nutritional scientists and others on which to
build another training approach seems to be disappear-
ing. If we do not move quickly, it will disappear.
Re-establishing the situation could be difficult.
Finally, let me plead that it is not necessary to say
that people should train practically. Doctorates and
master's degrees are needed. The idea that people have
to train in the subject, but not necessarily have
degrees, should be buried for a while. People should
-
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have degrees that are relevant in the specialties they
are choosing. In addition to the facility that has been
mentioned, we need to begin another facility immediately
to start re-establishing what should be included in
training for the food and nutrition problems of Africa.
DR. MELLOR: We have a series of studies at the
International Food Policy Research Institute (IFPRI) on
the question of improvement over time, particularly in
India. The extent of improvement is striking in the
lowest-income people, and we can document i t Nazi ~,
larly in agricultural production.
a, rem
It is important not to
stop where Lincoln Chen did, saying that we can show that
there are still some problems somewhere in India, and
leave the impression that the green revolution has not
been so great. One must spread it to other areas; I
think that Dr. Chen would agree that there is a need to
extend it to the marginal areas.
As a matter of fact, much of Bihar and West Bengal do
not have poor resources. They have rich resources, but
are being held back by inappropriate agricultural
policies. In the central plateau, where the resources
are poor, yields per acre have grown considerably in 20
years. Incomes of the poorest people were lower than
they were in Africa 15 years ago and have increased
considerably. Although it has not done as well in these
areas as in southern India, it has spread, and we need to
extend it farther.
DR. CHEN: If we had this meeting in India, I think
there would be a very strong polarization within the
Indian community. Although there has been progress,
particularly in the green revolution in the Punjab and in
southern India, there are deplorable areas in Bihar, in
West Bengal, in Orissa, in Madhya Pradesh and in large
cities. The particular question I was-addressing was
whether agricultural modernization in itself leads to the
reduction of poverty and improvement in nutrition. In
other words, the technological transformation, as John
Mellor himself has said, needs to be accompanied by
employment, wages, and access to productive assets,
rather than only by redistribution of programs. I
believe our office supported some of the IFPRI studies in
southern India. I agree with some of the findings that
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you have reported from Tamil Nadu, but I was pointing out
that the Indian policy-makers themselves would not agree
that everything is all right and that food self-suffi-
ciency has been achieved. On the contrary, there are
very serious worries that 30 million tons of food are
deteriorating in storage and that the income and
consumption levels of 150-300 million people are below
those required for adequate diets. We are talking about
the question of balanced growth.
DR. HORWITZ: Dr. Chen, will you elaborate on two of
your proposals for action--the Nutrition Project Develop-
ment Facility and activities to improve information
dissemination and documentation?
DR. CHEN: I was hoping that the members of the panel
representing international agencies and people in the
audience would carry these ideas further. I have not
thought in detail about their implementation. I would
note that you suggested the Nutrition Project Development
Facility in an early paper.
DR. HORWITZ: The Subcommittee on Nutrition is
exploring this possibility now, and we will see what
comes out of that; but I agree with you. My impression
is that for governments, even those which Dr. Mahler
wants to be free to be themselves, the moment eventually
comes when they need to present their proposals for
funding. Funds are not easy to find today in the
international community. Some of us have felt that it
would help just to invest available resources better at
the national level, let alone to seek international
assistance.
. . ~.. ... .. . . ...
DR. MAHLER: I want to make it clear that I did not
say "g vex ~rnments"; I said "people," and there is a big
difference. The United Nations system was set up for
people, not for ephemeral governments. They are more or
less representative of a lot of people, but it is
important to remember that they were set up for the sake
of people. Therefore, we have to manipulate the system
whenever it is necessary, particularly if governments are
not permitting us to get to where the action should be in
mobilizing people themselves, in examining their needs.
That is what I meant.
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DR. GWATKIN: I was interested that the question of
whether we are doing better or worse came only from the
next-to-last commentator in our conversation. I thought
that this would be fundamental in a discussion of nutri-
tion issues for the rest of the 1980s and the l990s.
This unresolved question of whether nutritional
status is better or worse is a very persuasive argument
in favor of the kind of documentation facility-Dr. Chen
was suggesting, and I know that there have been conver-
sations about this within the nutrition community as
well. I second his suggestion that this be given serious
consideration. The need for it is brought home by a
striking example. A top-priority item should be simply
tracking nutritional trends--what we are doing best, what
we are doing worst, what we are improving in. This would
be comparable with what has traditionally been done for
birth rates and death rates. It is particularly
important if there is some possibility, as you suggest,
that the two might start moving in different directions.
I have long assumed that the two would move in similar
directions. ~rat -~ 2 ~' '''
N~ltr'tion is important In Keen morCallcy
low. If death rates are falling, we need not be too
concerned about independent nutritional measures, because
we can assume that nutrition is improving. I am not
prepared to abandon that assumption yet, but there is
an argument that it is going the other way; that is
an important reason to start collecting independent
information. That is in part because of the mortality
information; but, even more important, for the reason
that Richard Jolly implied, this kind of information is
needed if we are going to have economic progress with a
human face. I would suggest that this is something that
the Food and Nutrition Board might look into.
DR. MERTZ: Some 10 or 20 years ago, birth control
would have been a prominent topic in a conference like
this. Although most speakers have mentioned birth
control or child spacing here, it was only in passing. I
wonder why that is so. Have we given up on the concept?
DR. MAHLER: Dr. Mertz, I agree that perhaps it was
pushed aside in the discussion, although I wanted to
bring some emphasis when I spoke of maternal and child
welfare, including family planning, because I speak from
the health angle.
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I believe that "God does not speak to an empty
stomach," as Gandhi said. The food and nutrition issue
~ concerns of families,
their home economics, future vision, and hopes. A broad-
based food and nutrition program gives a much better
opportunity to address family planning and make people
feel the need for child spacing and education. Food and
nutrition must be used as much as possible as one of the
vital points of entry to reach families in need in
addressing family planning.
is a powerful instrument to address
DR. CHEN: You are raising a very important point. In
our push in health and nutrition technologies in some
regions and societies, careful attention needs to be paid
to the balance of technologies made available. The rapid
population growth in Africa is a very serious concern. I
also expressed concern about the introduction of single
isolated health interventions and technologies without
adequate attention to such problems as birth spacing. It
is of deep concern, although in other countries it might
not be as important. In some regions, I believe that it
is incumbent on the scientific community to Generate the
knowledge and the support for a balanced technological
approach.
DR. SAI: Unhappily, we are beginning to feel that the
population issue is a nonissue, or at any rate an issue
not subject to critical intervention in the same way as
other issues. That might not be serving the cause of
development. I agree with what Dr. Chen has just said,
that any approach to the needs of people, especially
women and children, should consider their roles in
society, their educational and employment needs, and
population planning. If we look at this question from
the point of view of maternal and child health, anyone
working in maternal and child health in Africa who omits
family planning for child spacing is omitting one of the
most powerful preventive medicine tools that is available
today.
DR. ROGERS: Dr. Galbraith has suggested that we were
trying to impose characteristics of development that were
perceived from the perspective of developed countries.
If I recall correctly, in the days when the United States
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was a developing country and had an agricultural base,
large families' were very desirable. I expect, although I
do not know it for a fact, that that was true in other
agrarian societies as well.: If we go back to the
comments made earlier about the development process, we
should lookout it from the perspective of those countries
end' acknowledge that it is only with the certainty of
alternative employment, and with it the certainty of a
full stomach and good health, that we can even start to
talk about substantial changes in fertility.
All of us are aware that rapid population growth
underlies many of the problems we have been discussing
here, but I viewed the absence of discussion about family
planning as healthy. We want to address nutrition,
maternal and child health care, and the role of women as
the most basic issues. When we do that effectively,
population control will come along quite well.
DR. LUNVEN: Dr. Mertz is right in saying that there
is a decline in emphasis on family planning, and there
are various reasons. There are doubts about its
efficiency, and some governments, such as in Mexico, have
been considering that increased population is desirable.
The goal that the Mexican government has set is for
100 million people by the year 2000.
Conditions have changed in 10 years, and man-made and
natural disasters have changed the picture. The view-
points of governments have also changed. On the basis of
the World Bank report, the African countries that met in
the original conference last year produced the Harrari
Declaration. In it, they agree with the World Bank's
statement that, whatever~the amount of external assist-
ance provided for agricultural development in Africa, the
race for economic development cannot be won if the popu-
lation problem is not taken care of. It was a voluntary
declaration that they would adopt population policies to
limit population growth.
DR. JEFROM: I would like to address my question to
either Dr. Mellor or Dr. Lunven; both spoke of urbani-
zation or labor movement as affecting agricultural pro-
duction. Having lived in both developing and developed
countries, I assumed that the impact of urbanization was
not as disastrous in developed countries as in developing
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countries. Some planners have suggested that decen-
tralization should be promoted in developing countri
What are the tradeoffs?
DR. MELLOR: I think the issue probably should be seen
less as a matter of urban vs. rural than as a matter of
the pattern of urbanization. What we have had is a
megalopolis--one city that dominates the country and
becomes extremely large. There has been a pattern of
capital-intensive import displacement and export-led
strategies of growth that has driven this pattern of
urbanization.
The alternative is a much more diffuse pattern of
urbanization in which market towns are developed
throughout the rural regions with different towns of
different sizes. This took place in much of western
Europe and North America during their growth from an
original agrarian base. This pattern of urbanization
produces more employment than the alternative pattern,
which has lower per capita costs for central services in
the urban area. I think no country would want to remain
primarily rural, because that would mean that the
production pattern and the consumption pattern are both
mostly agricultural, and there is not much variety in
that. There is almost no margin for error; if bad
weather strikes, food consumption has to be cut.
Presumably everyone wants to diversify consumption and
production, and that calls for urbanization. However,
there could be a much healthier pattern of urbanization.
Investment patterns, rates of return of various
programs, and so on would be different if the bulk of the
urban population were in towns of 10,000 to 100,000,
rather than cities of 10 million. When we start
examining the mix between health and nutrition, we must
think in terms of the nature of the development strategy
and its effect on the pattern of urbanization.
UNIDENTIFIED SPEAKER: For about a decade, there has
been a division between people whose objective is to
reduce the misery of mankind and those who look for
strategies for growth and simply have not produced any
food or any employment.
What was not achieved by the disaffection with the
growth strategies of the 1950s and the early 1960s is a
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reorientation of growth in a way that creates employment,
values people's health, and leads to productive lives.
I am not saying that the objective is necessarily growth
per se. However, if a family cannot do anything to
improve its economic well-being, improving its health and
nutritional status will not solve its problems. It leads
to continuous dependence on handouts from UNICEF or some
other organization. We need to show humanitarian audi-
ences that there is something more than improving the
physical well-being of people. People need to have some
other objective and some way in which they are integrated
into the society and its larger economic activities.
Even given the humanitarian concern, the choices in
development should be considered, and choices should be
made that are related not only to the objectives, but to
the instruments used to move toward the objectives.
DR. MAHLER: To prevent our darkness of today from
becoming our doubt of tomorrow, we need to increase our
information on food and nutrition. I claim a knowledge
about some things in India, and I disagree violently with
some of the statements that have been made about India.
We recently returned after 25 years to 100 villages
chosen at random in southern India, and there had been
dramatic changes for the better. So, let us not just say
blankly, "Well, nothing has been happening in India."
Modernization can be shown in this random sample of
3 million in southern India. It is important to chal-
lenge ourselves to look at our information base. We need
better information so that we are able to say things with
greater relevance.
Representative terms from entire chapter:
southern india
