Equity in Health and Nutrition in a Structurally Unequal Society
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I would like to think that you -as me- often ask yourself what we could
all do better to achieve greater equity in what we do given that we
most often work in countries with appalling social inequities. Allow me
to share with you some of my thoughts on this.
I see our role in helping put in place the needed social processes and
mechanisms that will drive sustainable policies in health and nutrition
as being inseparable from us helping to re-establish a will and intent
to change underlying structural inequalities in society. To achieve the
latter, you can -as individuals- come to this will from either of 2
backgrounds: you can either come to it from a primarily ethical or from
a political motivation.
These 2 motivational approaches that can drive us to become more in-
volved in lessening social inequities represent, not packages of uni-
versal solutions, but rather paths to follow to get things that need to
be done, and the latter by whom and with whom (and against whom).
Living as we do in a mean, unfair and selfish world, I see the chal-
lenge we face as being one to graduate from the first into the second
approach. Let me explain why.
THE PRIMARILY ETHICS-LED PROCESS TO SUSTAINABLE DEVELOPMENT IN HEALTH
AND NUTRITION
[As is true for slavery, there are ethical limits to tolerating extreme
poverty].
The growing new development ethics that calls for working with the poor
as protagonists and not merely as recipients has, so far, itself unfor-
tunately remained mostly a top-down approach. It represents mostly the
view of academicians, of intellectuals, of church leaders, of interna-
tional bureaucrats and of a few politicians (mostly in the opposition).
Beneficiaries have remained mostly passive in this approach, merely be-
ing counted as the 'object' of the process. This ethics-led process is
mostly ethically motivated and assigns a key role to 'moral advocates'
who are to advance the following cascading process:
- NEEDS (Entails assessing needs
requiring fulfillment using
"objective"(?) field research
techniques)
>
- ENTITLEMENTS (Entails granting selected
identified needs the status of
entitlements to be honoured by
society)
>
- RIGHTS (Entails translating accepted
entitlements into actual rights)*
>
- LAWS (Entails delegating to members
of Parliament the legitimisation of
selected rights by promulgating them
into laws)
>
- LAW ENFORCEMENT (Entails assuring/securing that the
laws get enforced by government
institutions)**