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African Journal of Food & Nutritional Sciences (now African Journal of Food, Agriculture, Nutrition and Development), Vol. 2, No. 1, March, 2002 TRAINING FOR CONTEMPORARY UNDERSTANDING OF THE HUMAN NUTRITION CONDITION1 - Globalisation, Human Rights and Governance as dimensions of the study and practice of Public Nutrition in the 21st century - experiences from recent educational innovations at the University of Oslo Wenche Barth Eide2, Siri Damman3 and Unni Silkoset4, with Elisabet Helsing5 and Arne Oshaug6 1An
earlier version of this paper was presented at the IUNS Satellite
meeting "Progress in Public Nutrition", 24-26 August,
2001, 17th IUNS Congress on Nutrition, Viena, Austria. Code Number: nd02006 This paper reports on some recent educational innovations on the training in public Nutrition at the University of Oslo, in the form of three independent but mutually supportive graduate/postgraduate elective courses: Global Nutrition, Nutrition and Governance, and, Nutrition and Human Rights. These courses are offered internationally in English by the Institute for Nutrition Research, School of Nutrition, Formally Known as the Nordic School of Nutrition. The main aim of the courses is to have more Universities training programs take up the critical contemporary trends that may increasingly have an impact on the food and nutrition situation globally, manifested in different ways according to circumstances. Global Nutrition is a five-credit course, corresponding to 15 ECTS (European Credit Transfer System). The course stresses the importance of applying both a historical perspective and a system approach in discussing current and changing manifestations and interpretation of "the nutrition problem." This will help students understand the shifting priorities for research and action that take place over time. Nutrition and Governance combines aspects of nutrition policy formulation, nutrition programming, and assessment of nutritional impact of broader development initiatives. The students also get an understanding of the "micro-governance" exerted by various institutions that work with food and nutrition problems. The Nutrition and Human Rights course brings a new notion of formalized and legally based ethics and morale and thus hope. The understanding is conveyed, given time, the existing and evolving norms, mechanisms and how procedures of the international human rights systems may gradually become internalized. This can occur through the growing number of democratic governments, most of which would have ratified the relevant international conventions establishing food, health and good nutrition as human rights. A new challenge in the public nutrition community is the linkage between globalization and human development, nutrition and human rights, without going deeper into them. Further studies of such linkages in specific country situations are urgently needed and call for academic and professional openness towards interdisciplinary dialogue, research and implementation. Thus there is indeed progress in nutrition thinking within a global perspective. The potential role and contributions of African nutritionists in accelerating this progress is promising and encouraged. Key words: Training, Emerging issues, Role of African Nutritionists and institutions, Food and Nutrition rights. CONTENTS ABSTRACT This paper reports on some recent educational innovations in the training in Public Nutrition at the University of Oslo, in the form of three independent but mutually supportive graduate/postgraduate elective courses: Global Nutrition, Nutrition and Governance, and Nutrition and Human Rights. They are offered internationally in English by the Institute for Nutrition Research/School of Nutrition at the Faculty of Medicine through its comprehensive study programme in nutrition7. The three courses were generated out of an overall concern that the new generation of nutritionists ought to understand current social, economic and political processes and changes in the world today, in terms of their bearing on the human nutrition conditions and our opportunities to improve these conditions at both ends of the nutrition spectrum: undernutrition and overnutrition. The courses are offered first of all to students of nutrition wishing to work in international organizations, in institutions within the state machinery, or in non-governmental organizations dealing with various aspects of the food and nutrition system at national or international level. In the following we describe the rationale and overall design of the courses, which continue to be moulded and adapted as we are gaining experience from year to year. We also discuss some of the experiences from the last eight years of working with them, and ask whether this kind of training ought to be more commonly included in schools of human nutrition, and if so, how it can best be done. The paper is a contribution to the still limited literature on approaches to Public Nutrition at universities, as called for by the International Union of Nutritional Sciences (IUNS) Satellite Meeting on Public Nutrition in Montreal 24-26 July, 1997 [1,2]. Future discussions and curriculum development for this nutrition subspecialty should include more explicitly also the global economic and political framework of constraints and opportunities for the betterment of the human nutrition condition[3]. It is no exaggeration to say that the world is changing with a speed hitherto unknown. We choose to make the 1990s the "extended landmark" of change, first of all due to the end of the Cold War; secondly the explosive development in communication technology, and thirdly, the rapid liberalization of the markets and the said declining role of the state in controlling domestic developments. In this context, we also know that many would see the dominant position of the international financing institutions, the emerging terms of world trade, and the activities of many transnational companies, as major determinants in the process of globalization that increasingly affect us all in various ways. Public nutrition analysts are indeed aware of this and have captured the implications for what is now known as the nutrition transition [4]. However, the nutrition community has barely engaged in the debate on the nature and deeper causes of these trends. Nutrition experts are only rarely seen in the wider fora where such debates take place and where information about critical nutritional matters could make a real contribution to understanding observed and prospective implications for human development. Somewhat accentuated and provocative, we postulate that, by and large and with notable exceptions, a large part of the general nutrition community form an apolitical constituency, that to a large extent continues with "business as usual" while the world around them is spiralling faster and faster in a direction that may - in the short or longer term perspective - undermine much of the good work being done to study and improve the nutrition of human beings in different situations. Better data collection, better programming, better health promotion, and better nutrition policy formulations are all on the agenda for public nutrition, and necessarily so. But where is the discourse on how macro- and even mega-trends may impact, not only on the problems as such, but also on the opportunities for effectively addressing and solving them? To what extent do we nutritionists engage in that debate - also with our students, and how will they be prepared for the world facing them if we don't? We would like to see more university training programmes take up critical contemporary trends that may increasingly have an impact on the food and nutritional situation globally, manifested in different ways according to circumstances. We need to mobilize ourselves, fellow colleagues, and students in an effort to define the role for interested nutrition specialists in meeting new challenges implied in globalization. While the goals remain the same: food and nutritional security and nutritional well-being for all, broader and bolder strategies may be needed to achieve them. This is not a new thought in the nutrition community as we struggle for greater attention to the problems as we see them. But perhaps we have failed in involving in the broader debate? A prerequisite is that we begin to understand better what the challenges are. Each year we observe that nutrition students enter their studies with very limited insight in global matters, including little or no knowledge about the United Nations. They are also normally completely ignorant about how the states of the world, including their own, get together and make decisions in the various international or regional arenas for dialogue and intergovernmental agreements that may affect the nature of the future food supply and be of significance for the diets and nutrition of their children and grand children. Through their technical studies they learn a lot that could be of importance for this dialogue and agreements to be made, but normally acquire little insight in the potential role of the state in promoting nutritional well-being and what it means to act on this in national public or civil institutional contexts. They know even less about the system of international organizations and what these can and cannot do in fighting hunger and malnutrition, apart from providing much of the data that students have access to in their studies. And what do they understand of the underlying reasons for the civil protests in Seattle, Gothenburg and Genoa - if at all they are aware of those recent happenings in the first place?8 The question is how one can trigger their interest in becoming alert to some of the big challenges in our time that will also affect the problems they will work with. This would help them to understand how nutrition professionals can take responsibility for optimizing the positive and counteract the possible negative impact of some of the most worrisome aspects of globalization, that contribute to widening the gaps between the rich and the poor, leaving some people more and more marginalised in poverty, food insecurity and malnutrition. Realizing that there is no final recipe, we want to share some of our own experiences by briefly reviewing each of the three independent courses we have so far designed in this series. A five-credit course, corresponding to 15 ECTS (European Credit Transfer System) was offered first time in 1996. We first coined the term "global nutrition" in reaction to that of "international nutrition", a term we had used ourselves for years, but which we increasingly found in general to have a focus on nutrition in developing countries alone. In its most typical use, especially in the North American tradition, the term did not necessarily capture international processes in the global sense that we find so important in a word of increasing connectivity but also with increasing disparity between countries, and between groups within countries everywhere. A central aspect of the course is a rejection of the simple assumption that, with sufficient good intention and political will, things will automatically shape up for the better - so also the nutritional situation where this is inadequate. In some situations this may be true, in others one cannot ignore confounding factors and forces at different level of social organization that may tend to work against efforts for nutrition improvements. To identify and try to understand some of these forces is a major focus of the course. Another is to consider opportunities for the nutrition community to influence decision-making and implementation of nutrition-relevant policies and action, within single states and internationally through supranational agreements and cooperation. The core theme of the course in Global Nutrition is thus that many processes of change in society that affect food supply, dietary patterns and nutritional conditions, can best be understood in the light of long term global trends - economic, environmental and political [5]. Other changes may be specific to a given context, resulting from changing ecological conditions or induced by national and local political decisions including strategies for how to manage available resources. But even these changes may become further altered through increased exposure to external forces. To comprehend how global, national and local processes and trends may have varying effects on household resources and influence dietary intake and change, is crucial both in the analysis and the eventual solutions to nutritional problems. The course stresses the importance of applying both a historical perspective and a system approach in discussing current and changing manifestations and interpretations of "the nutrition problem". This will also help students understand the shifting priorities for research and action that take place over time. For example, in recent years modern biotechnology and the "gene revolution" have brought a new dimension to the debate, which goes beyond the biological and ecological aspects of the new technology, controversial enough as they are, and brings up polarized views concerning the role of that technology in possibly widening the gaps between the rich and the poor countries in their use and benefit from the new science and technology: for profit or for development? Those among us who lived through the equally heated years of debate around the "green revolution" in the 1970s, find it hard to accept that many of the young technology optimists today do not seem to have a clue as to what were the issues at stake in that debate. We do not want our nutrition students to fall in the same trap, and at most be worried about the health and safety of genetically modified organisms (GMOs) for food, while the wider economic and political concerns for our future food supplies and poverty patterns are overlooked, or thought to belong to somebody else. The opportunities for and constraints to an effective role of the United Nations System and other international structures are given special attention. The recommendations and commitments of both the International Conference on Nutrition in 1992 and the World Food Summit in 1996, as well as the forthcoming WFS: five years later in Rome in June 2002, constitute the frame for discussing activities and performance of UN bodies and specialized agencies. Twice we have been able to take the students to visit international organizations and see "their human faces", once to Rome and once to Geneva. Initial scattered insight and often corresponding scepticism towards these organizations and their bureaucracies, have quickly changed to an appreciation of the opportunities for meaningful work in their secretariats or in the field, but also a recognition of the limitations on action for staff as determined by member states within the political climates of their governing bodies. We hope to resume these study tours as an integral part of the study series, funding provided. In overview, topics in Global Nutrition include:
What have been our experiences with this particular course, which constitutes the foundation of the series? Overall, we can look back on a small but enthusiastic group of students, some forty in all since we started it. We have been thrilled to observe their enthusiasm when discovering the breadth of global issue areas, when understanding the depth of the underlying problems, and when discovering the wealth of information available from the international organizations and also about their actual work in the field. As to challenges in designing the course, there is of course the usual one how to delimit the scope and what to prioritize. There is also a danger that the course could become an interesting examination of globalization per se and not sufficiently make the links to nutrition as, after all, the core subject matter. We are aware of these risks and try to cope with them. We are also aware of the risk of overfeeding the students with information and "interesting background literature", especially with the wealth of material now available on Internet pertaining to the theme. Through an open dialogue with the students and an invitation to full participation in ultimately shaping the course, we have so far balanced reasonably well between the aim of the course and the limited time at disposal to meet it. We are pleased to note that several of the participants in this course have later gone into international work through UN internships or Junior Expert/Associate Professional Officer assignments, or are working with international problems in their research. What is hiding behind this theme for the second course? As many will be aware, "governance" - especially in the combination "good governance" - became development jargon from around 1990, when first the World Bank and thereafter United Nations Development Programme (UNDP) brought up the need to consider government performance - in terms of "the act of governing" - as a parameter in determining success or non-success in the national development processes [6]. "Good Governance" would be an objective to pursue through such tasks as eradicating corruption, strengthening participation of stakeholders in planning through developing human and institutional resources, and ensuring full transparency in all public affairs, and so on. Effective food and nutrition policies and planning must today be understood as closely linked to good governance. "Governance" would also have much in common with "management", whether of development programmes, non-governmental organization or corporations. Hence, there is a need to reflect on the way both the state and other actors address and manage nutritional issues, within the wider role of the state and government in promoting development. In our interpretation, governance in relation to nutrition would combine aspects of nutritional policy formulation, nutrition programming, and assessments of the nutritional impact of broader development initiatives. Within this broad interpretation, we have been concerned that students would also get an understanding of the "micro-governance" exerted by various institutions that work with food and nutrition problems. Or, said in other words: what shapes the work and ultimate outputs of international organizations, institutions within the state machinery, NGO programmes, and private organizations and companies? Is it only their mandates and professional portfolio, or has it also to do with the inner anatomy and life of various organizations, their structures, corporate culture and relationships with each other? Given the nature of our primary target: people who would like to work in international, national or private organizations concerned with food and nutrition - we aim to prepare them for what it may mean to work in an organized structure, more or less hierarchical, more or less dominated by the given "corporate culture". The course thus includes an introduction to organizational theory as well as examples of organizations at work in real life situations. It is our hope and belief, that by becoming alert to some of the principles that may govern the structure and performance of organizations, candidates may, when entering the work market, be in a better position to handle situations and problems they are bound to meet and with a more analytical understanding of why they occur, than if they had not been exposed to such an introduction. In overview, topics in Nutrition and Governance include:
This is the topic where we have most expertise for justifying a new and unorthodox course offer. The involvement of several of us over many years in promoting a human rights perspective on food and nutrition security, working both with conceptual developments and international lobbying activities, has given us a good basis to design a course that aims at building bridges between the international legal human rights framework and nutritional development goals and practice. What do we achieve by doing so, and teaching about it? Some of us who are seasoned enough to have taught global issues in the radical 1970s, may remember how sometimes students were left in a state of hopelessness after having received information about the bleak situations for the poor under the dominance of neo-colonial dictators, multinationals, and a growing population pressure: "If it is all that bad, what is there for us to do, if anything at all?" The human rights perspective brings in a new notion of formalized and legally based ethics and morale and thus hope. The understanding is conveyed that, given time, the existing and evolving norms, mechanisms and procedures of the international human rights system may gradually become internalized by the growing number of democratic governments, most of which would have ratified the relevant international conventions establishing food, health and good nutrition as human rights. Backed by an enlightened civil society including relevant technical experts (including nutritionists), the said declining role of the state can be redefined and further strengthened, a prerequisite also for guaranteeing public and individual nutrition security as both a goal and an outcome of national and global development. Topics in Nutrition and Human Rights include:
What are our experiences? Nutrition and human rights law are widely different areas each with their own history of conceptual evolution, instruments and methodologies for analysis and practice. Each has experienced vigorous internal debate about theoretical basis, scope, priorities and application. Both can be seen as broad clusters of intellectual goods and practical experience that gradually have become sub-divided into specializations as circumstances have demanded it. It is therefore now a great pedagogical challenge to establish appropriate connection points between two such widely different areas for study and practice. In addition we must acknowledge the fundamental transition in the way of thinking that is required from the nutritionist participants when having to cross over from the familiar nutrition causality analysis, as the typical basis for research and derived action in nutrition, to a human rights type of principles and practical legal and other measures built on an explicit normative system. Another concern has been how to assure an appropriate mix of theoretical knowledge about the system of human rights proper, and its relevance and potential use in pursuing food and nutritional goals. Too much emphasis on theory alone might lead to dissatisfaction because the participants would not understand how to use human rights in practice or how human rights concerns could have an impact on their work. On the other hand, too much "applied orientation" without a firm theoretical knowledge and understanding of the human rights framework in its normative, institutional and procedural dimensions, would be equally futile. In all this, we have of course tried to strike a balance, but it must be admitted that the required transition in "mindset" has proved to be the major challenge of this course. It has till now attracted a small but highly motivated group of students, from Norway, Europe and Africa, including one person under a staff development scheme of a UN agency. With the growing attention to a human rights approach as "the new paradigm in nutrition"9, we expect the number of applicants to grow. We also stand ready to exchange further experiences with other groups who wish to embark on similar efforts10. Particularly as regards nutrition and human rights, it should be mentioned that other forms of training exist in terms of an on-line course and a short summer course in Europe11. Information about still other initiatives is welcomed. A NEW CHALLENGE FOR THE PUBLIC NUTRITION COMMUNITY Both the 4th World Report on Nutrition [7] and the Final Report to the UN ACC/Sub-Committee on Nutrition by the Commission on Nutrition Challenges of the 21st Century [8], recognized that there are linkages between globalization, human development, nutrition and human rights, without going deeper into them. Further studies of such linkages in specific country situations are urgently needed and call for academic and professional openness towards interdisciplinary dialogue, research and implementation. The nutrition community should not hesitate to prepare itself for more vigilant participation in the debate on how different aspects of globalization may affect our food supply, consumption and nutrition, and how human rights should and could guide future national and world development. Universities in general may play an important role in inserting relevant elements into their regular curricula or prepare specific elective modules. Teachers within the nutrition community must do their part to ensure that this be offered also to the new generation of nutritionists. But to draw up a desirable future for nutrition training in the age of increasing globalization is one thing. To what extent would African universities be interested and ready to explore similar curriculum development components as we have indicated here? We have always warned colleagues in "the south" not to import ideas uncritically from "the north". In this case we express hope that African nutritionists and nutrition trainer colleagues in particular, will increasingly recognize their potentially forceful role in exploring and exposing possible relationships between globalization in its various facets on the one hand, and poverty, food insecurity and lack of nutritional well-being on the other. Similarly, technical nutrition expertise ought to lend itself to providing evidence for arguments that hunger and malnutrition are often generated or get accentuated by internal conflict and even civil war in many African countries. Likewise, the nutrition community everywhere should take as a point of departure when discussing solutions to the problems, that "governance" and especially "good governance" is at the basis of how public action can lead to positive change. Attention should also be paid to the role of appropriate institutions to deal with both planned and unplanned change. In observing recent initiatives in Africa to develop approaches to nutrition capacity-building at different levels, we gather that a momentum is growing among African nutrition trainers for doing things on their terms. The African Nutrition Capacity Building Initiative is one reflection of this, the ITANA group of university teachers [12] is another. The forthcoming conference in Nairobi July this year on Information Technology for Advancing Nutrition in Africa (ITANA), sponsored by Kenyan universities and the ITANA group and financed by GTZ and SIDA, is a third. While we highly welcome this initiative to strengthen the use of information technology in nutrition training, we also encourage boldness in setting priorities for the content of the curriculum development, which ought to find room for the kind of perspectives we have touched upon in this paper. The road ahead is by no means a straightforward one. Not only may considerable political sensitivities be involved in some countries. The resistance from influential peers who may have their strong opinions about what is appropriate to deal with in nutrition training, can equally block innovations towards an African-based global understanding of how malnutrition is caused at levels way beyond the household and individual choices of what right foods to eat. Where the latter statement is clearly an over simplification of the present situation, it nevertheless accentuates our concerns that some of the 'big issues' of our time, probably of the utmost significance for food and nutrition security, will not be considered because expected academic merits in our field do not accommodate them as accepted issues for scientific inquiry. Needless to say, the need remains for solid nutrition expertise in the classical sense combined with skills in epidemiology and dietary survey techniques, which must continue to form a strong foundation. But also food and nutrition policy research must become a respected sub-speciality, with interdisciplinary ramifications to the social sciences including economics, furthermore to public administration and law, bringing new perspectives to the nutrition debate that in turn must find outlets in curriculum components for those interested. Fortunately, a significant expansion of the international nutrition debate over the very last years comes to our assistance in implementing such ideas in our research and training responsibilities. Poverty has since long been a concern of nutritionists, and the 4th World Report on Nutrition [9] brought the double perspective of poverty, the life-cycle approach to malnutrition and the nutrition transition to understand some of the underlying causes of malnutrition. The 5th report is under way [13] and will bring further perspectives on some of the wider and basic causes of malnutrition related to trade liberalization [9,10]; If and as evidence accumulates for such linkages, it will be increasingly difficult to reject criticism against world trade and the WTO as merely ideology based. At the same time, one is unlikely to find clear-cut relationships and linear linkages either in a positive nor negative sense, however the important thing is that nutrition leaders-to-be become aware that there may be such linkages and that they acquire a critical attitude to simplified arguments from any corner. As to human rights dimensions of food and nutrition security, these was overtly written off by many nutritionists as being irrelevant to nutrition analysis and action as recently as only five-six years ago. Today there is little left of the near-to hostility expressed by many in established nutrition circles towards any mentioning of rights-based approach both at the International Conference on Nutrition in 1992, and later when the debate began to take roots in the UN ACC/Sub-Committee for Nutrition environment from the mid-nineties [11]. The majority of nutritionists concerned with world hunger and malnutrition now welcome this new paradigm in principle but may be asking for guidance to better understand what is practically implied [12]. Thus there is indeed progress in nutrition thinking within a global perspective. The potential role and contributions of African nutritionists in accelerating this progress is promising and encouraged.
Copyright 2002 - African Journal of Food & Nutritional Sciences |
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