PUBLICATIONS

Adjustment with a Human Face, Volume II, Ten Country Case Studies, A Study by UNICEF (Giovanni Andrea Cornia, Richard Jolly and Frances Stewart (Editors) Clarendon Press, Oxford, 1988 - 310 Pages)

Monetarists regard inflation, rather than unemployment, as a social malady. Milton Friedman invented the phrase “natural rate of unemployment”, a normal and acceptable outcome of the market process. The IMF neo-liberal monetarist model used for stabilization policies had led to measurably high unemployment and real low wages in the 70 or so countries where it has been applied. In the Philippines, real wages fell by 50% in the 1980's. Employment levels shrank from 55.5% in 1976, to 35% in Peru. Wages in Chile in 1985 were 14% less than in 1981.

A prerequisite of orthodox stabilization programmes is to reach quantitative targets: contraction of the money supply, credit restriction, wage freeze. Unemployment statistics and per capita GNP are considered to be economic indicators rather than terms used to quantify human distress. Reduction of government spending on poverty alleviation seems logical if the rationale is deficit correction or foreign debt servicing.

The IMF inadvertently contributes to a cycle of deprivation in its role as net recipient of capital from developing countries. It is a source of conditional loan finance to whom needed resources are delivered in the form of interest payments. Debt servicing obligations siphon export earnings and divert cash from social welfare programmes. In 1985, Brazil paid the equivalent of the entire budget of the federal social welfare and medicare system. The external debt in the Philippines is 82% of GNP (1985) and is so debilitating that it makes economic sense to convert it to equity, or to repudiate it. The IMF, as ringmaster of debt rescheduling, may be forced to modify the monetarist solution by shifting the emphasis from inflation to unemployment. If unemployment, rather than inflation, is defined as the social malady, the monetarist paradigm may be skewed to incorporate a humanist clause.

The modification of government strategies to include or exclude this human and quantifiable dimension, and the evolution of this process as it relates to IMF stabilization planning, is the subject of Adjustment with a Human Face, Volume II, Ten Country Case Studies, A Study by UNICEF. Edited by Giovanni Cornia, Richard Jolly and Frances Stewart, each monograph adopts the same format: a retrospective look at the administration of austerity plans during the 1970-1985 period in the context of world recession and local catastrophe, an update on trends from 1985, and a prognosis. Investigative reporting forms the backbone of the text, using social sector data to measure the impact of stabilization economics on human structures. The deterioration, or in some cases amelioration, of social conditions is analyzed in the language of input, process and impact indicators which provide detailed information on government expenditure correlated with access to employment, food, education and health service at the household level. Unemployment translates into a familiar arithmetic of low food purchasing power, malnutrition, increased child morbidity and mortality rates. Positive health interventions translate into child survival.

Among the other countries chosen for this research, Botswana, Peru, South Korea and Zimbabwe emerge on the credit side for combining adjustment with allocation of resources to vulnerable groups, compared with Brazil, Ghana, Jamaica and the Philippines, who have less political will in this regard. The contributors to these country case histories are aware that an analysis of the cycle of deprivation is insufficient without the corollary analysis of response: what decisions add up to a workable crisis resolution tactic. Botswana and Zimbabwe are cases in point. Their respective governments chose to fund a drought relief programme despite budgetary restrictions. At the onset of the drought in 1982, underweight prevalence rates were measured and an appropriate drought was undirected, resulting in an infant mortality rate of 120 per 1000 in the same period. A sharp decline in wages in Brazil caused the infant mortality rate to increase from 65 to 73 per 1000 from 1982-84. State and city governments worked with community groups to form buffer mechanisms to moderate adverse conditions. In Sao Paulo, wholesale food markets, food convoys and food network schemes provided poorer members of the community with food they could not otherwise afford. In Chile, these OEPs (people's economic organizations) provide 3% of the 1.2 million Santiago shanty town population with food. When unemployment is endemic, it is the woman who is responsible for the sustenance of her family. The ingredients for the stabilization agenda - or menu - directly affect what goes into the cooking pot. These examples provide valuable insight to both the economist and the nutritionist on the variation in causes of, and responses to, the economic crises that currently afflict many developing nations. They serve most of all to highlight the capacity of some countries to Successfully buffer the short term effects of structural adjustment on the health and well-being of the poor.

And no one exists alone
Hunger allows no choice
To the citizen or the police
We must love one another or die.
(W H Auden)

Rosemary Kevany

RAP is a set of procedures and guidelines which enable health workers and social scientists in fields other than anthropology to carry out rapid assessments of health related behaviour. The procedure was developed for the UN University Research Programme in order to improve understanding of programme implementation, its success and problems. It has to date been used primarily for nutrition and primary health care programmes, but can be adapted to suit many other areas.

RAP is a simplified method of collecting data using anthropological techniques for the assessment and evaluation. It has a specific function and is by no means a substitute for the more classical anthropological approaches and surveys. It is not meant to be comprehensive but to provide a systematic way to assess specific cultural aspects and behaviour. It can be used at various community levels and with individual, household and other community grouping. The method is especially concerned with beliefs and perceptions regarding health, illness and its treatment and the utilization of traditional and biomedical health resources.

RAP is designed primarily for short periods of data collection ranging from 4-8 weeks. It therefore involves a very brief period in the field and focuses on a few specific topics involving human behaviour. Small population samples are selected. The procedures used allow detailed recording of the socio-cultural context in which health related behaviour occurs. The methods used consist of:

a. formal and informal interviews with open-ended questions on specific topics allowing the respondents to explain their beliefs, views and experiences;

b. careful observation of nonverbal events and behaviour providing valuable clues to the socio-cultural context;

c. focus group discussions to help check the information collected with a large number of people.

The guide is intended to be used by persons trained or familiar with field data collection methods, but one does not need a degree in anthropology. Data collection outlines are presented on each topic providing a variety of sample questions, outlines, checklists, grids to complete and other data gathering aids.

In short, RAP is a very useful tool to gather information in a relatively short period of time and feedback can be provided immediately to evaluate and guide programme improvement. It provides qualitative information through direct observation and individual or group interviews to supplement quantitative information which is best obtained through questionnaires and other survey techniques. RAP was not designated to generate theory but to assess needs, evaluate and improve programmes.

Dr M. Deichmann, WHO, Geneva (Reference: UCLA Latin American Center, Reference Series, Volume 11, available from The United Nations University, Tokyo, Japan; and UCLA Latin American Center Publications, University of California, Los Angeles, California, USA.)

The FAO Manual on the Practical Application of Human Energy Requirements, and Accompanying Micro-Computer Programme Package

In 1950, FAO and WHO published the first report on calorie (energy) requirements with subsequent reports following in 1957, 1973 and most recently in 1985, in all cases dealing with the latest scientific information available for use in deriving estimates of energy requirements of children and adults. Although some attention has been given to applying energy requirements to food planning and food adequacy assessment, only since the 1973 Report has the difficulty of accurately applying energy requirements been recognized. Following the publication of the 1985 Report and its recommendation to treat the application issues separately from the scientific issues, FAO began preparing a manual for advising and instructing economists and planners dealing with problems of food supply at the national and subnational levels on how to calculate and apply energy requirements, based on the methodology from the 1985 Report. The Manual, which went through a series of revisions as a result of review by experts and potential users, is now with Oxford University Press (OUP) for anticipated publication in mid-1989.

The Manual describes how to calculate the actual energy requirements of a household, a group of people or a population with any variety of age/sex composition; it supplies those data needed for applying the methodology (e.g. average population body weights, age and sex population distributions for 1985, energy activity indexes for various occupations) should the user not have his or her own data. The Manual provides guidance on the selection and aggregation of extra individual allowances if one wishes to provide more food to sustain, for example, better growth in children or a higher rate of physical activity in adults. In addition, the Manual offers the additional possibility of introducing adjustments at a household, regional and national level for the post-harvest losses in food production, processing, storage, distribution, and in the preparation of food within the household.

Such an analysis which differentiates the various influences on energy requirements and allowances makes the distinction between food requirements and economic indices at a national level easier to understand. It can also focus attention on the possibility of alternative methods of improving food availability without necessarily needing to increase food production (e.g. reduction of food losses).

As a companion to the Manual, OUP will also publish a microcomputer programme package, which replicates the presentation format from the Manual for calculating the requirements of a population with the option of including various allowances. Like the Manual, the package also provides data from the Manual appendices needed for completing the calculations. A User's Guide for the micro-computer programme package is also to be produced, providing the necessary explanation for the use of the programme. It is planned during 1989 and the following biennium to promote the use of the Manual Package as a tool in development planning through regional and country level workshops, (Further details: Food Policy and Nutrition Division, FAO, Rome.)

World Bank calls for Action on Hunger in Africa

In a report published on 25 September 1988, the World Bank urged the international community to give food security “a high priority because it is one of the most intractable aspects of poverty in Africa”. The report, entitled The Challenge of Hunger in Africa: A Call to Action, stems from the work of a task force on food security which the Bank established to develop a strategy for helping the more than 100 million Africans who currently do not get enough to eat. The report proposes that a partnership be formed between African governments, the World Bank, and other international assistance agencies to support a comprehensive action programme for food security.

In the report's foreword, World Bank President Barber B. Conable emphasizes that increasing agricultural production and adjusting economic policies to achieve economic growth are two important means of helping to ensure food security for all African countries. He adds, however, that “a focus on agriculture and economic growth alone will not be enough to end hunger and ensure food security in Africa.” Thus, Conable notes, the report recommends a complementary set of “special actions to help reach Africa's poorest and hungriest people.”

These recommendations include:

- Preparing specific action programmes to promote food security in each Sub-Saharan country.

- Giving priority to projects and policies that raise the incomes of the food insecure and dampen fluctuations in food prices and supplies.

- Increasing the effectiveness of food aid - including improving the preparation and coordination of response to emergency food situations.

- Making more systematic efforts to identify the people at high risk of food insecurity.

Among the specific objectives to be accomplished over the next five years are the following:

- That food security action programmes will cover the majority of those in need;

- That food security will become a central theme in African government policy and donor assistance;

- And that donor assistance, through greater collaboration, will have a greater impact on the hunger problem.

(Source: The Challenge of Hunger in Africa: A Call to Action.)

Methodology for Assessing Food Consumption

A methodology book for food consumption studies entitled Manual on Methodology for Food Consumption Studies has been published by Oxford Medical Publications. This book, edited by Margaret E. Cameron and Wija Staveren, is the result of the IUNS Committee work on Measuring Dietary Intake.

The Use of Vitamin A in Emergency and Relief Operations

In recognition of the special needs of malnourished populations during famine and the logistical constraints of relief operations, in September 1988 the International Vitamin A Consultative Group (IVACG) published a report on the Guidelines for the Use of Vitamin A in Emergency and Relief Operations. The necessary measures for prevention and treatment of Vitamin A deficiency for populations at risk, and in particular, pregnant women and high priority risk groups, are given and summarized in tables. The report is available from the IVACG Secretariat, International Life Sciences Institute/Nutrition Foundation, 1126 Sixteenth St NW, Washington, DC 20036, USA. This guide is a valuable reference for those involved in relief operations.

Child Survival Programme in Gujarat, India

The Gujarat Institute of Area Planning in Gota, Ahmedabad, India, engaged in an action-research programme in Child Survival in Gujarat State. In March 1988, the Institute published a working paper entitled Growth of Children in a Drought Affected Rural Area in Gujarat: some results of a Longitudinal Study, by Leela Visaria and Jyoti Anandjiwala. The 47-page report is based on monthly results of weights of 1,568 children, aged 0-60 months. These data were collected during 1985-1987 from ten villages in Gujarat. Further information is available from The Gujarat Institute of Area Planning, Gota 382 481, Dist. Ahmedabad, India.

Cassava Toxicity and Food Security

The second revised edition of Cassava Toxicity and Food Security by Hans Rasling (International Child Health Unit, University Hospital, S-751 85 Uppsala, Sweden) was published in 1988 by UNICEF's African Household Food Security Programme. The aim of this 40-page review is to summarize available knowledge of effects on humans of cyanide exposure from cassava and to recommend ways to prevent these effects. This review is primarily intended for staff involved in agriculture and health programmes with little previous knowledge of cassava toxicity. The nature of cassava toxicity, determinants and methods for estimation of cyanide exposure as well as related diseases are discussed. The recommendations contained in the review will contribute to the understanding of the positive and negative effects of cassava in a broad perspective and also to define areas of future research. (Available from UNICEF, New York.)

Prevention of Iodine Deficiency

The Prevention and Control of Iodine Deficiency Disorders - A State-of-the-Art Review by B. S. Hetzel with discussions by F. Delange, J. B. Stanbury and F. E. Viteri and an introduction by Mahshid Lotfi and John B. Mason (ACC/SCN, Geneva). This Nutrition Policy Discussion Paper, published in March 1988, is the third in the ACC/SCN's State-of-the-Art series. The document focuses on IDD prevention and control measures, particularly through iodized oil and salt supplementation. Country control programmes and global strategy for IDD eradication are also emphasized. Copies are available from the SCN Secretariat.

African Crisis and Food Security

The International Labour Organization (ILO) has published a special issue of the International Labour Review (Vol. 127, No. 6, 1988) on food security during the African crisis. This special issue is a result of a two-year policy review project on agricultural performance in African countries. Five country case studies (Ghana, Madagascar, Nigeria, Somalia and Uganda) are included, along with a synthesis chapter. The country studies discuss food security in the context of food production and consumption trends, taking particular care to distinguish the impact of the crisis on different sections of the population. The synthesis chapter, entitled “Getting the crisis right: perspective on the African crisis”, probes further into aggregate production data to establish the extent of production falls in African countries. Rising food imports are discussed in the context of rapid urbanization and changing diet patterns in urban areas. Copies of this document can be obtained from the ILO, Geneva.

Nutrition Assessment Manual

(Draft Revision) by Nancy Binkin, CDC, Atlanta, USA. This manual is intended for use by health personnel who are called upon to assess the nutritional status of population groups who have experienced severe nutritional hardship as a result of famine, drought or war. It provides specific answers to basic epidemiological questions that allow decisions to be taken regarding follow-up surveys, relief efforts and technical assistance.

Food and Nutrition in Kenya - A Historic Review

This is available free-of-charge (excluding postage) to those interested in this topic. Further information from Dr A. A. J. Jansen, “La Calcine”, Llauro, 66300 Thuir, France.

Chronic Energy Deficiency: Consequences and Related Issues

Published by the International Dietary Energy Consultancy Group (IDECG). Edited by Beat Schurch and Nevin S. Scrimshaw, the book contains the background papers and working group reports presented at the first Scientific Meeting of the IDECG held in Guatemala, August 1987. It is available free-of-charge from the IDECG Secretariat, C/o Nestle Foundation, PO Box 581, CH-1001 Lausanne, Switzerland.

Food Studies

The “Food Studies Group” (FSG) has available a variety of brochures, project abstracts, FSG Focus and Publication Lists which provide information about the services and work of the Group. Details from:

The Director, FSG, Queen Elizabeth House, Oxford University, 21 St Giles, Oxford, OX1 3LA, UK.

A Health and Nutrition Atlas

WHO has published an atlas, with maps showing distribution by country of measures of wasting, stunting and birthweight, in relation to such factors as population, etc; food availability, diarrhoea, access to clean water; child survival, women's education; and various measures of diet, including micro-nutrients. (Source: World Health, May 1988.)

Cash Crops in Developing Countries

In April 1988, the Institute of Development Studies (IDS) published a special issue on Cash Crops in Developing Countries, edited by Simon Maxwell, which sets out to clarify the debate about cash crops; and to locate in a general framework specific arguments about growth, distribution and food security. (Source: IDS Bulletin, Vol. 19, No. 2.)

The IDS Bulletin is sent free-of-charge to selected third world institutions. For further information: Publications Office, IDS, University of Sussex, Brighton, BN1 9RE, UK.

The Africa Kit

This “Kit” contains comprehensive, up-to-date information on the crisis in Africa. It comprises three parts:

- African Update: Background information on governmental organizations since the Special Session on Africa (May, 1986);

- Non-Governmental Organizations and Africa; and

- a Resource Guide.

Infant Feeding and Maternal Nutrition

In January 1988, the American Public Health Association, Clearinghouse on Infant Feeding and Maternal Nutrition, published Report No. 5 which discusses Government legislation and policies to support breastfeeding, improve maternal and infant nutrition and implement a code of marketing breastmilk substitutes.

Monitoring of national legislations and policies to protect women and children is one activity of the Clearinghouse. They welcome readers' additions to their Report which is updated annually. Please contact: American Public Health Association, International Health Programmes, 1015 Fifteenth St, NW Washington, DC 20005, USA.

Derived Intervention Levels for Radionuclides in Food

Following the nuclear accident at Chernobyl in 1986, it was evident that available guidance on dealing with the long-term consequences of a nuclear accident was inappropriate. Of particular concern was the safety of radioactive contaminated food and drinking water in the “far-field” region. In response to this, WHO prepared the above guidelines. For various food categories, recommendations are made on levels of contamination by radionuclides at which corrective action might be justified to reduce the health risk to the population. The guidelines are based on accepted radiation dose criteria, on food consumption data from different parts of the world, and on dosimetric information for the relevant radionuclides. Further information can be obtained from: WHO, Distribution and Sales Service, CH-1211 Geneva 27, Switzerland.

Educational Handbook for Nutritionists

This draft handbook prepared by A. Oshang, D. Benbouzid and J. J. Guilbert in 1988, takes advantage of new material developed in recent years. It should be seen as a tool for “teachers of teachers” and not as a self-learning instrument, although this has been the case for a handful of committed workers in health sciences. As a draft, it is intended for testing by users during workshops. Comments on the handbook are welcome. The book can be obtained from, and comments addressed to: Dr D. Benbouzid, Nutrition Unit, Division of Family Health, WHO, CH-1211 Geneva 27, Switzerland.

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Our staff who handle word-processing thought others in a similar predicament might appreciate this.

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