From: rich@pencil.cs.missouri.edu (Rich Winkel)
Subject: UNICEF: State of the World's Children (4/5)
Followup-To: alt.activism.d
Originator: rich@pencil.cs.missouri.edu
Organization: PACH
Date: Thu, 28 Jan 1993 09:15:23 GMT

Media support

In both developing and industrialized nations, there are
particular occupational groups which could make a potentially
decisive difference.

In particular, the media in most countries is becoming the chief
midwife of peaceful change.  It is communication, not violence,
that has delivered so many nations from dictatorship in recent
years.  It is communication that is nourishing democracy and
popular participation by creating new levels of public awareness.

It is communication that has built the environmental and women's
movements over the last decade.  It is communication that has
made possible the dramatic rise in immunization levels in the
developing world.  And it is communication that could now make a
similarly massive contribution to the cause of meeting basic
needs.

In so far as it is possible to generalize at all, media coverage
of basic poverty issues tends to consider only what is and not
what could be, to focus only on the actions taken and not on the
opportunities missed or on the larger picture of need.  And if
the media is to make a serious commitment to both stimulating and
reflecting growing public support for meeting basic needs, then a
new kind of journalism-against-poverty will have to be pioneered.

Local priorities and local circumstances will dictate the nature
and content of that journalism; but its aim must be to keep
public and political leaders interested and informed of the main
facts and trends, the gains made and the needs still unmet, the
new technologies and the attempts to apply them on a sufficiently
large scale, the human consequences and the economic
implications.

Media professionals themselves are best able to decide how this
contribution can be made.  But in the gaps between today's
capacity and today's reality, there is scope for a decade of
reports and investigations, analyses and editorials.  Subjects
which the news media could legitimately be expected to
investigate, in those countries which now enjoy press freedoms,
might, for example, include:

- What proportion of the nation's children are growing normally
in mind and body and what proportion are being stunted by
malnutrition?  Is the nutritional health of the nation's children
being regularly monitored?  Is it easier to find out how many
households have television sets than it is to find out how many
children suffer from malnutrition?

- How many thousands of children have died from measles or
tetanus in the last year and what proportion are immunized
against these diseases?  Are there areas of the country, or
classes in society, that are being bypassed by immunization
services? 

- How many of a nation's children have been crippled by polio in
the last 12 months and what progress is being made towards
'surrounding' and eradicating the virus? 

- Is it known how many children are losing their health and/or
their eyesight each year because of vitamin A deficiency and
what, if anything, is being done about changing diets or
providing vitamin A capsules? 

- How many children are being born mentally damaged because of
iodine deficiencies and are plans being made for the iodization
of all salt supplies?

- What is the average age of marriage and of first pregnancy? 
How many babies are being born in the 'critical zone' (less than
two years since a previous birth, more than four births in total,
mother aged under 18 or over 35)(fn#38), and what proportion of
couples have access to family planning information and services?

- How many women are dying and being disabled in childbirth? 
What are the causes?  What is being done to extend emergency
obstetric care to rural areas? 

- How many children are still dying from diarrhoeal disease and
how many parents have been informed about life-saving oral
rehydration therapy?

- Are acute respiratory infections the biggest killer of the
nation's children, and what is being done to make antibiotics
available in time?

- What is the country's under-five death rate and is it
significantly higher or lower than in countries at similar levels
of economic development?

- What proportion of children are born weighing below 2,500 grams
(low birth weight)?  How does this compare with neighbouring
countries?  And what does this say about the health and
well-being of the nation's women?

- What percentage of the nation's children are attending primary
school?   How many drop out before becoming literate and why? 
Are more boys enrolled than girls?  What are the reasons behind
high drop-out rates? 

- What proportion of babies are exclusively breastfed for the
first six months of life?  How many infant deaths are estimated
to be caused each year by the drift towards bottle-feeding?  Has
government banned the advertising of commercial infant formulas? 
Are free samples of infant formula still being given away in
maternity units?                             
- Has the Convention on the Rights of the Child been ratified? 
Are its provisions being violated?  What changes in national law
and policy are being made to enforce it?

- What proportion of government expenditures are allocated to
meeting the most obvious and basic of human needs?  Is priority
given to low-cost services for the many or more expensive
services for the few?

- Are there significant differences between rates of illness and
death, malnutrition and illiteracy, between girl and boy
children, or between rural and urban areas, or between different
districts or provinces?
In both industrialized and developing countries, critical
attention could also be paid to how foreign aid is being used;
what proportion finds its way to the poorest groups, to primary
health care, to basic education, to low-cost water and sanitation
programmes, to family planning?

The questions and the style of the coverage will vary, but media
proprietors, editors, and journalists will find no shortage of
subjects which, on grounds of both national importance and human
interest, could sustain a decade of intense media attention in
support of basic needs goals.  Sporadic and casual reports will
not lift this cause; nothing less is required than a decade of
intense and sustained media attention and scrutiny of the
progress being made towards meeting the basic needs of the
poorest quarter of a nation's people.  But if a sufficiently
large number of respected media professionals were to take up
this challenge in the years ahead, then the public and political
pressure to meet agreed basic needs goals would be very
substantially increased.

Health professionals

Health professionals in the developing world already make one of
the most significant of all contributions to the meeting of basic
needs.  But it is a contribution that could be multiplied many
times over in the 1990s.

The number of health professionals has more than doubled in the
past decade, and there are now well over 2 million doctors and
over 6 million nurses, auxiliary nurses and midwives in the
developing world.  Along with health administrators, heads of
medical colleges, paediatricians, hospital administrators, and
medical researchers, these professionals form a vast army of
potential support for bridging the gap between today's knowledge
and technology and its widespread use.

It is true that some health professionals have made themselves
more a part of the problem than the solution.  In some nations,
doctors have encouraged bottle-feeding, continued to prescribe
antidiarrhoeal drugs instead of oral rehydration salts, and
opposed the use of antibiotics by community health workers.  But
increasing numbers of today's health professionals are beginning
to use their influence in other directions:

- They are advocating strategies of primary health care and
opposing the allocation of the great majority of health resources
to city hospitals.

- They are exploring ways to make more efficient use of highly
qualified medical personnel by deploying them in support of the
training, supervision, and referral back-up to community health
workers.

- They are using their influence to make the health benefits of
family planning more widely known.

- They are supporting the use of oral rehydration therapy and
arguing the case, within the profession, that community health
workers should be allowed to prescribe antibiotics.

- They are promoting breastfeeding, supporting the campaign to
make all hospitals and maternity units 'baby-friendly', and
helping to monitor the international code on the marketing of
infant formulas.

- They are helping to monitor micronutrient deficiencies and
raising awareness of these hidden problems and their low-cost
solutions.

- They are attempting to demystify medical knowledge and to put
essential information at the disposal of all families.

Through their professional organizations, health workers at all
levels are also beginning to contribute to bridging today's gap
between knowledge and need.  The International Council of Nurses,
representing 1 million nurses in all countries, is training its
members to inform parents of today's low-cost methods of
protecting the vulnerable years of growth.  The International
Pediatric Association has also called on its three quarters of a
million members to use "the combination of technology,
communication, and social organization which could reduce the
toll of diseases and death of children by half."  The Fdration
internationale pharmaceutique has recommended its 700,000
pharmacists in 65 countries to promote oral rehydration salts
rather than antidiarrhoeal drugs.  The International
Confederation of Midwives has asked 80,000 members in 42 nations
to become actively involved in reducing maternal mortality rates
and in putting today's child-care knowledge at the disposal of
new parents.

These efforts, too, are only a small beginning.  But they are
enough to show that if far larger numbers of health professionals
were to become actively involved in this cause, then some of the
most basic of health goals would be drawn within reach.

Educators

A third occupational group which could, in most countries, make a
significant and specific contribution to this cause is the
education profession.

For all the problems of underfunding of schools and inadequate
equipment, there are still at least five times as many teachers
as there are health workers in the developing world, and the
formal education system is by far the broadest channel for the
dissemination of the new knowledge in which so much of the
present potential resides.

As with the media and the health profession, generalization is
dangerous across so many different problems and priorities,
countries and cultures.  But a basic education, especially if it
is to last for only a few years, should attempt to better equip
children for the roles and responsibilities they will assume in
the future.  And because today's children are tomorrow's parents,
and also the carriers of information to their own parents, no
child should leave school without today's basic knowledge of how
to protect the vulnerable years of childhood in the most
effective and least expensive way.

This, too, is a specific rather than a general challenge.  No
child should leave school without knowing about:
- The basics of good nutrition.

- The importance of breastfeeding, the dangers of bottle-feeding,
and the special feeding needs of the young child.

- The enormous benefits of the responsible planning of family
size and the well-informed timing and spacing of births.

- The importance of clean water and safe sanitation, home hygiene
and disease prevention.

- The need for immunization. 
- What to do about the most common illnesses - especially
diarrhoeal disease and coughs and colds - and when it is
essential to get help from a trained health worker.

- Basic facts about both local and global environmental issues
and about what individuals and families can do to preserve the
integrity of that environment.

- The principle that girls have the same basic abilities,
potential, needs, and rights as boys and should have the same
education, status, and opportunities.

In addition, the education profession in most countries could do
more to tackle what is in many ways the most important
educational problem in the world today - the high drop-out rates
among those who start primary school, particularly among girls. 
Almost 90% of all children in the developing world now start
school.  But in many nations up to half drop out before
completing four years and before becoming literate.  Achieving
the goal of a basic education for all children therefore depends
in large measure on preventing this educational haemorrhage. 
Most of the factors behind high drop-out rates are beyond the
control of schools and teachers.  But an impact could be made on
this problem, in some countries, if education administrators,
school principals, and teachers were aware of both the many
reasons for dropping out of school and of the factors in the
content and organization of school life which could help to stem
this flow.

Many education systems have already assumed such responsibilities
- and particularly the responsibility for disseminating today's
essential health information.  In 1989, UNICEF, WHO, and UNESCO
jointly published the Facts for Life booklet, which sets out, in
its briefest and simplest form, the basic health information that
'every family now has a right to know'.  That booklet, translated
into 138 languages in over 100 countries, is now part of the
national education curriculum and/or national literacy programmes
in more than 30 countries.

But much more could be done if educators at all levels, including
the teacher training colleges and the professional associations,
were to decide to add the weight of their experience and
expertise to this cause. 
Practical and political help

Finally, support for meeting basic human needs has long been
forthcoming from a great variety of voluntary organizations in
the industrialized world.  The extent and importance of that
support, in helping many millions of families to meet their needs
and to cope with some of the greatest of human difficulties and
disasters, is much underestimated.  In particular, it is widely
assumed that such contributions are of vastly less significance
than government aid programmes.  But this is a piece of
conventional wisdom that is in need of reappraisal.

Voluntary organizations in the industrialized nations disburse
approximately $5 billion each year in support of programmes to
meet basic human needs (fn#39).  Aid from the Western
industrialized nations totals approximately $40 billion a year
($52 billion if multilateral aid is included).  But as we have
seen, the proportion of bilateral and multilateral aid allocated
directly to the meeting of basic needs is approximately 10%.  In
other words, it is about $4 to $5 billion a year - roughly the
same as the amount donated by the voluntary organizations
(although in some countries a proportion of government aid is
channelled through voluntary organizations).

If the quality as well as the quantity of aid is taken into
account, then the balance of this comparison tilts further in the
direction of the NGOs.  In recent years, NGOs in the
industrialized world have begun to work ever more closely with
counterpart organizations in the developing world: they have also
begun to offer the kind of aid programmes that meet the needs and
enhance the capacities of the poor, encourage the participation
of those whom they seek to assist, recognize the contribution of
women, and take into account environmental factors.

The overall contribution of voluntary movements in the
industrialized world is therefore far from insignificant in this
struggle.

It nonetheless remains true that at present the voluntary
organizations are not nearly strong enough, in either practical
or political impact, to take full advantage of the present
potential.  Such organizations can count on the support of
hundreds of thousands of people.  They need to be able to count
on the support of millions.  A different order of participation
must now be sought.

At the fund-raising level, it may be that the voluntary
organizations will respond to the direct challenge of the
additional $8 billion which is required as the industrialized
world's share of a new effort to overcome the worst aspects of
poverty in the decade ahead.  That target could almost be
achieved by a doubling of the industrialized world's voluntary
contributions - an increase which would be both a significant
practical contribution towards reaching basic social goals and a
sign of growing public support for this cause.

At the political level, a strengthening of the NGO movement could
make an even more crucial contribution to the meeting of basic
needs.   Only increased public pressure can make the meeting of
basic needs into a lasting national and international priority. 
But it is not only pressure for more aid that is required.  More
and more voluntary organizations are taking on the responsibility
of drawing public attention to the deeply entrenched injustices
in economic relationships between developing and industrialized
nations.  This year, for example, 20 of the best-known voluntary
agencies in 13 European countries have jointly lobbied for
further action on the debt crisis that continues to have such a
devastating effect on lives and livelihoods in the developing
world (fn#40).

In all countries, it is essential for individuals and
organizations involved in this cause to be aware also of the
mistakes and injustices which governments alone can correct and
which profoundly affect the efforts of millions of people to meet
their basic needs.  And it is to a brief consideration of these
wider issues that the last chapter of this report now turns.

* * * * *

IV

The wider context -
arms, debt, trade, aid

There is still room for hope that the changes occurring in the
political and economic landscape as the world emerges from its
political ice age may be creating more favourable conditions for
a successful advance against the worst aspects of poverty.

The collapse of the Soviet Union, and of faith in monolithic
politics and highly centralized economic systems, has ended the
cold war and opened up new possibilities for disarmament, for
economic reform, and for the advance of democracy.  If realized,
all of these possibilities would further the cause of meeting
basic needs.

First, the end of the cold war has made possible a reduction in
that vast share of the world's resources - physical, financial,
scientific, managerial - that has for so long been devoted to war
and to military repression.  It has therefore raised hopes that a
greater share of such resources might become available for
alleviating some of the great social problems facing the nations
of the industrialized world; for halting and reversing the damage
that is being done to the environment; and for investing in the
eradication of poverty and the achievement of sustainable
economic growth in the developing world.

At the moment, all this remains on the shelf of potential.

In the industrialized world, military spending has largely
withstood the geopolitical earthquake that has occurred. 
Overall, military expenditures stand at approximately $750
billion a year - the equivalent of the combined annual incomes of
the poorest half of the world's people.(fn#41)  In real terms,
the United States is spending approximately 50% more on defence
today than it was a decade ago.  Projected spending, in the
five-year defence programme presented to the U.S. Congress in
January 1992, envisages a decline so gradual that expenditures in
1996 will still be 25% higher, in constant dollars, than they
were in the era of Nixon and Brezhnev.(fn#42)  Similarly, in
Western Europe, where the political and military situation has
been utterly transformed in the last five years, there has been
much talk of defence cuts but no noticeable decline in the level
of military spending.(fn#43)
In the developing world, the reduction in military spending in
the six years from 1984 to 1990 has amounted to approximately
20%.  But this figure, too, proves a hollow prop for optimism. 
Almost all of that reduction has occurred in the Middle East.  In
other regions, there have been few really significant reductions
and most of the cuts that have been made are a result more of a
compulsion to service debts rather than of a commitment to meet
basic needs.

Nonetheless, change is surely in the air for some of the poorest
and most militarized nations of the world where the cold war has
for so long take a heavy toll.  In Ethiopia, for example, where
half a million soldiers have been demobilized in the last year,
the military's share of total government expenditure has fallen
from almost 60% to just over 30%, and spending on health and
education has risen from 12% in 1989/90 to almost 20% in 1992/3. 
Meanwhile the first anniversary of the new government was
celebrated with a parade not of troops and traditional military
hardware but of people bearing olive branches and waving flags on
which were emblazoned the white doves of peace.

Demilitarization

If the diversion of funds from defence to development remains
mainly a matter of potential, the ending of the cold war has
already begun to help the cause of the world's poor in other
ways.

Chief among those ways is the substantial progress that has
already been made, in many nations, towards the demilitarization
and democratization of society.  For the days are now gone when
military dictatorships could derive political legitimacy,
military equipment, and economic aid, merely by saluting the
ideological flag of one or other of the two superpowers.

In this sense, the significance of the ending of the cold war can
hardly be exaggerated.  Forty years of cold war rivalry has
contributed to the militarization of political cultures in many
developing nations, helping to fertilize the weeds of
dictatorship and to seed new tyrannies.  The result has been a
waste of resources on an extraordinary scale.  Military spending
in the developing world has quintupled, in real terms, in only 30
years(fn#44).  And over much of that time, militarized lites
have governed for the benefit of the few, used their weapons more
often against their own citizens than against foreign aggressors,
and succeeded only in denying people their rights without meeting
their needs.  In addition, the people of the developing world
have also had to pay the cost of the military culture in the
coinage of war itself.  And no one has paid a higher price than
their children.  In the last decade alone, more than 1.5 million
children have been killed in wars, more than 4 million have been
physically disabled, more than 5 million have been forced into
refugee camps and more than 12 million have lost their
homes.(fn#45)  

The effect of all this on progress towards meeting basic human
needs has been predictably devastating.  The famines and
deprivations endured in recent years in such countries as Chad,
Ethiopia, Liberia, Mozambique, Somalia, the Sudan, and Uganda
have all been either caused or exacerbated by military conflict. 
Crops, roads, markets, schools and clinics have been destroyed;
trade and commerce, and the very means of earning a living, have
been disrupted; civil liberties have been crushed along with the
hopes of millions of people for a minimally decent life.

To some of the victims of this long-running tragedy, the ending
of the cold war has brought new turmoil and new devastation.  To
others, it has brought new hope.  In the last three years alone,
over a third of the world's nations have changed the course of
their political development in the direction of democracy.

This is good news for a movement to meet basic human needs in the
years ahead.  For the more progress that is made towards
democracy, the more the poorest groups in society will begin to
exercise a degree of political influence.

Finally, the advance of political and press freedoms can also
help to create the kind of environment in which people and their
organizations can work for the changes that will enable them to
meet their own needs.  In an already quoted analysis, Amartya Sen
has argued this case - that political and press freedoms are
central, not incidental, to the cause of meeting human needs - in
relation to the more specific question of ending hunger and
malnutrition.  It is an argument that applies just as well to the
struggle for better health or education:

"Democracy and an uncensored press can spread the penalty of
famines from the destitute to those in authority; there is no
surer way of making the government responsive to the suffering of
famine victims.

"However, while democracy is a major step in the right direction,
a democratic form of government is not in itself a sufficient
guarantee for adequate public activism against hunger.  For
example, in India the issue of famines has been thoroughly
politicized, helping to eliminate the phenomenon, but the quiet
continuation of endemic undernourishment and deprivation has not
yet become correspondingly prominent in the news media and in
adversarial politics.  The same can be said about gender bias and
the greater relative deprivation of women.  The political
incentives to deal with these major failures would enormously
increase if these issues were to be brought into political and
journalistic focus, making greater use of the democratic
framework.

"... public action has to be seen as actions by the public and
not just as state actions for the public. To eliminate the
problem of hunger, the political framework of democratic and
uncensored press can make a substantial contribution, but it also
calls for activism of the public.  Ultimately, the effectiveness
of public action depends not only on legislation, but also on the
force and vigour of democratic practice."(fn#46)

Xref: sparky misc.activism.progressive:10316 alt.activism:21313 talk.environment:5709