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We argue that solutions to entitlement failure must operate not only at the level of prices and markets, but equally in the domains of public health and public nutrition. Entitlementsolutions focused only on food quantity, and not also on diet quality, are likely to fall short of their intended goals, and of a deeper responsibility to enhance the life-chances of survivors.
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Food quality the diversity of foods consumed and their adequacy in terms of nutrient content therefore matters a great deal in determining the evolution and impact of emergencies, contributing not only to outbreaks of disease but to diminished capacity of individuals to cope with entitlement failure.
Unlike food commodities, nutrients are invisible; consumers are usually unaware of their importance, their presence, or their deficiency. Consumer demand for food does not therefore equate with effective demand for nutrients. In this sense, public action intended to remedy vitamin and mineral deficiencies is unusual: While humanitarian professionals increasingly rely on micronutrient interventions to prevent crisis-related morbidity and mortality, populations most directly affected remain largely unaware of the deficiencies that they face and will continue to face once the emergency has passedand how they themselves might use recovered entitlements, in terms of income or exchange, to enhance their own micronutrient status.
This study explores two main aspects of the micronutrient problem as it relates to entitlements in humanitarian emergencies: The delivery of nutrients in emergencies is a key aspect of all relief operations today, but that in itself is insufficient without empowering beneficiaries with knowledge related to the importance of micronutrients, the Unu-wider research paper sources of those micronutrients, and greater capacity to act on such knowledge in both crisis and noncrisis settings.
While constrained access to food is a key feature of most humanitarian crises, an absence of food is not always the most significant aspect, nor is a total lack of food usually the cause of elevated mortality among large numbers of people.
While this conceptual approach has been hugely influential in debates on 5 famine causation, it can be argued that the role of food in the equation deserves to be reexamined—not to shift the pendulum back towards supply-side thinking, but rather to enhance the concept of entitlement so that it can incorporate recent scientific findings on the role of nutrients in determining vulnerability to death.
Micronutrient deficiencies raise important new questions about the nature of food entitlements. When they are delivered as in emergencies they are supply-driven, not supported by demand. A diversified diet a broad variety of foods consumed is closely related both to adequacy in total food consumption needs, and with adequacy in terms of micronutrients.
A monotonous diet is the norm for hundreds of millions of households that are ultra poor and food insecure. But even where families consume adequate amounts of energy kilocalories and protein, this does not automatically equate with adequacy in terms of vitamins and minerals. According to the World Health Organization Given the widespread nature of deficiencies in normal times, the stage is set for large-scale outbreaks of deficiencies in situations where food consumption particularly of items of higher dietary quality is impaired by natural disasters or armed conflicts.
Some crises involve previously well-nourished populations that suddenly face an elevated risk of mortality through disease, displacement, or the trauma of conflict such as in Bosnia, Kosovo, and Azerbaijan.
Other crises compound an already serious situation, bringing acute and chronic malnutrition into play simultaneously. For example, high levels of chronic malnutrition in Ethiopia and Bangladesh mean that even slow-onset crises can provoke a worsening of conditions with increased mortality.
Thus, pre-existing malnutrition influences how a crisis unfolds and responses must be tailored accordingly. The role of micronutrients in shaping crisis-related morbidity and mortality was not widely understood when Sen elaborated his ideas on food access via entitlement bundles.
These have been hugely influential ideas which shed light on the political economy of famine causation, while effectively pushing food into the analytical background.
While not disagreeing with the view that major humanitarian crises represent broader failure of the development agenda, the process by which incomes translate or not into nutrients before and during a crisis determines the nature and evolution of human suffering. That is, physiological complications of an individual should not be dismissed as secondary to the political or economic complications of whole populations—personal micronutrient deficiencies signal population-wide deficiencies that are directly linked to the macro-level processes of concern to Sen.
While access to food is an issue embedded in markets, prices and legal systems, access to good nutrition is a process embedded in household caring practices, specialized knowledge about micronutrient needs and nutrient-rich sources of foodand an ability to allocate income to food quality, not just food quantity.
For example, periods of widespread food scarcity invariably lead to scavenging and the consumption of products not part of a conventional diet. During the continent-wide European famine ofdesperate Germans and Swiss ate sawdust baked into bread, carrion, their own watch-dogs, even grass and roots Webb More recently, it has been noted in Ethiopia that over-consumption of boiled grass pea Lathyrus sativus during periods of famine may allow consumers to survive since the grass pea is drought-resistant and continues to be available when other cereals have disappearedbut it often condemns them to a neurodegenerative disorder that leads to irreversible paralysis Getahun et al.
In other words, while extreme hunger leads to desperate actions, turning to what are essentially toxic products may, in itself, kill or cripple the consumer long after the crisis has past. It is generally accepted that as long as sufficient amounts of food are available, the average diet in developing countries can supply both adequate energy and protein.
However, dietary sufficiency in energy and protein does not mean that consumption of sufficient vitamins and minerals in recommended quantities is assured. Thus, while consumption of maize and groundnuts may fill the belly and assuage hunger, such a diet is not enough to meet the full spectrum of minimum daily nutrient requirements.
Similarly, widely-consumed items such as tea contain tannins which also reduce iron absorption. Thus, even a diet sufficient in energy and protein may not be sufficient to assure survival.
On the other hand, eating only a few starchy food items may fill the belly assuage hunger but will not allow the consumer to meet minimum daily nutrient requirements.
A more varied diet is a valid outcome in its own right, associated with a number of improved nutritional outcomes such as improved birth weight, child growthimproved status of certain micronutrients, such as iron haemoglobin concentrationand reduced risk of mortality from cardiovascular disease.
However, there is also statistically significant association between dietary diversity and household per capita consumption, as well as between dietary diversity and per capita caloric availability from non-staple foods, which is where diet quality tends to reside Hoddinott and Yohannes In other words, diversified diets are closely linked to household food security, and both are closely linked to nutrition and health outcomes.
Importantly, this is where entitlement theory in its attention to the dynamics of markets and purchasing power and humanitarian operations intersect.
For example, the economic and drought shocks impacting Indonesia during the late s combined—primarily through their effect on food prices—to impair food consumption.
A study in rural Java shows that food price shocks led poor consumers those in the lowest income quartile to sacrifice both micronutrient-rich foods and preferred grains shifting from rice to cassava consumption in an effort to minimize the 8 decline in total caloric intake Block et al.Research Paper No.
/75 Evaluating Aid Impact Howard White* November Abstract The ultimate measure of aid effectiveness is how aid affects the lives of poor people in UNU World Institute for Development Economics Research (UNU-WIDER) Katajanokanlaituri 6 B, Helsinki, Finland.
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UNU-WIDER research confirms that these concerns are borne out by the data. Those countries with higher subsidies designed to increase fishing revenue, or lower the costs of fishing and thus enhance productivity, recorded higher losses due to overfishing and overcapitalization.
If you are searching for the book by Orlando San Martin Reaching the poor: Fine tuning poverty targeting using a poverty map: the case of Mozambique (WIDER discussion paper. I am a Research Fellow at the World Institute for Development Economics Research of the United Nations University (UNU-WIDER) where I lead the work on Social Protection and Social Policy.
My. "Globalization and Regional Income Inequality: Evidence from within China," WIDER Working Paper Series UNU-WIDER Research Paper, World Institute for Development Economic Research (UNU-WIDER).
Ming Lu & Guanghua Wan & Zhao Chen,