A tiring tale from the FAO that again ignores the global food industry

Cheap processed food advertised in Chengdu, P R China.

Why has the Food and Agriculture Organisation (FAO) not stated what has become painfully obvious to households the world over – that the macro-economics which determines everything from what farmers grow and what city workers pay for food is utterly out of control?

This silence is why FAO’s ‘State of Food Insecurity in the World 2013’ – with its updated estimates of undernourishment and its diplomatic paragraphs about progress towards the Millennium Development Goals (MDG) and World Food Summit (WFS) hunger targets – remains conceptually crippled.

The roles of the food industry, its financiers, its commodities satraps, the marketers and their fixers in government, the networks that link legislators and food business investors in countries with growing processed foods businesses, all these shape food security at the community and household level. Yet none of these are considered critically by an FAO report that ought to be thoroughly non-partisan on the matter.

The FAO ‘State of Food Insecurity in the World 2013’ (condensed to SOFI 2013) has said that “further progress has been made towards the 2015 MDG target, which remains within reach for the developing regions as a whole, although marked differences across regions persist and considerable and immediate additional efforts will be needed”.

How many more food insecurity indicators are needed to tell governments what their working class households already know? The table of SOFI 2013 indicators.

In the first place, let’s consider the 2015 Millennium Development Goals (MDG) target concerning hunger. This is to halve the proportion of hungry people in the total population. There is also the World Food Summit (WFS) target, which is to halve the number of hungry people. Both have 2015 as the target year. However, any hunger has no place in a world that today produces more than enough food to adequately feed every elder, child, woman and man.

But there is another aspect, and this is: who does the FAO think is paying attention to ‘global’ targets and placing these targets above any local needs or ambitions? Just as the MDGs are scarcely known and recognised outside the enormous development industry which perpetuates a growing mountain of studies and reports on the MDGs, nor are ‘global’ hunger reduction targets. When alleged leaders of the world gather together in the United Nations General Assemblies and other grand international fora and ask (in a tiresome and repetitive way) how we are going to feed 9 billion people, no individual smallholder farmer listens, because growing and feeding is done locally, and therefore ‘targets’ are also local, just as food insecurity or security is local.

This is why the SOFI 2013 approach – which is to say that “the estimated number of undernourished people has continued to decrease [but] the rate of progress appears insufficient to reach international goals for hunger reduction” – is utterly out of place and does not in any way reflect the numerous variety of problems concerning the provision of food, nor does it reflect the equally numerous variety of local approaches to fulfilling food provisioning.

Next, it is way past high time that FAO and the UN system in general jettison the “developing regions” label. It has no meaning and is an unacceptable legacy of the colonial view. Besides, as I point out a little later, food inadequacy (including insecurity and outright poverty) is becoming more and not less prevalent in the so-called developed regions. And moreover, I object to “considerable and immediate additional efforts will be needed” to reverse food insecurity, as the SOFI recommends, because this is the green signal to the global industrial agri-food industry to ram through its destructive prescriptions in the name of additional efforts.

SOFI 2013 also “presents a broader suite of indicators that aim to capture the multi-dimensional nature of food insecurity, its determinants and outcomes”. Once again, it is way past high time that the FAO ceased encouraging a proliferation of indicators of every description (and then some) that do next to nothing to ensure low external input and organic agriculture supported by communities and local in scale and scope, and in which the saving of seed and the preservation of crop and plant diversity is enshrined. There is not one – not a single indicator from FAO (and not one from any of its major partners, the World Food Programme (WFP) and the International Fund for Agricultural Development (IFAD) – for this need that is at the core of the myriad wonderful expressions of human civilisation.

Oxfam has made graphic the growing poverty in the European Union.

SOFI 2013 also said that “recent global and national food consumer price indices suggest that changes in consumer prices were generally much more muted than those recorded by international price indices, often influenced by greatly increased speculation in spot, futures and options markets”. This unfortunately is completely untrue, for even FAO’s own database on national consumer price indexes (supplied by FAO member countries themselves) suggests that the CPI follows international price indices (this blog has pointed out the correlation a number of times in the last two years). And it is the same macro-economics that rewards speculators in “in spot, futures and options markets” which also deepens food insecurity every year.

Now, to return to the question of who is “developing” and who is not. The European Union (28 countries) has a population of 503 million (the early 2012 estimate). The USA has a population of 313 million (mid-2012 estimate). How large a group in both the European Union and the USA are hovering around the poverty lines, or who are plain poor, and who cannot afford to buy enough food for themselves?

In a report released in September 2013, the Oxfam aid agency warned that the poverty trap in Europe, which already encompasses more than 120 million people, could swell by an additional 25 million with austerity policies continuing. The report, ‘A cautionary tale: Europe’s bitter crisis of austerity and inequality’, said that one in two working families has been directly affected by the loss of jobs or reduction of working hours.

The food insecurity problem has been growing in the non-“developing” world just as fast as it has been growing in sub-Saharan Africa, south Asia, south-east Asia and other “developing” regions that the FAO’s flagship reports habitually places in the foreground. In early 2012 news reports in European Union countries were mentioning regularly how “ever more people are threatened with poverty”. The European Commission’s office for Employment, Social Affairs and Inclusion said so too: “Household incomes have declined and the risk of poverty or exclusion is constantly growing.”

Across the Atlantic, a US Census Bureau report released in September 2013 titled ‘Income, Poverty and Health Insurance Coverage in the United States: 2012’, poverty was found to be “at a near-generation high of 15 percent, close to the high point since the 1965 War on Poverty, the 15.2 percent rate reached in 1983”. This report found that 46.5 million USA ctitzens (about 9.5 million families) live in poverty and that some 20.4 million people live on an income less than half of the official poverty line of the USA.

FAO’s ‘State of Food Insecurity in the World 2013’ will with its present methods, outlook and biases be useful neither to cultivating communities growing the food we eat, nor to administrators in districts and provinces who must plan and budget to encourage local action that brings about food security, nor to the member countries of the United Nations if it continues to ignore the very large and growing numbers of the poor in the European Union and USA – 170 million poor people, and therefore food insecure, is a population that is considerably larger than that of any country in sub-Saharan Africa which inevitably figures in these reports.

Here are the materials for FAO’s ‘State of Food Insecurity in the World 2013’: The FAO news story. A frequently asked questions document. The FAO page on State of Food Insecurity 2013. The executive summary. The full pdf file and chapters. The e-book. The food security indicators data.

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India in 2015 – 63 million-plus cities

The 27 cities shown on this map are no different from many others like them in India today, and the selection of these 27 is based solely on a single numerical milestone which I am fairly sure few of each city’s citizens (or administrations for that matter) will have marked.

On some day during the months since March 2011, the population of each of these 27 cities has crossed 150,000 – this is the criterion. March 2011 is the month to which the Census 2011 has fixed its population count, for the country, for a state, a district, a town.

And so these 27 cities share one criterion – which they be quite unaware of – which is that when their inhabitants were enumerated for the 2011 census, their populations were under 150,000 whereas in the four years since that mark has been crossed.

[You will find more on the theme of population, the Census of India 2011 and urban and rural population growth here: ‘So very many of us’, ‘To localise and humanise India’s urban project’, ‘The slowing motion of India’s quick mobility’, ‘The urbanised middle class symphony’. Thematic and state-wise links to direct data files can be found at: ‘India’s 2011 census, a population turning point’ and ‘India’s 2011 census, the states and their prime numbers’.]

When the provisional results of the Census of India 2011 were released, through the year 2011, the number of cities with populations of a million and over was 53.

The number of cities with over a million inhabitants, from 53 in 2013 to 63 in 2015. Cities with names in red type will reach a million in 2015.

That was the tally almost two years ago. Between the 2011 census and the 2001 census the growth rate of the urban population was 31.8% which, turned into a simple annual rate for those ten years, is just under 3.2% per year.

At this rate, in mid-2013, six more cities will have joined the list of those with a population of over a million.

These six cities are: Mysore (in Karnataka, estimated population of 1,046,469), Bareilly (in Uttar Pradesh, 1,042,257), Guwahati (in Assam, 1,030,149), Tiruppur (in Tamil Nadu, 1,024,228), Sholapur (in Maharashtra, 1,011,609) and Hubli-Dharwad (in Karnataka, 1,003,886).

Within the next few months, India will have 59 cities with populations of over a million.

By mid-2015 (the final year of the Millennium Development Goals, or MDGs), there will be another four cities with populations of over a million: Salem (in Tamil Nadu, estimated population of 1,036,066), Aligarh (in Uttar Pradesh, 1,025,255), Gurgaon (in Haryana, 1,016,698) and Moradabad (in Uttar Pradesh, 1,002,994).

That year, Bhopal (Madhya Pradesh), Thrissur (Kerala) and Vadodara (Gujarat) will have populations of over two million; the populations of Kanpur and Lucknow (both Uttar Pradesh) will cross three million and that of Surat (Gujarat) will cross five million. India will have 63 (ten more than in 2011) cities with populations of at least a million.

These are projections that have not taken into account the state-wise variations of rural and urban growth rates. Also not accounted for is migration, as the migration data from Census 2011 has yet to be released.

At 21, the Human Development Report and its message of equity in 2011

Today, the United Nations Development Programme (UNDP) will release its 2011 Human Development Report, the 21st in the annual series that lets us know how well – or not – the populations in countries are doing. Whether on education, health, income, poverty, cost-of-living the human development indices are now well-constructed and evolved measures of the well-being of people. Today, we’ll know a little more about how 7 billion people live on our Earth.

This year’s ediition is called  ‘Sustainability and Equity: A Better Future for All’. The HDR website has said the report will call for the urgent global challenges of sustainability and equity to be addressed together – and that the 2011 HDR identifies policies on the national and global level that could spur mutually reinforcing progress towards these interlinked goals.

These introductory articles are uniformly boring and uniformly useless to all those who deal with real questions, hard quetions and tough decisions every day. They say things like “bold action is needed if the recent human development progress for most of the world’s poor majority is to be sustained” and things like “the benefit of future generations as well as for those living today”.

The excitingly squiggly colourful HDI lines that debuted in 2010

This is irritating, but has become part of the HDI furniture. For some perverse reason top politicians and top UN agency muckamucks seem unwilling to cut the waffling and get on with it. Anyway. we’re interested in the rest of the report, the data, the statistics, the methodologies, the background studies and a whole bunch of related research – so that’s what this and related HDI posts will dwell on in the weeks to come.

The HDR website has mentioned that the 2011 report will talk about living standards. Here’s a sentence I want to read more about when the big package opens up: “Yet the 2011 Report projects a disturbing reversal of those trends if environmental deterioration and social inequalities continue to intensify, with the least developed countries diverging downwards from global patterns of progress by 2050.” What are the numbers that led to this prickly insight, I would very much like to see.

Look for these in the 2011 edition:
UNDP HDR 2011 International Consultations
UNDP HDR 2011 Advisory Panels
UNDP HDR 2011 Human Development Seminars
UNDP HDR 2011 Commissioned Research

Let’s look back. A year ago, in 2010 November, UNDP when releasing the HDR 2010 said that “most developing countries made dramatic yet often underestimated progress in health, education and basic living standards in recent decades, with many of the poorest countries posting the greatest gains”. HDR 2010 cautioned that “patterns of achievement vary greatly, with some countries losing ground since 1970”.

Overall, HDR 2010 showed that life expectancy climbed from 59 years in 1970 to 70 in 2010, school enrolment rose from just 55 percent of all primary and secondary school-age children to 70 percent, and per capita GDP doubled to more than US$10,000 (sorry, but this last is a particularly meaningless number). Life expectancy, for example, rose by 18 years in the Arab states between 1970 and 2010, compared to eight years in sub-Saharan Africa. The 135 cuntries studied include 92 percent of the world’s population.

The visual designing coup of 2010

Within the pattern of overall global progress, the variation among countries is striking, said HDR 2010. Over the past 40 years – that is, tilll 2010 – the lowest performing 25 percent experienced less than a 20 percent improvement in HDI performance, while the top-performing group averaged gains of 54 percent. Yet as a group, the quartile of countries at the bottom of the HDI scale in 1970 improved faster than those then at the top, with an average gain of 61 percent. Somewhat zanily, HDR 2010 then advised us that “the diverse national pathways to development documented … show that there is no single formula for sustainable progress”. Umm, we did somehow notice that, all by ourselves actually.

What was enormously useful in HDR 2010 were three new indices that the world’s rambunctious and usually argumentative development community has still not grasped firmly with opposable thumbs. These are:
• The Inequality-adjusted Human Development Index (IHDI) – For the first time, this year’s Report examines HDI data through the lens of inequality, adjusting HDI achievements to reflect disparities in income, health and education. The HDI alone, as a composite of national averages, hides disparities within countries, so these adjustments for inequality provide a fuller picture of people’s well-being.
• The Gender Inequality Index (GII) – The 2010 Report introduces a new measure of gender inequities, including maternal mortality rates and women’s representation in parliaments. The Gender Inequality Index is designed to measure the negative human development impact of deep social and economic disparities between men and women.
• The Multidimensional Poverty Index (MPI) – this is the equivalent of the 400-pound gorilla for all HDI-related stuff – it complements income-based poverty assessments by looking at multiple factors at the household level, from basic living standards to access to schooling, clean water and health care. About 1.7 billion people—fully a third of the population in the 104 countries included in the MPI—are estimated to live in multidimensional poverty, more than the estimated 1.3 billion who live on $1.25 a day or less.

So, while waiting for the goodies from HDR 2011, there are some questions that still smoulder from earlier editions. Here’s one: what does the evidence from the past 40 years tell us about the relationship between growth and changes in human development? The two-panel chart which accompanies this post (below) presents the basic result. The left panel shows a positive association — though with substantial variation — suggesting that growth and improvements in human development are positively associated.

Remember, however, that income is part of the HDI; thus, by construction, a third of the changes in the HDI come from economic growth, guaranteeing a positive association. That’s why a far more useful exercise is to compare income growth with changes in the non-income dimensions of human development (gift economies would be wonderful subjects). This has been done using an index similar to the HDI but calculated with only the health and education indicators of the HDI to compare its changes with economic growth. The non-income HDI is presented in the right panel of the chart – looking for the correlation? Remarkably weak and statistically insignificant, as they said so themselves.

That will deliver a smart kick in the collected pants of the G20 muckamucks when they assemble (what? again!) in France (Cannes) for a new episode of creative bullshitting fiscal sophistry. But, here’s the strange thing. Previous studies have found the same result. One of the first scholars to study this link systematically was US demographer Samuel Preston, whose landmark 1975 article showed that the correlation between changes in income and changes in life expectancy over 30 years for 30 countries was not statistically significant. As ideas such as ‘sustainability’ and ‘environmental’ began gaining traction from the early 1970s onwards – think ‘Limits to Growth‘ – more data became available, and other researchers obtained the same result. In a 1999 article, ‘Life during Growth‘, William Easterly found a remarkably weak association between growth and quality of life indicators such as health, education, political freedom, conflict and inequality. Easterly’s work was ignored by the bankers and their compradors for years thereafter.

Next, François Bourguignon, director of the Paris School of Economics, and several African and European colleagues concluded that “the correlation between GDP per capita growth and nonincome [Millennium Development Goals] is practically zero”. That should have been turned into a poster and hung on the wall of every bloody finance minstry from Abuja to Auckland. More recently, World Bank economist Charles Kenny recently confirmed the lack of correlation between improvements in life expectancy and growth, using both a large sample of countries over 25 years and a smaller sample covering a much longer period. I advise his still-serving colleagues to dust off his file and read his work, for the first time for them.

Well, ’nuff said. Let’s wait till the HDR 2011 starts streaming towards us, tweets and video and all.

Joining the dots between economics, income, health and poverty

The concerns about recession and its impacts on poverty are seen commonly as a question mark over household incomes, over food security and often involve debates about social protection. An aspect that all too often gets ignored in this equation – no doubt because of its complexity – is health and in particular the health of women and children.

Changes in neonatal mortality rates between 1990 and 2009. The map illustrates the change in NMR between the years 1990 and 2009 for each of the 193 countries estimated. PLoS Medicine 8(8): e1001080

This is linked very closely to poverty, however we measure it, and the conditions that either cause poverty to persist (leading to chronic poverty) or cause households at risk to lapse into poverty every now and then (shock). The human development index methodolgy, which is from this year using multi-dimensional indices for poverty for the first time, helps us link health, poverty, income and economic growth (or its opposite).

The question is: is this new understanding, which is more in tune with the way households actually carry on with their lives and are actually affected by wider trends concerning economy, helping integrate the connections? If there is one good reason to ask this question, it is the new study on ‘Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities’.

[The World Health Organization (WHO) has a report and summary of the study on this page – ‘Newborn deaths decrease but account for higher share of global child deaths’]
[The full study is available on PLoS Medicine, 1 August 2011 (Volume 8, Issue 8)]

This has shown that every year, more than 8 million children die before their fifth birthday. Most of these deaths occur in developing countries and most are caused by preventable or treatable diseases. In 2000, world leaders set a target of reducing child mortality to one-third of its 1990 level by 2015 as Millennium Development Goal 4 (MDG4). This goal, together with seven others, is designed to help improve the social, economic, and health conditions in the world’s poorest countries. In recent years, progress towards reducing child mortality has accelerated but remains insufficient to achieve MDG4.

“In particular, progress towards reducing neonatal deaths – deaths during the first 28 days of life – has been slow and neonatal deaths now account for a greater proportion of global child deaths than in 1990. Currently, nearly 41% of all deaths among children under the age of 5 years occur during the neonatal period. The major causes of neonatal deaths are complications of preterm delivery, breathing problems during or after delivery (birth asphyxia), and infections of the blood (sepsis) and lungs (pneumonia). Simple interventions such as improved hygiene at birth and advice on breastfeeding can substantially reduce neonatal deaths.”

Neonatal mortality rates in 2009. The map illustrates the NMR in year 2009 for each of the 193 countries estimated. PLoS Medicine 8(8): e1001080

The researchers used civil registration systems, household surveys, and other sources to compile a database of deaths among neonates and children under 5 years old for 193 countries between 1990 and 2009. They estimated NMRs for 38 countries from reliable vital registration data and developed a statistical model to estimate NMRs for the remaining 155 countries (in which 92% of global live births occurred).

They found that in 2009, 3.3 million babies died during their first month of life compared to 4.6 million in 1990. More than half the neonatal deaths in 2009 occurred in five countries – India, Nigeria, Pakistan, China, and the Democratic Republic of Congo. India had the largest number of neonatal deaths throughout the study. Between 1990 and 2009, although the global NMR decreased from 33.2 to 23.9 deaths per 1,000 live births (a decrease of 28%), NMRs increased in eight countries, five of which were in Africa. Moreover, in Africa as a whole, the NMR only decreased by 17.6%, from 43.6 per 1,000 live births in 1990 to 35.9 per 1,000 live births in 2009.

To return to my question concerning the understanding of economics, income, health and poverty, does most current analysis see to integrate these elements, or is it still GDP-income driven? A new (2011 May) paper released by the Brookings Institution indicates that the GDP-income route is still favoured. The paper, ‘Two Trends in Global Poverty’, Geoffrey Gertz and Laurence Chandy, has said that while the overall prevalence of poverty is in retreat, the global poverty landscape is changing. “This transformation is captured by two distinct trends: poor people are increasingly found in middle-income countries and in fragile states. Both trends – and their intersection – present important new questions for how the international community tackles global poverty reduction.”

The two charts show the trajectory of 20 developing countries along three dimensions: number of poor people, degree of fragility and real income per capita. These 20 countries collectively account for 90 percent of the world’s poor in 2005, and thus largely define the evolving state of global poverty. Graphic: Brookings Institution

“The increased prevalence of poverty in middle-income countries is in many ways a trend of success. Over the past decade, the number of countries classified as low-income has fallen by two fifths, from 66 to 40, while the number of middle-income countries has ballooned to over 100. This means 26 poor countries have grown sufficiently rich to surpass the middle-income threshold. Among those countries that have recently made the leap into middle-income status are a group of countries  –  India, Nigeria and Pakistan  – containing large populations of poor people. It  is their “graduation” which has brought about the apparent shift in poverty from the low-income to middle-income country category.”

This categorisation of middle, low and high income was to an extent useful in the 1970s, when the idea of a human development index was being discussed, but we’ve come a long way since. We know that even in smaller countries (rather, countries with populations that are relatively small compared to those whic bear the sort of burdens studied in the PLoS Medicine research) there is a great deal of income disparity. ‘Income’ itself is a condition with a bewildering number of inputs – social science is quite inadequate to the task of being able to recognise all of these, let alone quantify them and rationalise them across countries and regions – which is exactly what studies like this try to do unfortunately.

“In 2005, when more than half the world’s poor lived in such countries, it made some sense to think about fighting poverty in terms of a single developing country paradigm, based on what worked in countries such as Ghana, Tanzania, Mozambique or Vietnam,” Gertz and Chandy have said. “This logic was evident in two of the major events of that year which continue to shape today’s development agenda: the G8 meeting at Gleneagles and the High Level Forum on Aid Effectiveness in Paris. It was also apparent in Jeffrey Sachs’ influential 2005 best-seller, ‘The End of Poverty’. The legacy of these ideas is scattered throughout the work of the international development community in the design of traditional aid instruments and the standard methods of country engagement.”

The authors of the Brookings paper have said that this approach remains relevant for some countries, but with 90 percent of the world’s poor living in different settings today, its broader application can no longer be justified. Yet they have found that such an admission poses a dilemma. The dilemma exists because one of the reasons the stable low-income paradigm has persisted is because it characterizes an environment in which the international development community feels most comfortable and has the most experience. “The role of external actors in supporting poverty reduction in stable low-income countries is well understood and the standard tools of external assistance – financial and technical assistance – are well suited to them.”

Maplecroft's 2011 food security risk index

What does this mean? Does it give us a hitherto obscured insight into the inner world of aid agencies and international development departments and how they see ‘poor’ countries’ populations? Does it mean that we are burdened with three decades worth of simplistic labelling of populations at risk simply because labelling them any other way makes it difficult to help them? That’s what it looks like to me and I’d like to thank Gertz and Chandy for revealing this. But it’s way past high time this sort of categorisation was ditched, once and for all. It would do us and the battalions of development professionals a huge amount of good to simply be able to say, every so often, “we don’t know enough”.

It is worth being honest about the state of our knowledge concerning the lives of the the majority of households in ‘developing’ countries. Some of the reasons why such honesty will help in the long term are contained in a thoughtful new publication from the World Bank (whose army of development professionals will benefit from its reading). This collection is entitled ‘No Small Matter: The Impact of Poverty, Shocks, and Human Capital Investments in Early Childhood Development’ (The World Bank, 2011) and it has said that, as the 2008 global financial crisis has again demonstrated, economic crises are an unfortunate recurring event in the world and can have severe consequences for household livelihoods.

Progress in key health indicators, UN Human Development Report 2010

‘No Small Matter’ defines economic crises as sharp, negative fluctuations in aggregate income, these being especially common in developing countries, and the frequency with which they occur has been increasing in recent history. We know that declines in household and community resources are not the only risks that arise from an economic crisis because of its aggregate nature. We also know – from fieldwork and by hearing those whom we would wish to help – that at the same time as households cope with the possibility of reduced income from aggregate economic contractions, vital public services may also experience a decline in quality or availability, which in turn may have an additional impact on skill development among children. This is happening now, in more countries than ever before. The economic crisis that hit Latin America in 1982 led to a decrease in public health spending and had a disproportionate effect on the poorest groups. In 2011, the decrease in public health spending exists in many more countries.

A chapter in ‘No Small Matter’, ‘The Influence of Economic Crisis on Early Childhood Development: A Review of Pathways and Measured Impact’, by Jed Friedman and Jennifer Sturdy, is particularly useful.

This has said that “conservative estimates suggest that over 200 million children under five years of age living in developing countries fail to reach their cognitive development potential because of a range of factors, including poverty, poor health and nutrition, and lack of stimulation in home environments”. It is possible, the chapter’s authors have said, that this burden increases during times of crisis as poverty increases and food security is threatened. However, to investigate this claim more carefully it is necessary to understand the pathways through which poverty influences skill acquisition in children.

“The most severe condition affecting ECD (Early Childhood Development) is infant and early child mortality. Sharp economic downturns were associated with increases in infant mortality in Mexico, Peru and India. The mortality of children born to rural and less educated women is more sensitive to economic shocks, which suggests that the poor are disproportionately affected during most economic crises, and perhaps the poor face important credit constraints that bind in tragic ways during large contractions.

Weak relationship between economic growth and changes in health and education, UN Human Development Report 2010

The mortality of girls is also significantly more sensitive to aggregate economic shocks than that of boys. This gender differential exists even in regions such as Sub-Saharan Africa that are not particularly known for son preference and indicates a behavioral dimension where households conserve resources to better protect young sons at the expense of daughters.”

Finally, a further note about the extremely valuable PLoS Medicine study ‘Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities’. The authors are: Mikkel Zahle Oestergaard1, Mie Inoue1, Sachiyo Yoshida, Wahyu Retno Mahanani, Fiona M. Gore1, Simon Cousens, Joy E. Lawn and Colin Douglas Mathers (on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group – World Health Organization, Department of Health Statistics and Informatics; World Health Organization, Department of Child and Adolescent Health and Development; London School of Hygiene & Tropical Medicine; Saving Newborn Lives/Save the Children).

Children of poor households are more likely to die, UN Human Development Report 2010

The study found that of the 40 countries with the highest NMRs in 2009, only six are from outside the African continent (Afghanistan, Pakistan, India, Bhutan, Myanmar, and Cambodia). Among the 15 countries with the highest NMRs (all above 39), 12 were from the African region (Democratic Republic of the Congo, Mali, Sierra Leone, Guinea-Bissau, Chad, Central African Republic, Burundi, Angola, Mauritania, Mozambique, Guinea, and Equatorial Guinea), and three were from the Eastern Mediterranean (Afghanistan, Somalia, and Pakistan). Throughout the period 1990–2009, India has been the country with largest number of neonatal deaths. In 2009, the five countries with most deaths accounted for more than half of all neonatal deaths (1.7 million deaths = 52%), and 44% of global livebirths: India (27.8% of deaths, 19.6% of global livebirths), Nigeria (7.2%, 4.5%), Pakistan (6.9%, 4.0%), China (6.4%, 13.4%), and Democratic Republic of the Congo (4.6%, 2.1%). The top five contributors to the 4.6 million neonatal deaths in 1990 were: India (29.5% of deaths, 19.8% of global livebirths), China (12.3%, 18.0%), Pakistan (5.4%, 3.4%), Bangladesh (5.0%, 2.9%), and Nigeria (4.8%, 3.3%).

As the risk of children dying before the age of five has fallen, the proportion of child deaths that occur in the neonatal period has increased. This increase is primarily a consequence of decreasing non-neonatal mortality in children under five from infectious diseases such as measles, pneumonia, diarrhea, malaria, and AIDS. Globally, 41% of under-five deaths now occur in the neonatal period. Over the 20 y between 1990 and 2009, the proportion of global neonatal deaths that occurred in Africa increased. Although Africa is now the region with the highest NMR, the proportion of under-five child deaths that are neonatal remains relatively low in Africa—the fraction increased from 26% to 29% between 1990 and 2009. This apparent anomaly reflects the fact that Africa accounts for approximately 90% of child deaths due to malaria (0.7 million under-five deaths) and HIV/AIDS (0.2 million under-five deaths), resulting in relatively higher post-neonatal child mortality than other regions.

Global governance, food security? What do these mean?

Vendors in Mapusa, Goa. The middle basket contains 'nachne', local millet

Are the current arrangements fit for the job? This is the question posed in a current discussion on FAO’s The Global Forum on Food Security and Nutrition (FSN Forum). The Forum is set up and managed by by FAO’s Agricultural Development Economics Division and, in their words, “is a community of practitioners currently reaching more than 2800 members” around the world.

The short intro to this discussion is: one of the consequences of the 2007-08 food price crisis was the emergence of a number of new institutions and initiatives that were intended to strengthen global capacities to respond to such situations. “You are invited to share views on how an effective global food governance system should work and on what major issues are to be addressed in order to ensure an adequate and safe food supply for all humans at all times.”

Here is my contribution to the discussion on ‘Global Governance for Food Security: are the current arrangements fit for the Job?’.

‘Global governance’ and ‘food security’ are not compatible ideas in present circumstances. If we look at the idea of ‘food security’, which development agencies and social scientists tend to agree is achieved by every family/household having enough to eat – and able to find and purchase that food easily – then this is only part of a way of living. That way of living, where the production and consumption of food is concerned, has for some years now been more aptly called ‘food sovereignty’. The difference between ‘security’ and ‘sovereignty’ is a major one, and governance – as it is commonly understood by UN agencies and development professionals – may apply to ‘security’ but hardly can to ‘sovereignty’.

So there is a difficulty with how this has been framed. Global governance is I’m sorry to say neither feasible under current economic conditions nor desirable from a cultural diversity point of view. It may have been a guiding principle in the mid-1930s when the League of Nations was created, and has been re-articulated in many forms – sometimes grandly, at other times in attempts to find peace and end conflict. The idea lies at the heart of many of the multidisciplinary efforts led by UN agencies, especially concerning human development, environment, healthcare, the right to education. It is at the core of the Millennium Development Goals programme. It remains, as it was more than 70 years ago, a fuzzy notion that does more to distract than to build. FAO needs to have nothing to do with such an idea.

Rice is still planted and harvested in the coastal talukas, but fields such as these are threatened by urbanisation

The food crisis of 2007-08 is a point of extreme stress in the steady progress of the consolidation of the factors of food production and the organisation of the consumers of food products. In many ways, the ‘crisis’ began when the first fields were harvested with Green Revolution hybrids, and that was a long time ago. It is the growing concentration of capital in the post-harvest sequence – rather than in the people and households and villages who cultivate – that has led to the extreme food impoverishment which we first recognised in 2007-08 and promptly called a ‘crisis’.

This systemic difficulty continues simply because the same forces that, in public fora, in UN agencies, in corporate-industrial circles and within national policy, call for governance are also the forces that create legislation, treaties, trade agreements and multilateral institutions designed to sabotage all expressions of food sovereignty.

I have no doubt that within the ‘number of new institutions and initiatives’ there are also a number of people with the will and intention to help solve a problem that is found in many countries, many provinces and states. However, that does not make it a ‘global problem’. Some of the forces at work are international in scope and scale, such as the reach of the giant fertilisers corporations, the impact of the world’s major agricultural commodities exchanges, the dense links between grain trading cartels and the financial markets. These operate internationally, and the effects of deprivation and food price inflation are also seen in many countries. There are common elements, no doubt, but it is useful to distinguish elements that are common from the idea of ‘global’, for there will not be an inter-agency solution.

Identification of these problems, the reform of economic systems which permit such deprivation, and the creation and maintenance of social institutions (council of village elders for example) can only form locally and work locally. At best, there may be an exchange for methods and practice, available to all to participate in. That I think is what FAO should aim for on this subject.

New, improved human development indices

Now where did I put that new index?

Policymakers and commentators are constantly looking for new ways to measure development, writes Martin Ravallion, Director of the Development Research Group of the World Bank, in his column at VoxEU. In his comment, titled ‘Your new composite index has arrived: Please handle with care’, he warns against embracing new composite indices with little guidance from economic or other theories. Ravallion then talks about the strengths and weaknesses of using what he calls ‘mashup’ indices of development (a ‘mashup’ is a web term, which means to mix data in a new way using a new ‘app’ that presents it to users).

“A host of indicators are used to track development. The World Bank’s annual World Development Indicators presents hundreds of such indicators. The United Nation’s Millennium Development Goals are defined using a long list of indicators. Faced with so many indicators – a “large and eclectic dashboard,” as the Stiglitz report nicely puts it – there is an understandable desire to form a single composite index.”

You want to index our work? Surely you're joking.

“For some of the composite indices found in practice, economic theory provides useful clues as to how the index should be constructed (GDP, for example). This is not the case for another type of composite index that is becoming popular. For these, neither the list of underlying data nor the aggregation technique is informed by theory or practice. The maker of the composite-indicator has free roam and is largely unconstrained by economic or other theories intended to inform measurement practice.”

Having referenced in his article the Multidimensional Poverty Index (MPI) of the Oxford Poverty and Human Development Initiative, developed by among others Sabina Alkire and Maria Emma Santos, Alkire has commented on Ravallion’s musings. “I am grateful for the interest shown in our Multidimensional Poverty Index (MPI) that we developed as an experimental series for the 2010 UNDP Human Development Report that will be released 4 November.”

This paper recycling shop in Mumbai is not yet a beneficiary of the human development indexing effort

“In sum, I agree with Martin’s statement in his Mashup paper, “The lesson to be drawn from this review is not to abandon mashup indices.” I agree equally with the emphasis of this article: that we need to handle composite indices of all kinds with care and curiousity, to understand exactly their construction, their robustness, their legitimate policy interpretations, and their oversights. For that reason Maria Emma Santos and I have stated explicitly the strengths and limitations of the new Multidimensional Poverty Index, and undertaken thorough robustness tests and quality checks, and found it was indeed robust to a number of plausible changes to the indicators, thresholds, and changes in the poverty cutoff. We also have highlighted the areas which do require further research, are undertaking that work and hope others will contribute.”

Well, an index is only as good as the intention that guides it. It will be most useful if it helps the right questions to be framed, and indicates where the answers may be found. Indices of poverty and human development which command most attention are also those that are global in scope. As Ravallion says, these help people – policymakers among them – see where their country stands when compared with others. That’s well and good, but much of our work is within countries, not across them, and much of our work involves dealing with realities that are highly subjective and fluid, open always to a variety of forces and influences.

Poverty for example may be deepened just as much by barriers of caste or environmental degradation as it is by ill health and natural calamity. How does one capture caste biases and environmental degradation as it affects a sub-tribe in a particular locale? An index that attempts to do this will be both dreadfully complex and not portable. Perhaps it is best for locals to develop their own means of measurement, comparison and rating. In that, the lessons provided by Ravallion, Alkire and the host of social scientists on whose shoulders they rest can be put to use.

State of Food Insecurity 2010 – FAO says too little, too timidly

The 2010 edition of the State of Food Insecurity says much too little and what it does say is unconvincing. There is a theme for this years edition of one of the Food and Agriculture Organization’s (FAO) ‘flagship’ reports. The theme is “countries in protracted crisis” by which FAO means conflict and war, internal and external.

FAO doesn’t say so explicitly in the introduction to SOFI 2010 on its website. There’s no excuses for FAO not to when the World Food Programme, Oxfam, ActionAid and a number of international agencies and aid groups have done so, not just this year but for at least a decade.

As the world’s pre-eminent compiler of food and agriculture-related research, data and analysis, FAO ought to see itself as duty-bound to be clear and fair in its reportage but it is not.

SOFI 2010 says that the majority of the world’s undernourished people live in developing countries. Two-thirds live in just seven countries (Bangladesh, China, the Democratic Republic of the Congo, Ethiopia, India, Indonesia and Pakistan) and over 40% live in China and India alone.

The report says that “FAO’s projections for 2010 indicate that the number of undernourished people will decline in all developing regions, although with a different pace. The region with most undernourished people continues to be Asia and the Pacific, but with a 12% decline from 658 million in 2009 to 578 million, this region also accounts for most of the global improvement expected in 2010″. Where does FAO think this improvement is going to come from, given the fact that its own food price index shows how cereals have risen at a clip this year to match the rise in 2007?

Just as it did a month ago, the FAO is sounding like it is in two minds about what to report. SOFI 2010 says that “developing countries as a group have seen an overall setback in terms of the World Food Summit goal (from 827 million in 1990–92 to 906 million in 2010), while some progress has been made towards MDG 1 (with the prevalence of hunger declining from 20% undernourished in 1990–92 to 16% in 2010)”.

Which are the 22 countries covered by the ‘protracted crisis’ theme? Here they are, the numbers in total population in millions followed by number of undernourished in millions, both for 2005-07. (Why couldn’t these have been for 2009 in a report dated 2010?): Afghanistan (na / na), Angola (17.1 / 7.1), Burundi (7.6 / 4.7), Central African Republic (4.2 / 1.7), Chad (10.3 / 3.8), Congo (3.5 / 0.5), Côte d’Ivoire (19.7 / 2.8), Democratic People’s Republic of Korea (23.6 / 7.8), Democratic Republic of the Congo (60.8 / 41.9), Eritrea (4.6 / 3.0), Ethiopia (76.6 / 31.6), Guinea (9.4 / 1.6), Haiti (9.6 / 5.5), Iraq (na / na), Kenya (36.8 / 11.2), Liberia (3.5 / 1.2), Sierra Leone (5.3 / 1.8), Somalia (na / na), Sudan (39.6 / 8.8), Tajikistan (6.6 / 2.0), Uganda (29.7 / 6.1), Zimbabwe (12.5 / 3.7).

SOFI 2010 says: “On average, the proportion of people who are undernourished is almost three times as high in countries in protracted crisis as in other developing countries (if countries in protracted crisis and China and India are excluded). Nonetheless, not all countries in protracted crisis present very high levels of undernourishment as in some of these countries crises are localized to certain areas or regions. There are approximately 166 million undernourished people in countries in protracted crisis – roughly 20% of the world’s undernourished people, or more than a third of the global total if China and India are excluded from the calculation.”

The question, what happens when China and India are excluded from calculations? With the exclusions 130.4 million (China) and 237.7 million (India) fall out of the equations? Moreover, SOFI isn’t following it’s own data. The para above says 166 million (approx) undernourished in countries in ‘protracted crisis’ but the table annex shows that the 22 countries together have 146.8 million undernourished. If the larger number for the 22 countries is the 2009 estimate, then FAO could have used the same method to provide estimates for all countries for 2009.

When FAO recalculates its food price index monthly (the current index is up-to-date for September 2010) why are these estimates three years old? Why should China and India be excluded when they account for over a third of the global undernourished population? Last month FAO said that 925 million people in the world live in chronic hunger and explained that “the decline (from 1,020 million in 2009) was primarily attributable to better economic prospects in 2010 and the fall in food prices since mid-2008”. What fall in food prices? What better economic prospects?

The State of Food Insecurity 2010 is a disappointing and pedestrian effort. FAO ought to retract this version and revise it thoroughly without dwelling on themes like ‘protracted crisis’ and instead get to grips with the market- and economics-related reasons for food price spikes and the hunger they bring.

Poverty, low carbon, Transition and history

UN Millennium Development Goals Report 2010 / UNICEF Photo

Energy Bulletin, which is a project of the Post Carbon Institute, has just published my article on the Transition movement and poverty (in the South, Asian and African). I have raised some questions and perspectives about this aspect of the Transition movement which has intrigued me for some time.

It also has to do with knowing the perspective from Europe – which sadly has too often been coloured by a “we know best how to help you” approach. That’s led to all sorts of inter-cultural problems and the last thing I want to see is for Transition ideas to be looked at with suspicion in the South because of historic blunders on aid and ‘dev-econ’.

The full article is available on Energy Bulletin. Here is the intro:

Serious traders see the trends before anyone else. They do so because their business depends on seeing the minute deviation that signals the beginning of a trend. Early in June 2010 commodities traders charted the new signals they were getting from the world’s agricultural exporters and major consumers. What they saw then became the picture that in late July began to alarm governments and international development agencies. World foodgrain supplies were entering a new phase of tightening, as the impacts of drought and extreme weather in grain producing countries around the world became clear.

For the trading community – whose strong and deep links with the world’s financial markets and banks have become more visible since 2008 – the opportunity is large, perhaps even bigger than the one that slowly unfolded in 2007, when the last global food price crisis swept through cities and villages alike. For inter-governmental agencies such as the United Nations system, the news is a body blow to the idea and effort that has sustained work on social justice and equality.

UN Millennium Development Goals Report 2010 / UNICEF Photo

The effects of the 2007-08 food price crisis were still being unravelled when the 2009 financial crisis took hold. That prompted many UN agencies, major aid organisations and hundreds of large NGOs to quickly study the impact of both on their work, and on those whom they work for, which is the poor and marginalised on all continents. Much less visible and quite unrecognised is the impact of the same two crises on the small but philosophically very sound transition movement. Guided by tenets that became clear in the 1960s and 1970s, this constellation of movements (low carbon, sustainable communities, local resilience being some variations readily recognisable in the ‘west’) has adapted practices central to all ur-rural settlements, and continues to internalise the collected wisdom and practice of the world’s indigenous peoples. In so doing, the transition movement in the ‘west’ (and therefore North) has for the most part been unable to conceptualise a response to the human development and social justice needs of the South.

Much of this lack, as I see it, has to do with the very formidable inertness which western societies inherited from the transformations wrought by the Industrial Revolution, and the apparently incontrovertible ideas of ‘progress’ and ‘growth’, which by the time the Bretton Woods institutions came into being were well suited to form the core of a ‘development economics’ that has wrought havoc on both North and South, although in different periods of the 20th century. Transition ideas and praxis have had to therefore first wage an intellectual battle against ‘development economics’ and then launch a physical struggle against the socio-ecological degradation that followed such economics on the ground.

What we do know is that rural realities and living conditions are usually very different from the sketches contained in funding documents. Poverty is the main source of hunger now, not a lack of food. Efficiency has become a central theme, which means getting higher yields on small plots with fewer inputs of water and chemical/synthetic fertiliser. It hasn’t helped that government investment in basic research and development on agriculture, in the countries of the South, is very little. Here are a few points that help explain why the MDGs assessment is crippled by its reluctance to face facts:

UN Millennium Development Goals Report 2010 / UN Photo

1. In 2009, more than 1 billion people went undernourished – their food intake regularly providing less than minimum energy requirements – not because there isn’t enough food, but because people are too poor to buy it. The US$1.25 a day line (which can be replaced by any currency unit at any ruling amount) does not describe a poverty threshold. At best it provides a measure of one marker out of many for poverty, and even that marker needs to be localised for it to have community meaning. Although the highest rates of hunger are in sub-Saharan Africa – correlated with poverty – most of the world’s undernourished people are in Asia and particularly South Asia.

2. The percentage of chronically hungry people in the developing world had been dropping for years even though the number of hungry worldwide has barely dipped. But the food price crisis in 2008 reversed these years of slow gains, and now the gathering 2010-11 food crisis (a shortage of availability coupled with price rise) will further reverse the gains.

There is another linkage, that of population. Scientists long feared a great population boom that would stress food production, but population growth is slowing and could plateau by 2050 as family size in almost all poorer countries falls to roughly 2.2 children per family. Even as population has risen, the overall production of food has meant that the fairly weighted global average of available calories per person has increased, not decreased. Producing enough food in the future is possible, but doing so without drastically sapping other resources, particularly water and energy, is not (which is exactly where transition concepts and praxis come in).

3. An outlook published in 2009 by the Food and Agriculture Organization (FAO) of the United Nations and the Organization for Economic Cooperation and Development (OECD) says that current cropland could be more than doubled by adding 1.6 billion hectares – mostly from South America and Africa – without impinging on land needed for forests, protected areas or urbanisation. But Britain’s Royal Society has advised against substantially increasing cultivated land, arguing that this would damage ecosystems and biodiversity. Instead, it backs “sustainable intensification,” which has become the priority of many agricultural research agencies.

Sound and fury over the ‘New Delhi superbug’

The Government of India has decided on a matter of medical research to protest what it sees as an attack on India’s pride and reputation. In the process it is ignoring entirely the public health implications of the findings concerning the ‘New Delhi metallo-beta-lactamase 1 (NDM-1) positive Enterobacteriaceae‘ which a typically hair-trigger and chronically underinformed media have promptly labelled the ‘New Delhi superbug‘.

National politicians are notoriously quick to point out and rubbish any perceived stain on Mother India’s honour – never mind that 53 million children under five are malnourished and 456 million live in poverty. And so it is with the Lancet Infectious Diseases paper whose findings ought to be treated with the seriousness they deserve, rather than be rubbished out of hand as being an attempt to scuttle India’s ambitious medical tourism industry. The problem is seen as commercial, not health, which becomes clear given the non-partisan nature of the defenders.

India’s Union Health and Family Welfare Minister Ghulam Nabi Azad directed the ministry he heads to issue a statement which said: “While such organisms may be circulating more commonly in the world due to international travel but to link this with the safety of surgery hospitals in India and citing isolated examples to show that due to presence of such organism in Indian environment, India is not a safe place to visit is wrong.” The Indian health authorities also complained to the Indian media that several authors of the Lancet study had pharmaceutical ties. “After seeing the research paper I strongly refute that hospitals in India are the source of the strain and strongly condemn naming the bacteria after New Delhi,” said Director General of Health Services RK Srivastav.

Malnourished children under 5, MDGs map, World Bank

Politician S S Ahluwalia, who is deputy leader of opposition in the Rajya Sabha (upper house), called the study a “sinister design” of foreign multinational companies to undermine India’s burgeoning medical tourism industry. He said in the Rajya Sabha that “the timing of the article was suspicious” as it came when “India is emerging as a global power in medical tourism”. However, being in the opposition, he also asked the government to “come out with a registry that will record infections when they are detected in hospitals, and also antibiotics for their treatment”. This demand was probably prompted by a report citing an official of the Indian Council of Medical Research as having said that India currently does not have any rules or registry to record hospital-acquired infections.

In all the expressions of outrage, what is clear is that the immediate concern of the Union Health Ministry and the assortment of politicians and health officials protesting is the impact of the Lancet study on India’s medical tourism industry, which is no doubt booming, of which a substantial portion is composed of medical visitors from Britain, and which is estimated by the healthcare industry to reach USD 2.3 billion in value by 2012. Perhaps the only rational response was from the Minister of State for Science and Technology and Parliamentary Affairs, Prithviraj Chavan, who told Parliament he would provide an answer “after consulting with the health ministry and department of biotechnology”.

What actually set off the outrage in India? As Nature Blogs explains, the ‘New Delhi metallo-beta-lactamase 1 (NDM-1) positive Enterobacteriaceae’ comprise a new breed of multidrug-resistant bacterium. Germs carrying the NDM-1 gene fend off almost every known antibiotic, including the carbapenem family of drugs reserved as a last resort. One such bug claimed its first known fatality in June, when a Belgian man infected while hospitalised in Pakistan died in Brussels. The Lancet paper found the NDM-1 gene in isolates of Escherichia coli and Klebsiella pneumoniae taken from sites in the United Kingdom, India, and Pakistan. Of the 29 UK patients found with NDM-1 germs, 17 had recently traveled to India or Pakistan, and several had been hospitalised while undergoing elective surgery.

What does the Lancet study actually say? Entitled ‘Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study’, the 31 collaborating authors say that “Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-beta-lactamase 1 (NDM-1) are potentially a major global health problem“. They say this because they investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK. Enterobacteriaceae isolates were studied from two major centres in India – Chennai (south India), Haryana (north India) – and those referred to the UK’s national reference laboratory.

Here is the short statement of findings: “We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries.”

And this is the no-nonsense assessment: “The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed.” Who funded the research? The European Union, Wellcome Trust, and Wyeth. Does this pose conflicts of interest? According to the Indian government it does, for the Union Health Ministry has pointed out that one author “has received a travel grant from Wyeth” and another “has received
conference support from numerous pharmaceutical companies, and also holds shares in AstraZeneca, Merck, Pfizer, Dechra, and GlaxoSmithKline, and, as Enduring Attorney, manages further holdings in GlaxoSmithKline and Eco Animal Health”. However what was not mentioned is the statement that “all other authors declare that they have no conflicts of interest” which covers 29 out of 31.

The Lancet paper makes several observations which have implications for public health in India, Pakistan, Bangladesh and South Asia and these are:

Population living in poverty, MDGs map, World Bank

“NDM-1-positive bacteria from Mumbai (32 isolates), Varanasi (13), and Guwahati (three) in India, and 25 isolates from eight cities in Pakistan (Charsadda, Faisalabad, Gujrat, Hafizabad, Karachi, Lahore, Rahim Yar Khan, and Sheikhupura) were also analysed in exactly the same manner but in laboratories in India and Pakistan. These isolates were from a range of infections including bacteraemia, ventilator-associated pneumonia, and community-acquired urinary tract infections.”

“In addition to the collections of isolates from Chennai and Haryana detailed above, we have confirmed by PCR alone the presence of genes encoding NDM-1 in carbapenem-resistant Enterobacteriaceae isolated from Guwahati, Mumbai, Varanasi, Bangalore, Pune, Kolkata, Hyderabad, Port Blair, and Delhi in India, eight cities (Charsadda, Faisalabad, Gujrat, Hafizabad, Karachi, Lahore, Rahim Yar Khan, and Sheikhupura) in Pakistan, and Dhaka in Bangladesh suggesting widespread dissemination.”

The concern is that there is widespread nonprescription use of antibiotics in India, leading to huge selection pressure, which led the study authors to predict that the NDM-1 problem is likely to get substantially worse in the foreseeable future. “This scenario is of great concern because there are few new anti-Gram-negative antibiotics in the pharmaceutical pipeline and none that are active against NDM-1 producers.” Even more disturbing, the authors have said, is that most of the Indian isolates from Chennai and Haryana were from community-acquired infections, suggesting that NDM-1 is widespread in the environment.

New Delhi and other India metropolises and cities have witnessed repeated surges in the incidents of dengue and, especially in monsoon months, malaria, which the city authorities of Mumbai (Bombay) are currently battling in a haphazard and quite ineffectual manner. The conclusions of the Lancet study on NDM-1 naturally also raise question about the ability of a worn out public health system to identify and respond to new threats, and it is this aspect which ought to be exercising the Union Health Ministry rather than the perceived slur on five-star medical tourism facilities. Moreover, as the affiliations of the study authors show, this is a South Asian effort concerning what ought to be viewed as a South Asian health issue, and the Indian Government’s nationalistic response ignores the regional dimension entirely (and typically).

“The introduction of NDM-1 into the UK is also very worrying and has prompted the release of a National Resistance Alert 3 notice by the Department of Health on the advice of the Health Protection Agency,” the study has said in conclusion. “Given the historical links between India and the UK, that the UK is the first western country to register the widespread presence of NDM-1-positive bacteria is unsurprising. However, it is not the only country affected. In addition to the first isolate from Sweden, a NDM-1-positive K pneumoniae isolate was recovered from a patient who was an Australian resident of Indian origin and had visited Punjab in late 2009. The isolate was highly resistant and carried NDM-1 on an incompatibility A/C type plasmid similar to those in India and the UK.”

“Several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India or Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and NDM-1 will likely spread worldwide. It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money. As our data show, such a proposal might ultimately cost the NHS substantially more than the short-term saving and we would strongly advise against such proposals. The potential for wider international spread of producers and for NDM-1-encoding plasmids to become endemic worldwide, are clear and frightening.”

The authors of the Lancet study and their institutional affiliations are: Department of Microbiology, Dr ALM PG IBMS, University of Madras, Chennai, India (K K Kumarasamy MPhil, P Krishnan PhD); Department of Infection, Immunity and Biochemistry, School of Medicine, Cardiff University, Cardiff , UK (M A Toleman PhD, Prof T R Walsh PhD, the lead author); Health Protection Agency Centre for Infections, London, UK (J Bagaria MD, R Balakrishnan MD, M Doumith PhD, S Maharjan MD, S Mushtaq MD, T Noorie MD, A Pearson PhD, C Perry PhD, R Pike PhD, B Rao MD, E Sheridan PhD, J Turton PhD, M Warner PhD, W Welfare PhD, D M Livermore PhD, N Woodford PhD); Department of Microbiology, Shaukat Khanum Cancer Hospital, Lahore, Pakistan (F Butt MD); Department of Microbiology, Pandit B D Sharma PG Institute of Medical Sciences, Haryana, India (U Chaudhary MD, M Sharma MD); Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden (C G Giske MD); Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan (S Irfan MD); Department of Microbiology, Amrita Institute of Medical Sciences, Kerala, India (A V Kumar MD); University of Queensland Centre for Clinical Research, University of Brisbane, Herston, QLD, Australia (D L Paterson MD); Department of Microbiology, Apollo Gleneagles Hospital, Kolkata, India (U Ray MD); Department of Medical Microbiology, Northumbria Healthcare NHS Foundation Trust, Tyne and Wear, UK (J B Sarma MD); Department of Microbiology, Apollo Hospitals, Chennai, India (M A Thirunarayan MD); and Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India (S Upadhyay PhD).

The global water trade, by ship from Alaska to India

Niger: Men draw water from a deep well in Zinder. They must make tough decisions as to how to divide the scarce resource between cattle, people and crops. Photo: Anne Isabelle Leclercq/IRIN

The ecological crimes committed in the name of trade and for the benefit of the ‘market’ grow in outrageousness. The latest example of utter irresponsibility, both regulatory and environmental, comes from a company headquartered in the state of Texas, USA, which plans to ship water from Alaska, USA, all the way across the Pacific Ocean, to India, where it plans to set up what it calls its ‘global water hub’.

The alert came on the Triple Pundit site, which quickly explained that the Texan company, S2C Global Systems, plans to ship 11.35 billion litres of water every year from the Blue Lake Reservoir in Sitka, Alaska to the west coast of India and other Asian countries. From there, S2C Global Systems plans to sell the water via “smaller ships that can deliver to shallower ports, like Umm Qasr in Iraq”. Do you smell the hand of US defence contractors like Halliburton here? S2C said the project is expected to begin moving water within six to eight months.

There are a number of obvious questions here. How has a Texan company gained conttrol of an entire lake in Alaska, which is a common property resource? How have the communities and settlements there in Alaska permitted this, or have they? How can US environmental regulation – the EPA for example – permit such commercial exploitation? Who is funding this obscene project – India may be a way-station for S2C now, but the company categorically says India is going to be an important market for its water. But at what cost to Alaska and to India?

S2C says it will sell the water in “20-foot containers with flexi-tanks suitable for pharmaceutical/high tech manufacturing and packaged water (18.9 and 10L) for the consumer markets anywhere containers are delivered in south and west Asia from India.” In a statement dated 07 July 2010, the company said that for “security reasons” the Indian port which is to serve as its “world water hub” will not be disclosed. It will “include a berth for a Suezmax vessel (156,000 cubic meters/41Million USG), an offloading system to a dedicated tank farm and a distribution complex for packaged water. Within 18 months after that we will be able to switch to a very large class vessel (302,833 cubic meters/80 Million USG), as both the ship and the berth for her will be completed within this time frame. Contracts for the distribution hub and ships are being finalised.”

Nepal: In some places, children have to walk more than five hours to fetch water. Photo: Naresh Newar/IRIN

The company says: “India itself provides a particularly significant growth market for the packaged waters with a current population of 1.15 billion people, an emerging middle class and an increasing clean water shortage. Sales efforts throughout south and west Asia will continue with travels planned immediately through the region.”

Rod Bartlett, managing partner of Alaska Resource Management and President of S2C Global Systems, USA, is quoted in the statement as saying: “S2C Global has an exciting future in India and the region. After recently spending time in India meeting port authorities and potential distributors, our vision to distribute water globally became real. We fully expect the India World Water Hub to fulfill our minimum expectations of a half a billion gallons sold annually”.

Export Development Canada (EDC), Canada’s export credit agency, announced in March 2010 up to US$10 million in equity commitments to XPV Water Fund Limited Partnership, a venture capital fund focused on investing in the water sector. The press release described the water sector as an “area of significant growth potential for Canada”.

I can’t imagine this profiteering being part of a ‘growth’ strategy that the average Canadian would subscribe to. Meanwhile, what are conditions in countries which companies like S2C say are its world water market?

In India, figures from the Ministry of Rural Development show that the country had enough drinking water for its people in 1951 at 5,177 cubic metres per person per year. But by 2000 India had become a water-deficient country. In 2003, the country had a 25 per cent deficit, at a rate of 1,500 cubic metres per person per year. The deficit is projected to rise to 33 per cent by 2025, unless measures are taken to resolve it.

In Liberia, three out of four Liberians have no access to safe drinking water and six out of seven cannot access sanitation facilities, such as toilets, according to Oxfam. A further US$93.5 million is needed to boost clean water access to 50 percent of all Liberians; and to improve access to toilets to 33 percent – goals set out in the government’s 2008-2011 poverty reduction strategy.

Chad: Chadians receive US$3 in water aid per capita annually. Photo: WaterAid

In Iraq, there is an acute shortage of water nationwide and a collapsed economy, which makes it very difficult for farmers to do other work. Tribal sheikh Ali Ismael al-Zubaidi from Diwaniya Governorate, about 200 km south of Baghdad, said in an IRIN report he had been having “tough negotiations” over water allocations with another tribe that lives upstream from his. “We have daily problems with water. They are siphoning water with huge electric water pumps and leave only drops for us. Government officials can’t control the regulation of irrigation and stop those who violate their regulations either because of corruption or because they fear for their lives. So we have to solve this issue ourselves.”

In Nepal, according to government statistics, more than 4.4 million people do not have regular access to safe drinking water in rural and urban areas, be it via piped water, wells, rainwater or bottled water. Public health concerns are increasing as a result. Already, more than 10,500 children die before their fifth birthday from diarrhoea, mainly due to inadequate access to safe drinking water, sanitation and hygiene, according to WaterAid. More than 80 percent of diseases are the result of unsafe drinking water and poor sanitation, according to its 2009 report, ‘End Water Poverty in Nepal’.

In 2000 the world pledged that half the 2.6 billion people without safe drinking water and basic sanitation would have access to these basic facilities by 2015, but poor countries will need US$18.4 billion more a year to reach this Millennium Development Goal (MDG), which at this rate will only be met in 2200. In 1997, 8% of overall development aid went to water and sanitation; in 2008 this dropped to just 5%-less than commitments for health, education, transport, energy and agriculture, according to the Global Annual Assessment of Sanitation and Drinking Water (GLAAS) report by the UN Children’s Fund (UNICEF) and the World Health Organization (WHO). Moreover, the bulk of this global aid went to middle-income countries, with low-income countries receiving just 42%, said WaterAid, an international NGO working to provide access to clean water, sanitation and health education.