Chapter 1 by HC120718151837


									                                         Chapter 7

                     NUTRITIONAL SAFETY NETS

                                 (Draft of April 20, 2010)

It is important to make long-term plans to deal with chronic hunger, but there is also a

need to deal with current problems. This is recognized in the Twin Track Approach of the

Food and Agriculture Organization of the United Nations, based on the recognition that

while pursuing long-term strategies for sustainable growth, there is also a need for

immediate hunger relief interventions (FAO 2003). As the FAO put it, “To help hungry

people now, safety nets and social protection programmes must be created or improved to

reach those most in need (FAO 2009c, 4).”

Many different approaches have been tried to achieve quick improvements in the

nutrition status of vulnerable people, with very mixed results. Chapters 3 and 4 argued

that such programs are likely to be more effective if they are based on the recognition that

adequate food is a human right. This chapter proposes the development of guaranteed

nutritional safety nets with enforceable legal entitlements. Key characteristics of such

safety nets are numbered and italicized, and then repeated at the end of the chapter.


The World Bank describes social safety nets as “formal and informal mechanisms that

protect people against the adverse outcomes of poverty.” It then goes on to explain:

       Food-based safety nets represent a subset of possible safety net programs.

       They are designed to ensure livelihoods (for example, through the

       provision of public works employment paid in food), increase purchasing

       power (through the provision of food stamps, coupons, or vouchers), and

       relieve deprivation (through the direct provision of food to households or

       individuals). They differ from cash-based programs—public employment

       or cash transfers— in that they are tied to food as a resource. All have in

       common the fact that they increase the household’s real income but in the

       form of food or cash-equivalents associated with food (Rogers 2002, 1;

       also see Grosh 2008).

These include supplementary feeding programs, food for work programs, food stamp

programs, and emergency feeding. The bank’s approach emphasizes the impact of

assistance on the family’s income rather than on its nutritional status. There are also

many different types of cash support programs, such as Temporary Assistance for Need

Families (TANF) in the United States, the employment guarantee program in India, and

the Conditional Cash Transfer Programs favored in Latin America (Handa 2006). Some

are designed to provide social protection broadly (Devereux 2009). All of them are likely

to help improve families’ nutrition status.

Here, however, we focus on programs that are explicitly nutrition-centered and are

intended primarily to improve nutrition status rather than income. Ethiopia’s Productive

Safety Net Programme is a good example. It helps over seven million chronically food-

insecure people primarily through employment schemes and food or cash transfers

(Oxfam 2009, 3).

In its final report, Halving Hunger: It Can Be Done, the United Nations Millennium

Project’s Task Force on Hunger offered Recommendation Five, to Reduce the

vulnerability of the acutely hungry through productive safety nets (United Nations

Millennium Project 2005, 143-152). It focused on protecting those who are made acutely

hungry by natural disasters and economic shocks, and was not designed to lift those who

suffer from chronic malnutrition.

In The National Nutrition Safety Net: Tools for Community Food Security, the U.S.

government’s perspective is that community food security “includes both a Federal

nutrition assistance safety net and local organizational and policy structures that ensure

that all community members have access to a safe, nutritious, and affordable food supply

(USDA 2000, 2).”

Some people understand food safety net to refer to a wrapping material for food; that

certainly is not the meaning here. When the food industry says there is already a good

food safety net in place worldwide, they are saying that people are protected from

contaminants, not that the world’s people are all getting enough good food (Grocery

1998). Our focus is not on food safety but on the idea of a safety net, a form of protection

comparable to that used by acrobats or people who work on construction of high-rise

buildings. While there may be several different kinds of safety devices for people who

work on high-rise building, such as tether lines, the safety net is the final layer of

protection, ensuring that there is some level below which one will not fall.

In the perspective adopted here, not every program that helps is a safety net program.

Rather, we suggest that (1) by definition, safety net programs establish a lower limit to

how far people are allowed to fall by providing services to those who are most needy.

The number of people served does not measure the success of a safety net. A successful

nutritional safety net is one that ensures that no one’s nutrition status falls below a certain


Thus, (2) safety net programs should focus sharply on the most needy, and (3) Safety net

programs should provide strong guarantees to prevent anyone from falling to a lower

quality of life. A nutritional safety net should not be the primary method for feeding one’s

family, or even the secondary or tertiary method. The nutritional safety net is what is

used when all else fails. It is where you land when you fall through the cracks in the

system. In the U.S. context, for example, the primary means of feeding one’s family is

likely to be regular employment. Those who are unemployed or underemployed, or do

not have an intact family, might depend on Food Stamps or other governmental

programs. Some needy people might go to a food pantry at a neighborhood church. If

there is no food pantry in the neighborhood, there may be some other food source of last

resort, such as garbage bins. Those who do not have any available sources would go

hungry. Effective nutritional safety nets would be the final backup that prevents hunger.

Many countries have numerous food and nutrition programs, but still have widespread

food insecurity. The position taken here is that (4) all countries, rich or poor, need

effective nutritional safety nets to back up their other food and nutrition programs. Even

rich countries that have few malnourished people should have programs in place for those

who are at risk. All countries should be prepared for unpredictable situations.

Some observers have an aversion to safety nets, saying we should instead work on

solving the deeper problems and thus prevent malnutrition from occurring. However, no

one says that we should work only on prevention and not bother with cures and

symptomatic relief for heart disease or tuberculosis. Undoubtedly, the best way to end

hunger in the world would be to end poverty. The question raised here is, what should be

done while we are waiting for that deeper solution to be achieved? Hungry children can’t


The safety net approach is a form of symptomatic relief, making no pretense to address

the underlying forces that cause the problems. It does not replace social structures that

need to be replaced. Safety nets may be stopgap measures, to be implemented while

waiting for deeper changes. Or, where there is no prospect for deep change, they could

become permanent. For example, in the United States, there is little prospect that there

will be changes in the society that make it no longer necessary to offer the Supplemental

Nutrition Assistance Program (SNAP), formerly known as the Food Stamp program.

Such programs can be temporary for individual beneficiaries, but be set up as permanent

institutions to serve an ever-changing set of beneficiaries.

Some observers have suggested that social safety nets should be like trampolines, helping

people who have fallen to bounce back up. That is a nice idea, but it might be difficult to

implement. The first concern should be to assure that there is a dependable safety net,

with no tears in it.

We are not calling for safety nets instead of other approaches that reach to the roots of the

problem. Programs that build human capital and facilitate people in providing for

themselves certainly are preferable. They should be designed to minimize people’s

dependence on the safety net. But the reality is that such programs are often inadequate,

and some backstop is needed to protect people from extreme adversity. In an ideal world,

there would be strong and effective safety nets in place, but would rarely be used.

                            GUARANTEED SAFETY NETS

Social service programs generally specify criteria of eligibility and the packages of

services that people who meet the criteria are supposed to get. Often, people don’t get

what they are supposed to get. A study of child survival programs shows that “typically

fewer than half of all children are reached by any given intervention.”

       Children belonging to the poorest families are consistently less likely to

       receive preventive and curative interventions than those from other

       families. . . . The fact that many children do not receive any intervention is

       a painful example of social exclusion as applied to child survival. . . . The

       odds are stacked against the poorest children, who tend to have higher

       exposure to disease, lower coverage of preventive and curative

       interventions, less access to health care at all levels, and when services are

       available, poorer quality of care than children who are less poor.

       (Victora 2005, 1460, 1464).

Even in the richer countries, safety nets are flawed in many different ways. In the

Netherlands, for example:

       In practice, not everyone can keep his or her head above water. For many

       the red tape is too complex. Those with no permanent address or place of

       residence find it hard to gain access to municipal facilities. People with

       mental problems don’t have an easy time of it (Hospes 2009, 23).

In the United States, many of the assistance programs are funded by the federal

government, but administered by the separate states, so the services are very uneven

(DeParle 2009).

To ensure that safety net programs reach those they are supposed to reach, there is a need

for clear and enforceable entitlements to services. With an entitlement, if you meet the

criteria, you have a right to those services. If you do not get them, you can go through an

administrative or a judicial procedure to demand what is yours. For example, in the

United States’ Supplemental Nutrition Assistance Program (formerly called the Food

Stamp program), people who feel they are not getting what they are supposed to get can

request a Fair Hearing (USDA 2009). In other places recourse might be obtained by

complaining to some sort of administrative body, or the complaint could be brought to a

court of law.

Thus, (5) A guaranteed safety net is one for which there is a clear entitlement, enforced

by institutional arrangements that help to ensure people in fact get that to which they are

entitled. The guarantees increase our confidence that the programs in fact protect those

who are not served adequately by the other programs.

Clearly, nutritional safety nets can make an important contribution to meeting obligations

under the human right to adequate food. This framework was described earlier, in

Chapter 4, but here it might be useful to point out some aspects of the law that are

particularly relevant to safety nets.

For example, in General Comment 12, paragraph 14 says:

        Every State is obliged to ensure for everyone under its jurisdiction access

        to the minimum essential food which is sufficient, nutritionally adequate

        and safe, to ensure their freedom from hunger.

The safety net approach takes the idea of a defined minimum very seriously.

A subsequent document, Voluntary Guidelines to Support the Progressive Realization of

the Right to Adequate Food in the Context of National Food Security, shows the different

ways in which the obligations relating to the human right to adequate food might be

fulfilled (FAO 2005). Paragraph 17 says, “States Parties should, to the extent that

resources permit, establish and maintain safety nets or other assistance to protect those

who are unable to provide for themselves.” The first line of Guideline 14 says safety nets

are “to protect those who are unable to provide for themselves.”

In a well-functioning society, governments should focus on facilitating people so that

they can provide for themselves. However, where facilitation proves inadequate or breaks

down in some way, the obligation of the government to provide directly becomes

important. Nutritional safety nets can provide basic food for people when they are unable

to provide for themselves. Like fire-fighting equipment that stands by in case of

emergencies, one wants to minimize the calls for actually using this form of protection,

but it is essential to have it ready, and to make sure it is effective when it is used.

Not every program that provides assistance is a rights-based program. Poor people may

get free meals at a local church’s soup kitchen, but they cannot claim an entitlement to

those meals. As a charity operation, that soup kitchen is free to close its doors and turn

people away. However, when a program is based on entitlements, people have a right to

the service. They have a claim to it, and someone owes it to them, as an obligation.

In entitlement programs, people should have administrative or judicial remedies through

which they can insist on getting what is theirs. This is the distinctive feature of

guaranteed safety net programs.


Whether local, national, or global, guaranteed safety net programs have three key


           criteria of need that determine eligibility for services;

           the package of services to which eligible people are entitled; and

           accountability, with institutional arrangements to ensure that these services

            are readily available to all who are eligible.

                                            7 - 10
There are other requirements as well, such as sound systems for financing and monitoring

the operations. However, the purpose here is to highlight the ways in which

accountability mechanisms can help to guarantee the delivery of services to those who

are eligible.


The criteria for eligibility for a nutritional safety net could be specified in many different

ways. For example, in the Integrated Child Development Services scheme in India, every

child up to six years of age is eligible for ICDS. The criterion for eligibility could be

based on anthropometric measures, especially wasting (low weight in relation to height),

stunting (short for their age), or underweight in relation to age. New growth charts for

infants and young children have been worked out by the international agencies, taking

into account the fact that normal patterns of growth depend on how the child is fed. The

new standards are available at

Given that malnutrition problems can take many different forms, it would be wise to

deploy several different types of nutritional safety nets and other types of nutritional

support programs at the same time, including some to deal with specific micronutrient

deficiencies. Ideas can be drawn from standards and procedures proposed for the delivery

of assistance in emergencies. The Sphere Project ( expects

                                           7 - 11
to publish its updated “Minimum Standards in Food Security, Nutrition and Food Aid” in

the 2010 version of its Handbook, Humanitarian Charter and Minimum Standards in

Disaster Response. While these standards have been designed for use in sudden-onset

emergency situations, many of them could sensibly be adapted for dealing with chronic

problems of malnutrition.

To show how safety nets can be designed, we will focus here on the challenge of

reducing severe acute malnutrition in young children. This approach is presented for

purposes of illustration; it is not being advocated as a replacement or substitute for other

kinds of approaches.

The definition of severe acute malnutrition is based mainly on wasting in young children,

low weight for height:

       Severe acute malnutrition is defined by a very low weight for height

       (below -3 z scores of the median WHO growth standards), by visible

       severe wasting, or by the presence of nutritional oedema. In children aged

       6–59 months, an arm circumference less than 110 mm is also indicative of

       severe acute malnutrition. Globally, it is estimated that there are nearly 20

       million children who are severely acutely malnourished (World Health

       Organization 2009, 2).

                                           7 - 12
There are advantages to specifying the criteria in terms of individuals, but collective

considerations may be used instead. For example, instead of saying that the safety net

will target those children who are diagnosed as having severe acute malnutrition, it could

instead promise certain services to all children under six in communities where the child

mortality rate is above some specified level.

No matter what measures are used, if the criterion level was set to be highly inclusive, too

many children would be eligible, and the program would become economically

infeasible. If the criterion was too limiting, the program would reach few needy children,

and thus have little impact. An appropriate balance must be found. Programs could begin

modestly, and then cover more children as more resources become available.


Malnutrition in young children takes various forms and can be prevented or treated in

various ways, as described in the Lancet Series on Maternal and Child Malnutrition

(Bhutta 2008). Consideration should be given to guidance provided by the World Health

Organization for Feeding in Exceptionally Difficult Circumstances, as described at


                                           7 - 13
The appropriate treatment for severe acute malnutrition will vary from place to place,

depending in part on the resources available. Where resources are abundant, an

individualized treatment plan should be devised for each affected child and carried out by

skilled health professionals, with careful follow-through over time. Of course, severe

acute malnutrition rarely occurs where resources are abundant. In resource-poor

situations, treatments may be less than ideal, often based on providing standard

treatments for large groups of children, with little assessment and differentiation of

treatment for individual cases.

Specifications for the entitlement packages could take different forms. For example, in

the Integrated Child Development Scheme in India the policy has been:

       Each child up to 6 years of age shall get 300 calories and 8-10 grams of protein.

       Each adolescent girl to get 500 calories and 20-25 grams of protein.

       Each pregnant woman and each nursing mother to get 500 calories and 20-25

        grams of protein.

       Each malnourished child to get 600 calories and 16-20 grams of protein (Dhavse


Significantly, only the fourth point depends on the nutrition status of the child, which

means most services are not sharply targeted. These rules have been revised from time to


                                           7 - 14
Where programs are intended specifically for children with severe acute malnutrition, the

service might be centered on the use of ready to use therapeutic foods (RUTFs) such as

Plumpynut, made from peanut paste, dry milk, and vegetable fat. However, as shown

later, in Chapter 11, this medical approach, based on bringing in some sort of “medicine”

from the outside, may not be best over the long term.

Instead of describing the entitlement in terms of “inputs” to the child, it could be

described in terms of the “outputs” or results that are required. For example, it could be

specified that children with severe acute malnutrition under a specified age must be

provided with whatever services are needed to ensure that they come out of that status

within a specified time. If their severe acute malnutrition does not end in the designated

time frame, the services provided to them would be expanded.


In 2001 India’s Supreme Court recognized the right to food, and it has been issuing a

series of orders to implement it. However, the programs still fail to reach many of the

people they are supposed to reach. For example, in the Supplementary Nutrition Program

in Madhya Pradesh, only 22 percent of the children up to six years of age were actually

enrolled (Dhavse 2004). The missing piece in the right to food system in India—and

many other places—is effective enforcement of the entitlement (Kent 2006a). Some of

ICDS planning documents never speak of rights or entitlements (Ministry of Women


                                          7 - 15
The Supreme Court case in India became necessary partly because there were no

effective mechanisms of accountability available to ordinary people at the local level.

Intervention by the Supreme Court is a mechanism of accountability, but it is not

normally available to ordinary people on a local basis. Until people know their rights and

know that they have effective means through which to exercise them, there will be no

good way to ensure the realization of the right to adequate food in India.

The same principles would apply to any guaranteed nutritional safety net. It is important

to have clear criteria of eligibility and a clearly specified service package. They in turn

must be handled through effective management arrangements with adequate financing. In

that context, it is important to work out strong mechanisms of accountability, to make

sure that the services in fact reach those who meet the criteria. Many programs for

addressing child hunger could be strengthened with the inclusion of effective rights-based

accountability mechanisms (Save the Children UK 2009).

Guaranteed nutritional safety net programs should meet the requirements of any well-

functioning rights-based social system. As discussed in Chapter 3, there are three major

roles to be fulfilled: the rights holders, the duty bearers, and the agents of accountability.

The task of the agents of accountability is to make sure that those who have the duties

carry out their obligations to those who have the rights.

                                           7 - 16
Rights imply entitlements, which are enforceable claims to specific goods or services.

This means that there must be some sort of institutional arrangement to which rights-

holders whose claims are not satisfied can appeal to have the situation corrected.

Enforceability means that those who are to fulfill rights/entitlements must be obligated to

do so, and they must be held accountable for their performance.

The rights of the rights holders and the obligations of those who carry the obligations (the

duty bearers) need to be plainly specified. If some people have a particular right, the duty

for ensuring the realization of that right should be assigned to some specific agency. In a

nutritional safety net within a country, the primary carrier of the obligations could be the

Ministry of Health, acting on behalf of the national government as a whole.

While there can be many different mechanisms of accountability, the most fundamental is

that available to the rights holders themselves or their representatives. Individuals who

fail to get what they are entitled to under the law should have means available to them for

pressing their claims. Remedies for rights holders rest on the foundation that they must

know their rights, and they must have appropriate institutional arrangements available to

them for pursuing the realization of those rights. It is through these remedies that claims

become enforceable. All rights in the law (not just human rights) rest on the principle ubi

jus ibi remedium--where there is a right there must be a remedy. Where there are no

effective remedies, there are no effective rights.

                                            7 - 17
The remedies available to rights holders are essential elements of any properly

functioning rights system. These remedies ensure that individuals will not be treated

simply as passive objects. Having rights that are enforceable means recognizing that

people should have specific powers to make claims on the world in which they live.


One normally thinks of social safety nets as national or sub-national projects, but

consideration should be given to the potentials for establishing global nutritional safety

nets of some form. The poorest countries do not have the capacity to establish adequate

safety nets on their own. There is a moral obligation and, arguably, also a legal obligation

for the global community to respond to the most serious forms of malnutrition throughout

the world. If human rights really are universal, the obligations should be universal as

well. There should be guaranteed nutritional safety nets at the global level (Kent 2008a).

The international community should at least prevent extreme malnutrition, which can be

defined as nutritional deprivation that results in early mortality. In places where people

die long before their time because they do not have adequate food, the poor should be

seen as having a right to assistance. When their numbers are large, as they are now, this

ought to be seen as a gross violation of human rights.

International human rights law can be understood as the project of articulating universally

accepted standards of governance with regard to the protection and promotion of human

                                           7 - 18
dignity. Human rights imply that there is some level of obligation to everyone

everywhere, and not only to those individuals under the jurisdiction of one’s own national

government. The guiding principle should be that the international community is subject

to human rights obligations similar to those of states. If we agree that each country should

have a guaranteed nutritional safety net, it is only sensible that there should be a global

one as well.

Seriously underweight children are to be found mainly in sub-Saharan Africa and South

Asia (de Onis 2004). These regions should get strong support from the outside world for

solving their food and nutrition problems. From a human rights perspective, a global

safety net of the sort envisioned here should target individual children, not countries or

regions. A hungry child in a small country such as Niger or Malawi should have as good

a chance at receiving assistance as a child in a large country.

Designing global nutritional safety nets to deal with various forms of severe malnutrition

would be a formidable task. Flawed as their programs may be, much could be learned

from the ways in which large countries such as the United States and India have worked

with their sub-national governments to accommodate local perspectives and

circumstances while at the same time applying some common standards. The European

Commission’s food distribution program for the most deprived people in the European

Union certainly would be relevant. Like the United States’ Supplemental Nutrition

Assistance Program, it began as a means for disposing of large surpluses that resulted

                                           7 - 19
from subsidies to agriculture, but it has grown to include market purchases of food. Its

budget for 2009 was around 500 million euro (European Commission 2008).

(6) There is a need for a guaranteed global nutritional safety net, and, arguably, under

human rights law there is an obligation to provide one. The global system could be

designed on the basis of nested nutritional safety nets. In large countries, sub-national

units (e.g., states, provinces) could set up their own safety nets. Richer units could have

higher levels of protection. The national government could then set up a nationwide

safety net that would elevate the level of protection in the poorer units. The global

system, in turn, could provide a worldwide safety net to guarantee that there would be at

least a minimum level of protection everywhere. Its main function would be to lift the

level of protection in those countries that are least capable of providing protection for


Ideally there should be a system of global nutritional safety nets, with one for each major

type of nutrition problem, including disaster relief, micronutrient deficiencies, etc. For

purposes of illustration, this study has focused on severe acute malnutrition in young

children. That would be a good place to start. Comparable safety nets could also be

developed for other specific kinds of malnutrition.

There could be a system of layered safety nets, beginning at the local community level,

then at the sub-national level, the national level, the regional level, and finally, the global

level. In each case, higher levels of governance would establish safety nets to protect

                                            7 - 20
people who live in places in which local capacities to provide such protection are


The Director General of the World Trade Organization, Pascal Lamy, understands the

need for safety nets. In his view, there is continuing resistance to global integration of

agricultural trade because

       . . . we have yet to build robust safety-nets for the world’s poor. Each and

       every government must turn its attention to this issue, urgently, in my

       view. In the absence of such safety nets, there will always be resentment at

       a time of crisis to a country’s food supply going abroad (Lamy 2009).

If they were designed with the good will and material support of the strongest supporters

of global food trade, perhaps robust safety nets for the world’s poor could be established.


The primary form of assistance for those who are at risk nutritionally should be in the

form of facilitation, establishing conditions that enable them to provide for themselves.

This means ensuring that there is good access to land for cultivation, and good

employment opportunities. One way to open new opportunities is through education.

Another way is through micro-loans, following the model of the Grameen Bank in

                                          7 - 21
Bangladesh (Yunus 2007). Similarly, FINCA International and Kiva (

provide small loans to help poor people start up small businesses.

When the needs are great and facilitation cannot be accomplished quickly enough, it may

be sensible to directly provide food, health care, and other social services. Safety nets

often take the form of direct provision.

There are risks because direct provision may be disempowering, reducing people’s

motivation to provide for themselves. Programs should be designed to minimize long-

term dependence on handouts. Thus, it is wise to design safety nets so that, to the extent

feasible, they are empowering, helping to support and encourage people in climbing out

of their neediness, rather than providing an incentive to remain in that condition. In some

cases, it can be useful to simply provide a time limit on the service. For example, in the

United States, the TANF welfare program (Temporary Assistance to Needy Families) has

a basic five-year limit, although there are some exceptions.

In general, policymakers should recognize the need for an exit strategy for any safety net

program, finding ways to end services not only for individuals but also for entire

communities. One major objective of such programs should be to make themselves

unnecessary. To illustrate, an international agency might come in to a community to help

establish a school feeding program, but rather than do that with the expectation of staying

for an unlimited time, it should come in with the clear and announced intention of exiting

                                           7 - 22
by a specified time. Everyone should understand that part of the program’s task is to

prepare the local community for the day when the outsiders will leave.

Similarly, when an outside agency brings specially made ready-to-use food packets into a

community to help deal with severe acute malnutrition in young children, it should work

out plans not only for how to launch and operate the program but also for how to end it.

The plans for funding safety net programs should be made clear. Who will pay for what,

for how long? One way to work out an exit strategy would be to gradually shift from

external to internal funding, where that is feasible. This might mean shifting to national

funding or community funding or a mix of both. That should be discussed earlier on in

order to facilitate a smooth transition as the outsiders exit.

In establishing any sort of nutritional safety net there will be a need to pay for products

and services. The costs for each individual served may be low, but in the aggregate the

project could involve a lot of money. The availability of funds may attract honest vendors

who seek nothing more than fair compensation for their efforts, but it may also attract

unscrupulous operators whose motives are questionable. Measures need to be taken to

protect the integrity of the project.

There is a need for caution. To illustrate, under its Corporate Social Responsibility

program, the Heinz corporation has pledged to provide free micronutrient assistance to

ten million children by 2010 (Heinz 2008; Murtagh 2008). It is spending millions of

                                            7 - 23
dollars on this. Could it be that Heinz is using this approach to create demand for

commercial products that it plans to market in the near future? Are these just free

samples, intended to draw in future customers? This pattern of operation is already

evident in the way that manufacturers of infant formula distribute free infant formula to

new mothers throughout the world. Government agencies are often drawn in to act as

partners in that distribution (Kent 2006c).

Food aid has often been used in ways that make developing countries excessively

dependent on food imports. This is demonstrated in Taiwan’s gift of rice to the tiny

Marshall Islands, in the middle of the Pacific (Office of the President 2009). One needs to

be alert to possibly unscrupulous uses of the addiction model for building a customer


Alarms have already been raised with regard to the use of Ready to Use Therapeutic

Foods to combat severe acute malnutrition. While the use of RUTFs for therapy is widely

accepted, there are fears regarding its possible use for preventing malnutrition. There is a

concern that widespread use of RUTFs could interfere with the promotion of

breastfeeding. Some say it should be regarded as medicine, not food, and its use should

be limited accordingly.

Guidelines are needed for how such products should be used. Guidance is needed not

only with respect to clinical practices, but also with respect to the economics. If a product

                                              7 - 24
is made available for nutritional safety nets, who will pay for it, on what terms, for how

long? What will happen after external funding is discontinued?

Thus we can say, (7) There is a need for guidelines to ensure that nutritional safety nets

are managed in ways that protect the legitimate interests of all who are involved.

                        THE ROLE OF INTERNATIONAL LAW

Guaranteed nutritional safety nets could be established based on the understanding that

they are required by human rights law, but the more fundamental reason for establishing

them is that it is the right thing to do.

Some people have an exaggerated view of the potential of human rights law in dealing

with major social issues, perhaps thinking that the human right to adequate food is the

solution to widespread problems of hunger and malnutrition. It is not. Human rights tells

us about qualities that should be part of any solution, but it is not itself the solution.

Social issues need to be addressed with a broad range of tools. Dealing with them

requires good analysis, clear vision regarding what needs to be done, and hard political

work, including a great deal of communicating and organizing. Human rights are a useful

tool in some circumstances and not in others.

                                             7 - 25
Those who need to act need to care about the issue. It would be naïve to think that

individuals or governments will care about poverty, malnutrition, and similar issues

simply because it is in the law. The enforcement mechanisms currently available are not

sufficient to induce adequate caring, or the right kind of caring. In most cases, people and

agencies do not care because they have legal obligations, but rather they accept

obligations under the law if they care.

Difficulties in implementing social programs often are due not to technical obstacles but

to the fact that those who are supposed to act simply do not care enough. Similarly, often

the lack of action is not simply because some institutions are missing, but rather the

institutions are missing because of the absence of caring. The absence of strong

enforcement for human rights within countries and globally does not happen because we

don’t know how to accomplish that, but rather, it is because governments don’t want

strong enforcement. This is clearly demonstrated by the paltry budget provided to

national human rights commissions (where they exist) and to the United Nations Office

of the High Commissioner for Human Rights. When the motivation is not adequate, it is

difficult to make things happen.

While the international human rights system might have limited impact locally, designing

local programs as rights-based social systems should help to improve their effectiveness.

The discussion of rights-based social systems in Chapter 4 was separated from the

discussion of the human right to adequate food in Chapter 5 to make it clear that these are

different things with different sorts of impacts. People and agencies that have specific

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duties should be held accountable against clear standards, no matter what those standards

might be or where they came from.

Guaranteed nutritional safety nets can make major contributions to meeting obligations

under the human right to adequate food based on international human rights law.

However, even where there is no explicit recognition of that human right, limits should

be placed on the degree to which malnutrition is tolerated. Guaranteed nutritional safety

nets of various kinds would be helpful everywhere.

                         Key Features of Safety Net Programs

The main features of safety net programs may be identified as follows:

   (1) By definition, safety net programs establish a lower limit to how far people are

       allowed to fall by providing services to those who are most needy.

   (2) Safety net programs should focus sharply on the most needy.

   (3) Safety net programs should provide strong guarantees to prevent anyone from

       falling to a lower quality of life.

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   (4) All countries, rich or poor, need effective nutritional safety nets to back up their

        other food and nutrition programs.

   (5) A guaranteed safety net is one for which there is a clear entitlement, enforced by

        institutional arrangements that help to ensure people in fact get that to which

        they are entitled. Thus it is a rights-based program.

   (6) There is a need for a guaranteed global nutritional safety net, and, arguably,

        under human rights law there is an obligation to provide one.

   (7) There is a need for guidelines to ensure that nutritional safety nets are managed

        in ways that protect the legitimate interests of all who are involved.

Safety nets of the sort described in this chapter could be created in any jurisdiction at any

level, local, national, or global, provided that adequate motivation for it was built up.

Material resources would be required, but if the will is there, resources could be obtained.

The campaign to build the safety net could be initiated by a governmental agency or a

civil society organization. The effort could begin with a simple concept paper attuned to

local circumstances, and it could build by drawing increasingly larger circles of people

into the planning process.

Creating strong nutritional safety nets will not be easy. Nevertheless, we need to take on

the challenge and find ways to overcome the difficulties. With children falling by the

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millions every single year, we should find a way to catch them. The world certainly has

the capacity to do that.

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