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Children's right to adequate nutrition
There is a long history of concern with the right to food, or, more broadly, the right to adequate nutrition, in international law. The Universal Declaration of Human Rights of 1948 provides that "everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food ... " Article 11 of the International Covenant on Economic, Social, and Cultural Rights recognizes "the fundamental right of everyone to be free from hunger." Article 24 of the Convention on the Rights of the Child says that "States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health" and shall take appropriate measures "to combat disease and malnutrition" through the provision of adequate nutritious foods, clean drinking water, and health care.
However, historically the idea of the right to adequate nutrition has not been taken seriously. There have been many nutrition programmes within countries and internationally, but they have been provided as a matter of charity, not entitlement. There has not been any legal recourse for those who fail to receive service. The right has not been effectively implemented.
The idea of the right to nutrition, in some form, should be more acceptable if it focuses on children. Very poor countries might limit their commitment only to severely malnourished children under five years of age, while others might assure that services would be provided for both moderately and severely malnourished children up to the age of 16. The important point is to establish the principle that vulnerable children are entitled to adequate nutrition as a matter of right. Implementing children's right to adequate nutrition does not necessarily mean creating new programmes; it means assuring that they get the nutrition services to which they are entitled.
Increasing food production, nutrition education, feeding programmes, and all the other conventional approaches have important roles to play in ending hunger in the world, but so far they have not been adequate. Perhaps it would be useful to work more directly with the social/legal/political tools of entitlements, rights, responsibility, and accountability to get the job done.
There are different types of malnutrition, including protein-energy malnutrition and specific micronutrient deficiencies such as those due to inadequate vitamin A, iodine, iron, or other particular nutrients. Malnutrition may result not only from improper diet but also from ill health and inadequate or improper care. The most widespread form of malnutrition among children is protein-energy malnutrition. Apart from its most serious clinical manifestations (kwashiorkor and nutritional marasmus), protein-energy malnutrition can be gauged by measuring the heights and weights of children and comparing them with the heights and weights of well-nourished children. With these data, indicators can be derived for wasting (low weight for height), stunting (low height for age), and underweight (low weight for age). It is widely accepted that if a child's weight is more than two standard deviations below the reference for his or her age, that child should be described as malnourished. As the data in table 1 and figure 1 (see FIG. 1. Trends in the prevalence of underweight children, 1975-1990 (Source Ref. 1, p. 10)) indicate, in recent decades the proportion of children in developing countries who are malnourished has declined, but the absolute number has gone up . At least 184 million children are underweight. More than half of these children are in South Asia. There are now more children on earth suffering from malnutrition than ever before in history.
Malnutrition is a major factor in the massive morbidity and mortality of children throughout the world.
TABLE 1. Regional prevalence and numbers of underweight preschool children (0-60 months of age) in developing countries, 1975-1990
|Percent underweight||Numbers underweight in millions|
|Near East/North Africa||19.8||17.2||15.1||13.4||5.2||5.0||5.0||4.8|
|Total 0-4 child population in developing countries||402||434||493||536|
Throughout the 1980s and early 1990s more than 12 million children died before their fifth birthdays each year, many from a combination of malnutrition and disease.
I do not want to open an extended examination of the causes of hunger here, but it should be noted that one compelling line of analysis, spearheaded by Amartya Sen and Jean Dreze, argues that hunger is due primarily to a failure of entitlements rather than, say, to inadequate agricultural productivity or population growth [2-4]. If that is so, the remedy lies in strengthening entitlements. One way to do this is through the law. Children should have a fully implemented legal right to adequate nutrition. (Sen and his colleagues have provided an overview of ways in which social service programmes can be structured, but did not develop the argument that the needy should have rights to some services under some conditions  )
To say this another way, many problems of children derive from their powerlessness. Promoting recognition of their rights enhances their relative power in society.
When he was Director-General of the Food and Agriculture Organization of the United Nations (FAO), Addeke Boerma said that "if human beings have a right to life at all, they have a right to food" . More recently, Richard Jolly, Deputy Executive Director of UNICEF, said: "Freedom from hunger is a basic human right. It is unacceptable that 150 million children under five should be suffering from serious malnutrition in a world that has the capacity to prevent it" . Certainly widespread malnutrition and the massive mortality of children associated with it is unacceptable. But what about the idea that freedom from hunger is a basic human right? Is it true? Can it be implemented?
The right to adequate nutrition (or right to food) concept has a long history [8-14]. In 1948 the Universal Declaration of Human Rights asserted in article 25(1) that "everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food ..."
On 14 March 1963, a Special Assembly on Man's Right to Freedom from Hunger met in Rome and "issued an historic Manifesto calling on the governments and people of the world to unite in the struggle against man's common enemy--hunger." The manifesto described the character and scope of hunger in the world, and asserted that "freedom from hunger is man's first fundamental right" . A variety of action programmes such as increasing agricultural productivity and improving trade relations were suggested and moral concerns were expressed, but the idea that "freedom from hunger is man's first fundamental right" was not elaborated.
The International Covenant on Economic, Social, and Cultural Rights was adopted by the United Nations General Assembly in 1966 and came into force in 1976. Article 11 says that "The States Parties to the present Covenant recognize the right of everyone to an adequate standard of living for himself and his family, including adequate food, clothing, and housing," and also recognize "the fundamental right of everyone to be free from hunger."
In 1974 the World Food Conference issued a Universal Declaration on the Eradication of Hunger and Malnutrition. It asserted that "Every man, woman and child has the inalienable right to he free from hunger and malnutrition in order to develop fully and maintain their physical and mental faculties." That declaration was endorsed by the United Nations General Assembly in Resolution 3348 (XXIX) of 17 December 1974.
In September 1976 both the United States Senate and House passed right to food resolutions. It was the sense of the Congress that every person throughout the world has a right to a nutritionally adequate diet, and the United States should increase its development assistance until it reached 1 % of the US gross national product .
In November 1984 the World Food Assembly, comprised primarily of representatives of non-governmental organizations, met in Rome. Its purpose was to call attention to the fact that the promise made at the 1974 World Food Congress that "within a decade no child will go to bed hungry" had not been fulfilled. Its final statement asserted that "the hungry millions are being denied the most basic human right - the right to food."
In 1991 the House Select Committee on Hunger chaired by Congressman Tony Hall, through House Resolution (H.R. 2258) advocating the Freedom from Want Act, urged the United States to propose a United Nations Convention on the Right to Food .
In the Convention on the Rights of the Child, which came into force in 1990, two articles address the issue of nutrition. Article 24 says that "States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health" and shall take appropriate measures "to combat disease and malnutrition" through the provision of adequate nutritious foods, clean drinking water, and health care. Article 27 says that States Parties "shall in case of need provide material assistance and support programmes, particularly with regard to nutrition, clothing, and housing."
The rights idea was voiced frequently at the International Conference on Nutrition, organized by the Food and Agriculture Organization of the United Nations and the World Health Organization and held in Rome in December 1992. In his address opening the conference His Holiness Pope John 11 said:
It is up to you to reaffirm in a new way each individual's fundamental and inalienable right to nutrition. The Universal Declaration of Human Rights had already asserted the right to sufficient food. What we must now do is ensure that this right is applied and that everyone has access to food, food security, a healthy diet and nutrition education.
In the conference's concluding World Declaration on Nutrition the nations of the world agreed that "access to nutritionally adequate and safe food is a right of each individual." Yet there was nothing in the accompanying Plan of Action for Nutrition to elaborate that right, nothing providing for clear entitlements with effective accountability.
The idea of the right to food appears in many different contexts in international law. Most are not binding. In some cases, as in the International Covenant on Economic, Social, and Cultural Rights, the obligations are technically binding on the States Parties. However, because the obligations lack specificity and because there are no effective mechanisms for implementation and accountability, they are not binding in practice. With regard to food or other issues, "the main problem in regard to social and economic rights has been to define the obligations corresponding to the rights.... The obligations remain vague until the present. In the absence of effective international supervision, they have not been made clearer through case law" .
Several nations have articulated nutrition rights in some form in their laws. Cuba's constitution assures that "no child be left without schooling, food and clothing." The Italian, Spanish, and Greek constitutions assure a right to health. In many countries there is language referring to other sorts of assurances, such as the right to social security (as in the Netherlands and Spain) that can be interpreted as implying nutrition rights. In most cases, however, the assurances are vague and have not been enforced through the courts. There is practically no elaboration in detailed statutes of distinct nutrition rights, and no legal enforcement.
Although there have been many expressions of concern, and many laudable anti-hunger programmes at local, national, and global levels, the idea of the right has not yet been implemented. As Ved Nanda put it, "no framework presently exists for the realization of the right to food, nationally or internationally " .
On reviewing the hunger data, Philip Alston and Katarina Tomasevski observe that "these statistics make hunger by far the most flagrant and widespread of all serious human rights abuses." Alston adds that "the right to food has been endorsed more often and with greater unanimity and urgency than most other human rights, while at the same time being violated more comprehensively and systematically than probably any other right" . The idea that people should have a right to adequate nutrition is an old one, one whose vision has not been fulfilled.
Many groups vulnerable to malnutrition should be protectedmothers, the elderly, the handicapped, unborn children, refugees, people in armed conflict situations, and so on. I suggest that the idea of the right to nutrition, in some form, will be far more acceptable if it focuses on children. There are several reasons for this.
First, no one can doubt the powerlessness of small children. Not even the most callous politician could tell a three-year-old that if she wants to eat she should go out and work.
Second, it can be argued that saving a child's life is more valuable than saving an older person's life simply because there are more life-years saved. Similarly, the benefits from an improvement in the quality of life accrue over many more life-years for a child than they would for an older person.
Third, there are well-developed means for assessing the nutrition status of children on an inexpensive and objective basis, using anthropometric techniques. There is a strong consensus among nutrition professionals on the interpretation of these data. Techniques for measuring malnutrition in other groups are not as well developed.
Fourth, anthropometric data collected around the world show unambiguously that children's malnutrition is a massive problem.
Fifth, graphic news coverage of the suffering in places like Ethiopia and Somalia and constant calls for donations keep the issue in the public's consciousness.
Sixth, political work for children can be based on creating alliances among the many organizations concerned with children and the many organizations concerned with nutrition. Hungry children already have a well-established constituency.
Seventh, the Convention on the Rights of the Child and the World Summit for Children of September 1990 have created new appreciation of the rights of children.
Eighth, both the World Summit for Children and the Declaration and Plan of Action on Nutrition agreed upon in Rome in December 1992 call upon
participating states to prepare National Plans of Action, on children in one case and on nutrition in the other case. The obligation to prepare these two plans gives states new opportunities for examining the nutrition needs of children.
All these reasons together lead to the judgement that obtaining recognition of effective nutrition rights may be more politically feasible for children than for others. We can begin with children, and later go on to address the needs of other vulnerable groups as well.
Nested rings of responsibility
Before setting out the ways in which children's right to nutrition can be meaningfully established in the law, it will be useful to have a systematic framework for understanding our responsibilities to children.
Our principal obligation toward children is to promote their development, understood as empowerment or increasing self-reliance. The task is to help increase children's capacity to define, analyse, and act on their own problems.
Who is responsible for children? The question is not whose fault is it that children suffer so much (who caused the problems?) but who should take action to remedy the problems. Many different social agencies may have some role in looking after children, but what should be the interrelationships among them? What should be the roles of churches, fraternal societies, local and national governments, and other agencies in dealing with the hunger problem?
Most children have two vigorous advocates from the moment they are born, and even before they are born. Their parents devote enormous resources to serving their interests. These are not sacrifices. The best parents do not support their children out of a sense of obligation or as investments. They support their children as extensions of themselves, as part of their wholeness.
In many cases, however, that bond is broken or is never created. Fathers disappear. Many mothers disappear as well. In some cities hundreds of children are abandoned each month in the hospitals in which they are born. Bands of children live in the streets by their wits, preyed upon by others. Often children end up alone as a result of warfare or other political crises. Many children are abandoned because they are physically or mentally handicapped. Often parents become so disabled by drugs or alcohol that they cannot care for their children.
Often children who cannot be cared for by their biological parents are looked after by others. In many cultures children belong not only to their biological parents but to the community as a whole. The responsibility and the joy of raising children are widely shared.
In many places, especially in "developed" countries, that option is no longer available because of the collapse of the idea of community. Many of us live in nice neighbourhoods in well-ordered societies, but the sense of community of love and responsibility and commitment to one another---has vanished. In such cases the remaining hope of the abandoned child is the government, the modern substitute for community. We look to government to provide human services that the local community no longer provides.
As children mature the first priority is to help them become responsible for themselves. So long as they are not mature, however, children ought to get their nurturance from their parents. Failing that, they ought to get it from their local communities. Failing that, they ought to get it from the local governments. Failing that, it should come from their national governments. Failing that, they ought to get it from the international community. The responsibility hierarchy looks like this:
international non-governmental organizations
international governmental organizations
We can picture this as a set of nested circles, with the child in the centre of the nest, surrounded, supported, and nurtured by family, community, government, and, ultimately, international organizations.
This is straightforward. The idea that needs to be added is that in cases of failure, agents more distant from the child should not simply substitute for those closer to the child. Instead, those who are more distant should try to work through and strengthen those who are closer to help them become more capable of fulfilling their responsibilities toward children. To the extent possible, local communities should not take children away from inadequate parents but should help parents in their parenting role. State governments should not replace local governments, but should support local governments in their work with children. The international community should help national governments in their work with children. The same reasoning should apply to care for the physically disabled and the mentally ill.
The international community is the last resort, the outer ring of responsibility in looking after the welfare of children. The very outermost ring includes international governmental organizations (IGOs) such as UNICEF, the Food and Agriculture Organization of the United Nations, the World Health Organization, and the United Nations Committee on Human Rights. Just inside that ring are the international non-governmental organizations (INGOs). In the pattern of concentric rings of responsibility, the international bodies' task is not to deliver services to children directly but, to the extent possible, to empower agencies in the inner rings.
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