Palais des Nations, Geneva,
12 April 1999

Nutrition, Health and Human Rights

Excellencies,
Colleagues,
Ladies and gentlemen,

One year ago, it was my pleasure to serve as chairperson at the SCN's 25th session symposium on "A gender perspective on nutrition through the life cycle" that was held in Oslo.

Today, nearly nine months into my new duties, I am pleased to speak on behalf of the World Health Organization on an issue which cuts across all of WHO's political and technical priorities. Human rights cannot be departmentalized. It has to be a cross-cutting perspective in all we do.

It is no coincidence that the Universal Declaration on Human Rights was drafted at the same time as the founding mothers and fathers of WHO drafted our constitution. And the issue of nutrition certainly has both a health and a human-rights perspective. What are the primary links between nutrition and health seen from a human-rights perspective?

First, nutrition is a key universal factor that affects, as much as it defines, the health of all people.

A banal observation, but the thing is it is so obvious a truth that it is regularly overlooked. Well-functioning metabolism based on a regular intake of the proper mix of nutrients, safely ingested, prepares our bodies for the main tasks at hand - growth, development, work, resistance to infection, and the attainment - and enjoyment - of physical and mental well-being.

Nutrition is a key factor. The effects of nutrition not only on growth and physical development, but also on cognitive and social development are well documented. A malnourished child is not only more vulnerable to disease. Cognitive development will be in peril, especially during the first three years of life. Stunted physical growth is closely linked to reduced mental development.

With a distorted intake of nutrients - too little, too much, or unsafe - or with too great a loss of nutrients - for example through diarrhoea or errors of metabolism - we easily fall prey to ill-health and disease. This is an undeniable physiological reality. The proper mix of nutrients under clean and safe conditions must be available to all.

We also know just how far from this gold standard we remain. We live in a world where inequity, poverty, underdevelopment, as well as maldistribution and inadequate access to food, health and care still prevail. There are tragic consequences:

• Half of the more than 10 million deaths every year among children under five are associated with malnutrition;
• 170 million children are underweight, 208 million are stunted, and 49 million are wasted;
• More than 900 million people suffer from goitre, 16 million are severely retarded, and another 50 million suffer other forms of brain damage, due to a deficiency of iodine;
• 3 million children are at increased risk of infection, blindness and death because they are vitamin A-deficient;
• Anaemia and iron deficiency affect more than 2000 million people the world over; and
• Some 22 million children, and more than 200 million adults, are obese, and thus at significant risk from a range of serious noncommunicable diseases and other threats to health.

But there is more to it. I see a second category of crucial linkages.

Because nutrients come from the soil, from forests, from the seas and lakes, nutrition, as a process, is linked to complex interdependent issues like production, the environment, economic structures, social organization, and human roles and behaviour. In short, nutrition is linked to the same forces and factors that determine the degree to which human beings are able to obtain the food and nutrients they require.

We must discuss nutrition in the widest possible development terms. A main part of the problem, as you have repeatedly emphasized during the last two SCN symposiums, is that a host of factors relating to the essence of development - poverty being first among these - impinge on this ability, as much as they define it, for individuals and entire societies.

We know, and have discussed for years, the countless factors at play, including unemployment, low income, unsuitable shelter, sex-based discrimination, and inadequate knowledge and other barriers to providing the vulnerable with the care they need. Finally, they converge to determine the ultimate - and measurable - individual quality that we call nutritional status.

While focusing on the crucial role of nutrition – let us, however, sound a note of caution. We should take care not to cede to the ever-attractive temptation to single out one factor, or even a few factors, of the complex interplay between nutrition and health, and think that they can somehow be confronted and resolved in isolation. The last 50 years of development experience have made abundantly clear just how unrealistic such an expectation is.

It is no coincidence that the idea to establish a world health organization emerged from the same process that, in 1948, identified the universal value of human rights. WHO's mandate is also universal. Our constitution calls for equity in stating that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition."

If we were to point to one single factor explaining ill-health in our world today it is poverty. Poverty is the main obstacle to the attainment of health. Poverty leads to ill-health – but it also works the other way - ill-health breeds poverty. Where there is structural poverty and ill-health there will be poor development - poor nutrition, poor health, and poor human rights.

The global UN conferences in recent years –Rio, Vienna, Cairo, Copenhagen and Beijing all point to the same conclusion: Not a single country has succeeded in sustaining economic growth and human development without first investing in human development. And no country is likely to sustain progress and the health of its people if they suppress democracy and neglect human rights.

One reason for an unfulfilled agenda is precisely to be found in the neglect of basic human rights. The health sector is often left dealing with the results of abuse: The suffering from war and torture. The mutilations from the killing fields of anti-personnel landmines. Diseases find fertile ground where information and education are lacking. Building healthy communities is hampered where freedom of organization is restricted. Diseases recede when the conditions exist for individuals to acquire knowledge and information. When they fully enjoy their legitimate human rights.

Discrimination on the basis of race, colour, sex, language, religion or any other reason makes the negative impact of poverty on health far worse.

Look at gender. Girls and women who are denied access to education, information and real forms of economic, social and political participation are particularly vulnerable. Some political regimes favour vaccination of young boys over young girls. It is totally unacceptable and we need to speak out against such practices.

The clearest abuse of human rights sometimes becomes pure violence. Between 20% and 50% of women are victims of physical abuse by their partners at some time in their lives. Violence against women in situations of conflict and against women refugees is part of the same drama. Our evidence base tells a sad story: By 2010 - violence will in itself be a leading global burden of disease into the next century.

If we are to take human rights seriously, we have to become familiar with the difference that a human-rights perspective brings to our diverse missions, policies and activities in a development context.

I would like to make two elementary distinctions:

The first is the distinction between having basic needs versus having rights that can be legitimately claimed by the rights-holder.

The second is between charity that flows from the benevolent - when convenient - versus obligations that, by definition, must be met by responsible duty-bearers.

An explicit human-rights approach to health and nutrition means that mechanisms and procedures are gradually put into place to ensure that the values we advocate are underpinned in international human-rights law, are subsequently incorporated into national laws, and thereby have a chance of becoming reality for greater numbers of people.

We know it all too well: There are serious imperfections of the current system of human-rights implementation. But I would counter pessimism by saying that we have barely begun to use the opportunities that this road of action offers.

Here lies the challenge that we face as members and observers in this sub-committee. And such, too, is the nature of our task, in following up WHO`s work along a perspective of human rights.

In the process of globalization there may be emerging a growing convergence, in the family of nations, in at least the principles - if not always the acts - of governance. A political consensus among governments is at last building, slowly but steadily, in favour of a single overriding notion: development, to be sustainable, must be based on equity.

The UN system has been at the forefront of this evolutionary debate from its earliest days, championing human rights for all, and seeking to anchor their protection firmly in international law.

During the celebration of the Universal Declaration's fiftieth anniversary last December I focused on a new call for action:

• We need sustained momentum to win and re-win respect for human rights
• We need political commitment at the highest level
• We need mobilization of civil society, and
• We need a progressive force to stand up for the hundreds of millions who are denied the enjoyment of their rights

h Organization is part of this force, and we will renew our focus on the political and legal links between health and human rights.

We need to define more explicitly the links between the technical substance and the vocabulary of health and nutrition, and the way we think and speak about human rights. The professional, institutional and operational bridges between health and nutrition and human rights, though off to a promising start, remain to be further refined.

To continue building a solid foundation for action I believe that all our agencies should continue to be active on two parallel tracks.

First, individually, we need to define - and refine - our human-rights objectives and establish explicitly our human-rights goals in relation to nutrition and health.

Second, collectively, we need to use forums like this one to ensure consensus, compatibility and complementarity with the action of all concerned parties, in an effort to achieve those objectives and goals.

A human-rights perspective provides the international community with yet another opportunity to support the development, in countries, of sound public health policies and practices that promote healthy nutrition as a cornerstone of all social and economic development. This approach is consistent with how international intergovernmental organizations like ours function, both as policy advocates and providers of technical support.

In line with our mandate, the primary entry point for influencing and shaping national policies is building national capacities to meet diverse nutrition challenges. Governments have the main responsibility for protecting the human rights of their citizens. It is our responsibility to support governments, by providing the tools they need to help them do the job.

Human rights should begin at home. For our agencies, and the technicians and managers working in them, this implies learning more about human rights as they directly affect our many specialized fields.

This concerns the norms contained in the best-known instruments but it doesn't stop there. It also includes learning about how the drafters of the UN's own charter and, later, the International Bill of Human Rights, envisaged a functional system for implementing these norms internationally.

We must become familiar with the institutions, the mechanisms, and the procedures. They are there for all of us, to support and to make use of, in our common mission to promote and protect human rights, including the right to nutrition and health.

We have a responsibility to contribute to a similar learning process among our human-rights colleagues. We can do this in a variety of ways, by sharing our insights, and applying our indicators, to improve understanding of how inadequate access to food combined with inadequate health care result in malnutrition that is so rampant and so serious that it is one of the worst public health problems we face globally. Therefore this remains a gross violation of the human right to health!

Let me end by focusing briefly on this sub-committee's relationship with its parent body, the ACC. The example you set here has important implications, through the ACC, for how the entire UN system addresses the issue of human rights.

We should all be able to ensure that a "human-rights culture" permeates each of our agencies. I am not suggesting that we begin each day by reciting the Universal Declaration of Human Rights! What we can do is create working environments where staff will be continually challenged to explore two interdependent avenues:

• How they can make effective use of human-rights norms, and their implementation systems, in accomplishing their daily tasks, and
• How they can contribute to the still wider, and more effective, application of these norms through the daily tasks they accomplish

This is the essence of the challenge for the UN system, and what it implies when we talk of "mainstreaming human rights".

We should be sure to do this in concert with our Member countries. We must strive to benefit fully from a process that simultaneously engages both international and national perspectives and stimulates new opportunities for growth and learning.

Governmental accountability for human rights standards requires an understanding of minimum standards of nutrition, of the body of operational laws and policies, and of monitoring mechanisms that help establish the evidence of the contribution of health - and, in today's context, of nutrition - to human rights.

Our advocacy for human rights contributes to a global public good that the UN system is there to provide. Doing it together will provide new nutrition and energy to an important human cause.

Thank you.