Institute Insights: April 2019

Contents:

Duesseldorf, Germany: Fridays For Future protest against climate change. Credit: iStock

From the Director

It’s April, and several Bread for the World Institute colleagues are in Kenya, learning about its national plan to end hunger. Read more in “Country Ownership: Setting Ambitious Goals” in this issue.

Also in this issue, we explore what it means to end “malnutrition in all its forms,” take a look at the broadly shared benefits that an increase in the U.S. minimum wage would bring, and ask what we can learn from the water crisis in Flint, Michigan—exactly five years after it began.

April 22 is Earth Day. Not long ago, it was a one-day, often rather low-key event. Kids might make posters about recycling. Teenagers might help clean up a local park. In the era of climate change, however, youth around the world are mobilizing, calling on their governments to respond to climate change as the crisis that it is. “Environmental awareness” has become climate advocacy—an advocacy certainly not confined to Earth Day.

On March 15, well over a million teenagers and children in at least 105 countries went on strike from school to call on global and national leaders to act on climate change, most urgently to stop greenhouse gas emissions. The inspiration for many participants is Greta Thunberg of Sweden. She was 15 last year when she spent three weeks outside Parliament in Stockholm, calling for action on climate change, rather than going to school. She still strikes for climate action every Friday, joined by high school students, middle school students, and a smaller contingent of adults on every continent except Antarctica. Most recently, Greta Thunberg has been nominated for the Nobel Peace Prize.

Thunberg and others from our next generation are making headlines—and making waves. Adults were not expecting the message they got when she was invited to speak at the World Economic Forum in Davos, Switzerland. Thunberg had the facts, the analysis, the succinct speaking style of a seasoned activist, but she also did what teenagers do best: challenge the complacency of adults—in this case, world leaders. A couple of examples from that speech:

“You only talk about moving forward with the same bad ideas that got us into this mess … You are not mature enough to tell it like it is. Even that burden you leave to us children.”

“Adults keep saying: “We owe it to the young people to give them hope.” But I don’t want your hope … I want you to panic. Until you start focusing on what needs to be done rather than what is politically possible, there is no hope ... Either we prevent 1.5C of warming, or we don’t.”

She got their attention and we will surely hear more from her. Greta has a lot to teach us all about the courage to speak up and speak out.

Asma Lateef is director of Bread for the World Institute

Asma Lateef is director of Bread for the World Institute.

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Women farmers from Kenya. Photo by Jim Stipe.

Country Ownership: Setting Ambitious Goals

By Jordan Teague

In 2015, our colleague Faustine Wabwire wrote, “Stronger local capacity for development—the ability of individuals and institutions to perform functions, solve problems, and achieve goals—is essential to building resilience, spurring broad-based economic growth, and achieving the ambitious global development goals of the post-2015 era.”

I couldn’t agree more. The United States invests billions of dollars each year in assistance to advance human health and productivity overseas. How can we expect to see lasting, sustainable results from those investments if they are not supporting a country’s own priorities? Or if they are not also helping the country equip its own people to achieve their priorities?

I’m glad to report that many countries are eagerly creating and taking on opportunities to set their own development goals, plan their own paths, and hold themselves accountable for what they’ve set out to do. Not only individual countries, but entire groups of countries, have become more proactive than they were in the past. For example, in 2003 the African Union (AU) and its member states established a policy framework called the Comprehensive Africa Agriculture Development Program (CAADP). The CAADP agreement set ambitious targets for countries: achieving 6 percent annual growth in agricultural Gross Domestic Production (GDP) and allocating at least 10 percent of national budgets to agriculture. 41 AU member states have signed compacts, or plans, related to achieving CAADP targets.

In 2014, AU member states met in Malabo, Equatorial Guinea, and built on CAADP by adopting the Malabo Declaration on Accelerated Agricultural Growth and Transformation for Shared Prosperity and Improved Livelihoods (Malabo Declaration). In the Declaration, member states committed to ending hunger in Africa by 2025, including through doubling agricultural productivity levels and cutting post-harvest losses in half by that year. The Malabo Declaration also committed AU member states to reducing stunting to 10 percent and underweight to 5 percent by 2025 – far exceeding the World Health Assembly targets in most cases.

39 African countries have also joined the Scaling Up Nutrition movement. To join SUN, countries must commit to ensuring that all government development programs are nutrition-sensitive and to increasing the scale of nutrition programs for people who are in what’s known as the 1,000 Days – the critical window for human nutrition, from a woman’s pregnancy to her child’s second birthday.

Countries themselves are setting their own ambitious goals. In 2008, Kenya—which also signed on to both CAADP and the Malabo Declaration—launched its own Kenya Vision 2030, which “aims to transform Kenya into a newly industrializing, middle-income country providing a high quality of life to all its citizens by 2030 in a clean and secure environment.” In its current medium-term plan (the third phase of the Kenya Vision), Kenya is focusing on the “Big Four” pillars: food security, affordable housing, manufacturing, and affordable health care for all.

In 2010, Kenya adopted a new Constitution with the African continent’s most progressive Bill of Rights. The Constitution recognizes every person’s right to:

  • Respect and protection for their dignity
  • Fair labor practices, including fair remuneration, reasonable working conditions, freedom to participate in trade unions, and the right to engage in collective bargaining
  • A clean and healthy environment
  • The highest attainable standard of health
  • Freedom from hunger and an adequate amount of food of acceptable quality

These are just some of the rights that Kenya’s Constitution and government have promised citizens. In its Constitution, Kenya also decided to decentralize its government, giving county-level governments more control over budgets, policies, and programs.

Clearly, signing declarations, launching ambitious plans, and developing policies will not magically transform the health and well-being of the Kenyan people. However, it is a major first step to show that the Kenyan government recognizes the importance of investing in its people, including efforts to end hunger, malnutrition, and extreme poverty.

So, what difference have these declarations and policies made for hunger, poverty, and malnutrition in Kenya? Stay tuned – a team of us are in Kenya right now exploring that very question! Future editions of Institute Insights will dive in to Kenya’s progress toward ending malnutrition.

Jordan Teague is senior international policy analyst with Bread for the World Institute.

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Indian kids eating. Photo by Jim Stipe.

A Broader Understanding of Malnutrition

By Tanuja Rastogi, ScD

I began my doctoral field work in nutrition 20 years ago, in hospitals that served low-income people in New Delhi (whose population even then was more than 12 million and growing rapidly) and Bangalore (a large city in southern India). My research topic, the double burden of malnutrition, was considered an emerging public health crisis.

The main focus of public health nutrition in India at the time was undernutrition or micronutrient deficiencies, and I was acutely aware of the high levels of hunger and child undernutrition. Yet cardiovascular diseases had become the leading cause of death in India, and I was trying to understand how that had happened. I was perhaps motivated by concern that, unlike the West, India had limited epidemiological research available, either on what was driving the increasing rates or on how to prevent these diseases.

Prevention of serious chronic illnesses was, and still is, essential—globally, but especially in a country with large numbers of lower- and middle-income urban people who are increasingly affected by chronic illness but simply cannot afford costly, prolonged medical care. Obesity, diabetes, heart disease, and cancers impose an increasingly heavy burden on a public health system that was stretched to begin with.

Identifying and scaling up effective public health prevention measures was essential. My field research produced useful findings, such as the benefits of mustard oil intake and the health risks posed by obesity, tobacco use, and physical inactivity. Not surprisingly, I was often puzzled as to how two “extremes” of nutritional problems—undernutrition and obesity (and related conditions such as diabetes, hypertension, and heart disease)—could co-exist not only in the same urban area, but even at times within the same household.

Most research and discussion of the links between undernutrition and obesity and their causes (e.g., the Barker hypothesis) took place primarily within the fields of public health or nutrition. But the January 2019 Lancet Commission Report on the Global Syndemic of Obesity, Undernutrition, and Climate Change offers unparalleled perspective and depth on how inter-connected our health, food systems, and environment are today—and what actions must be taken to sustain future generations and the planet.

The word “syndemic” may be here to stay—the realities it captures certainly appear to be here to stay. Syndemic refers to two or more diseases that “adversely interact with each other, negatively affecting the mutual course of each disease trajectory, enhancing vulnerability, and which are more deleterious by experienced inequities.”

The report takes a bold approach—putting obesity in the broader context of a global syndemic as well as going beyond individual diseases to examine the underlying human drivers and feedback loops that lead to several interconnected problems. The specific problems are climate change and malnutrition in all its forms, meaning obesity, undernutrition, and nutritional deficiencies. The report looks closely at how both poor countries, and the poorest groups within all countries, will be disproportionately affected by increasing demand for food (particularly animal-source food) by 2050. It calls for establishing a global Framework Convention on Food Systems, similar to the Framework Convention on Tobacco Control.

As I reflect on the report, I recall witnessing firsthand the co-existence of obesity and stunting in India, which the authors state is an “urgent warning” sign of the syndemic. I am further motivated to broaden my thinking on nutrition to include a systems lens and to understand how policy initiatives can collectively tackle the global syndemic.

Editor’s note: Bread for the World Institute welcomes Tanuja Rastogi, a global nutrition policy specialist who has been seconded to us from the World Food Program for two years. We are already learning from her experience! Her first piece for Institute Insights coincides with the Lancet’s use of the concept of “syndemic,” a word that may look vaguely familiar to some of us from a different context but hasn’t been in common use in the anti-hunger community. I think of it as meaning roughly, “The whole of the problem is worse than the sum of its parts.” As Tanuja points out, it requires a systems-level look at problems. It emphasizes interconnectedness, as the Sustainable Development Goals do, but, to my mind anyway, takes a less optimistic approach.

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The federal minimum wage would now be more than $19 an hour if it had continued to keep pace with growth in economic productivity. Source: Economic Policy Institute

The Minimum Wage Has Not Increased Since 2009 – Unlike the Cost of Living

By Todd Post

Allen Ginsberg, one of the great American poets of the 20th century, had this line in the 1956 poem he titled America: “When can I go into the supermarket and buy what I need with my good looks?”

I think we all find that amusing. You get what you need at the supermarket with money, and if you don’t have enough, you don’t get what you need. And that’s why we should all be concerned about the value of the minimum wage.

In recent years, campaigns to raise the minimum wage have largely settled on $15 an hour as a just and equitable minimum wage. A few cities, including New York City, already have minimum wages of $15 or more. New York, California, and several other states and municipalities have passed legislation to gradually increase the minimum wage to $15. A number of states are on track to reach $15 by 2023 or 2024. Workers in states that have indexed their minimum wage to inflation will receive increases without need for further government action.

However, the federal minimum wage, and the minimum wage in the 21 states that follow the federal policy, is $7.25 an hour. Despite increases in the cost of living, it has been $7.25 an hour for 10 years, since 2009.

The workers who will receive pay increases if the federal minimum wage were to rise to $15 would include, of course, everyone who is currently paid less than that. People earning slightly more would also benefit from a ripple effect. All told, this is a significant share of the workforce. The Economic Policy Institute, one of the nation’s top think tanks on labor issues, has done the calculations and shown that nearly 40 million workers, more than one-fourth of the workforce, would benefit if the federal minimum wage reached $15 by 2024.

When we look at demographics, we see that workers of color would benefit disproportionately because they work disproportionately in the lowest-wage occupations. Nearly 40 percent of all African American workers would get a raise, along with one-third of Latino/a workers and almost a quarter of white workers. The benefits would be broadly shared among people of different racial/ethnic identities.

Women would benefit disproportionately—nearly a third more women than men would receive a raise. Again, this is because they work disproportionately in the lowest-wage occupations. Because on average, white women are paid less than white men, and women of color are paid less than white women, women of color would benefit more than either white women or men of color. The group of people most likely to receive a raise, however, is not defined by race: 43 percent of single mothers would receive a pay increase. The EPI data does not break down the category of single mothers by race, but given the pay disparities just mentioned, we expect that women of color would benefit disproportionately.

Of course, when single mothers are paid more, the other people who benefit are their children. One-third of all U.S. children are being raised by single parents, and 80 percent of these families are led by women.

In 2018, the economist Arindrajit Dube published a comprehensive analysis of the voluminous data available on connections between the minimum wage and poverty. It showed that for every 10 percent increase in the minimum wage, the poverty rate would shrink by an average of 5.3 percent. A full-year, full-time worker at $15 an hour would have an annual income of $31,200. Today’s poverty line for a family of four is about $25,000. While the poverty line will be slightly higher in 2024 due to inflation, this increase won’t be significant enough to offset the additional income from a $15 minimum wage. Increasing the minimum wage to $15 means that a family of four with a full-time minimum wage worker would not fall below the federal poverty line.

Opponents of increasing the minimum wage argue that it will cause higher unemployment among the low-wage workers the increase is intended to help. In a separate study, Dube and his co-authors examined the effects of state-level minimum wage increases between 1979 and 2016. They found that on average, employment levels remained stable following the increase. One reason for this is that low-wage workers generally spend most or all their additional income on products and services they need, which boosts the local economy.

The poverty line is not based on the actual cost of living. Economists estimate that families need an income of about twice the poverty level to meet their basic needs. (“Basic needs” is specifically defined for research purposes—for example, it includes health insurance but no travel or vacations). Also, as we reported in our 2018 Hunger Report on jobs, the minimum wage would now be more than $19 an hour if it had continued to keep pace with growth in economic productivity, as it did between the end of World War II and 1980. Even with these two caveats about what the minimum wage should be, however, establishing an hourly pay rate that is high enough to keep full-time workers and their families out of poverty would be a very significant step in the right direction.

The minimum wage is the floor. It is the value society places on the time and effort of a low-wage worker, the minimum amount she should be paid so she can have housing, food, and other necessities. Currently, unemployment is at very low levels, yet tens of millions of people worry about running out of money for food.

Not increasing the minimum wage for 10 years has revealed the fundamental problem with a statement we hear frequently, a statement that arguably should always be true, but isn’t: “The best way out of poverty is a job.” As it turns out, that depends entirely on which job.

Todd Post is senior researcher, writer, and editor with Bread for the World Institute.

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City of Flint, Michigan water, filter distribution, and sample turn-in, on Wednesday, October 5, 2016. While U.S. Department of Agriculture partners may have water available for residents, the responsibility here has been taken on by the City of Flint, wi

Learning from Flint

By Karyn Bigelow

The water crisis in Flint, Michigan, began five years ago this month, on April 25, 2014, when the city began delivering water to 100,000 residents from a new source—the Flint River.

A ceremony that day, covered by local media, marked the moment the switch took place. Flint was in the midst of a financial crisis and needed to save money. Switching to treated water from the river seemed to many people a promising way to do so, since the previous source, the Detroit Water Department, was very expensive. The water treatment plant would also mean new jobs.

None of these things come to mind when we hear “Flint” mentioned now.

Most of the city’s water lines were old and not well maintained, and the plant failed to use corrosion control methods. The result was contamination of the water with lead and other metals. Lead is particularly dangerous to children’s developing brains, which is why pediatricians routinely test one-year-olds for lead exposure. The full extent of the long-term damage to the children of Flint won’t be known for some time, but thousands of children were exposed to the contaminated water for more than a year. Many children’s blood tests showed extremely high levels of lead.

The deadliest short-term effect of the water crisis was a surge in Legionnaire’s disease, a dangerous infection. The city averaged six to 13 cases a year before 2014, but in the two-year period 2014-2015, 91 people in Flint were diagnosed, of whom 12 died. Many other Flint residents reported hair loss, persistent rashes, and other health conditions caused by contaminated water.

A convergence of factors caused the crisis in Flint. The more immediate causes of the initial contamination included poorly-researched decisions made under financial pressure. The months and months that followed, however—when residents were reporting problems and bringing in water samples, but authorities refused to act—raise the question of government and individual accountability.

In What the Eyes Don’t See, Dr. Mona Hanna-Attisha wrote that Flint “is the story of a government poisoning its own citizens, and then lying about it … It is a story about what happens when the very people responsible for keeping us safe care more about money and power than they care about us, or our children.” Hanna-Attisha is the director of the pediatric residency program at Michigan State University’s teaching hospital. It was her analysis of Flint residents’ blood tests that supplied proof that the water was contaminated, despite official denials. “There are lots of villains in this story,” she added.

In 2016, Michigan’s then-attorney general, Bill Schuette, promised to investigate the scandal and said that state regulators would go to prison for fudging data and misleading the public. Though a special prosecutor originally charged suspects with felonies such as involuntary manslaughter, he later “negotiate[ed] seven plea deals for misdemeanors as minor as ‘disturbing the peace at a public meeting.’” Schuette himself has argued that the state doesn’t have a constitutional obligation to provide clean water.

There were other, less immediate factors that led to the environmental disaster in Flint. The larger context is that Flint was and is a city of concentrated poverty, with a poverty rate of more than 41 percent, and a city where 63.1 percent of the residents are people of color. Chronic economic struggles for a 30-year period prior to 2014 had led many people to leave. This made the city even more fragile than before, since when people left, their human capital, social capital, and financial resources left with them.

Although the crisis in Flint was created by people in a more immediate sense than climate change was, it shares many features of the current and future vulnerability of fragile communities to climate change. As climate-related extreme weather events become more intense and more frequent, government must develop better plans and stronger systems of accountability. Because effective planning cannot be “one-size-fits-all,” one essential element is involving people from the most marginalized communities in the planning.

Take the example of Hurricane Katrina in 2005. It was obvious in hindsight that a plan that depended on people driving their own cars to safety was bound to fail in a city where many families did not have cars (or did not have cars that would be reliable for long distances), and where many people did not have immediate access to the money needed to keep filling the gas tank. If people who lived in neighborhoods where these would have been common problems had been consulted about the evacuation plans, they could have pointed this out. Or even failing that, if the people who did participate in the planning had had a rudimentary understanding of the realities of life in lower-income parts of the city, they could have pointed this out.

As climate change increasingly affects the United States, it is more important than ever to identify and put in place effective policies and practices to protect our most vulnerable communities. Both more immediate factors, such as limited financial resources and lack of government accountability, and larger context factors, such as concentrated poverty, structural racism, and long-term economic and environmental neglect, make climate change a greater risk to people living with food insecurity and hunger than to others.

Karyn Bigelow is a research associate with Bread for the World Institute.

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"Until you start focusing on what needs to be done rather than what is politically possible, there is no hope ... Either we prevent 1.5C of warming, or we don’t.”

– Greta Thunberg addressing the World Economic Forum in Davos

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