GLOBAL HEALTH AND FOOD SECURITY: IMPERATIVES FOR THE FUTURE
Thursday, October 16, 2003
Speaker: Dr. Josh Ruxin
Session Chair:
DR. M. S. SWAMINATHAN
1987 World Food Prize Laureate
Co-Chair, UN Hunger Task Force
Chairman, UNESCO Cousteau Chair in Ecotechnology
Chairman, M.S. Swaminathan Research Foundation
Well, ladies and gentlemen, since we are already behind time, I shall be brief in my introductory remarks. I think the subject has been eloquently addressed and also introduced by our wonderful luncheon speaker, Jeffrey Sachs. I think he brought out the very strong relationship between food, nutrition, health and productivity, poverty, in his own inimitable style. So I think the introduction to this session on Global Health and Food Security has been made.
This morning Dr. Sakiko Parr gave some dramatic figures. For example, she said in Botswana the life expectancy has come down from 65 to 40 as a result of HIV/AIDS and other problems. So it is a very important area for food security and health, and we have three eminent panelists: Dr. Josh Ruxin, who will speak first. He is currently serving as director of the program to scale up health in developing countries at the Center for Global Health and Economic Development, which is a joint initiative of Columbia University’s Earth Institute and the Mailman School of Public Health. In addition, he is also coordinator of HIV/AIDS task force of the U.N. Millennium Project. So, very appropriate that we start with him.
Our second speaker, Dr. Mushtaque Chowdhury is from a very famous organization, which is well known, BRAC from Bangladesh, both Gramin Bank and BRAC of Bangladesh are well known as the most outstanding nongovernmental initiators in the attack on poverty. He had his Ph.D. degree from the London School of Hygiene and Tropical Medicine. Currently he is visiting professor at Columbia University in the United States, and he has worked in very many countries – China, Ethiopia, Nepal, Thailand – and has been a consultant. And he is currently executive director of the Research and Evaluation Division of BRAC.
Our third speaker, the very eminent Scientist, Dr. Abenaa Akuamoa-Boateng from Ghana. She currently serves as principal Nutrition Officer with the Ghana Health Service and Ministry of Health. She is in charge of nutrition policy and planning for Ghana’s most populace Shanti region, which is the most populace region of Ghana. She has conducted numerous studies on quality protein maize, for which as we know the World Food Prize was awarded a couple of years ago to Dr. Evangelina Villegas and Dr. Vasal.
So we have three eminent speakers. We hope we’ll have some time. We must close the session at three because we have two very important speakers following. So the speakers will take 10-12 minutes, and they hopefully will have opportunity for a few questions. Josh.
Food Security and Global Health
Dr. Josh Ruxin
Co-Chair, UN Millennium Project Task Force on HIV/AIDS, Malaria, Tuberculosis and Access to Essential Medicines
Assistant Professor of Public Health, Director of Macrohealth and Access Projects at the
Mailman School of Public Health
So there are actually two features which make it very difficult to be a speaker at a conference like this. The first is if you’re the first speaker after lunch, and I don’t know if the World Food Prize has done any investigations into the snooze factor of post-lunch speech giving, and the second is to follow Professor Jeffrey Sachs. So I consider it an honor to be here today in the single most difficult position. And perhaps here to speak about one of the most troubling issues that we are all concerned with, and that is the issue of hunger and AIDS.
Last week I was in Ethiopia, and I was invited over to a friend’s home. I had visited him a few years ago and at his home had seen that he had adopted three children who suffered from spinal tuberculosis. They had a very delicate medical condition, and he was caring for them. But last week when I went to visit him, I saw that he had 12 children, and I asked him what happened – where did this reproduction come from. And he told me this is what AIDS is doing to Ethiopia.
So he introduced me to a six-year-old named Meskim, and this is a photograph of him, whom he had found on the streets of the city this year. And I want to talk a little bit about Meskim, because I think that he provides a lens through which we can consider hunger and AIDS in the poorest countries on the planet.
But before I tell you a little bit about his story, I just want you, to hear a little bit of his voice. With a little bit of coaxing, we managed to get him to sing for us, and he sang a bit of an Ethiopian traditional song... Meskim was abandoned in the street because last year his mother died of AIDS and this year his father, while he was suffering from AIDS and tuberculosis, he decided that he couldn’t carry on any longer. His parents were farmers, and they’re among the seven million, at least seven million, who have perished from AIDS in sub-Saharan Africa in recent years.
If we run our hand over the globe right now and take a look at the top killers, the usual suspects come across quite quickly – heart disease, which tends to affect the elderly more than the young, and then moving down the list we see that HIV/AIDS has really moved up in position. We heard earlier that it’s claiming three million lives per year, probably considerably more than that in years to come. And also tuberculosis and malaria. And I think often when we look at these charts and these statistics, they really obscure the faces of those who are being impacted – Meskim and his parents and his family members.
And as we saw earlier today, the results of this devastation are dramatic. If you take a look at life expectancy, just ten years ago there were a number of countries that were perhaps approaching life expectancies in the high sixties, and they have all plummeted. It’s not unusual to find countries in sub-Saharan Africa where the average life expectancy is in the high thirties.
There’s another side to what is happening with this epidemic, and that, of course, is AIDS orphans. There are more than ten million in the world today, and that number is growing rapidly. I took this photograph a couple weeks ago in Rwanda at an AIDS orphanage. Not only are these AIDS orphans, that is to say, not only were they abandoned by parents who died of AIDS, but they are AIDS orphans with AIDS; so they are some of the most neglected children on the planet and are just receiving palliative care. The director of the center told me that one out of the couple hundred who are at the center is dying every week.
Well, as we heard from Professor Sachs, there is something that we can do, not only about AIDS and tuberculosis and malaria, but all these diseases. And what we can do is we can start to directly send financial resources at these plagues. And the estimates from the Commission on Macroeconomics and Health suggest that with about $34 billion you could begin to scale up health systems to meet these very critical needs.
The problem with scaling up is that it takes time, and it takes management resources, and it takes political commitment, and it takes all of those different characteristics that we’ve been hearing about today to overcome what we have ignored for so many decades. In clinics around sub-Saharan Africa, latex gloves (if they have them) are recycled and reused. The shelves in pharmacies are empty and bare because the supply lines are not in place, and because the financial resources are not in place to pay for the essential drugs that people need, which very poor people cannot afford to pay for themselves.
AIDS is placing a particular burden on an already-stretched public health system. In the internal medicine ward in this central hospital in Kigali, Rwanda, 60% of in-patient admissions are HIV-positive and dying of AIDS, and they’re sleeping two or three to a bed. In fact, you can’t make it out in this photograph, but underneath the beds there are more people who are there sleeping and slowly dying. They’re not receiving the anti-retroviral drugs that could extend their lives.
Well, how does all this relate to hunger and how does all this relate to the World Food Prize? Here’s a simple view of it which I think makes some sense. What we are seeing in the world today is continuing increased incidence of HIV/AIDS, and it is part of a vicious cycle which is destroying many countries in the world. It is leading in part to lowered agricultural activity and lower household purchasing power, which in turn results in hunger and malnutrition, which in turn...
We happen to have Dr. Nevin Scrimshaw with us today, who many years ago was one of the first to define the relationship between nutrition and infection. And we know now that AIDS is also one of the diseases which you are much more susceptible to acquire if you are hungry and if you are malnourished, whether you’re a child or an adult. So with this increased susceptibility and the increased need to earn capital in order to keep families... which leads to community sex work, we are seeing more orphans and more AIDS. This is a snapshot of the massive problem that we face today.
But I don’t want to simply point out a grim picture, because food actually, when inserted in the right parts of this cycle, can play a major role in breaking this cycle. If you want to keep kids in school, you can provide them with free lunch programs and provide them with additional food to take home. If they’ve lost their parents to HIV/AIDS and they’re living with their grandparents, or they’re living with extended family, the likelihood that they will stay in school, if they’re provided with free food, is over 60% higher than without providing them with free food. So that’s just one area in which you can actually start to solve these problems by using food.
One of the things that’s making it difficult to extend food in these countries is that ministries of agriculture themselves are some of the hardest hit by AIDS. If you look at Lesotho, if you look at Malawi and speak with ministers of agriculture, they’re finding that up to a third of their staff is HIV-positive; and they’re spending a lot of their time attending funerals when they could be doing agricultural extension work. And so these are some of the critical people that we need to start reaching if we’re going to take seriously the need for investment in agricultural resources in the poorest countries.
This is a photograph taken in Rwanda of a World Food Programme project. Catherine Bertini no doubt knows quite a bit about this program. It’s a program where families who are impacted by HIV/AIDS are given food supplements, because these food supplements are keeping the kids healthier, they’re helping to keep them in school, and they’re helping to keep families together.
So let me just present very quickly a vision for why food is important in the fight against AIDS, why it should be considered as important as anti-retroviral drugs and condoms. If you look at the curve today of where this epidemic is heading, it has not capped off yet. In the years to come we will be seeing four and five and six million new infections happening every single year.
However, with a comprehensive response – which is this lower bar, that includes condoms, which includes education, it includes anti-retroviral drugs because that link between treatment and prevention is so critical – we need to add to that war chest discussion of food, because food, in the case of children like Meskim and his friends from school will be one of the critical ways in which we actually have success against this increasingly grim epidemic.
Thank you very much for your attention.