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Global Nutrition Part 2 Roadmap to a world without hunger Where are we headed? The ugly What works? It wasn’t an accident How did we get here? Where are.

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Presentation on theme: "Global Nutrition Part 2 Roadmap to a world without hunger Where are we headed? The ugly What works? It wasn’t an accident How did we get here? Where are."— Presentation transcript:

1 Global Nutrition Part 2 Roadmap to a world without hunger Where are we headed? The ugly What works? It wasn’t an accident How did we get here? Where are we now? Can anything help? Stuffed & starved The bad What doesn’t? The good Most of you will see hunger in museums!

2 Who to ask what’s happening? Where are we now, really ? What works & what doesn’t? Roadmap to a world without hunger

3 Questions that need qualifying The 50% (actually 49.2%) is children that will require food-aid at some time during childhood Pct % of people hungry is declining dramatically Evidence-based analysis & solutions Who’s lying? Be deeply suspicious of Keep an open mind: free enterprise, free trade, GM seeds, globalization?... Those who speak from dogmatic idealism Those with a strong self interest... Those with history of lying or cheating Yunus - yes if it helps the poor follow the money

4 When experts disagree... Do we believe in GM seeds?... don’t expect to agree with anyone? Do we believe in globalization? Do we believe in free trade? Beware of those with small ears, ideologues, those who allow no voice for the dispossessed Those with a strong self interest Those with history of bribery, lying, or cheating Look for common ground Be deeply suspicious of... Follow the money Does it benefit the poor?

5 What kinds of aid don’t work Teams of publish or perish “anthropologists” “Another needs assessment? … “We have noticed that Americans have very tiny ears”...... & very large mouths. But we would prefer it to be the other way around Aid that designed to benefit the donor, not the recipient Not billions given to buy loyalty of corrupt leaders Advocates for the poor rate the World Bank, IMF, & WTO fail! Vandana Shiva Look around. Ask people”

6 Who tilts the playing field... Development begins at independence Discovery of natural resources  impoverishment! Read: Confessions of an economic hit-man Donor countries insist that recipient open their markets... farmer’s lobby in rich countries get barriers Food must be bought from US farmers, processed in US mills, shipped in US ships We do: Our tax dollars, the leaders we elect Harper? Ignatieff? Layton? WTO? World bank?

7 a significant fraction will be unable to stay alive they live mostly in isolated rural areas most are subsistence farmers what they eat this month is what they can take out of the ground from last month's planting who to call in an emergency?... Page 7 The poorest of the poor Have resources worth less than $1 per day If you give a cell phone, battery will run down! Jeffrey Sachs video

8 Money? Useless Unless one has seen remote villages, it’s hard to imagine a community without commerce No shops to spend money in, no one to employ anyone, no one to sell things to Hungry & stunted children are all too visible. Those who didn’t survive are in tiny unmarked graves Hospital, dispensary, emergency services > 1 day walk Their needs are much more immediate than money. We don’t need studies to learn what they need - read on! Page 8 Don’t give them money …

9 What’s more important than $? Everything Short term – need to survive emergency rations, safe water, first aid, antibiotics, public health – vaccinations, drugs, &c In conflict zones, shelter, safety to live, plant, harvest Medium term - need is to become self-sufficient : good seeds, fertilizer, usable water, sanitation, low technology agricultural info & resources, drip- irrigation, mosquito nets, Page 9

10 Long term village needs tools for sustainable development health services, Dispensary pharmaceuticals, emergency nurse within 7 miles Hospital within 50 miles Transport system bicycle ambulance Every village has a cell phone, a motor-cycle Every truck-driver has a cell phone Kids need perinatal & long term nutritional support

11 Pitfalls problems & roadblocks Financial melt-down National scale land purchases Food  fuel... War on terror... Nations in bondage to IMF debt Unfair trade practices Climate change Globalization of food economics Clean water & air have become commodities Vandana Shiva on globalization Vandana Shiva on Food Laws Diverts development & aid $ Increases the price of foods Also  displaced persons & Destroys the local economy

12 Routes to famine Discovering resources... Armed conflict … Uncertain rainfall & drought... Being landlocked – no one to trade with... Bad governance... Afghanistan Out of a tiny acorn the mighty oak doth grow... South Africa Lesotho Being on a trade or pipeline route... Zimbabwe Everywhere Sahel, Palestine... or a tiny bonsai tree Let’s try to avoid blaming the victim, the people Yunus:

13 A vicious cycle: economics, hunger, health Page 13 Economic marginalization  inability to provide for self or family Poverty  diminished access to agricultural & food resources  malnutrition Physical & cognitive impairment, susceptibility to disease, early death  inability to earn an income nutrition

14 Initiatives making a difference Grameen Family of social enterprises The Kings of Philanthropy The Millennium Village project Influential voices for change Scientists & students who are making a difference The Millennium Development Goals You!... $7 can deliver an insecticide treated mosquito net If you believe 1 person can’t make a difference, you’ve never been in a tent with a mosquito MGH students

15 Innovations that make a difference Barefoot agiculturists Truck-drivers Soil conservation, don’t burn contour farming, irrigation, crop rotation Pump installation Burkina Faso planting-pits & stone furrows  land  food for 500,000 Tilapia in Phillipines for 30,000,000 Hybrid rice in China – enough for 60,000,000 Market liberalization in Bangladesh  rice yield 3x x x Millions fed

16 Zero-tillage wheat-seeder drill - $100? Labour goes further. Earlier planting  yield  Doubled yield  govt subsidy Farmer buys & rents to pay off loan 2 factories  100 in Haryana & Punjab


18 Appropriate technology Innovations that make a difference $25 pump irrigates ½ acre  $100/y net Watering can irrigation rainwater collection pits valve sub-surface drip irrigation

19 The Millennium Development Goals Page 19 World’s nations committed to meet 8 goals by 2015 The development challenges were identified Specific actions & targets (the MDGs) A pledge to provide the means was made by 189 nations & signed by 147 heads of state The MDGs break down into: 21 quantifiable targets with 60 time-lined indicators. Some of the richest now say they will not meet their commitments... but those who keep faith &Arab states, Cuba, China &? will turn the tide

20 Nutrition & Millennium Development Goals Page 20 Primary goal is to eradicate extreme poverty & hunger Nutrition – direct prerequisite to goals 1, 3, 4, 5 & 6; indirectly to 7 & 8 see next 2 slides 1  maternal health  Child mortality  Gender equity Empower ♀ Achieve universal primary education  HIV, malaria, other diseases  Environmental sustainability Global partnership for development

21 Centrality of nutrition to MDGs 1, 2, & 3 Page 21 1. Eradicate extreme poverty & hunger. Poverty is the main determinant of hunger. Malnutrition irreversibly compromises physical & cognitive development & transmits poverty & hunger to future generations. 2. Achieve universal primary education. Malnutrition diminishes the chance that a child will go to school, stay in school, or perform well in school 3. Promote gender equality, empower women. Women’s malnutrition impairs the whole family’s health & nutrition

22 Centrality of nutrition to MDGs 4, 5, & 6 4. Reduce child mortality. Delivery of a live healthy child is dependent, above all, on a well nourished mother. Protein & folic acid are critical here 5. Improve maternal health. Malnutrition accentuates all major risk factors for maternal mortality. NB protein, iron, iodine, vitamin A & calcium 6. Combat serious infectious diseases. Malnutrition aggravates infections,  immune competence,  transmission & mortality in HIV, malaria, tuberculosis Page 22 Adapted from Gillespie and Haddad (2003)

23 Solutions to global hunger are within our reach - IFPRI "Successes in agricultural development need to be recognised... so that others can learn lessons from them“ "The need to invest in agriculture is more important and urgent than ever before."

24 Progress toward elimination of poverty Millennium Development Goals Report Panel of experts July 2009 Many factors complicate interpretation BRIC countries (Brazil, Russia, India, China) break the curve Sub-Sahara Africa has not done as well Experts agree that the situation has worsened since 2008 – food prices remedy is urgent

25 Slow progress toward the MDGs Page 25 Only goal #2 is fully within reach! At half-way, most MDGs are partly met.

26 Who gives 0.7% of GNP? Myths, truth, & omissions $57.5: given by the EU’s 20 most developed countries $22.74: given by USA with about the same population US aid goes mostly to nations it can use Kuwait gives 8.2% of GNO, Saudi Arabia 4% in 2002 Cuba may give the highest % of GNP. China & India?? Myth: In absolute terms the USA gives more than anyone else Truth: Omissions:

27 Social enterprizes – Grameen family

28 Grameen family of Social Businesses 1 Grameen Community Development Bank for the poor (p) 2 Grameen Trust (np) 37 countries 3 Grameen Fund (np) Risk capital for small-med business 4 Grameen Telecom (np)  poor to profit from a cell phone 5 Grameen Phone (p) 50% of all telephones in Bangladesh 6 Grameen Solutions (p) fast-growing software company 7 Grameen Communicns (np) soft & hardware networking 8 Grameen Fish & Livestock (np) village aquaculture & dairy 9 Grameen Shakti (np) renewable energy in remote regions 10 Grameen Shikkha (np) educational loans literacy & tech 11 Grameen Byabosa Bikash(np) supp services for microcr. 12 Grameen Danone Foods (p&np) nutritious food near cost 13 Grameen America (p) alleviate poverty in working poor

29 Microfinancing successes Donkey carts for $200 repay in 2.5 mos 4 Factories for treadle pumps. Now there are 75 Drip irrigation allows winter cukes @ 3x price. 1A farm profit $100  $550 / yr Business Week

30 Grameen Impact 9.4 million poor have been helped 1,000,000 microloans have been generated Grameen village phone 10M subscribers 300k cell-phone ladies



33 Millennium Village Project Farm production Gender equity Nutritional services Energy & environment Health services Water Prevent malaria & TB Environment

34 The GOBI prescription: doesn’t have to be big $ Growth monitoring Oral rehydration therapy Immunization Breast-feeding Child health – low-cost solutions $14 can save a child’s life (2 mosquito nets@$7)

35 Eliminate hunger & malnutrition in the village increase production of nutritious foods improve nutritional status of pregnant & nursing mothers & infants < 2 Provide equipment for a safe supply of drinking water Equip kitchens with improved stoves outfitted with a chimney Renovate or construct a local clinic & dispensary Train local community health workers for home-based care micronutrient supplementation

36 Access to clean water & sanitation Explore and cost options technologies (e.g. boreholes, dug wells) for increasing water supply at the household level at each village Install and train community in rainwater harvesting and collection from rooftops and storage tanks in schools, medical facilities and other appropriate buildings in the area Provide material and training to filter and/or disinfect all collected water depending on the raw water quality Promote the creation of ventilation improved pit latrines Rainfall pits Drip irrigation

37 Improve livelihoods & increase incomes for agricultural workers Provide technical expertise and required inputs to diversify parts of farmland to higher value products after food security is achieved focus on improving nutritional status of pregnant women, nursing mothers and infants under two Provide equipment for water harvesting techniques for small-scale irrigation Develop organized systems for selling products to more distant markets and purchasing farm inputs Provide training to develop new village businesses (e.g. agro-based processing, small livestock cooperatives, small-scale artisans) Assist farmers and entrepreneurs to partner with larger food processors, supermarkets and export-oriented distributors Provide all-weather vehicle access road and village vehicle

38 The Kings of Philanthropy Bill Gates $28b + Warren Buffet $37b ($10b to B&M Gates) George Soros $6b Gave $1b to start world's largest social entrepreneurship foundation Omidyar ebay owner $10b a conversation with the world to discuss the direction of their philanthropy Ashoka Bill Drayton CEO, Lecturer at Harvard & Stanford "In US people are very down on foreign aid, because its just not working! University in a box Rider Sahel Jeffrey Skoll $1b ebay ceo President Obama proposed $50-million for the Serve America Act Jim Brockerman Benetec Silicon valley deliberately non-profit Ben Kingsley balancing the planet Ted Turner $1b to UN programs EU gov money will follow Rockefeller Philanthropy advisors President Melissa Berman has guided $1b in private resources for public benefit The person giving the $ away has a hard time getting honest criticism There's a need in philanthropy to set very high goals Need for a critique CBC Ideas 2009

39 Resources for a world without hunger Clinton Global Initiative Bill & Melinda Gates Foundation Grameen Family of Social Businesses Millennium Village Project (WHO, UN, Jeffrey Sachs) Official Development Aid The Cuba, China model for bootstrap development University Global Health initiatives Sweden, Luxenbourg, Norway, Netherlands, Denmark spreading in Africa, Latin America, Middle East Spreading in Latin America, Africa, USA, Australia, Canada, Switzerland – through student power, and top administration, not...

40 What can we do?

41 Take home message Catastrophic inequities in distribution of foods Kinds of nutritional status & health impact Through the life cycle, the hardest hit are We’ve faced difficult questions re inequities As we face the future we are... A billion overweight - a billion hungry water, protein, iron, vitamin A, iodine “Not by accident?”; “Who’s responsible?” childbearing women and children not just across nations – increasingly within Impatient Optimistic

42 America is well covered in text, Canada gets a nod - world is ignored! Roadmap to the next 2 lectures 1.Where are we, the world, now? 2.How did we get here? 3.Where are we going? 4.What is working and isn’t Compare your mindset with evidence-dataset Indignation at inequities & the causes Realistic optimism re a world without hunger Impatience at slow progress & cost in lives

43 Next lecture Nutritional concerns in Canada and in LMICs

44 Do we need to know? We ignore our compassionate impulses at our peril We live in an interconnected world

45 Nutrition in relation to global health For all nations, rich & poor, among the immediately modifiable factors that affect individual & public health … nutrition is of prime importance nutrition determines physical health & development through the life-cycle, including: – Success in childbearing, cognitive function, socio-economic independence, education, disease resistance & employability – Health & economic development are contingent on provision of adequate food, nutritional resources & support at every stage of life lays a foundation for the ensuing stage Page 45



48 Page 48 Nutrition in Global Health C auses, mechanisms, solutions 1. Why nutrition is crucial to global health & MDGs 2. Overview of nutrition across humankind 3. Human nutrition fundamentals in global context 4. Top five world nutrition problems, & their solutions 5. Nutrition across the life cycle & in rich and poor nations 6. Cause & effect: Determinants in population nutrition 7. Roadmap to a world without hunger: Nutrition Part II

49 Worldwide distribution of malnutrition Over 20 million children suffer from acute malnutrition WHO Page 49 Scientific American, Sept 2007

50 Worldwide, nutritional inequities follow poverty (as do health inequities & life expectancy) Globally, there is plenty of food for everyone but …those who have more than they need don’t want to share The result – in the time we spend on this module over 1000 children will have died of hunger Each day 1500 children go forever blind from lack vitamin A The poorest are 50-200x more likely to die in pregnancy About 2 billion people (56% of pregnant women) have iron deficiency. Their babies have low birth-weight, &  mortality Page 50

51 The goal is to see everyone self-sufficient, The MDG agreement & promises of 0.7% of rich country GDP for aid could, in a few years, eliminate extreme poverty & hunger But there are some nations whose promises mean little. Long before 2008, US & Canada “changed their minds” Thanks to those nations that keep their promises, extreme poverty will be largely eliminated, but in 50 (not 15) years Page 51 Note g

52 Some communities may need long-term help Even among the richest, there are some individuals so marginalized that there seems little hope for them The larger culture, if it is compassionate, takes long-term responsibility for ensuring them the necessities of life Globally there are communities that have been denied the resources to ever become wealthy. Often from geography, climate, invasion, or appropriation of their natural resources Regardless, a world community of compassion provides the necessities of life, & offers new life to refugees the dispossessed, even North America once opened its doors Page 52 Note h

53 Roadmap to a world without hunger- what works & what doesn’t

54 Canadian nutrition in global context Nutrition Canada Report 1974 The good We are privileged c.f. the rest of the world No difference among income groups! The bad >10% of population are at risk for (& signif clinically) folic a 60%, thiamine, vit C, iron, fibre, fluoride, Ca The ugly obesity is widespread 9/10 provinces - diabetes alcoholics, teenage girls, first nations, vegetarians big differences among income groups (new data)!! Compassion for the needy, but no political action at home or abroad

55 Reasons for the decline On the Canadian scene We exercise too little 2 out of 3 don’t consume recommended food groups Healthy foods are priced out of the reach of many... fish, fruit, some vegetables, nuts... mass produced junk is cheap & promoted Social concerns no longer  political action No update of 25 year-old data On the global scale We are no longer good global corporate citizens

56 The N American diet lacks: Ca, iron, folate: present in available foods Iodine, vitamin D: in fortified foods Fluoride, fibre: supplement indicated vitamin E, Mg, Zn: no symptoms despite intakes below the RNI Most of all we lack evidence-based info misinformation is commercially driven Even more true globally misinformation is political & ideological

57 Page 57 Nutrition in Global Health C auses, mechanisms, solutions 1. Why nutrition is crucial to global health & MDGs 2. Overview of nutrition across humankind 3. Human nutrition fundamentals in global context 4. Top five world nutrition problems, & their solutions 5. Nutrition across the life cycle & in rich and poor nations 6. Cause & effect: Determinants in population nutrition 7. Roadmap to a world without hunger: Nutrition Part II

58 Determinants of population nutrition Page 58 Any broken link can  nutritional inequities. Think about how …

59 The mechanisms of hunger – many paths Page 59 “Repositioning Nutrition as Central to Development: A Strategy for Large- Scale Action“Repositioning Nutrition as Central to Development: A Strategy for Large- Scale Action” Notice how one path can feed-back to affect others As diagrammed by WHO in

60 Sub-determinants of nutritional sufficiency Page 60 Each factor has its own contingencies. Here are a few: Economic development depends on agricultural sustainability irrigation & soil maintenance (crop rotation, contour plowing) seeds, fertilizers, appropriate insecticides Agricultural productivity depends on good harvests climatic – drought and floods drought- and frost-resistant crops hybrid seeds and related biotechnology market for any excess crop, non-exploitative pricing

61 Sub-determinants of nutritional sufficiency Page 61 Each factor has its own contingencies. Here are a few more: Stability includes freedom from disruptive forces war (revolts, invasion, political upheaval, social disruption) exploitation from outside corruption externally – from rich countries or multinational corporations who offer bribes corruption internally –where some developed nations set a poor example e.g. non-transparent procurement policies

62 Poverty - greatest cause of malnutrition (hunger, blindness, disease, birth defects, maternal/neonatal death) Page 62 The causes of poverty are disputed – no one wants to be part of the cause. What we know is…. Poverty doesn't just happen, it is caused by economic, political, social & geographical circumstances & and decisions Usually these decisions are made outside the groups of people most affected by it!

63 Poverty - greatest cause of malnutrition (hunger, blindness, disease, birth defects, maternal/neonatal death) Page 63 Old people, women and under-supported children are most likely to be impacted by poverty Uneven distribution: 2 / 3 of undernourished people live in Asia Hunger is growing fastest in Ethiopia, Sudan, Rwanda, Burundi, Congo, Sierra Leone, Zimbabwe, Somalia, Kenya and Tanzania.

64 Page 64 Nutrition in Global Health Core concepts: Global nutritional issues: causes, mechanisms, solutions 1. Why nutrition is crucial to global health & MDGs 2. Overview of nutrition across humankind 3. Human nutrition fundamentals in global context 4. Top five world nutrition problems, & their solutions 5. Nutrition across the life cycle & in rich and poor nations 6. Cause & effect: Determinants in population nutrition 7. Roadmap to a world without hunger (Millions more are being fed but without urgent action, millions more will still starve. Introduction to Part II Nutrition module)

65 Where are we? Considerable hope for the future, with great distress & urgency in the present Page 65 Globally, more are now adequately fed than ever before. Many populations are growing... and yet the percentage being fed continues to increase The MDGs will mostly be mostly met... but not on schedule, while extreme hunger decreases worldwide

66 Where are we? Great hope for the future, with great distress & urgency in the present Page 66 Does that mean we are doing enough? Absolutely not! Sadly, improvements in nutrition are not equally spread: in Africa more are hungry Most of us born today will live to see hunger shrink to temporary pockets, efficiently managed by food aid Meanwhile, each year of delayed progress millions of lives are needlessly lost

67 What has changed? At last it’s clear Disparities are now so great that there is now complete agreement that the plight of the poorest must be addressed The cost of conferring great benefits is a fleabite to the rich. $20 from an individual can save a child’s life and 0.7% of GDP from the richest nations could, in two decades, wipe out the deadliest disparities

68 What has changed? At last it’s clear Page 68 What’s needed was defined in 2001. Amazingly 22 nations signed on to fund 7 MDGs with 60 indicators of success, and to provide the funds! 1 st aim: eradicate extreme poverty & hunger We’ve seen what worked & what didn’t. The MDG projections were accurate, but...

69 While some well-intended nations... Page 69... honoured their commitments in full, or at a higher level (here we honour Northern EU & Kuwait)... most provided approximately half the aid that they undertook – (here we include many nations of west-central EU & Saudi Arabia)... a very few provided a fourth or less of what they contracted – (here we must list the nations of N. America) the consequences are unsurprising….

70 Page 70 The consequences are unsurprising Thanks to nations & individuals who put worthwhile goals ahead of personal greed, we see a better nourished world emerging The majority of nations are now solidly on the development ladder Millions will die unnecessarily in Sahel & sub-Saharan Africa, and the major cause rests with a few nations

71 Roadmap toward a world without hunger Page 71 We’ve concluded Part I of the nutrition modules with a preliminary assessment of prospects for “eradicating extreme poverty & hunger.” In Part II we ask “ what works and what doesn’t? ” We will… 1.… discuss the confounders & wild cards & elaborate on the range of possible future scenarios 2.… contend that many controversies fail to realize that many “competing” approaches are, in fact, complementary 3.... categorize competing viewpoints as evidence- or ideology- based & subject them to the test of science 4.… survey current strategies, assessing their strengths, weaknesses, & applicability to real life problems

72 Review your pre-quiz to confirm that you have advanced your knowledge. As we move now to the future, here is part of the pre-quiz for the Part II Nutrition module Page 72 Does globalization promote nutritional health? For whom? Is free enterprise good for everyone? If not, for whom? Are most African leaders dictators? Does most Africa aid end up in Swiss bank accounts? Does food aid do more harm than good? Academics & politicians argue about these questions and what should be done. Does that mean that we don’t know what to do? We will show in Part II that the answer is: Absolutely not!

73 Summary: What you’ve learned (& applications) Nutritional health is not equitably distributed worldwide Correcting nutritional inequities is crucial to a viable future We've reviewed nutritional principles in global context Nutritional health, public health, & economics are inseparable Worst nutritional risks: water, protein, iron, vitamin A, & iodine. Putting this information to work in context helps us know what to look for, what to ask for, and what to do

74 Summary: What you’ve learned & its applications Across the life cycle, kids & mothers are at greatest risk. So we know priorities & best practices for risk mitigation We have seen setbacks, slow progress toward the MDGs We have substantial agreement about what needs to be done We see powerful signs of hope: fortunes given away, crazy ideas, lending money to the poorest & getting it back, & fresh voices with new workable strategies for a better future We join those working for a better world with renewed clarity & energy

75 Acknowledgements I can single out only a few of many whose insights, persistence, & courage evaporated the dread & pessimism with which I began this task. In rough chronological order: Jeffrey Sachs, Yunus Muhammad, Raj Patel, Kumi Naidoo, Paul Collier, Howard Zinn, and Frances Moore Lappé I learned from them, and others of a generous spirit, that: (1)clear thinking & scientific evidence trump ideology (2)generosity & compassion can flourish amid greed (3)a combination of indignation, optimism and impatience

76 Useful links for additional information Page 76 Note ff: Tool kit for finding information An amazing collation of resources is available The New Zealand Digital Library Project is maintained by Lethbridge University in Canada, and is machine searchable at Each of the following selection of topics has many dozens of useful (evidence-based) modules on topics relevant to the tool kit of an "agent of change" Agricultural Information Modules Medical and Health Library Virtual Disaster Library FAO on the Internet (1998) FAO document repository Collection on Critical Global Issues Food and Nutrition Library 2.2 WHO Health Library for Disasters Indigenous Peoples Poverty Alleviation Greenstone wiki collection

77 Sources Books, publications, and talks from any of the writers mentioned in the Acknowledgements section are a reliable source of information regarding what works and what doesn’t in relation to aid. Germs, guns & steel Confessions of an economic hitman Salud! Sources of government information Supercourse WHO Nutrition Nutrition databases Nutrition & Global Health: Micheline Beaudry is professor of Community Nutrition and International Nutrition at Universite Laval in Quebec city, Canada (since 1989). From January 1995 to December 1996, she was on leave from the University and Chief of the Nutrition Section in UNICEF Headquarters (New York). Previous positions include professor at Universite de Moncton (1980- 1989) and

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