Médecins Sans Frontières / Doctors Without Borders (MSF) UK Life on the margins: the inequality of food and nutrition security POVERTY, VULNERABILITY AND HEALTH INEQUALITIES PowerPoint presentation by Médecins Sans Frontières / Doctors Without Borders (MSF) UK Schools Team: Mary Doherty and Severa von Wentzel January 2014

Left behind, left out “A long but inequitable period of economic growth has lifted many developing countries into middle-income status but left a minority of their populations mired in poverty. Since countries involved include China and India, even a minority amounts to a very large number of people” - “Free Exchange, the geography of poverty”, The Economist, September 1st 2012 “Growth alone does not guarantee less poverty. Income distribution matters, too. One estimate found that two thirds of the fall in poverty was the result of growth; one-third came from greater equality. More equal countries cut poverty further and faster than unequal ones” “Briefing Poverty: Not always with us”, The Economist June 1st 2013 Action for students: What does marginalisation mean? What does the author mean by ‘mired in poverty’? What is meant by ‘inequitable growth’? Clearly, growth on its own does not guarantee less poverty. Income distribution matters too. What is meant by ‘income distribution’? In your answer, refer to the GINI co-efficient or other income inequality metrics. What is the difference between relative and absolute poverty? Note to teachers: There is usually a link between economic growth and a declining proportion of the population that is hungry, but economic growth can also be accompanied by increased poverty and hunger. Income distribution is an important concept. Understanding that there is variation within populations and within regions is important. Many countries have seen a broader rise in disparities all along the income distribution with rising numbers of ultra-wealthy, an increase in the share of income received by the top 1%. Absolute poverty: a set standard consistent over time and between countries; e.g., percentage of the population eating less food than required to sustain the human body. Relative poverty: defined and dependent on a social context; e.g., comparing the total wealth of the poorest one-third of the population with that of the richest one per cent of the population.

Life on the margins Overview slide Why do so many people live on the edge of survival whilst there is enough food globally? Growing inequality poses one of the biggest social, economic and political challenges. Today’s disparities and their dangerous likely trajectory reduce the pace of human development most markedly for education and health. Why does some form of hunger and malnutrition exist in every country? Hunger and obesity, which can both be forms of malnutrition*, are complex conditions and a serious worldwide problem. The deadly cycle of poverty, malnutrition and disease is also largely preventable. Malnutrition is directly affected by physical factors such as low nutrition. It is indirectly affected by social inequality, poverty, education, social status of women, food systems, climate change and the resilience of vulnerable populations to stressors such as drought, floods, price hikes and conflict. Malnutrition: An abnormal physiological condition caused by inadequate, unbalanced or excessive consumption of macronutrients and/or micronutrients. Source: The Lancet “The complex challenge of hunger” http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962198-4/fulltext

Left out, left behind “The world is doing a lot better than it ever has in the past, at least on average. And that's terrific news. Not so good news is that a lot of people got left behind and haven't got there yet.” – Angus Deaton Vulnerable groups of people Landless rural dwellers Anyone on a low income Refugees and displaced people People with low literacy rates Women and children and aged Urban dwellers with no formal employment People with poor health especially HIV/AIDs, Malaria Ethnic/religious minorities Socially excluded Note to teachers: Aggregate indicators do not reflect inequality within a country, communities and households. Source: Edexcel Student Guide Unit 4, Option 3; http://www.edexcel.com/migrationdocuments/GCE%20New%20GCE/Unit-4-Option-3-Life-on-the-margins-Food-supply-problem-final.ppt.; http://www.econtalk.org/archives/2013/11/deaton_on_healt.html

Factors of people on the margins Action for students: Note in your folder the factors experienced by those at the very bottom of the income distribution. Those on the margins tend to have one and usually more than one of the following factors: Live in remote areas, Have low literacy, few assets and are low-skilled Poor health with little or no access to a medical, public health or welfare system, Stem from socially or economically excluded groups (e.g., ethnic minorities, migrants, refugees) or parts of society (e.g., women in some cultures) Be landless (non-landowning, dispossessed or nomadic) Be victims of natural hazards, violence or war Be aware that statistics may be presented in different ways – for example, the absolute number of hungry people is increasing with the growing world population while the percentage of people who are hungry in the world is declining. . Note for teachers: You may also wish to consult “The poorest and hungry” by Joachim von Braun http://www.ifpri.org/sites/default/files/publications/oc63.pdf You may want to discuss with students during which period poverty reduction measures had the greatest impact. You may also want to discuss with students the possible reasons why poverty rates have fallen most swiftly in east Asia and the Pacific. Income gaps between countries have not narrowed over the past 50 years in spite of the scope for rapid catch-up growth. On the one hand, there have been countries such as Malaysia and Thailand that have become richer and more developed and countries with very large populations - China and India - have experienced rapid growth, but African states such as Congo and Niger have actually lost ground and become poorer. Teacher resource slide: Sustaining life on the margins

Vulnerability Vulnerability can be variable within a country, within communities and even within households. It is not defined by income or wealth alone, but the key factor in the food insecurity cycle is wealth. There is a range of people more vulnerable to food insecurity. Note to teachers: As growth has slowed, this has meant widening gaps between people within most countries. Source: http://siteresources.worldbank.org/EXTPREMNET/Resources/EP125.pdf

Well-being: Health, wealth and inequality Well-being is not defined merely in terms of material living standards, which is one of its parts. It is judged by looking at the whole, not one or more of its parts. Above and beyond an average, inequality must be taken into account to judge well-being. The concept includes: Income and wealth Physical and psychological state (health and happiness). These are about how people are when they are alive, not just living and dying. Education Ability to participate in society. Action for students: Watch the Financial Times interview with Angus Deaton on health, wealth and inequality. What has been the trend in the last decades and how is progress measured? http://press.princeton.edu/titles/10054.html

Inequality by region for health, education and income Income inequality is correlated with health / social problems Individual income / circumstances, background (culture, ethnicity and history) and welfare state institutions and social policies can also be correlated with well-being. Note to students: correlation does not equal causation (producing an effect). A correlation (mutual relationship) between variables does not mean that one causes the other(s). Note for teachers: It may be worthwhile to spend some time teasing out with students what is meant by causation and also what is meant by correlation. Again, it may well be worthwhile enlarging this slide or enlarging it and providing hard copy which students can share to inform discussion. Students could also identify the way in which the three graphs link with reference to specific areas. There have been remarkable successes in health notably antibiotics, pest control, vaccinations and clean water, but also big setbacks such as catastrophic famines and the HIV/AIDS epidemic. K Source: 2013 Human Development Report http://hdr.undp.org/en/reports/global/hdr2013/; Joseph Rowntree Foundation “Does income inequality cause health and social problems?” http://www.jrf.org.uk/sites/files/jrf/inequality-income-social-problems-summary.pdf

The causes of health inequalities More inroads are being made into global inequality, if you take improvements in health into account. The gap between life expectancy between countries has shrunk since the second world war. Note to teachers: You might want to relate this slide to the pillars of food security introduced later. Source: http://www.nao.org.uk/wp-content/uploads/2010/07/1011186es.pdf; http://www.economist.com/news/business-books-quarterly/21587755-measuring-fairness-sickness-and-health

Inequality and poverty globally and locally One of the world’s great challenges today, poverty and inequality (income, gender, etc.) affect the well-being of populations or parts of populations. A triad that holds true for all populations, Poverty reduces Dietary Quality/Adequacy and lowers Health. The development gap describes the social and economic disparity between the wealthy and the poor between and within countries The global development discourse has moved from the Brandt Line and indicators on income (e.g., GNI, GDP, PPP) to Social indicators, deprivation, adult literacy, access to fresh water. Qualitative indicators dealing with vulnerability, Inequality, empowerment and human rights. BUT the global measures of inequality and poverty are fraught with difficulties. In terms of inequality, the development discourse refers to gender and malnutrition mostly in LEDCs countries. Adverse political and social policies, instability and conflict are at the root causes countries of countries on the wrong top ten (e.g, DRC, North Korea). Note for teachers: It may be helpful to take some time to discuss this slide with students. Throughout this section students are presented with information in the form of maps, charts, graphs etc. You and students will need to consider what are the key messages of each slide, how students can capture these messages and how they could be used in the report they will prepare in the examination.

Income groups Source: http://passthrough.fw-notify.net/download/253468/http://www.grida.no/files/publications/FoodCrisis_lores.pdf

Inequality Inequality can emerge as a consequence of progress and affect progress. Inequality also has its own effects. Modern inequality was brought about by modern economic growth. North-West Europe and North America started experiencing sustained economic growth about 250 years ago and pulled away from the rest of the world. This ‘Great Divergence’ set the stage for the persistent gaps, the hugely inequalities of the present day. The starkest evidence: around a billion people still have low life expectancy and live in abject poverty. Overall, the trend is encouraging, but the list of countries falling behind is getting longer. Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.

Comparing living standards How do we compare who is poor, to what extent and who is not? Does being poor mean being hungry? The rhetorical link between poverty and hunger remains firmly established even though the only the poorest in poor countries actually spend most of their money on food. Economic growth means that: People become better-off, and even while they are still poor by most standards, they spend a smaller fraction of their budgets on food. Economic growth makes it increasingly difficult to think of poverty entirely in terms of food. How to compare living standards around the world and count the number of poor people on the basis of those comparisons? Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.;; http://siteresources.worldbank.org/EXTPREMNET/Resources/EP125.pdf; http://www.rrojasdatabank.info/deaton_povertymeasured.pdf

Comparing income between countries Comparisons between countries that are broadly similar such as USA and Canada or OECD countries can stand on relatively firm ground. PPP comparisons made between broadly similar regions or countries can be useful. It is very difficult to compare real income between countries, particularly where countries have markedly different relative prices and economic structures. Though these measures will be contested and debated, they can serve as the basis for global and national policy to allocate funds to the poor. They are adjusted from time to time.

Measures of income: Purchasing power parity In order to measure poverty, we need to measure income. Doing so across countries is difficult. Using foreign exchange rate of the local currency is basically meaningless. PPP Purchasing power parity helps compare living standards across the world. It is used instead of the official exchange rate to calculate the poverty line. Simply put, PPP can better account for how price levels vary across settings. For example, a price level for a bundle of goods will cost only 40% of what it would cost in the USA, so the PPP rate will be lower than the foreign exchange rate in India. Teams of international researchers and statisticians collect and average out data on the prices of comparable items in different countries to determine price levels around the world. The measure is far from perfect, because there are no market prices for a substantial share of what people spend. Note to teachers: Absolute versus relative poverty line – the absolute line sets a fixed amount deemed necessary to escape poverty. A relative line also takes into account what it takes to keep up with others in society. Where living standards are rising, an absolute poverty line, which is kept constant, can mean that the poor are actually falling further behind the mainstream of society. Poverty can thus be understated. Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.

Measures of income: poverty line Poverty line – is about defining a minimal standard of living, especially having enough to eat. Choosing a poverty line is fraught with difficulties and is almost always controversial. When states recognise poverty, they may also have to accept responsibility to offset its worst impacts by distributing funds to the poor. Originally conceived as calorie-based poverty lines in many countries around the world. The association with food also gives more political support to anti-poverty programmes. Lines have tended to be updated for inflation and changes in prices, so have usually been held constant in real terms. $ 1.25 / day – originally $1 / day, the World Bank Global Poverty Count number of people in the world who live on less than a dollar a day, where the international differences in prices are adjusted using purchasing power parity exchange. It gained currency with the World Development Report 1990 and was incorporated into the Millennium Development Goals. Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.

Poverty China and India, the two countries with the largest populations in the world, drove much of the reduction in global poverty since 1980, improving the lives of over 1 billion people. Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.;; http://siteresources.worldbank.org/EXTPREMNET/Resources/EP125.pdf

Poverty line Although the trend has gone down, poverty reduction measures have tended to help people living close to the poverty line, not the very poorest persons living on the margins. Graphs: http://siteresources.worldbank.org/EXTPREMNET/Resources/EP125.pdf

Global inequality cartogram * A cartogram depicts values by areas while preserving the aesthetics of relative geographic position in striking images depicting global inequalities. Global inequality cartogram Equal area cartogram* Action for students It may be helpful to provide students with an outline map (equal area cartogram) and ask them to label in green countries with the highest human development indices and to label in red the countries with the lowest human development indices. Students could then see at a glance how this compares to the Brandt Line or the north/south classification of countries. This may be the basis of a fruitful discussion. It may also be worth discussing with students the advantages of depicting global inequalities as distorted maps. You may want to enlarge this map on to A4 and print out a few copies for students to share and to inform the discussion about global inequalities. Source: http://www.worldmapper.org/display.php?selected=173

GINI co-efficient Action for students: What does the GINI coefficient measure? Explain the global index measure. Explain the key for this map of income distribution and give examples of most, medium and least equal countries. Note for teachers: The Examiners Report for June 2010 examination noted: stronger students used the IFPS Global Hunger Index and GINI/HDI indices. The GINI Co-efficient is a measure of inequality in incomes, a snapshot, rather than an explanation (why?) of outcomes. The Gini is constructed in a way that even a difference that sounds modest actually marks a significant difference in inequality; for example, on opposite scales of the spectrum, South Africa at the most extreme has a Gini co-efficient of 0.6 compared to around 0.25 for Scandinavian countries. The level of income inequality varies around the world, where emerging economies tend to be more unequal than rich ones. Global inequality has started to fall, but inequality within countries has risen. More than two thirds of the world’s people are in countries in which income inequality has increased, often substantially, since 1980. Teacher Resource Slide: Income Disparity since WWII K

North-South Division and the “Rise of the South” In the past the world was divided into North and South, also called the Brandt line after an 1980s report on the rich North and the poor South, the UNDP now reports on the “Rise of the South” with significant advances in countries like Brazil, China, India, Indonesia, Mexico, South Africa and Turkey. (See http://hdr.undp.org/en/reports/global/hdr2013/.) Note to teachers: It may be useful to discuss the North-South division even though it is losing validity, because it still is a common reference point in development discourse, a starting point to discuss how things have changed in the last decades. What can be some of the issues around preconceived dichotomies such as the West and the Rest (Third World)? The “North” continues to have an advantage owing to the superiority of its technology and infrastructure. Action for students: What are the strengths and weaknesses of the Brandt line as an indicator? Read Hans Rosling’s Debunking myths about the “third world” http://www.gapminder.org/videos/hans-rosling-ted-2006-debunking-myths-about-the-third-world/ Source: 2013 Human Development Report http://hdr.undp.org/en/reports/global/hdr2013/ Image success stories: http://www.economist.com/news/international/21573613-growth-national-income-poor-predictor-welfare-not-bread-alone

Southern success stories Source: 2013 Human Development Report http://hdr.undp.org/en/reports/global/hdr2013/

Poverty line in the UK Action for students: Find out what is meant by the poverty line. Why is it useful? Where is it set? Who sets it? Is it relative in relation to different countries? Is the experience of poverty the same in the UK and the developing world? Note some of the similarities and differences relating back to the factors. Start your research with the Trussell Trust. Note to teachers: You may wish to remind your students to avoid simplistic statements which are re-modelling of environmental determinism with a little Malthusian theory mixed in (feedback from examiner’s report). Source: http://www.trusselltrust.org/foodbank-projects

English North-South divide? Action for students: Read The Guardian article on “Deprivation mapped: how you show the poorest (and richest) places in England” including an animation on the English indices of deprivation. How and why do you map micro-level deprivation? What are the limitations, inaccuracies of scale (e.g., South Africa – Lesotho) on maps? http://www.theguardian.com/news/datablog/2011/mar/31/deprivation-map-indices-multiple K Crown copyright and database rights 2012 Ordnance Survey 100020290 Source: http://www.noo.org.uk/uploads/doc/vid_16966_AdultSocioeconSep2012.pdf

Living on the margins in the UK Being left behind is not only confined to countries with low income as indicated by the graphs on growing income inequality and the poorest tenth in the UK, for example. Note for teachers: This slide highlights that poverty also exists in the UK and income inequality is growing particularly for the poorest tenth. It will be worthwhile spending time discussing with students what these graphs show and the implications for those at the margins in the UK. http://www.poverty.org.uk/09/bh.png Graphs: http://www.poverty.org.uk/09/bh.png

Poorest closer to home 3.8 million children estimated to be living below the poverty line 3 million people estimated to be suffering from malnutrition in the UK 3.8 million children in the UK currently living below the poverty line. Nutritious food perceived as too expensive and out of reach Note for teachers: Again, it would be fruitful to spend some time on this slide unravelling what the data shows. It may also be worth prompting students to consider the key messages they should record from this data to have accessible during the pre release phase if necessary. “The long economic slump and the rising price of food and energy have already made life harder for the very poorest. At a church in Brixton, South London, desperate flock wait for parcels of donated food....In the past, children collected food for the elderly, remarks the vicar. Now they collect it for their classmates” Image of report: http://www.cpag.org.uk/sites/default/files/Going%20Hungry%20young%20peoples%20experiences%20of%20Free%20School%20Meals.pdf Image and graph from “Measuring Poverty: The end of the line”, The Economist November 17th 2012, http://www.economist.com/news/britain/21566691-government-sets-out-redefine-what-it-means-be-poor-end-line Source: http://news.bbc.co.uk/1/hi/health/7879201.stm; Report: http://www.cpag.org.uk/sites/default/files/Going%20Hungry%20young%20peoples%20experiences%20of%20Free%20School%20Meals.pdf

Austerity measures and inequality in the UK “I felt very ashamed having to go to a food bank the first time. It was down to my son’s school liaison officer coming round to my house, because I hadn’t sent my son into school for a couple of days as I couldn’t afford a packed lunch for him and I couldn’t afford to pay for a school dinner. I couldn’t do what a mum should do for them – look after them. I couldn’t even feed them. That just makes you feel really low as a parent.” Lorna, school dinner lady and mother of three, Tower Hamlets, London “The long-term social cost of the economic crisis has been underestimated. More people are being evicted from their homes. More people are trapped in over indebtedness, as they face increased living costs with reduced income. Child poverty is growing and young people are being deprived from the possibility to imagine a future. Vulnerable people feel more and more stigmatized in the public opinion, as if they were responsible for their situation and if social protection was a luxury in times of austerity.” European Anti-Poverty Network, August 2013, as quoted in Oxfam’s ‘ A Cautionary Tale’ Action for students: Read Oxfam’s Briefing Paper “A Cautionary Tale”, September 2013: English paper and UK case study ‘http://policy-practice.oxfam.org.uk/publications/a-cautionary-tale-the-true-cost-of-austerity-and-inequality-in-europe-301384?cid=disp_PP_Net_twt19 What reasons and experiences does the report give for why austerity measures in the UK have increased poverty and inequality? Why are the poorest and women hardest hit? Note for teachers: Again, this Action for Students provides a very useful diagnostic opportunity to gauge students level of understanding of the issues and the challenges of A level study.

LIFE ON THE MARGINS: Urban – Rural LINKS

Rural – urban food and nutrition (in)security There is a myth that food insecurity is a rural problem that will be resolved through technical innovation among smallholders. Actually, rapid urban growth in developing countries and informal settlement expansion have been correlated with a significant rise in undernutrition in urban populations. Rural and urban areas also tend to be perceived as separate spheres with a deep divide between them.. Actually, it’s a two-way flow where rural-urban contexts and households are highly interconnected. People, goods and money move in and out along a spectrum. Financial remittances can play an important part in rural development. Rural households buy some or most of their food with cash from family members who have moved within the country or across borders to earn income Migration and urbanisation can have ambiguous consequences for nutrition security, as they can help poverty alleviation, but also obstruct it. In town and village, increased production rather than more equal access to food is often assumed to be the answer to food security; actually, access to food – notably, lacking means to purchase food buy it - can be a greater issue. Urban households are more dependent on food purchase. Note to teachers: You may wish to refer to the Food and nutrition security presentation Source: http://www.cigionline.org/articles/2012/07/migration-must-be-food-security-agenda

Urban terms “Megacities: A city with a population of 10 million or more residents – largest are Delhi, Shanghai, Mexico City, New York and Tokyo with over 20 million. Metropolitan area: A large concentration of population, usually an area with 100,000 or more people. The area typically includes an important city with 50,000 or more inhabitants and the administrative areas bordering the city that are socially and economically integrated with it. Urban: Countries differ in the way they classify population as "urban" or "rural." Typically, a community or settlement with a population of 2,000 or more is considered urban. A listing of country definitions is published annually in the United Nations Demographic Yearbook. Urban agglomeration: Refers to the population contained within the contours of a contiguous territory inhabited at urban density levels without regard to administrative boundaries. It usually incorporates the population in a city or town plus that in the sub-urban areas lying outside of but being adjacent to the city boundaries. Urbanization: Growth in the proportion of a population living in urban areas.” Peri-urban are located in-between consolidated urban and rural regions and have also been traditionally important in food supply. Outskirts of large cities (e.g. Beijing) are under constant threat from urban sprawl. Peri-urban areas tend to be defined by mixed land use, poorer urban infrastructure and lower demographic density. Note for teachers: These are important definitions and it may be helpful to set students a task of learning them for a short test. Source: Definitions taken verbatim from http://www.prb.org/Educators/TeachersGuides/HumanPopulation/Urbanization.aspx

Place of residence Urban versus rural Recent studies indicate that socio-economic factors determine health status (indicator: child mortality) more than residence per se, so differences at the household level have a greater effect than at the community level. Urban versus rural Usually has a modern health care system, facilitating public health interventions (vaccinations, control of epidemic diseases, mother-to-child programmes) Usually more advantageous environmental conditions – better electricity and water supply. Road and rail links usually ensure more constant and abundant food supply But population explosion not matched by increase in services in recent decades and access to services is uneven (proximity ≠ access) Traditional and cultural norms changed by more wide spread schooling, greater access to information and ethnic melting pot Source: Lalou, Richard and Thomas LeGrand Child mortality in the urban and rural Sahel http://webcache.googleusercontent.com/search?q=cache:E-GASt37RWQJ:www.researchgate.net/publication/236495789_Child_Mortality_in_the_Urban_and_Rural_Sahel/file/9c960517fb06a8fd4f.pdf+sahel+rural+urban+health+differences&cd=4&hl=en&ct=clnk&gl=uk http://www.ons.gov.uk/ons/rel/hsq/health-statistics-quarterly/no--39--autumn-2008/differences-in-mortality-between-rural-and-urban-areas-in-england-and-wales.pdf.; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831359/

Urbanisation and urban rural change Action for students: What are displacement factors? How can rural-urban links relate to life on the margins? Look at “Rural-Urban Links for Growth and Poverty Reduction”, Joachim von Braun, World Bank slideshare, http://www.slideshare.net/jvonbraun/ruralurban-linkages-for-growth-employment-and-poverty-reduction Watch clip on megatrends: population growth, urbanisation are displacement factors http://www.youtube.com/watch?v=BhBVm590Q7Qhttp://www.youtube.com/watch?v=BhBVm590Q7Q Article on urbanisation http://siteresources.worldbank.org/INTPROSPECTS/Resources/334934-1327948020811/8401693-1355753354515/8980448-1366123749799/GMR_2013_Overview.pdf On England’s big cities. Urban Living: The city roars back, http://www.economist.com/node/21559338 Construct a mind map or spider diagram on urbanisation and urban-rural migration, compare your diagram with a partner and then another pair, add in additional detail which you consider relevant from the diagrams of other students. Image: http://www.fig.net/pub/figpub/pub33/fig_1.jpg Teacher resource slide: Percentage of population in urban areas

Migration Huge urban growth is connected to urban-rural migration, and most urban growth is projected to take place in less developed countries. Magnitudes of migration varied greatly Negative net-migration is most likely in rural areas. Positive net migration concentrates around urban areas (e.g., New Delhi) Africa and Latin America’s population has declined due to out-migration across all decades. Asia has experienced fluctuations, but with overall out-migration. In Europe there was out-migration in 1970s and 1980s, which reversed in the 1990s. North America has had an increase in migrants. The positive net migration in North America and to some extent also in Europe may be for non-economic reasons, a move to drier and sunnier areas with good amenities like Arizona or the Mediterranean. Image and source: Center for International Earth Sciences Network, “Migration in Risk-Prone Areas” http://blogs.ei.columbia.edu/2013/02/04/migration-in-risk-prone-areas/

Urban and rural populations Action for students: Watch the TED Talk by Carolyn Steel on how advances in transport and technology have emancipated cities from geography such that they can grow to any size. Discuss why this has also distanced us from nature. http://www.2learn.ca/specialedition/worldfood/worldfood.aspx Urban and rural populations by population group 1950 - 2050 K Source: http://esa.un.org/unup/pdf/WUP2011_Highlights.pdf; http://www.nutritionworks.org.uk/our-publications/programme-review-and-evaluation/2011/153-urban-malnutrition-a-review-of-food-security-and-nutrition-among-the-urban-poor

Urbanisation trend: terms and figures The urban population is growing by 193,107 new city-dwellers: 2 every second. (UNHabitat). Urban growth highest in Africa and developing countries Note for teachers: This is an opportunity to emphasise synopticity- students will have learnt about the trend towards urbanisation in other units. Source UN Habitat http://www.un.org/esa/population/meetings/EGM_PopDist/Moreno.pdf; http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/8444.pdf

Rapid urban expansion K K The benefits of urban expansion are uneven. Urban settings are not as homogenous in terms of livelihoods and socio-economic status as rural ones, and they can vary significantly within and between settings, countries and continents. Note to teachers: Discuss with students the vulnerability of cities in the developing world to urban disasters and humanitarian crises. Can they support the discussion with evidence from recent events. K K Source: United Nations, World Urbanization Prospects: The 2007 Revision.http://www.prb.org/Educators/TeachersGuides/HumanPopulation/Urbanization.aspx; http://www.nutritionworks.org.uk/our-publications/programme-review-and-evaluation/2011/153-urban-malnutrition-a-review-of-food-security-and-nutrition-among-the-urban-poor http://www.prb.org/Educators/TeachersGuides/HumanPopulation/Urbanization.aspx

World urban population Cities of different sizes play important role. People also move from one city to another, not just from country to town. Agriculture has to compete for water and land with sprawling urban areas and populations. Population by city size in millions in 1970, 1990, 2011 and 2025 Distribution of the world urban population by major area 1950, 2011, 2050 % of world urban population K K Note to teachers: Teacher resource slide: Accelerated and declining city growth rate It may be worth having students work out that the cities with populations under 500,000 still account for the majority of world population, but that the rate of growth in larger cities has been far greater than in the smaller ones. You may ask students why the majority of the population lives in smaller cities rather than bigger ones. City size Major area Source: http://esa.un.org/unup/pdf/WUP2011_Highlights.pdf

Urban poor Whilst very diverse across regions, countries and even within cities, the urban poor tend to share deprivations day to day, including: Limited access to employment and income: urban poor are usually more dependent on informal sector jobs that do not meet their consumption needs. Women least likely to have secure jobs. Insecure and inadequate living conditions, Limited access to basic services and poor infrastructure, Vulnerability to risks (e.g., environmental hazards, natural disasters and health risks particular to living in slums) which impact household health Barriers to mobility and transport Problems of inequality and exclusion, as the (World Bank 2007) Source: http://www.nutritionworks.org.uk/our-publications/programme-review-and-evaluation/2011/153-urban-malnutrition-a-review-of-food-security-and-nutrition-among-the-urban-poor; WB 2007. Bangladesh, Dhaka: improving living conditions for the urban poor. Report No. 35824-BD World Bank; Sustainable Development Unit, South Asia Region.

Urban expansion and links to human well-being Note to teachers: This may be a revision slide that could underpin students’ synoptic understanding with an emphasis on well-being Source: www.unep.org/geo/geo4/report/03_land.pdf‎

Migration to cities: urban displacement Displaced people = refugees (migrants who cross borders) and internally displaced people (migrants within country) Scale is growing: numbers estimated at 72 million, with growing numbers moving into urban areas rather than camps Urban displacement trend becoming more protracted Causes complex, manifold and overlapping Low and middle income countries send and receive disproportionate number of urban displaced Migration not always rural to urban, also between urban areas Urban arrivals not homogenous group New arrivals exacerbate local vulnerability, as they compete with already resident urban poor for resources and livelihoods, which can lead to conflict Response to challenges beyond the scope of any one actor or sector: urban displaced people often beyond the reach of humanitarian and development agencies and other formal assistance structures Note to teachers: Emphasise how this mig ration to cities increases vulnerability. Refugee: a person who has crossed a national border to another country to escape conflict or persecution. About 15.2 million worldwide according to UN Refugee Agency. IDP: an internally displaced person seeks refuge from violence or disaster within the borders of the own country. IDPs outnumber refugees by more than two to one, but no single UN or other international agency has responsibility for responding to internal displacement. About 26.4 million worldwide according to Internal Displacement Monitoring Centre. Source: http://www.fmreview.org/en/urban-displacement/FMR34.pdf Simone haysome, “Sanctuary in the city? Urban displacement and vulnerability” http://siteresources.worldbank.org/INTPROSPECTS/Resources/334934-1327948020811/8401693-1355753354515/8980448-1366123749799/GMR_2013_Overview.pdf

Internally Displaced People (IDP) collective centre in former hospital building, Tbilisi, Georgia. An estimated 148 families live in this hospital complex which suffers from widespread rat and insect infestation and falling masonry Image and text: http://www.fmreview.org/en/urban-displacement/FMR34.pdf

Urban displacement Principal drivers: Climate change and natural disasters Armed conflict and violence Human rights abuses Dislocation due to development policies and projects Land grabbing Factors: Ethnic, clan or family ties Better access to basic services Perception of better economic opportunities Greater proximity to powerbrokers Increased security, host country not a fragile or failed state Degree of anonymity Potential to access humanitarian and development assistance Note to teachers: A useful summary slide. It may be worth checking ALL students understand the words and terms used. Further info: “Adapting to Urban Displacement”, Forced migration http://www.fmreview.org/en/urban-displacement/FMR34.pdf

Urban survivors: chronic vulnerability As of 2010 more than half of the world’s population lives in cities compared to 20% one hundred years ago. Urban growth rates and slum growth rates are nearly identical (UN Habitat) One in 10 lives in a slum, which have grown in numbers and size with urbanisation. Video life in megaslum Kiberia http://www.stwr.org/megaslumming/film/ Article 7 myths of slums http://www.stwr.org/health-education-shelter/the-seven-myths-of-slums.html Note for teachers: Ask students to watch the video at least twice and on the second viewing record as much information about Kiberia which is relevant to food security etc. People living in slums are often productive manufacturers and traders. Urban rural graph: http://www.grida.no/graphicslib/detail/biofuels production-2005-by-country ethanol-and-biodiesel_1353#; UNHABITAT http://www.un.org/esa/population/meetings/EGM_PopDist/Moreno.pdf A train, known locally as 'The Lunatic Express' passes through the centre of Kibera. © Francesco Zizola/Noor

Slum populations in developing countries 1990- 2010 Note to teachers: Since 1990, the share of the urban population living in slums in the developing world has declined significantly, dropping from 46% in 1990 to 33% in 2010. This decrease shows that many efforts to give inhabitants of slums access to improved water or sanitation, and/or more durable housing have been successful. On the other hand, the absolute number of people living in slums has increased by 26% over the same period, equalling 171 million additional people. “Although nowhere is immune from urban disasters and humanitarian crises, cities in the developing world are far more vulnerable to the consequences than those in the developed world. The risk of disaster [and humanitarian crises] is sharply increased by rapid urbanisation, and poorly managed or uncontrolled urbanisation and inadequate governance...” with less well-resourced small and medium-sized cities particularly vulnerable* Source: http://geodev.grid.unep.ch/extras/geg_slider.php; * Quote: http://www.fmreview.org/en/urban-displacement/FMR34.pdf

The Sahel: growth in informal urban settlements The Sahel is not only rural – a common misconception. The region with a population of about 50 million people has experienced unprecedented urban population explosion and most future growth is set to occur in cities. Urban environments are more heterogeneous than rural ones. Many of the newcomers are from most disadvantaged rural backgrounds, and thus have fewest resources to help them cope in cities. Economic decline or slowdown (stagnating or declining gross domestic product annually),results in urban economies strained with limited ability of local and national governments to provide minimally decent living conditions, basic social services and livelihood opportunities. Overcrowded and extremely unsanitary slums and shantytowns which leads to epidemics and outbreaks of diseases – pockets of severe deprivation, poverty and concentration of ill health. Health care systems affecting health and mortality tend to be better for urban than rural populations. However, overall the rural-urban gap in child health is narrowing due to increase in urban malnutrition, and health and nutritional outcomes for poor urban children can be worse in cities. Notes for teachers: Ask students to use the information on this slide and the next slide to construct a spider diagram with the title: The Sahel: growth in informal urban settlements Source: Lifland, Amy. Starvation in the Sahel http://hir.harvard.edu/crafting-the-city/starvation-in-the-sahel Urban-Rural Differentials in Child Malnutrition Trends and Socioeconomic Correlates in Sub-Saharan Africa http://irnegotiation0708.pbworks.com/f/download+malnutrit.pdf

Growing urban poverty: Mali, Chad, Burkino Faso Action for students: How do growing poverty and a breakdown of the country’s social fabric relate to growing urban settlements and malnutrition in the Sahel? Bamako, Mali http://www.irinnews.org/report/76375/mali-urbanisation-fuelling-begging-on-streets-of-capital BBC Photo journal on Chad urban migrant story http://news.bbc.co.uk/1/shared/spl/hi/picture_gallery/06/africa_chad_urban_migrant0s_story/html/1.stm Burkino Faso’s urban hunger http://www.irinnews.org/report/85854/burkina-faso-hunger-stings-worse-in-the-city What do the slums look like in the Sahel? More on Chad’s N’Djamena, for example, pictured here: http://tripwow.tripadvisor.com/slideshow/chad/n-djamena.html Image: http://tchadonline.com/index.php/monde-ndjamena-vitrine-du-neant/

Life on the margins: Sudan, Bangladesh and Kenya

Urban and rural Sudan Action for students: Create a mini country profile and fact file on what is meant by life at the margins to someone in Sudan’s western region of Darfur region versus someone in a city such as Djibouti City. MSF Starved for Attention “Frustration” Urban malnutrition in Djibouti http://www.starvedforattention.org/ BBC country profile Djibouti http://www.bbc.co.uk/news/world-africa-13231761 Food insecurity looms in Djibouti http://www.irinnews.org/report/98408/food-insecurity-looms-in-djibouti BBC Sudan timeline http://www.bbc.co.uk/news/world-africa-14095300 Note to teachers: It may be worthwhile discussing with students what is meant by life at the margins? What does it mean to be marginalised? What is marginal land? Life can be at the margins physically, conceptually and emotionally. It can mean living on the edge! Darfur Image Derk Segar / IRIN

Bangladesh and Kenya urban case studies Action for students: Watch Urban survivor film series and related material: http://www.msf.org.uk/article/urban-survivors-voices-worlds-slums in: Dhaka, Bangladesh. Kibera, Nairobi, Kenya. See also MSF account http://www.msf.org.uk/article/kenya-escaping-death-africas-largest-urban-slum 2. Relate these case studies to quality and adequacy of food, food production, increased vulnerability and life on the margins. Why can it be harder to reach vulnerable people in urban settings? Why can be well-being be variable at the sub-state level? Further info: Series also covers: Karachi, Pakistan; Johannesburg, South Africa. See also report http://www.msf.org.uk/sites/uk/files/2009_No_Refuge_Access_Denied__Medical_and_hum nitarian_needs_of_Zimbabweans_in_South_Africa_200907234924.pdf Port au Prince, Haiti Note for teachers: Ask students to watch the video at least twice and on the second viewing record as much information about Kiberia which is relevant to the questions

Kamrangirchar slum In the Kamrangirchar slum of Dhaka - on the banks of one of the most polluted rivers in the world - MSF runs a primary healthcare centre that provides care to children under five and pregnant and lactating women. Nearby, MSF also runs a therapeutic feeding centre. Through a largely home-based programme, these children are being fed with Plumpy Nut, a thick nutrient-rich peanut paste which helps children regain normal body weight. Houses in the Boubazar slum near Kamrangirchar and children playing (inset) Action for students: read this slide and the next one, and extract the key information for your own fact sheet. Find out where the Kamrangirchar Peninsula is, the name of the river and make a sketch map showing the locations. Photos: Julie Remy

MSF doctor reporting from Kamrangirchar Terrible living conditions often with three generations of one family crammed together in one room. Tensions between liberal and conservative strands of Islam with the stricter mainly being based in the slums. Patients often child brides with malnourished and premature babies – a vicious cycle of malnutrition and stunting. Overpopulation and pollution mean that infectious and chronic diseases spread easily and quickly. Many factories based in the slums with a lot of child workers and poor conditions (sanitation and hygiene) – diarrhoea particularly problematic and spreads especially quickly during the wet season. People’s homes become flooded during this time. Very high prevalence of domestic and sexual violence with many of the women living in the slums experiencing some form of domestic or sexual violence. Note for teachers: This slide shows the complexity of life on the margins and the conditions in Kamrangirchar. Policies and investment are needed to address local environmental factors, to promote well-being at the household, community and country-level, which have been shown to be impacted by availability of electricity, health and sanitation services and at least minimally decent living conditions.(UN Documents, Our Common Future - http://www.un-documents.net/ocf-05.htm)

Kamrangirchar malnutrition An MSF nurse measures the height and weight of a child to determine the level of malnutrition. MSF hopes to bring its expertise and experience in treating malnutrition so that more children and their mothers can continue to live and grow up healthily. Photo: Julie Remy The MUAC (middle upper arm circumference) bracelet is used in conjunction with the height to prescreen children for malnutrition directly in the community Photos above Alfons Rodriguez

URBAN SURVIVORS: Kibera, KENYA A rooftop view of Kibera during the day. Kibera is one of the biggest slums in Nairobi, and the second largest urban slum in Africa. Photo: Charlie Dailey Geographically divided into 12 ethnically heterogeneous villages of similarly poor conditions, this sprawling slum it is one of the most densely populated districts of Nairobi, home to an estimated 220,000 to 250,000 people. The land is owed by the Kenyan Government, but private housing is owned by individuals who rent them out to inhabitants. These buildings are made of mud and corrugated iron sheeting that make up small, narrow rooms to house whole families. Some shelters are even used in shifts, people working during the day outside the slum sub-let their rooms for others who work at night. Poor sanitation, open sewers, overcrowded accommodation and a lack of access to free healthcare all contribute to the spread of diseases.

MSF clinic Kibera South Inaugurated in 2013, the centre offers comprehensive primary healthcare and maternity services integrated with the management of chronic diseases Photo: Andre Francois Photos above: MSF

Walking to the MSF centre Kibera, Nairobi, Kenya Photo: Charlie Davy Photo: Charlie Davy Photo: Charlie Davy Photo: Andre Francois

Rural households Rural households are most affected by poverty and hunger. They account for 75% of the world’s hungry Agriculture is the main source of income in more than 60% of rural households Thirty per cent of these households live in extreme poverty. Source: http;//www.ifad.org./rpr2011/report/a/rpr2011.pdf; International Assessment of Agricultural Knowledge, Science and Technology for Development (2009). Agriculture at a Crossroads: A Global Report. IAASTD. Washington; http://siteresources.worldbank.org/EXTPREMNET/Resources/EP125.pdf

Rural change As economies grow, so does the importance of non-agricultural income in the rural economy as a whole. Developmental transition More people buying food rather than growing it Cloke’s 1971 Index of Rurality helps to understand the changing features on the rural-urban continuum. It is composed of: Occupancy rates Commuting Female population (15-44) Amenities Population density Agricultural employment Elderly population Remoteness (distance to 50,000) Note to teachers: You may want to set the students the task of working in pairs to plan and write a report based on the slides in this section ( Teacher to determine report title appropriate to students current level of understanding ) Source: http://www.fao.org/publications/sofi/en/

20% of the world’s population lives on less than $1.25 / day. Incidence of extreme rural poverty percent of people living on US$1.25/day) Source IFAD; http://www.farmingfirst.org/green-economy/; http://www.youtube.com/watch?v=qtKK2Fuu1QY

Rural vulnerabilities Action for students: Discuss with other students and taking an evidenced based view, draw conclusions to agree or disagree whether “The Urban Rural divide: Is it a Myth or Reality” http://www.macaulay.ac.uk/economics/research/SERPpb2.pdf 2. Debate the issues in “Managing Risk and Vulnerability in the Rural Space”, Joachim von Braun, World Bank slideshare http://www.slideshare.net/jvonbraun/managing-vulnerability-and-risk-in-the-rural-space 3. Discuss and map the physical and socioeconomic impact of climate change and globalisation (integration of the world) on farmers in “Climate Change, Rural Vulnerabilities and Migration” http://www.prb.org/Publications/Articles/2007/ClimateChangeinRuralAreas.aspx Source: http;//www.ifad.org./rpr2011/report/a/rpr2011.pdf; International Assessment of Agricultural Knowledge, Science and Technology for Development (2009). Agriculture at a Crossroads: A Global Report. IAASTD. Washington.