This is a reflection paper I wrote on May 6, 2023 for college course Anthro 216GH: Case Studies in Global Health with Professor Felicity Aulino.
Word Count: 927
In this essay I ask, through what pathways of causation have neoliberalist policies, with other social-economic factors, created the malnutrition crisis in Maiduguri, Nigeria? I argue that similar to IMF policies’ pathways to exposing women and children to HIV/AIDS (de Vogli & Gretchen, 2005), pathways happen at macro, meso, and micro levels; the poverty-malnutrition interplay led to sicker people.
Neoliberalism is an economic and political theory. Neoliberalism intends to form a world (market) without state involvement. Individuals are rational beings who know the market and can always make perfect choices for their benefits. Clark Simon (2005) argues that “the point for [those who espouse] neoliberalism is not to make a model that is more adequate to the real world, but to make the real world more adequate to its model.” “Neoliberal rationality,” Wendy Brown (2003) argues, “…it involves extending and disseminating market values to all institutions and social action, even as the market itself remains a distinctive player.”
After World War II, the Bretton Woods Agreement was established to stabilize the international monetary system and reconstruct postwar Europe through the working bodies of the International Stabilization Fund (the later International Monetary Fund, IMF) and the International Bank for Reconstruction and Development (IBRD, core of the World Bank). In the 1980s, the World Bank changed from seeing health as a basic human right to adopting neoliberal policies of structural adjustment. When poor countries in the 1980s faced economic crisis and had the only option to borrow money from outside, the IMF announced that the poor countries could get money only after undergoing structural adjustments of stabilization, liberalization, and privatization to their economies. Stabilization is achieved through limiting monetary growth. A frequent method is cutting state spending on social programs. Liberalization aims to clear all state interventions in the market such as subsidies. Individuals are charged user fees and need to pay to use public goods such as healthcare, food, water, and education. Privatization is achieved when the government sells state assets to private owners, leaving little control of the state over economic policies and development, so that the state needs to ask for loans from other countries (through the World Bank).
When neoliberalist policies of structural adjustment are applied to healthcare, “public health system is only a distortion that should get out of the way.” (Rowden, 2009, 157) Stabilization stops governments from running their own healthcare and education programs, disrupting self-reliance and training for expertise. Liberalization decreases the local health services (which are increasingly private) utilization because service is expensive. It also enlarges the informal drug market where alternatives of expensive drugs are sold, however, the quality of drugs are “expired, prohibited and/or incorrectly prescribed.” (Rowden, 2009, 158) Privatization makes health services private, overly concentrated in high-income areas, and too scarce to meet the needs of poor patients, and the state has no power to pull services together to serve the poor since public services are sold and development is prohibited. The state has to comply to foreign aid.
In Maiduguri, Nigeria, malnourished children coming to international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF)’s therapeutic feeding center reached an increasing rise in spring 2023. “‘The number of weekly admissions is two to three times higher than [what we’ve seen] over the past five years, and it’s still rising,’ said Htet Aung Kyi, MSF medical coordinator.” Admissions also started earlier than the June-to-November annual hunger gap, suggesting that other factors play in the malnutrition crisis.
At the macro level, funds requested not through the humanitarian response plan were secured at a low percentage. Food subsidies were fertilizers. Evidence for subsidies for other commodities was limited. Nigeria food import dependency remained high in 2021, especially for wheat and sugar (Jung 2023, Figure 13). Although Nigeria set foreign exchange restrictions, the US turned its focus and exported “private sector investments in the agribusiness value chain” to Nigerian farmers who “cheaper, basic, easy-to-use-and-maintain farm machinery from Asia.” A 2021 report by U.S. Commercial Service suggested that Nigerian public healthcare infrastructure was “underdeveloped.” (critical analysis can start from this word choice) Not enough healthcare professionals were in place. Planned construction of primary health care centers (PHCs) in both urban and rural areas were inconsistent. Less than 5% of Nigerians were enrolled in the National Health Insurance Scheme (NHIS).
At the meso level, beds ran short in the MSF feeding centers. People in Maiduguri were forced to move out of their homes and travel to official camps. After 2021, official camps were closed. People arrived, in poor health, at transit camps with harsh conditions. A redesign of Nigerian currency made people unable to buy food. Food prices underwent post-pandemic global inflation and became higher. A fire destroyed the largest physical market in Maiduguri. Climate change decreased the quality of crops and challenged food production and supplies. People need to pay user fees to receive healthcare.
At the micro level, adults and children could not afford food, reach food supplies, or farm, leading to higher susceptibility to disease for malnourished children, adults, and newborns. People might not be able to turn food they eat into energy due to illnesses such as TB, HIV, and measles, which can be created by water scarcity, concentrated harsh living conditions in the transit camps, and prostitution as the only source for income. Since people could not earn wages, they became poorer, and in turn, have less access to treatment of malnutrition.
Through macro, meso, and micro level pathways, neoliberalist policies and other social factors affect malnutrition and health of people in Maiduguri, Nigeria.
Writer’s Reflection:
Due to word limits, I cannot incorporate more historical context of Maiduguri, Nigeria. The social factors in this analysis are limited. I also did not get into feasible strategies and interventions for this case.
I wrote on how neoliberalism engages social construction of reality:
Social construction of reality (Peter L. Berger and Thomas Luckmann) states that the perceived reality and knowledge we have are socially constructed through habituation, institutionalization, and legitimization. Neoliberalism reflects institutionalization since it utilizes law and institutions to set up rules of doing things, and actors go through the cyclical stabilization – liberalization – privatization – loaning again and again. Neoliberalism engages habituation when local people had to pay for healthcare and take paying as part of their routine. When neoliberalism as an ideology is promoted and used more and more in the local communities, it becomes natural. This process is hegemony (Jean and John L. Comaroff).
Bibliography
Clark Simon. “The Neoliberal Theory of Society” (2005)
Brown, Wendy. “Neo-liberalism and the End of Liberal Democracy.” Theory & Event 7, no. 1 (2003) doi:10.1353/tae.2003.0020.
Rick Rowden, 2009. The Deadly Ideas of Neoliberalism: How the IMF Has Undermined Public Health and the Fight Against AIDS. Zed Books.
De Vogli, R., & Birbeck, G.L. (2005). Potential impact of adjustment policies on vulnerability of women and children to HIV/AIDS in sub-Saharan Africa. Journal of health, population, and nutrition, 23 2, 105-20 .
Jung, I. (2023). Food Insecurity in Nigeria: Food Supply Matters: Nigeria, Selected Issues Papers, 2023(018), A001. Retrieved May 6, 2023, from https://www.elibrary.imf.org/view/journals/018/2023/018/article-A001-en.xml
2001. https://www.trade.gov/market-intelligence/nigeria-food-and-agriculture