Background
Shri Rahul Gandhi has wisely noted that our society pays more attention to high position than to greater knowledge. This has emboldened me to present some analysis that seems to go counter to the results expected by the Congress party at the center and BJP in the States, from their respective food security Acts. In 2004-2005, 2% of households suffered from hunger at some point during the year and about 25% of people were below the poverty line, but as many as 45% of children below the age of 3 (5) years were malnourished.Logic vs. Ideology
A simple, non-ideological examination of these facts suggest that,(a) As hunger affects only 8% of the poor generalized policies and anti-poverty programs are not the best way of reaching the hungry. They have to be identified geographically and individually and reached directly. Once this is done it would not cost much to eliminate this hunger through direct cash or food transfers, depending on whether there are or are not competitive food markets in the area where they live. Thus in remote or hilly areas it is probably necessary to supply food.
(b) Malnutrition is a much bigger problem than poverty and the causes are unlikely to be the same, even though there may be some overlap. Anti-poverty measures/programs are unlikely to solve the malnutrition problem.
Research
Analysis of the state wise 2004-5 NSS
and 2005-6 NFHS data led to the conclusion that the most important cause of
malnutrition in India was the abysmal state of ‘public health’ in terms of
sanitation, pure drinking water and public knowledge about the importance of
cleanliness (al la germs in dirty water, dirt and grime) and nutrition (basic
food groups etc.). If this appears
surprising, think about the simple act of eating and digesting food and absorbing
energy and nutrition from it. A child or
adult who is sick with diahorea or dysentery can eat as much as (s)he wants but
will not be able to absorb it effectively.
Recent medical research goes further, to show that even those children
who are living in unsanitary conditions, but do not show any symptoms of
gastro-intestinal disease, are infected with germs in their intestines that do
not allow them to absorb nutrients from the food they eat.
Cross country analysis of
malnutrition data confirms the conclusions of the India analysis.[i]
The quality of public health,
as measured by variables such as access to better sanitation and improved water
sources, explains much of the cross-country variations in the prevalence of malnutrition
and the high malnutrition in India relative to other countries with similar
levels of per capita income and poverty.
Improvements in environmental sanitation are the clearest and most
effective policy-program tool for the Central government to reduce if not
eliminate the excessively high levels of malnutrition in India. The cross country compliments the Indian
Inter-state study by showing that female primary education, is an important
factor in reducing child malnutrition,
by helping spread information and knowledge about personal hygiene, sanitation
and nutrition.
Misleading Indices
The misnamed Global Hunger index
(actually an average of calorie availability, poverty rates and child
malnutrition) has been a major factor in misleading policy makers and advisers
that Indians are hungry and starving and if we can assure them enough calories,
the problem will be solved. The World
food Program’s single minded focus on cereals availability (and wheat and rice
in India), has also contributed by arousing “liberal guilt,” about the
declining average calorie intake.
Those of us who have dealt with food issues for the last few decades, have often cautioned that easy availability of subsidized wheat and rice has driven out coarse cereals and other more nutritious local foods (e.g. wild berries, roots) from the diets of the poor and may thus have had a negative impact on nutrition. In some cross state regressions the size of the PDS has an adverse effect on malnutrition, thus showing that the intuition s not completely wrong. As the result is not statistically robust, it suggests that the PDS has had both positive and negative effects and in some cases the first and in others the second dominates.
Those of us who have dealt with food issues for the last few decades, have often cautioned that easy availability of subsidized wheat and rice has driven out coarse cereals and other more nutritious local foods (e.g. wild berries, roots) from the diets of the poor and may thus have had a negative impact on nutrition. In some cross state regressions the size of the PDS has an adverse effect on malnutrition, thus showing that the intuition s not completely wrong. As the result is not statistically robust, it suggests that the PDS has had both positive and negative effects and in some cases the first and in others the second dominates.
Conclusion
Here is my forecast: The Food security Act will have little or no
effect on malnutrition, poverty and hunger.
Hunger can be eliminated if and only if the government and/or NGOs
identify the 40 lakh affected households and ensure that cash or food reaches
(despite usual problems of leakage-corruption) the principle female (mother) of
the household. An, “Elimination of
Hunger Act”, with severe penalties for officials in whose area a hungry family
is found, could do this at a small fraction of the cost.
Child malnutrition can be dramatically reduced, if not eliminated within a decade, through a massive “public health” campaign: This would insure a modern sewerage and sanitation system in every urban, semi-urban and semi-rural area and pure drinking water, septic tanks and lavatories in rural areas. The issue of Poverty requires a separate note.
Child malnutrition can be dramatically reduced, if not eliminated within a decade, through a massive “public health” campaign: This would insure a modern sewerage and sanitation system in every urban, semi-urban and semi-rural area and pure drinking water, septic tanks and lavatories in rural areas. The issue of Poverty requires a separate note.
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A version of the above post-appeared as an op ed article in the Economic Times, of February 4th, 2013, under the title, "Focus on Malnutrition, not hunger," http://m.economictimes.com/opinion/comments-analysis/focus-on-malnutrition-not-hunger/articleshow/18327041.cms
[i] Virmani, Arvind
(2012), “Under Nourishment in Children: Causes of Inter-country variation,”
Working paper number WsWp 4/2012, October
2012. http://sites.google.com/site/drarvindvirmani/working-papers.
1 comment:
Dr. Virmani your post and article are very close to what the Commission on Social Determinants of Health has been trying to put across. Henry Hazlitt has strongly (and I feel rightly) argued in his writing, about the short sightedness of our policies. You've aptly stated the shortsightedness of "Cereal Availability". Looking at the practical political perspective such lack of vision emanates from the struggle parties and organisations face in preserving their votes. Circumstance where the longest time a leader can lead is 5 years; blocks the vision of many leaders. So the local political will power and vision is difficult to instill. Interestingly such lack of vision has been displayed even by some global organisations. So in such situation a strong targeted intervention which gives short term goals (for our dear political leaders to publicise on) and a long term vision (which allows people to benefit from); lies the hope for think tanks and academicians. I guess it is time where the research community dissolves its academic boundaries to interact with all kinds of real world people, including our politicians. After all isn't a good policy research the one that voices many?
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