Hunger and Malnutrition

with Prof. Charan Singh, IIMB

Introduction

 Does India suffer from food insecurity, hunger or undernutrition?  According to FAO, food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food for an active and healthy life. And hunger, as professionally defined, is a condition, in which people lack the basic food intake to provide them with energy and nutrients for fully productive lives. Still more important is undernutrition, which can exist in the absence of hunger and can be caused by non-food factors. Under-nutrition can result from critical lack of nutrients in an individual’s diet,  weakened immune system and inability to absorb nutrients. A weakened immune system can make people susceptible to diseases which in turn can lower appetite and nutrient absorption. The weakening of the absorptive capacity of the stomach due to gastrointestinal diseases and germs can lead to reduced nutrient intake even when sufficient nutrients are available in the diet. Under nutrition increases the risk of chronic diseases and its impact lasts lifelong.

 Hunger

  Hunger and Under nutrition are the most persistent challenges for policy makers. According to FAO, 18 percent of India’s population was undernourished in 2012. And worst, children are the most visible victims of undernutrition, which is the underlying cause of diarrhea, malaria, measles, and pneumonia. Undernutrition accounts for half of the deaths in children below the age of five years. According to UNICEF, India houses one–third of the Stunted/Wasted (termed malnourished) children of the world and 46 percent of the children below the age of three are too small for their age and 47 are under weight. Undernutrition, from conception to the age of two years, can cause an irreversible impact on the child’s physical and mental development and has long-term consequences for social and economic development.

 Malnutrition

GHI

Malnutrition is often confused by policy makers as simply a ‘lack of food’ problem. It is not. Rather, it is a complex multidimensional and intergenerational problem and needs a multisectoral as well as direct and specific interventions. In recent times, as these issues have been worrying global policy makers, there are new indices, different from the popular Global Hunger Index released annually since 2006 that are being developed to illustrate the complexity of hunger and malnutrition. At the outset, it must be mentioned that these indices, cannot capture important cultural and political dimensions that prevail at national and sub-national level but are merely tools to highlight the problem.

 HANCI

Hunger and Nutrition Commitment Index (HANCI), launched in April 2013 for 2012 compares performance of 45 developing countries using 22 indicators of political commitment to reduce hunger and undernutrition. It looks at government action in terms of policies and programs, legal frameworks and public expenditures. HANCI is also computed separately for hunger reduction commitment (HRCI, based on ten indicators) and nutrition commitment (NCI, 12 indicators). HANCI takes into consideration a variety of indicators that address only hunger, only nutrition and then both. It takes into consideration women’s empowerment, social protection, food and agriculture, and health and nutrition environment. HANCI compares relative performance of countries and also provides raw indicators for individual countries. Though it is based on secondary data, primary research is employed to deepen analysis as it has been developed and shared with practioners in key countries. Overall, on HANCI, India is ranked 29th (2 ranks above its per capita GDP rank) while Brazil (4^th), China (22^nd) and South Africa (23^rd). According to HANCI, there is low commitment by the government in India towards addressing the problem of stunting in children below 5 years of age.

GFSI

A year earlier, Economist Intelligence Unit created the Global Food Security Index (GFSI) in 2012 to deepen the dialogue on food insecurity and measure the associated risks. The 2013 index is comprised of 27 indicators and applied to 107 countries. The indicators can be broadly classified into three categories – affordability, availability, and quality and safety.  In this index, an important contributory factor is quality and safety which takes into account availability of nutrients, micronutrients, vitamin A, iron, protein quality, potable water, and national nutritional strategy. India ranks 70^th while Brazil (29), South Africa (39), Russia (40) and China (42) are ahead of us as they are in per capita GDP.

 Causes

In case of both indices, two main factors that are substantiated are lack of sanitation, and inadequate nutrition. Hygenic means of personal sanitation, end of open defecation and clean drinking water would help in child survival. Studies have also shown that level of mother’s education and dietary diversification also positively impact balanced nourishment of the child. On nutrition, it needs to be debated whether India distribute vitamin A and iron supplements or adopt biofortification of crops with essential micronutrients at the sowing stage, as researched and implemented in some countries, including India, under HarvestPlus initiative?

 Conclusion

On various indicators, developed by experts, it is consistently observed that India needs to focus attention and public expenditure on public education, sanitation, potable water and dietary intake of its citizens. Therefore, it would be essential to have a focused public health and nutritional policy with a concerted public campaign that would help in successfully achieving positive nutritional outcomes.

A version of this article appeared in the Financial Express of August 14, 2013 under the banner, “Tackling The Under-nutrition Challenge: India Needs a Focused Health and Nutritional Policy,  http://epaper.financialexpress.com/c/1485767.

Food Security Bill and The Global Hunger Index

jointly with Prof. Charan Singh

Introduction

       The Food Security Bill (2013, FSB), promulgated recently by an ordinance is expected to be debated in the Parliament soon. The intention behind the FSB is noble, to eradicate hunger from the country but the means adopted need serious reconsideration. FSB, under the targeted public distribution system (TPDS), aims to provide door step delivery of subsidized food to nearly 75 percent of the rural and 50 per cent of the urban population. It also seeks to empower women in the households.   The thrust of criticism against FSB has been on issues like procurement, storage, transportation, distribution, identification of the beneficiaries and pricing of food grains covered under the scheme. 

Global Hunger Index

    The FSB is motivated by two significant facts. First, disturbing statistics: According to National family Health Survey 2005-06 that 43.5 percent of children under the age of five years are underweight, 33 percent of women in the age group of 15-49 years have a body mass index below normal and 78.9 percent of children in the age group of 6-35 months are anemic. Second, the influential Global Hunger Index (GHI) developed by the International Food policy Research Institute (IFPRI), which has successfully galvanized policy makers across the world. IFPRI has computed a GHI of 22.9 for India in 2012, with countries like Libya, Iran, Mexico, Brazil, Sri Lanka, Pakistan and many others recording much better performance.

Hunger: Definition

     Unfortunately, the term “Global hunger index” is a misnomer as it does not, in its construction take into account the ‘hungry’. Actually, the terminology “hunger” itself is very confusing and means different things to different organizations and policy makers. First and foremost, it evokes images of the extreme discomfort associated with lack of food. On the other hand UNDP defines it as a condition in which people lack the basic food intake to provide them with the energy and nutrients for fully productive lives.

GH Index

    GHI takes into account, in equal weights, undernourishment, child underweight and   child mortality. The indicator, undernourishment, is based on the share of population with insufficient (relative to a norm) calorie intake. Child underweight is defined in terms of wasting and stunted growth and child mortality in terms of death rates, both reflecting unhealthy environment. It is much too simplistic to assume without evidence that either underweight or mortality is due to under-nutrition (signifying deficiencies in energy, protein, essential vitamins and minerals). Child stunting and wasting, and mortality is equally if not more likely to be due to infections and illnesses due to insanitary conditions that result in inadequate absorption of nutrients. These in turn may be linked to inadequate maternal health or child care practices, inadequate access to health services, safe water and toilet facilities. Thus, supply of food may be a necessary but not a sufficient condition for improvement of a part of the hunger index.

GHI is too simplistic and does not take into account the complexities of the problem but sways the opinion makers in developing countries. GHI is already much accused and abused index which has lost respectability because of its various deficiencies, including the weighting priority and data base that is used. The index is also prone to dramatic change in case of unreliable data of even a single partial indicator. For example, the cause of such a dismal GHI for India is mainly data on child underweight in India, which is worst, just next to Timor-Leste.

Underlying Problems & Solutions

  To improve India’s ranking in the GHI, we have to identify the causes of stunting and wasting and to eliminate these causes.  Thus the solution is to improve the supply/availability of clean-safe drinking water, improved sanitation, preferably piped sewerage system, septic tanks or pit latrine with slabs, to avoid outbreak of water-borne diseases like diarrhea, dysentery and cholera; and improved personal hygiene. According to WHO, less than 30 percent of households had access to piped drinking water and nearly 60 percent of Indians still practiced open defecation in 2006. We also need better governance of medical facilities in rural areas, providing more effective primary health centers for maternal and child care. Even with respect to food, though per capita availability of cereals has improved, that of pulses has declined from 69 grams per day in 1961 to 39 grams in 2011. Pumping free cereals into a leakage prone system will not improve even calorie intake as these have a near zero price elasticity and low income elasticity.

The need is to directly address these serious issues and not the imposition of simplistic FSB that is driven more by philosophy than by pragmatic problem solving. As there is no free lunch, a huge hike in subsidy would either lead to higher taxes or higher debt or lower capital expenditure. It also detracts attention from the really “hungry” who constitute less than 2% of the population but are dispersed across the country in remote, hilly locations and need to be painstakingly identified and reached directly.

This article appeared under the banner, “A Misnomer Called Food Security,” in the Op Ed page of the Indian Express, on Thursday 1^st August, 1913. http://epaper.indianexpress.com/c/1423467  or

http://www.indianexpress.com/news/a-misnomer-called-food-security/1149426/.