Nutrition policy needs a change in approach

In yet another eyeopener for our country’s policymakers, in the 2019 Global Hunger Index, India ranks 102nd out of 117 qualifying countries. India suffers from a level of hunger that is ‘serious’. It is a shame the largest number of hungry people in the world live in India.

There’s something fundamentally wrong when one considers that the country is the world’s second largest producer of rice (more than 100 million tonnes) and wheat (more than 90 million tonnes) and the largest in pulses (23 million tonnes). At any point of time, public stocks of fine cereals run into several tens of millions of tonnes.

Dal-roti or dal-chawal are the staple meal for most of the population. Yet, India’s poor nutrition status is not news anymore. It is well-known that the country suffers from pervasive undernutrition. Protein deficiency in particular is palpable. The several welfare programmes implemented have not yielded the desired results.

Malnutrition has long-term adverse effect on human health, labour productivity and general well-being. Perpetual undernutrition results in low resistance against infections and increased morbidity. It raises healthcare costs and adversely impacts the country’s GDP growth prospects. Given the age profile of the population, the implications of protein deficiency are serious.

Admittedly, malnutrition is a complex, multi-dimensional issue impacted by a number of generic factors including poverty, inadequate food consumption due to access and availability issues, inequitable food distribution, improper maternal, infant and childcare practices, inequity and gender imbalances, poor sanitary and environmental conditions, and restricted access to quality health, education and social care services.

Tackling malnutrition

The status of malnutrition in India is reflected in the data captured in the National Family Health Survey (NFHS). The survey was last conducted in 2015-16 and shows the level of prevalence of malnutrition among women and children (see Table).

Of course, the government has recognised and accorded high priority to the issue of malnutrition. There are several schemes by various ministries. These include the Integrated Child Development Services (ICDS) implemented by the Ministry of Women and Child Development; the National Rural Health Mission, Ministry of Health and Family Welfare; the Midday Meal Scheme, Ministry of Human Resources Development; Targeted Public Distribution System, Ministry of Food and Public distribution; the Drinking Water and Total Sanitation Campaign/ National Rural Livelihood Mission/ National Rural Employment Guarantee Scheme, Ministry of Rural Development.

A coordinated approach among various ministries is the need of the hour. The budgetary outlay is large, but outcomes are limited. It can be argued that dovetailing of all schemes under one authority is critical for achieving tangible outcomes.

Undernutrition is pervasive in rural areas. Per capita protein availability has been falling in the last 30 years. It fell from 65 grams in 1985 to 55 grams in 2005; and then to less than 50 grams by 2015.

The government supplies rice and wheat under the public distribution system at highly subsidised rates. These cereals contain provide calories. This writer has been strongly advocating inclusion of pulses under PDS in order to provide protein; but policymakers have remained unmoved. Strong advocacy is the way forward.

India is the world’s largest producer, processor and consumer of pulses. Pulses are among the most economical vegetable protein available here. Pulses consumption deserves to be popularised through government welfare programmes. The responsibility to educate policymakers on social, economic and political benefits of raising protein consumption rests with trade and industry bodies.

If the hunger and nutrition challenge is not addressed on a war footing, the country faces the risk of moving towards nutrition insecurity.

Agricultural aspect

We need to recognise the close relationship between agriculture, nutrition and health. Agriculture is a source of food — and thereby nutrition — as well as of income that helps buy nutritious food. Agriculture policies impact food output, availability and prices.

Although the government claims to accord high priority to malnutrition issue, the implementation of programmes and schemes is decentralised. Progress in promoting nutrition is not uniform across the country, as evidenced by stark inter-State variation in the nutrition status. The case for dovetailing the various schemes has never been stronger.

All the boast of India being the world’s fastest growing significant economy sounds hollow when social development indicators are far from flattering. Our policies may have ensured overall ‘economic growth’; but there is no real ‘social development’. No wonder, India ranks rather low in Human Development Index and high on the Global Hunger Index. What we have is ‘growth without equity’ and little distributive justice, an important cause of the nutrition status.

For ensuring sustainable food and nutrition security, here are some practical policy recommendations:

Turn policy focus slightly away from fine cereals to nutri-cereals, pulses, oilseeds, milk, poultry and fish.

Include pulses and edible oil under Public Distribution System and National Food Security Act.

Encourage food fortification.

Raise protein, micro-nutrient content in MDM and ICDS foods.

If this involves some subsidy, so be it. The long-term economic and social benefits will far outweigh costs.

The writer is a policy commentator and food security specialist. Views are personal

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