Nutrition crisis looms large

Nitin Sharma Paramita Sarkar | Updated on January 16, 2018

On weak legs: India’s programme to address malnutrition K GOPINATHAN

It could deter our progress. Fortification of staple foods should become part of a national programme

India, a rising star, is one of the few countries globally witnessing a steady GDP growth. Yet, while factors such as human capital, growing FDI, and initiatives to promote the country as a manufacturing destination are catalysing our development, there are some things with the potential to impede this growth.

One of the biggest challenges among those is malnutrition.

Our vision of becoming a developed nation needs to be fuelled by a healthy population. However, we are on the brink of facing a malnutrition crisis.

We need to act now, or risk severely denting our progress as a nation.

It’s a crisis

A 2006 World Bank Report on India, Undernourished Children: A Call for Reform and Action, estimates the prevalence of underweight children in India to be among the highest in the world, and nearly double that of Sub-Saharan Africa.

Fifty per cent of Indian villages are severely affected by malnutrition. It is the single largest contributor to under-five mortality. Even if the children survive to adulthood, their brain development will be affected and they will suffer from a life-long elevated risk of infection.

The World Bank’s Nutrition at a Glance research report has put a figure to the crisis we are facing: annually, India loses over $12 billion in GDP to vitamin and mineral deficiencies.

This is a substantial amount. Yet if we scale up, core micronutrient interventions would cost less than $574 million per year.

How do we combat India’s malnutrition crisis? One important approach lies in food fortification. Fortification of staple foods such as milk, oil, sugar and flour has been globally recognised as an important strategy to eradicate malnutrition.

The key vitamins and minerals used for food fortification include iron, iodine, zinc, vitamin A, vitamin D, folic acid (B9), thiamin (B1), riboflavin (B2), niacin (B3), pyridoxine (B6) and cobalamin (B12). Among those vitamins and minerals, vitamin A, iodine and iron deficiencies create the greatest burden on public health and rank high on priority.

Other micronutrient deficiencies, such as riboflavin, folic acid, vitamin C and calcium, are also widespread. These deficiencies increase the risk of diseases such as goitre, blindness, anaemia and cognitive disorders.

Additionally, many country reports highlight the magnitude of malnutrition due to a family’s economic costs incurred and cultural links associated with micronutrient deficiencies.

Start with advocacy

As compared to other South Asian countries, India calls for advocacy programmes as a starting point for food fortification initiatives. While some non-governmental organisations (NGOs) and private organisations have been actively pursuing the food fortification programme with support from the Centre, the need of the hour is unique initiatives that will support a nourished lifestyle among the poor.

For example, in Rajasthan and Haryana, 80 per cent of the wheat consumed is processed in local mills. Some NGOs are collaborating directly with these local mills to ensure micronutrient fortification by providing vitamin A and vitamin D in flour.

Another successful initiative is providing vitamin A sachets to schoolchildren in municipal schools, as part of the midday meal programme.

Another approach is through public/private partnership which can help resolve the issue through unique business models. In the Philippines, 40 per cent of children between the ages of six months and six years had severe Vitamin A deficiency as of 2008, contributing to conditions such as night-blindness and Bitot’s spots.

The government started a nationwide food fortification program by enriching sugar with vitamin A, as sugar is the most widely consumed staple food in the nation.

They enlisted the support of the largest sugar manufacturer initially and then extended it to various food items such as fruit juices, noodles, margarine, canned tuna, etc.

They also promoted the importance of a balanced diet along with food fortification and vitamin A supplementation by creating a sustainable food fortification programme where stakeholders such as sugar manufacturers, the department of health, the Food and Nutrition Research Institute and the Unicef, came together to address the malnutrition issue.

Today, although the country has not yet eradicated malnutrition, less than 15 per cent of the children suffer from vitamin A deficiency.

It is, therefore, heartening to see that there are joint efforts already being taken to address this challenge, with national and global organisations joining hands.

Some States have taken a leaf from this initiative. Such programmes are under way on a small scale in certain States of India, but there is clearly a need to roll out such programmes nationwide.

Make it the law

For the children of the country to benefit from food fortification, centrally mandated laws are required.

We need a programme that is nationally scalable, such as the widely successful programme of salt fortification with iodine, which has significantly reduced goitre on a national basis.

We need to learn from our neighbouring countries such as Bangladesh and Pakistan. Bangladesh started a national wheat and oil fortification programme by adding vitamin A, iron, zinc, B1, B2, niacin, and folic acid nutrients across the country. Pakistan undertook a nationwide campaign to fight anaemia and vitamin A deficiency by undertaking wheat flour fortification with iron; edible oil/ghee with vitamin A and D; bio-fortification of wheat with iron and zinc; and zinc-fortified fertiliser.

This has been possible for both the countries due to measures taken and supported by their central governments.

In India, we are gradually taking some steps in the right direction, but we need to do very much more.

The Group of Secretaries on Education and Health — Universal Access and Quality has, among other things, identified fortification of food items like salt, edible oil, milk, wheat and rice with iron, folic acid, vitamin D and vitamin A, with a timeline of three years, as one of the measures to be undertaken to address the issue of malnutrition in the country.

A task force is slated to be formed from various ministries to support fortification.

We now need concrete action with a unified front. This is a crucial factor in combating malnutrition in the country.

We hope for the task force to be formed soon and the introduction of adequate measures to begin at the earliest opportunity. After all, a healthy today will be the deciding factor for a prosperous tomorrow.

Sharma is Head, Human Nutrition, BASF India Limited; Sarkar, Head, Nutrition and Health, BASF South Asia

Published on December 22, 2016

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