To remove hunger, address poverty first

 Rumi Ajiyaz, Hunger, Malnutrition, Poverty, Health, ORFHealth

One of the most basic human needs, and desire, is good health. Although it is a need felt during the entire lifespan, it’s when ill-health comes in the way of performing any human activity or achieving a goal that we particularly understand its importance. Those who are blessed with the necessary requirements for attaining good health right from birth, and thereafter, are able to live longer and are better placed to achieve their goals than those who do not receive those blessings for whatever reason.

Just as individuals have learnt of the ill-effects of bad health, so have national governments and international organisations. An unhealthy population can be a major hindrance to building a strong economy and attaining development goals. It also leads to wasteful expenditure and healthcare burdens on governments.

India’s health profile, in particular, is not very promising as a large proportion of the population is suffering from one or the other ailment. In particular, the situation of the rural and urban poor is cause for concern. Their health is significantly affected by, among other things, hunger and undernutrition. The middle class and affluent population also has its problem of malnourishment, but that’s due to consumption of excessive quantities of processed foods and sedentary lifestyles, resulting in weight gain and lifestyle disorders.

Hunger and malnutrition have adverse impacts on human health, and the severity of the problem in India comes through shocking statistics. The Food and Agricultural Organisation (FAO) reports that India has the highest number of hungry (undernourished) people in the world, at some 194.6 million or 15% of the country’s population during 2014-16. Further, on the International Food Policy Research Institute’s (IFPRI) Global Hunger Index, India’s ranking has slipped from 97 in 2016 to 100 this year.

The ill-effects of not having sufficient access to food, or nutritious food, as well as excessive consumption of nutrients, are seen in both children and adults. National Family Health Survey (NFHS-4) data on the nutrition status of the Indian population in 2015-16 showed that among children under five years, 38.4% have low height for their age (stunted), 21% have low weight for their height (wasted), 35.7% have low weight for their age (underweight). Some 58.4% of children aged between six and 59 months are weak (anaemic) due to deficiency of iron and other essential nutrients and vitamins.

In adults aged 15-49 years, severe thinness, indicated by the Body Mass Index (BMI), which is the ratio of weight-to-height, is noted among 22.9% women and 20.2% men. A low BMI can be a serious problem, as people in this state are more susceptible to tuberculosis. In the same age group, weakness (anaemia) is observed among 53% women and 22.7% men. On the other hand, obesity is seen in 20.7% women and 18.6% men. A 2016 study revealed a dramatic increase in the prevalence of obesity in India and its consequent impact on the burden of non-communicable diseases (NCD) such as diabetes and cardiovascular diseases.

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Among the many reasons responsible for the prevalence of malnutrition in India, hunger is perhaps the most significant one. The FAO and IFPRI have highlighted India’s deteriorating situation in this respect, and the UN, based on India’s performance on the Millennium Development Goals, has cautioned that India must accelerate progress on eliminating hunger.

In post-Independent India, the problem of hunger (and undernutrition) was well recognised by the national leadership, which made a series of interventions. Important among these are the Mid-day Meal Scheme (MDMS), Special Nutrition Programme, Integrated Child Development Services (ICDS), National Plan of Action on Nutrition, Public Distribution System (PDS), and the more recent implementation of the National Food Security Act (NFSA), and the National Health Mission. However, progress has been modest at best. If India is to overcome the problem of hunger, several measures would be required. The first is that people need sufficient cash in hand to buy enough food to meet their daily dietary energy requirements.

However, there is a major problem of uncertainty of income among the rural population, especially agricultural labourers, marginalised groups, and the informal sector workers. The most recent poverty data shows 21.9% of the country’s population still living below the national poverty line. Informal sector worker incomes have also been badly hit by demonetisation. Further, the International Labour Organisation’s 2017 World Employment and Social Outlook Report predicts rising unemployment and worsening social inequality in India. These need to be addressed urgently.

The mechanism of direct benefit transfer (DBT) was created by the government in 2013 to transfer subsidy amounts for a variety of purposes, including food subsidy, directly into the bank accounts of beneficiaries. This allows ration card-holders to buy their choice of food grain from the open market, instead of from the PDS shops. However, states have shown reluctance in taking this idea forward.

Another issue that needs to be addressed is that of making nutritious food available to the poor at subsidised rates. The National Food Security Act, 2013, aims to do this. However, its implementation is wanting, as surveys in Uttar Pradesh have shown. Implementation difficulties include distribution of quality food, low-paid and inadequately trained anganwadi workers, loss of food grains in government warehouses. Equally important is awareness among people about consumption of wholesome, balanced and natural diets, and the significance of child-feeding and caring practices.

This commentary originally appeared in Deccan Herald.




Rumi Aijaz