“Malnutrition Is A Combination Of Lack Of Nutritious Food, Water And Sanitation And An Inadequate Healthcare System”

New Delhi: October 16 is observed as World Food Day every year to promote food as a fundamental right for each human being. This year, owing to the COVID-19 pandemic, the Food and Agriculture Organisation (FAO) has set the theme for World Food Day as ‘Grow, Nourish, Sustain. Together.’ With this, the organisation calls for solidarity to heal those most vulnerable and to help make food systems more sustainable for them amid the unprecedented public health crisis. To mark the occasion, NDTV had an exclusive chat with Global Alliance for Improved Nutrition’s (GAIN) Executive Director, Lawrence Haddad. GAIN is an independent non-profit foundation, launched at the United Nations in 2002 to tackle the human suffering caused by malnutrition.

Dr Haddad, a recipient of 2018 World Food Prize, analyses India’s current malnutrition crisis and further talks about what can be done to tackle the issue.

What are some of the causes of the malnutrition crisis of India and its consistent unsatisfactory performance on the Global Hunger Index?

Out of India’s overall performance on the Global Hunger Index, some of the components have improved while some have gotten worse. The Hunger Index consists of four different components and most of them, India is doing better than it has done in the past. It’s reducing its child stunting, that’s when kids are too short for their age and that reflects a whole range of body compromises, cognitive functions and the immune functions.

However, there’s one indicator that is getting worse – young children are getting wasted, this means children are just too thin for their height. This number is going up and this is what is driving the Global Hunger Index performance for India.

No one really knows what the answer is, the science is not clear, on what we think this is. This might have something to do with the fact that India’s health system and the social assistance system can be disconnected at times. So, if children get wasted in the community, where they get too thin for their height, and this gets so severe that they go to a health clinic, where they get cured or their situation is improved in the clinic using therapeutic foods. But they then get back to the community and the underlying causes of the wasting are not really addressed. So, there’s a big risk of them just getting wasted and severely wasted all over again.

Some people in India have called for a ‘ Wasting Audit’ similar to how there’s a mortality or death audit, to look into the causes behind the wasting.  There should be a clear understanding and investigation as to why they have become wasted, and that’s the way looking into the underlying causes.

Also Read: “Nutrition Is More Than Food, More Than Hunger,” UNICEF India’s Arjan De Wagt Talks About The Impact Of COVID-19 On Poshan Abhiyan 

What explains the dichotomy where India is one of the largest producers of food in the world and yet one of the worst performers in terms of Nutrition?

We know that hunger is about much more than just producing food, you have to also be able to afford the food. Poverty rates have come down in India, which is admirable and fantastic news. But, the problem is that the malnutrition is not just caused by lack of calories. It is caused by a lack of nutritious food, water and sanitation and a healthcare system that is not quite adequate.

There was a study from the organisation I used to work for, International Food Policy Research Institute
(IFPRI), that 63 per cent of rural Indians can not afford a nutritionally adequate diet. This goes beyond calories to things like pulses and dairy and eggs and fish and fruits and vegetables. And 63 per cent of Indians living in rural areas can’t afford these foods.

So we need to reduce both poverty and we also need to bring the price of these highly nutritious foods down.

Also Read: How Has COVID-19 Impacted The Nutritional Status Of India’s Children? An On-Ground Report From Non-Profit Organisation CRY

India has programmes like Poshan Abhiyan, Mid-day Meals, Public Distribution System and so on. How effective are these programmes and what more can be done to strengthen these to tackle India’s nutrition crisis?

I think if you would’ve asked me this question 20-years ago, I would’ve said they are not terribly effective. But over the last two decades, they have become much more effective. A lot more evidence has been brought to prove their efficiency. There are incredible variations of performance from state to state and district to district and block to block, in these programmes. We need to be learning about how did the bright spots really do it and what’s going on in the areas where these programmes are not performing well.

One really crucial thing, all the food-based programmes can do, to diversify the kinds of foods that are used in these programmes. And bring in not just rice and wheat, but also other foods that are really important. Some states have done it bringing in pulses. But also, bringing in vegetables and fruits and nuts, which are high in nutrients.

Another thing to consider is moving from food-based to cash-based protection programmes.

Cash-based programmes give the power to consumers to spend the money as they wish and they can use it for more diverse diets. Which sends a strong signal to farmers and other food producers to produce more of these kinds of food beyond the traditional staples.

Another thing that is really important is the fortifying some staple crops, foods. These should be foods that are consumed every day by every Indian. They still don’t contain the levels of Vitamin A and Vitamin D, and iron and zinc. Foods consumed in Europe and North America are the same foods but they contain these nutrients. This is really a no regrets kind of policy, one that really protects the most vulnerable, who can’t afford the nutritious foods.

Also Read: Can India Piggy Bank On Food Fortification To Achieve The Goal Of POSHAN Abhiyaan?

What has been some of the positive and negative effects of the COVID-19 pandemic when it comes to nutrition? What are the biggest learnings from this crisis?

Some work that I’ve been involved in with the researchers from around the world including India show that the kinds of income declines we’re seeing at the national and community levels are going to result in big increases in the wasting rates, which is an important marker of their morbidity and mortality. Globally, these numbers are going to go up from 47 million to 55 million, as per a study published in the Lancet a few months ago.

India is home to the majority of cases, so we’re expecting to see the wasting numbers go up because of COVID. I would expect other nutrition and hunger indicators to also slow down and result in a reversed progress. That’s because income has gone down, jobs have been lost or put on hold. This also means that farmers have fewer demands for their products, so they are struggling to figure out what to produce and to get people to buy their produce. Food systems need systems to move food around, being transferred and distributed to another place, in a way that keeps it fresh and safe. If that can’t happen, people are really struggling, whether in food growing areas or urban areas.

The final problem for nutrition is the health system, which delivers lots of very important nutrition programmes like breastfeeding promotions, antenatal care, Vitamin A supplementation, these programmes are also not happening because of the health systems being under pressure from having to deal, quite rightly, with COVID-19.

When it comes to some lessons that are learned, people keep saying we need to build back better, but I like the term, build forward better. The past wasn’t so great, we need to learn that our food systems and our health systems are very vulnerable to shocks.  The one principle to rebuilding will be looking at more diverse sources of food production, shorter value chain and more risk mechanisms, especially for farmers, many of who lack access to insurance.

Also Read: Pros And Cons Of Food Fortification, An Effective Way To Address Micronutrient Deficiency

How can the policymaking around food systems, involve young activists and youth to have positive transformational change to the current food systems?

If we don’t involve the youth, we run the risk of consigning them to a really dire future because of the adults’ decisions. They have a lot of agency, ideas and energy and we just need to collectivise it.

I’ll give you an example of we at GAIN have been doing in Bangladesh. We have a nation-wide youth movement called Shornokishoree Network Foundation or SKNF, this movement has millions of members. The members of this movement visited our Bangladesh office and talked about how the youth in the country, and millions of members of the movement, are raised the issue about lack of nutritious food in the country. They have tiny amounts of pocket money, which they spend on junk food. They asked us to come up with a solution. Together, working with the group leaders of that group, and that movement in itself, we came up with the pocket money pledge. This is a pledge that adolescents will eat healthier food if it was more available and affordable to them. A million adolescents have signed this pledge and this is now being used to put pressure on the government to do something more than they’re already doing to make nutritious food more affordable. This is also putting pressure on the businesses, showing them the latest demand for nutritious food from their target costumers. That’s one way of mobilising adolescents to put pressure on the key decision-makers in the pubic and the private spheres to do more for nutrition.

How and why adolescents have access to less nutritional diets especially in a country like India?

The most important period in everyone’s life is the first two years. But, after that, its the adolescence, where an individual’s growth spurts have specific nutritional requirements to help their brain develop, for their cognitive development, and have the immune system develop and for girls, they are going through menstruation. All these functions require huge amounts of nutrients.

Their body is in dire need of nutrients at this age, and it is also the time when they have a lot of preference, and food habits are formed. These food habits are hard to shake off in adulthood. So, if we can get adolescents on healthy eating habits at this part of their lives, it will be beneficial for them for the rest of their lives.

Also Read: Protecting Health And Nutrition Rights Of Children During COVID-19 Is Important For India, Experts Speak

The food systems must provide a healthy and sustainable diet for everyone. Therefore, sustainable agriculture is critical to the transformation of food systems. How has climate change impacted this phenomenon, and what is the need of the hour in this regard?

Climate change is having a number of effects on the availability of nutritious foods and on nutrition itself. Climate change means the weather is unpredictable, it’s more extreme and it’s more variable.

For farmers, that’s really very difficult as they don’t have any risk management or risk mitigation mechanisms. They don’t have access to insurance, many don’t even have a large enough land to diversify their food production to protect themselves through this variability. So, there’s much more risk for them when they’re planting. They often make wrong choices because they make wrong guesses about the climate. It’s getting harder and harder to predict the climate and it results in highly invariable incomes for farm families and very variable food prices for people who buy food.

Additionally, climate change increases the chance for infection rate for plants, animals and humans. Climate change and high levels of carbon dioxide in the atmosphere depress the level of nutrients in foods. Not only it is more difficult to produce foods, but now foods that are being produced are lower in essential nutrients.

The food system is a victim of climate change but it is also a culprit when it comes to generating CO2 emissions and other greenhouse gas emissions.

So we need to look for a different food production system that is lower in carbon footprints but I feel that it is a job for mostly the higher and middle-income countries. The lower-income countries can for sure develop more efficient food production systems when it comes to greenhouse gas emissions, but for the lower and middle-income countries, the real challenge is to make food systems more resilient to climate variability. Again, that means more diverse food production systems; shorter value chains, distance, the time difference between where you produce foods and where it is being consumed. Things like social protection systems have to be better connected to the availability and access to nutritious food like fruits, vegetables, pulses and nuts.

Also Read: How Does Climate Change Affect The Food Chain?

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.