Malnutrition is a disservice to humankind and deprives millions of vulnerable children and adults from attaining their full potential. India alone has about 200 million people going hungry to bed on the one hand, while ranks second highest in childhood obesity. The eradication of malnutrition is a critical step in socially sustainable development. The Constitution of India states explicitly in Article 47 that the “State shall regard the raising of the level of the nutrition and the standard of living of its people and the improvement of public health as its primary duties”. More than 75 years after independence, many sources of data show that the nutrition situation in India has not improved as desired, with almost half the children underweight and more than 50 per cent of women and children with serious nutritional deficiencies such as anaemia. Although there are success stories and developments in parts of India that show what we can achieve, the level of malnutrition in our country today is morally unacceptable, and has enormous costs in terms of health, wellbeing, and economic development.
This Poshan Maah which also co-occurs while India celebrates her Azadi ka Amrit Mahotsav, it is important to reflect on the public health nutrition policy aspects, progress made and what can be done to further expedite the attainment of independence in the true sense from all forms of malnutrition.
Post-Independence, the first major development programme launched in India was Community Development Programme, 1952 made an attempt to increase the involvement of rural people in the development process. India ratified the Convention on the Rights of the Child in 1989, which was the first legally binding international instrument to incorporate a range of human rights – civil, cultural, economic, political, and social. This Convention protects children’s rights through standards in health care and education as well as legal, civil and social services. Article 24 on the topic of health states “Children have the right to the best health care possible, safe drinking water, nutritious food, a clean and safe environment and information to help them stay healthy.”
The Government of India has been implementing a number of programmes, which have the potential to improve the current nutrition security situation, through the Ministries of Women & Child Development (MWCD), Health & Family Welfare (MHFW), Rural Development, Panchayati Raj and the Urban Poverty programme. The Government also has a number of cross-cutting programmes including the National Health Mission, National Food Security Mission, Horticulture Mission, Mahatma Gandhi National Rural Employment Guarantee Act, Jawaharlal Nehru National Urban Renewal Mission and the Rajiv Gandhi National Drinking Water Mission. The Integrated Child Development Services (ICDS) scheme, although often considered as the nation’s main nutrition programme, has not shown an impact on nutrition over the past four decades of its operation.
The world is focused on the achievement of the Sustainable Development Goals (SDGs), which are greatly dependent on tackling the critical problem of nutrition in India. Malnutrition affects every SDGs indicator identified by the United Nations as the most meaningful indicator of human development: poverty, hunger, education, women’s empowerment, child mortality, maternal mortality and infectious chronic diseases.
Journey of Coming Together for Nutrition Security in India
• NFHS 3 result highlights India’s slow progress on nutrition
• Multi-stakeholder nutrition conclave hosted by Prof. M. S. Swaminathan, laid the foundation for a broad stakeholder coalition for nutrition
• First Lancet Series on Maternal and Child Nutrition launched,
• First Leadership Agenda for Action, emphasizing a focus on the first 1000 days, essential nutrition actions, and role of leadership was launched by Prof. Swaminathan.
• Second Lancet Series on Maternal and Child Nutrition launched,
• Costed Block Operational Plan which mandated Whole of Society approach and intersectionality/convergence closest to the community and its inclusion in the Government’s Five-Year Plan Document;
• Second edition of Leadership Agenda for Nutrition, updated by a wide range of stakeholders,
• NFHS 4 results highlight continued nutrition challenge but also identifies nutrition successes in key states in India
• India’s National Nutrition Mission (POSHAN Abhiyaan) launched, emphasizing convergence and the leadership role across Ministries to help achieve malnutrition free India. Launch of Jan Andolan against Malnutrition by Hon’ble Prime Minister of India.
• In the context of COVID-19, the launch of renewed Commitment to Action – for stakeholders to regroup around preserving progress on nutrition in India. Developed by the core group and signed-off on by 180+ stakeholders across academic, development partners, civil society and more.
India is at a historic juncture with respect to the eradication of malnutrition and its position in the world. The Commitment to Action may move forward in a concerted, coordinated and effective manner to achieve nutrition security in the context of the COVID-19 pandemic also. However deriving inspiration from the Chinese social philosopher- Confucius’s quote: “Our greatest glory is not in never falling, but in rising every time we fall”, we propose ways to strengthen our preparedness in this battle against malnutrition. The most important piece of the response is the public health nutrition P-O-L-I-C-Y and we use it as an acronym to suggest our recommendations.
• P- Prioritized persistent political actions. This is the foundation stone for attaining public health nutrition. The world produces enough food to feed us all, yet undernutrition and obesity coexist. Double duty actions as suggested by WHO are a must now which integrate tackling multiple forms of malnutrition and not just undernutrition. Most of the policies in nutrition in India are still centred around ameliorating hunger and calorie deficiency. It is imperative that we telescope the transition in the society and tune our policies to also arrest rising obesity across all our societies (irrespective of income and geography). Further, experts and evidence suggest that strong, committed leadership, transparent governance can help prioritize equity and gender issues in social safety nets, schemes for the vulnerable. It is pertinent that we overpower the conflict of interest and corruption which are often blamed for inefficient implementation of policies at the ground level. Leaders must prioritize proven and cost-effective interventions, such as Maternal Multiple Micronutrient Supplements, Breastfeeding Promotion, Vitamin A Supplementation, Balanced Energy Supplementation, Treatment of Severe Acute Malnutrition and support for improved Infant and Young Child Feeding Practices. Making diverse sustainable diets and healthier foods affordable, accessible to all must be brought centre stage while making key policy decisions. For example, Promoting Poshan vatika, kitchen gardens, community gardens etc are examples highlighting multisectoral coordination to achieve synergistic nutrition, health, agriculture and environment goals. If we demonstrate this partnership to begin with, using shared ownership and joint accountability model, many other sectors can also join in and help solidify the gains and amplify the success.
• O- Opportunity to reform, perform and transform at each stage of the food value chain. India currently grapples with multiple forms of malnutrition – undernutrition, overweight obesity, micronutrient deficiencies and their deadly combinations too. Changing the malnutrition narrative means governments enabling healthier environments using all their might and resources to promote the right to health and to nutritious foods for all as a priority to deliver sustainable health benefits. Few examples from PHN sector include preventing food wastage at each level – India reported to waste 50kg of food per person per year. This is hugely preventable. Another example is using climate smart approaches to produce and feed nutritious foods to our growing population which will be good for the planetary health in addition to human health. Thus research and development boost, infrastructure and resources to improve sustainable food systems must be looked into. Innovation and local solutions can help save resources but delaying action means depriving millions of people from attaining their full potential to lead a productive life.
• I- Information technology. We will be missing a huge opportunity if we don’t tap into the power of digital revolutionization for nutrition research, planning, delivery and monitoring. The reports of ICDS-CAS not working efficiently and resulting in huge wastage of resources and discontinuity in important data reflect poorly on the promises made under POSHAN Abhiyaan. Innumerable sectors use technology to predict events, situations, troubleshoot etc but we haven’t fully utilized this space in PHN. The critical importance of integrating nutrition information and data systems into early warning systems and shock-responsive safety nets with a focus on women and children must be urgently realized.
• C- Continuity in Public health nutrition (PHN) services, funds, personnel, training, research, data availability. Maximize nutrition “entering” the food value chain and minimize nutrition exiting these chains at various points like production, Post-Harvest, storage, processing, distribution, marketing and retail Consumption, food Utilization etc. The life-course approach to make nutrition and wellbeing cannot be over emphasized. Estimations by Accountability Initiative showed that India needs more than 38500 crores to fully finance direct nutrition interventions alone (PS: this does not include supplementary nutrition costs for 3-6y olds which was worked out to be ~40970 crores for 2020-21). However, the budgetary allocations for nutrition in 2020-21 were 35600 crores in all.
• Y- Yes, we can achieve Kuposhan Mukt Bharat but only with committed resources towards it. The optimistic mindset of dedicated committed stakeholders may not be enough unless robust policy support measures are in place. India’s nutrition action/inaction affects numbers globally. There is a need to align the mindset, methods and motivation to gear up to undertake this Herculean task of making India malnutrition.
(Co-authored by Dr Shweta Khandelwal is Head, Nutrition Research and Additional Professor, Public Health Foundation of India and Program Manager India Taskforce, Lancet COVID commission and Dr Sujeet Ranjan, a Public Health Nutrition Expert, the former Executive Director at The Coalition for Food and Nutrition Security)
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NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. 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 will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that 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 the country can become a Swasth or healthy India.