A Sustainable Nutrition Revolution Is What India Needs Today!

Good nutrition is good life. Healthy diets and good nutrition with adequate macro and micro nutrients are the fundamental basis for health and human development. India needs to make nutrition a top investment priority in order to catalyze its demographic dividend, enhance productivity and growth and achieve success in its national and state flagship programmes.

Despite its high economic growth rate India has the unflattering distinction of having the highest number of malnourished children in the world with abysmal nutrition indicators. More than 50 percent of women in India are anaemic and nearly 60 percent of children in the 6-23 months crucial age bracket are anaemic, hugely compounding the problem of malnutrition in the country.

Only a Sustainable Nutrition Revolution in an Indian Way -- with women at the forefront -- can transform India into a developed nation, ensure food sovereignty and climate justice and empower the present and future generations. Nutrition is extremely crucial for inclusive and sustainable development in the country.

Good nutrition from early life, notably in the first 1,000 days of life, leads to high Intelligence Quotient (IQ), enhances human capital potential, and breaks the passivity, the culture of silence, perpetual poverty, as well as ensure social justice, rights and entitlements.

Any investment made in sustainable food and nutrition gives significantly high returns. A pertinent point to be considered, according to global studies, is that for every dollar invested in nutrition there is an average return of 16 dollars.

The Debilitating Costs of Malnutrition

Malnutrition outcomes such as Stunting and Anaemia severely affect physical and cognitive growth and pose a huge burden on economic productivity.

Stunting:

• 1% loss in adult height due to stunting impacts 1.4% loss in productivity
• Stunting reduces IQ scores by 5-11 points. Children affected receive lower grades in school
• Children with low birth weight are 2.6 times less likely to go on to higher education or graduate
• Stunted children will earn at least 10 percent less in lifetime earnings
• Stunting, and the associated cognitive deficits lead to reduced schooling attainment (0.5 years lost in educational attainment), decreased adult earning (average loss of lifetime earnings of $1,400 per child), and huge economic costs (estimated 4% to 11% of GDP in Africa and Asia each year)
• Chronically undernourished children short in physical stature, but the development of their brains — their “grey-matter infrastructure”—is also stunted. There is also a strong linkage between poor intrauterine development and later life morbidity due to non-communicable diseases and related mortality (WHO, 2016).

 Anaemia:

• Eliminating anaemia increases 5-17% adult productivity (Horton and Ross (2003)
• Iodine deficient children lose on average 13 IQ points and iron deficiency anaemia reduces performance on tests by 8 IQ points, making them less educable (World Bank 2006).
• Childhood anaemia alone is associated with a 2.5 percent drop in adult wages.  Anaemia in adults has been estimated to be equivalent to 0.6 percent of GDP, and goes up to 3.4 percent when including the secondary effects of retarded cognitive development in children (Horton 1999).

Vision, Goals and Objectives

Vision- A Mission Hunger and Malnutrition-Free India -Ensure food and nutrition security and sustainable agriculture to realise the full human potential and supercharge the demographic dividend and make India a global nutrition pioneer by the year 2040.

Key goals and objectives-

To bring about a Nutrition Revolution, India needs to adopt a Mission Mode Approach and ensure safe and healthy diets for sustainable nutrition for all.

• In order to bring down key malnutrition indicators like stunting, wasting, undernutrition and anaemia to single digits by 2040, India needs to Double or even Quadruple the current rate of reduction levels by giving it the required push.

• India should ensure ZERO Hunger and Malnutrition deaths by 2040.

India needs to prioritize actions and investment in the first 1,000 days of life -- from conception to two years of age of the child -- as the first window of opportunity; and also focus majorly on Adolescent Girls – future mothers -- as the second window of opportunity.

Transforming India’s Nutrition Landscape by 2040: Bringing down Malnutrition to single digit status

According to the National Family Health Survey (2015-16), India has 38.4 percent Children Under 5 who are stunted. The Annual Average Rate of Reduction (AARR 2005-06 to 2015-16) now stands at 2.2 percent. However, the AARR required to reach single digit values by 2040 is 5.50 percent, to arrive at the projected target of 9.3 percent. (The AARR has been calculated by taking the reference period between NFHS-3 and NFHS-4. The AARR is the average relative percent decrease per year in prevalence or rate. A positive sign indicates a reduction or downward trend, while a negative sign indicates increase, or an upward trend.)

• Similarly, the percentage of children under 5 years who are wasted (weight-for-height) stands at 21 percent. The AARR is -0.6 percent, which needs to be scaled up to 3 percent by 2040 to reach 9.8 percent.
• For children under 5 years who are underweight (weight-for-age), India has 35.7 percent such children. The current AARR is 1.7 percent, which needs to be scaled up to 5 percent by 2040 to arrive at the single digit of 9.9 percent.
• For children in the age bracket 6-59 months who are anaemic (their HB levels are below 11.0 g/dL), the prevalence stands at a high of 58.4 percent. The AARR currently is 1.7 percent, which needs to be 6.90 percent by 2040, to arrive at 9.8 percent.
• Among non-pregnant women in the bracket 15-49 years who are anaemic (Hemoglobin levels below 12) the prevalence stands at 53.1 percent, with an AARR of 0.4. This needs to be improved to 6.50 percent to achieve 9.9 percent status by 2040.
• Among pregnant women between age 15-49 years who are anaemic (with Hemoglobin below 11.0 g/dL), the occurrence is again at a high of 50.3 percent, with a current AARR of 1.4 percent. This needs to be scaled up to 6.30 percent to arrive at the single digit of 9.9 by 2040.
• Among women in the age 15-49 years who are anaemic, the prevalence is 53 percent, with a current AARR of 0.4. This needs to be raised to 6.50 percent to reach 9.9 percent by 2040.

This shows that to bring down the malnutrition indicators to single digit, India would need the Annual Average Rate of Reductions (AARRs) to be four or five times the current rate. It also shows that there is an urgent need to accelerate and compound all the efforts we are putting in, to achieve the desired results.

Good nutrition and a Mission Malnutrition-Free India are the only ways to realise India’s vision for a brighter future India needs to adopt multiple approaches, convergence strategies, including promotion and replication of successful nutrition models to demonstrate high impact.

(This article is the first of a four-part series on the need for a Nutrition Revolution. Basanta Kumar Kar is the recipient of the prestigious global ‘Transform Nutrition Champions’’ award for outstanding contribution to nutrition in South Asia, and ‘Odisha Living Legend’ award for contribution to public policy. For his decades long contribution to champion the cause of sustainable food and nutrition security in India and globally, Kar is also known as the ‘Nutrition Man’. Kar is currently working as Country Director of Project Concern International/India. He can be reached at basantak@rediffmail.com.)