India’s double burden on malnutrition: Time for urgent redressal

India’s double burden on malnutrition: Time for urgent redressal

India has ~65% population below the age of 35. This translates to the fact that more than half of the potential workforce over the coming decade in Asia will come from India. This will have huge economic and leadership implications for our country. However, a major requirement will be for these young people to be healthy and skilled. We all know that optimal nutrition will be the most essential factor propelling proper growth and development of human brain and body. Unfortunately, in 2016 the number of chronically undernourished people in the world is estimated to have increased to 815 million, up from 777 million in 2015. India alone contributes 200 million (about a quarter) to this staggering number.

Evidences clearly state that suboptimal quality of diets is projected to be the most important and largest cause of most forms of malnutrition. With the current rise in BIG FOODS pushing cheaper packaged foods (high in trans fats, simple sugars and salt) aggressively across the developing countries, mass nutritional security is on high alert. Global leaders and public health advocates have produced several high quality reports, scientific papers and op-eds in the last year or so (including several like India: Health of the Nation’s States, The India State-Level Disease Burden Initiative, Global Nutrition report, FAO’s food insecurity report, Centre for Science in public interest’s Carbonating the world, India Health Report, WHO advisories on high salt and sugar etc.) portending a massive threat to public health and nutrition. India is a very tempting market for Big Foods because lack of awareness coupled with pseudo-social status indicators (like eating and buying packaged foods) makes people willingly choose unhealthy ultra-processed products over their fresh home cooked meals. The ready to eat options, marketed as cool and convenient (non-labour intensive) choices are becoming inadvertently but increasingly popular among the working parents. The realisation, that these unhealthy products may soon become addiction and default choice, usually sets in when the damage is done. No wonder childhood overweight and obesity often accompanied with multiple micronutrient deficiencies is skyrocketing in India.

Another looming but related threat is the increase in adverse climatic calamities and crises (mind you- these are our own doings!) across the globe. This has dual implications- on one hand, much of the recent increase in food insecurity can be traced to the greater number of conflicts, often exacerbated by climate-related shocks. Additionally, the decrease in nutrient quality of our produce is associated with poor air quality and pollution.

The FAO’s 2030 Agenda as well as United Nations Decade of Action on Nutrition (2016–2025) are global efforts to earmark resources towards tackling malnutrition by proposing time-bound, cohesive framework for action. However each country needs to engage with all their might and implement evidence-based customised strategies towards attaining suggested success in health and nutrition indicators. The BIG question is what should and can be done?

Although complex, this problem of worsening food quality and in turn exacerbating human health and nutrition needs to be urgently curtailed. Effective strategies include: strong government policy/regulation to check the influx of poor quality processed foods (checking manufacture, sales, advertising), promote locally available fresh fruits and vegetable consumption, investing in mass awareness campaigns using digital technology (homes, schools, workplace, religious places, etc.) national level high-quality regular monitoring and surveillance of health and nutrition indicators. To implement each of the suggested strategy a strong action plan which cuts across sectors (health, nutrition, education, commerce/trade, finance, agriculture, and environment etc.) is needed. The NITI Aayog has recently shared a 3 year road map for action including a commitment on enhancing the nutritional status of our population. The MoHFW and FSSAI have convened expert panels to prepare reports on related issues but faster, evidence based concrete action needs to emerge and implemented with all sincerity. For example to control access to and affordability of ultra-processed foods, the government needs to firstly have a sound system to screen products in our markets, then devise a method for easy identification of relatively healthier products. This needs to be followed by the rules/policy around sale and advertising of such products. All these action points need strong coordination amongst various government departments/ministries and stakeholders. The environment, agriculture and education ministries have a big role and stake in this mission. It should be realised and inter-ministerial committee should be formed for prompt discussion and action. Many such small but unadulterated drops are required to collectively fill up India’s health and nutrition container which in turn will quench/extinguish the malnutrition fire in our country.

The recent news of pulse-rice-vegetables combination popularly called ‘khichdi’ to be branded as India’s global food was heartening. It not only reinforces it as a nutritious choice but also preferentially glorifies local home cooked recipes in comparison to packaged foods. This also lends support to our argument of not replacing hot cooked meals (including this nutritious khichdi) with packaged foods as a part of mid-day meals. We have wonderful public health policies but action /implementation on ground needs to be strengthened multi-fold for meaningful strides in human health and nutrition status of our country. The time to act against the multi-headed malnutrition demon is NOW.

Dr Shweta Khandelwal
Associate Professor
Public Health Foundation of India

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