Are we heading towards an era of malnutrition?

Image Courtesy: Tehelka

Recently the landslide victory of BJP in the major state assembly elections gave a perspective to many that the country is growing in the right direction in the right hands. With the GDP growth rate to be estimated between 6.75% and 7.5%, the policy makers seem to be satiated with the current performance of India. However as is widely believed in the parlance of economics, growth and development are more of complements, rather than substitutes. As such growth without concomitant development may have deleterious socio-economic impacts on the economy. The other side of this coin reveals a bleak and gloomy future for India from developmental perspective.

Few weeks ago the National Family Health Survey-4 data was released by the International Institute for Population Sciences, Mumbai. The survey conducted in 2015-16 covered around 6 lakh households. The survey results are indicative of the fact that the country may be moving towards what may be termed as the Era of Malnutrition.

Child under-nutrition in India continues to be amongst the worst in the world. Though India has become sufficient in terms of food grain production, yet while feeding its population, especially the children, the performance is appalling. In fact more than 90% of the total children population aged 6-23 months in the survey are reported to have not received adequate diet.

In fact the situation was so grave in the previous decade, that it prompted many notable economists like Deaton and Drèze to have compared malnutrition rates with that of the sub-Saharan African countries.[1] The sad state of affairs has improved only marginally during this decade. Specifically, the proportion of children under the age of five years suffering from Stunting (low height-for-age) has declined from 48% to 38.4%. The corresponding figures for underweight (low weight-for-age) have declined from 42.5% to 35.7%. However, compared to the other developing nations these figures are still dismal. On the other hand, the prevalence of Wasting (low weight-for-height) has increased from 19.8% to 21%. With respect to the presence of haemoglobin in blood, more than 50% of the pregnant women and children are suffering from anaemia. Considering the projections of child population to be 12.4 crore, this leaves India at state of shame with around 7crore children anaemic, 5crore stunted children, 3 crore wasted, and more than 4crore children underweight.[2]

To add to the distress of health and nutrition experts, the obesity rates among adults are found to be increasing irrespective of gender. In the last decade, percentage of women who are overweight or obese (BMI ≥ 25.0 kg/ ) has increased on an average from 12.6% to 20.7%. For men, the corresponding share has increased from 9.3% to 18.6%. In Chandigarh, Delhi, Andhra Pradesh, Kerala and Tamil Nadu obesity rates for women have even exceeded 30%. One matter of particular concern is the alarmingly high rates of obesity among women in the major metropolitan cities of India with around 30-40% of the women being obese. In Hyderabad these rates are as high as 47%. This may be attributed to the increasing effect of social globalization on diet. The result is around 1 out of 3 urban women and 1 out of 4 urban men to be suffering from obesity.

States Stunted Wasted Underweight Obese women Obese Men
Bihar 48.3 20.8 43.9 11.7 12.6
Delhi 32.3 17.1 27 34.9 24.6
Gujarat 38.5 26.4 39.3 23.7 19.7
Haryana 34 21.2 29.4 21 20
Jharkhand 45.3 29 47.8 10.3 11.1
Karnataka 36.2 26.1 35.2 23.3 22.1
Kerala 19.7 15.7 16.1 32.4 28.5
Maharashtra 34.4 25.6 36 23.4 23.8
Madhya Pradesh 42 25.8 42.8 13.6 10.9
Odisha 34.1 20.4 34.4 16.5 17.2
Punjab 25.7 15.6 21.6 31.3 27.8
Rajasthan 39.1 23 36.7 14.1 13.2
Tamil Nadu 27.1 19.7 23.8 30.9 28.2
West Bengal 32.5 20.3 31.5 19.9 14.2
India 38.4 21 35.7 20.7 18.6

Chart showing the prevalence of malnutrition in some of the major states and India on an average.

Source: NFHS 4 report, 2015-16.

Till recently the attitude of the government towards tackling these twin issues of malnutrition has been grossly insufficient. Total public expenditure on health as a percentage of GDP remains stagnated at less than 2%. Though the recent National Health Policy 2017 has a target of increasing this share to 2.5% of GDP by 2025, yet it still lags behind many developing nations, let alone the developed ones in terms of public spending on health. Moreover the policy marks a shift from the previously stated rights-based approach to a “progressively implemental assurance based approach”. IMR and life expectancy at birth seems to be the key targets in the proposed blueprint. It has also given more priority to preventive health care rather than curative one. Though several goals have been stated, yet the blueprint fails to convince how these targeted goals would be met. Several aspects of food and nutritional security have also been completely ignored.

This narrative indicates that India may witness an Era of Malnutrition with abysmally low levels of child under-nutrition rates, coupled with an increase in obesity rates for adults, if the current situation persists. Instead of setting insufficient targets and goals which may fail without proper formulation, it is the need of the hour for the policy makers to understand the multi-faceted aspects and determinants of health outcomes in India to combat the twin vices of malnutrition.

[1] For further information refer to: Deaton, Angus and Jean Dreze (2009): “Food and Nutrition in India: Facts and Interpretations”, Economic & Political Weekly, 44 (7), pp 42-65.

[2] Based on Census Data, 2011.