Diversity Is The Challenge
Photograph by Usha Ramesh
Within the next decade, India will be the world’s most populous country, overtaking China. It will also, for the next three decades, be blessed with a demographically young population—a huge development dividend. Yet, the challenge of providing adequate and appropriate nutrition for this vast population looms large, with worrisome concerns on the impact of climate change, water shortages, growing economic disparities, and the disconnect between commercial food production engines and human nutrition needs for health and wellbeing. Even before that future unfolds, we are witnessing major challenges of malnutrition in many forms. The National Family Health Survey (NFHS-4; 2015-16) records the percentages of underweight, wasted or stunted children at 35.7, 21 and 38, respectively. The corresponding figures vary across states—in Madhya Pradesh, they were 42.8, 25.8 and 42.
The inter-generational effects of malnutrition can be devastating not only for the affected families, but also for national productivity and development. Poor maternal nutrition in pregnancy results in a low birth weight child, who runs the risk of poor growth, infections and low educational attainment, and more prone to cardiovascular disease and diabetes in adulthood. Indeed, since an undernourished female baby in utero will experience epigenetic effects of poor nutrition on its own germ cells even before birth, the adverse effects of maternal nutrition can carry not only into the unborn child, but also its future offspring.
Exclusive breastfeeding in the first half of infancy and appropriate complementary feeding are essential. Undernutrition is also manifest as the ‘hidden hunger’ of micronutrient deficiencies. Overweight and obesity extend the spectrum of malnutrition in the other direction, especially visible in the urban affluent and middle class. There is an overlap of nutrition deficiencies even in those who are overweight or obese since their imbalanced diets may be high in calories but lack vital nutrients. Even among those with ‘normal bodyweight’, there is a high level of body fat and reduced lean muscle mass in many, indicating a nutritional imbalance that places such individuals at a higher risk of obesity-related diseases. So, the spectrum of inadequate or inappropriate diets extends across a wide arc of our population. No wonder, we see many faces of malnutrition in our population.
A range of diet-related chronic diseases—diabetes, cancers, cardiovascular and liver disorders—are rising rapidly in menacing magnitude, claiming lives or corroding health and productivity in midlife. These chronic diseases now affect all classes, with the poor most vulnerable because they can’t afford diverse nutritious diets and access to healthcare is inadequate. Dietary diversity, with balanced nutrients, is the key to growth and good health across the life course. A healthy diet provides adequate calories and appropriate nutrients in the right mix. Unfortunately, such diets are becoming more and more difficult to access due to barriers of income and affordability, skewed commercial priorities in agricultural crop selection, food processing and marketing practices that sacrifice nutrient needs for aggressively advertised sale of calorie-rich but nutrient-poor foods and beverages. Even daily fruit and vegetable consumption, a vital source of essential nutrients, is at a very low level of 150 grammes per capita, in contrast to the globally recommended norm of 400-500 grams per day. The result is an alarming mix of nutrient deficiencies and empty calories.
Climate change and environmental degradation bring fresh dangers. Crops like rice and wheat are now operating at the upper margin of their temperature vulnerability; as temperatures rise, productivity and nutrient value will diminish. For every 1 degree further rise in temperature, the productivity of these staples will fall by 7-10 per cent. Non-staples too will decline in nutrient quality. Fruit and vegetables will ripen and rot early. Water shortage and natural disasters escalated by climate change will further compromise agricultural production and nutrition security. The poor will become even more vulnerable. We need to urgently develop climate-smart agricultural practices to assure nutrition security to all as we work to weather the impact of climate change.
To make nutrition a springboard for development and not a roadblock, we need to overcome poverty, lack of nutrition literacy and nutrition-insensitive agricultural and food processing practices. For the nutrition security of India’s large and growing population across the life course of each individual, we need policies and programmes to steer our agriculture, food production and processing enterprise to the goal of assuring calorically adequate and nutritionally appropriate diets to everyone, of all ages. For this, we have to place equity as the cornerstone of our development.
(The writer is president, Public Health Foundation of India. The views expressed are personal.)