Well-Nourished Minds Are Our Nation’s Future
The stress on the importance of stimulating creativity and innovation in early years to positively influence young minds by our honorable PM, could not be missed in his
Mann ki Baat episode dated 30 Aug 2020. He eloquently substantiated his point on innovation by mentioning manufacturing local toys and making them accessible to all
children which in turn may improve their neurodevelopment. The other important point he highlighted was the role of good nutrition in growth and development of a nation.
He said “Nation and nutrition have deep linkages” and rightly so. Experts concur that investing in the early life years is one of the smartest things a country can do. About 11% of Gross National Product (GNP) loss is ascribed to undernutrition in countries in Asia and Africa. In fact, India's 2.5% economic output is lost owing to micronutrient deficiencies, such as iron deficiency anaemia. Even maternal iodine deficiency has grave consequences for fetal development and child intelligence quotient (IQ). Children born to mothers who were iodine deficient during pregnancy experience, on average, a loss of 12.5 to 13.5 IQ points. Another focus theme of this year’s Poshan Maah is identification and referral of SAM children. It is well known that if left untreated, SAM in early childhood can lead to dire short-term consequences, such as a 12-fold increased risk of dying or higher likelihood of contracting infectious diseases. Children with wasting are also more likely to become stunted. It can also affect various developmental processes that may predispose affected children to chronic disease later in life and cause cognitive deficits. Equitable prenatal and early childhood policies and programmes are therefore crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults.
Research shows that about 250 million children (43%) younger than 5 years in low-income and middle-income countries like India are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multi-sectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. David Barker also showed that some prenatal insults (like poor maternal nutrition, stress, violence etc) have adverse metabolic implications in later adult life especially predisposing them to non-communicable diseases. The links between early childhood nutrition and human capital have been well recognized for some time. The World Bank report (2018) noted that “…investments in nutrition are durable, inalienable, and portable. Durable because investments made during the critical 1,000-day window of opportunity last a lifetime without ever needing to be replenished. Inalienable and portable because they belong to that child no matter what and wherever she or he goes. These investments in nutrition are among the best in development, with a return of between $4 and $35 for every $1 invested.”
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The first 1000 days are now a focus area of the Poshan Abhiyaan, and this needs to be bolstered to extend the continuum of care across life-course so that kids get a healthy productive adult life. Smart investments in the physical, cognitive, linguistic, and socio-emotional development of young children —from before birth until they transition to primary school— are critical to put them on the path to greater prosperity, and to help countries be more productive and compete more successfully in a rapidly changing global economy. Studies show that a deficient environment is the root cause for multiple health and nutrition problems. This deficiency can be related to poor nutrition and stimulation which can be due to either poverty, lack of resources, gender inequality, lack of awareness, domestic violence or abuse or broken families,etc. While some of them are non-modifiable or very difficult to change, most of these can be tackled by providing a stimulating environment for the child to grow in. Psychosocial stimulation, good nutrition, lots of opportunity to play and access to effective education may actually mitigate the adverse impact of disadvantaged or poor childhood. Some examples include a 20-year study of children in Jamaica, which showed that early stimulation interventions during early years increased their future
earnings by 25 percent. A World Bank Group (WBG) analysis of the long-term benefits of early childhood education in 12 countries found that children who attend preschool
stay in school for nearly a year longer, on average, and are more likely to be employed in high-skilled jobs.
Thus, the concurrent mention of school poshan monitors, the importance of alleviating micronutrient deficiency using local sustainable agricultural produce (also Agri fund) by our highest leadership in the same speech is very crucial. We propose a M-I-N-D outline to translate PM’s vision into reality in an expedited fashion.
·Multisectoral action to plan and execute integrated policy and program interventions –
There are many win-win situations in combining actions, from ensuring health and nutrition to social protection to economic growth. This needs commitment from all with shared accountability. There is a need to think beyond the nutrition silos. Nutri gardens are a wonderful example of shared vision by several players – in particular, nutrition, agriculture, forests, AYUSH, WCD, Education, MoH, horticulture, environment etc. These gardens not only help improve health, nutritional status but environment too. Such effective, inter-sectoral mechanism need careful measurement and monitoring of their efficiency and of their expected educational, nutritional and agricultural outcomes. Nutrigardens, if scaled up can also be linked to school meals with nutrition education, family and school community involvement, school gardening, and training and technical support to help schools achieve an overall healthier environment. Similarly nutrition-sensitive interventions and programmes in WASH, health, agriculture, social safety nets, early childhood development and education have enormous potential to enhance the scale and effectiveness of nutrition specific-interventions. In addition, they also have a role in supporting livelihoods, food security, diet
quality, and women’s empowerment, and in reaching with high coverage nutritionally at-risk households and individuals.
·Investment – Financial commitment to make shared vision and joint action a reality. As discussed above, investing in nutrition across life-course will fuel progress on
all of the 17 development goals enshrined in the Sustainable Development Goals (SDGs), including education and alleviating poverty. In addition to finances, other resources like time and attention from all stakeholders in form of constructive, collective and practical engagement to support development and roll out will also help catalyze policy and programmatic action.
·Nutrition and health surveillance along with regular monitoring, periodic checks, and evaluation using technology should be a key priority. Feedback mechanisms should
also be transparent and robust. Prevention and management of public health and nutrition issues like SAM etc will get a huge boost if surveillance is regular, efficient
·Develop and demonstrate that local capacity can be built to cater to local needs- Top down approaches often don’t yield favorable outcomes and even if they are complied with due to pressure, they are often not sustainable. Thus developing innovative local sustainable models in research, education, service delivery etc., will help provide economically viable pragmatic long term relevant options. Youth leaders, women groups etc can be trained after rigorous needs assessment. Public participation as envisaged by our Prime Minister will also be more engaging if we propagate ‘Vocal for local’ in leadership and ownership for public health and nutrition issues.
In short, loss of creative and intellectual energy owing to poor nutrition will be a shame to any country’s human capital especially for India aspiring to be a superpower. Thus investments in nutrition provide an opportunity not only to improve nutrition indicators, but also to contribute to achievement of other goals, such as increasing school completion, raising adult wages, helping children escape poverty, and accelerating nation’s economic growth. Let all stakeholders pledge to work towards this shared vision of a productive nourished and healthy India not only during the Poshan Maah but throughout with all their might!
(The author is the head, Nutrition Research and Additional Professor with PHFI)