M5L3: Starvation in India - India and Global Hunger Index

THE CONTEXT: Recently, the GHI report ranked India at the 103rd position among 119 countries. This stands in contrast to the 55^th rank India scored in the year 2014. This has triggered controversy at political levels on whether India is improving or not in this sector after a change in govt.

WHAT IS GLOBAL HUNGER INDEX? The Global Hunger Index (GHI) is a tool designed by the International Food Policy Research Institute (IFPRI) to comprehensively measure and track hunger at global, regional, and national levels. It is designed to raise awareness and call attention by the govt. to eliminate it.

HOW ARE THE GHI SCORES CALCULATED?

GHI scores are calculated based on four indicators:

Undernourishment: the share of the population whose caloric intake is insufficient.

Child Wasting: the share of children under the age of five who have low weight for their height, reflecting acute undernutrition

Child Stunting: the share of children under the age of five who have low height for their age, reflecting chronic undernutrition

Child Mortality: the mortality rate of children under the age of five that reflects a fatal mix of inadequate nutrition and unhealthy environments

TYPES AND DIMENSIONS OF HUNGER

Hunger in simple terms is the desire to consume food. However, it has two dimensions

1.    Overt (or raw) hunger which is the need to fill the belly every few hours.

2.    Hidden hunger: This means that there is no demand for food but the requirement for nutrition is still not catered satisfactorily. This is determined by Body Mass Index.

WHAT IS THE CALORIE CONSUMPTION PUZZLE IN INDIA?

In almost all the countries, it has been found that with development in economy, the per capita calorie consumption of its population also increases proportionally. In case of the India, the per capita calorie consumption has declined despite a reduction in overall poverty.

DOES THE 2018 GHI RANKING REFLECT THE REAL SITUATION?

·         The method to determine the GHI is different in 2014 and the reports that have followed since 2017.

·         In 2014, India was ranked 55 out of 76 countries. In 2017, it included 44 more countries in the ranking list and India has been ranked 100 out of 119 countries.

·         India score 31.4 in 2017 and 31.1 in 2018 which means that the situation is improving (GHI should ideally be zero or close to it)

DEVIL in the DETAILS

The GHI assigns 70.5% weight to children below five (that constitute 11.5% of overall population) and 29.5% weight to the population above five (that constitutes 81.5% of the total population)

Therefore, the term “Hunger Index” is highly skewed towards undernutrition of children rather than representing the status of hunger in the overall population. Critics call it as child malnutrition index than Hunger index.

IMPACT OF MALNUTRITION

a)    Undernutrition in children reduces the nation’s economic advancement by at least 8% due to the impact on young child mortality, increasing incidence of sickness, direct productivity losses, poor cognition, and reduced schooling. This may eventually impact his earning capacity in his professional life.

b)    Undernutrition in early childhood also increases the chances of adult-onset chronic diseases such as diabetes and cardiovascular diseases. Most of this expenditure in India is out of pocket that can push a family into a permanent poverty trap.

c)    Malnutrition results into making our youth asset un-productive and hence, India is unable to escape the middle-income trap.

d)    In the case of India, this undernutrition costs $2.5 billion annually, and that the productivity losses make up almost 3% of GDP.

FACTORS RESPONSIBLE

Demand-side issues	·         Hunger and malnutrition are caused by a large number of factors, of which availability and access to a balanced diet are crucial. ·         The consumption basket of the underprivileged households in India is likely to be cereal-centric and not necessarily balanced (due to lack of pulses, coarse grains, fruits, vegetables, dairy products, egg, fish and meat, etc.)
Supply-side issues	·         The per capita availability of pulses declined steadily from about 69 g per day in 1961 to 51 g per day in 1971, and to about 43 g per day in 2013 (Economic Survey 2016). ·         This shows the adverse impact of the agricultural revolution that is biased towards certain crops and neglects the rest.
Governance	·         Commonly held belief within the government is that food insecurity is the primary cause of malnutrition. This notion is misplaced since stunting and low weight is also due to the interaction between genetics, environment, and sanitation ·         Even the focus of National Food Security Act, 2013 only on food, and not on health and care-related interventions. This results in the lack of an integrated approach between Ministry of Consumer Affairs, Food and Public Distribution, the MoHFW and MoWCD

Gender status and awareness	·         The low status of women in Indian society, their early marriage, low weight at pregnancy and illiteracy lead to the low weight of newborn babies. This is compounded by unscientific breastfeeding practices. ·         In the 100 districts studied in the Hunger and Malnutrition (HUNGaMA 2011) report, 51% mothers did not give colostrum to the newborn soon after birth and 58% mothers fed water to their infants before six months.
Poor Sanitation	·         Due to the bad quality of water and lack of toilets children are exposed to stomach infections, develop diarrhea and start losing weight. ·         At that time, it is unlikely that he/she will be able to ingest much good and healthy food and absorb the nutrition
Lack of targeted approach	·         The current National Sample Survey Office (NSSO) data on Household Consumption Expenditure is based on calorie norm than nutrition norms. ·         Additionally, since health is a part of the state list, the existing quality of data captured by the health system across states through (censuses and household surveys) is not sufficient and lacks any standardized format
Reach of Healthcare services	·         Due to lack of infra, many services like vaccination or primary emergency services in healthcare are unable to reach to the interiors of India. ·         Additionally, many of these areas are also affected by violence and insurgency.
Flawed approach	·         The ICDS targets children mostly after the age of three when malnutrition has already set in. It places more priority on food supplementation rather than on nutrition and health education interventions. ·         It has been found at multiple points that due to lack of accountability, it is poorly delivered, and the staff fudges the reported data so as to avoid responsibility for high malnutrition
Unresponsive bureaucracy	·         The government is found to carry its responsibility without in-depth analysis of grassroots scenarios. They appear to take a minimalist view of their responsibility by and reducing it simply to tendering and contracts for ‘take-home rations’ or ‘ready to use food’ without consultation with medical professionals. ·         While the effectiveness of RUTF is not proved completely, such practices may also lead to grand corruption at the Ministerial level that will lead to diversion of essential funds reserved for this sector. ·         A better option is hot freshly cooked mid-day meals wherein the local community is engaged. The success of ‘Tithi Bhojan’ in Gujarat is a point in this case.
Minimalist approach	·         When the new Ministry of Women and Child Development was set up, it was expected that it would take a holistic view of the problems that impinge children’s welfare. ·         This includes education, sanitation, health, environment etc. that overlap with other ministries ·         However, in this case, it has been found that it has restricted itself to specific programs like ICDS and MDM while neglecting the other factors that are likely to impact children’ growth and development.

Lessons from international experiences

·         Child malnutrition rates around 1980 in Thailand were similar to what we had in India in 1992. However, they could reduce this from 50 to 25% by 1988.

·         This was achieved through a mix of interventions including intensive growth monitoring

·         and nutrition education, strong supplementary feeding provision, high rates of coverage ensured by having high human resource intensity, iron and vitamin supplementation and salt iodization along with primary health care.

·         The programme used community volunteers (with no honorarium) on a huge scale (one per 20 children), and involved local people, so as to instill self-reliance and communicate effectively with target groups.

·         Communities were involved in needs assessment, planning, programme implementation, beneficiary selection and seeking local financial contributions.

·         Inter-village competition in reducing the number of under-nourished children was encouraged, and villages were rewarded for their success.

WHAT SHOULD BE DONE?

Direct Policy Measures

·         Expand the safety net through ICDS to cover all vulnerable groups and empower mothers and expectant women)

·         Fortify essential foods with appropriate nutrients (eg., salt with iodine and/or iron)

·         Popularise low-cost nutritious food

·         Control micro-nutrient deficiencies amongst vulnerable groups

Indirect Policy Measures

·         Ensure food security through increased production of food grains

·         Improve dietary pattern by promoting production and increasing per capita availability of

·         nutritionally rich food

·         Effecting income transfers (improve the purchasing power of landless, rural and urban poor; expand and improve public distribution system)

·         Other: Implement land reforms (tenure, ceiling laws) to reduce the vulnerability of poor; increase health and immunization facilities, and nutrition knowledge; prevent food adulteration; monitor nutrition programmes and strengthen nutrition surveillance; community participation

Integrated approach at the ministerial level

·         Currently, all the factors that impact child’ overall development are divided among various ministries. (explained in next image). An integrated approach is required to address the same.

·         Additionally, since health is a part of the state list, the union government should work hand in hand with the state government to improve accountability. With improved finances to the state under the 14^th Finance Commission, this can be executed in a far better way. till 2035.

·         This issue should be addressed at war footing if India wants to seize this opportunity and become a part of high middle income or list of developed countries.