Hello! I am back, after what I realized was an extended blog break that lasted for over a year (yes, my last blog post was in June 2018!). Going back to school ain’t that easy…is also what I realized during the past year 🙂 ! So, the reason that compelled me to make a blogging comeback of sorts is the one public health issue that is very near and dear to my heart – ‘MALNUTRITION’!
The high rates of maternal and child mortality from under-nutrition and anemia in India and rather much of the low and middle income/developing world was one of the foremost reason why I took up public health as a full time life and/or career goal. That said, this blog is not at all about myself, however, it is definitely about India’s malnutrition problem, the real reasons behind the high rates of malnutrition, and how we can end malnutrition or at least keep trying to do so!
As a public health student and young (or rather that’s how I like to think about myself!) global public health professional, it is disheartening to see India from afar (now that I am based out of Canada) not progressing, both in terms of direction and velocity in which many of us would have liked. I believe that it is certainly partly Government’s fault and partly media’s (print, electronic, digital, social, etc. communication modes that exist in the current day and age) lack of attention devoted to health and/or allied healthcare issues. Malnutrition issue in India has further exacerbated due to lack of proper devolution of public financing (healthcare) schemes (in terms of reach, relevancy, sufficiency, and channelling of funds), lack of decentralization and autonomization in relation to States’ (regional and local levels) respective public health systems (especially among high burden backward districts), and monetary/non-monetary corruption (decay in terms of both moral and ethical values), among myriad of other social and behavioural factors.
That said, in the past few years all the efforts by the Government and media were not in vain. For starters, I understand that India is currently celebrating the National Nutrition Week (NNW) 2019. The NNW in India is not something new and has been around for nearly four decades now. But it is only in recent years, that the NNW has gained attention in terms of media coverage and has got a Government push due to improved governance mechanisms and regular reporting requirements regarding social and health indicators (thanks to Government of India’s premier policy think tank NITI Aayog’s Aspirational District Programme, among others).
NNW is an annual public health nutrition event launched by Food and Nutrition Board within the Ministry of Women and Child Development, Government of India in the year 1982. NNW is observed throughout India during the first week of September, that is, September 1st – 7th. The main objective for launching the NNW was to acknowledge ‘malnutrition’ as health and economic crisis in India. Further, the NNW was launched to tackle the public health problems and create awareness among people about the importance of adequate nutrition and balanced diet. Furthermore, NNW is celebrated with an overarching goal to raise awareness on the importance of nutrition for health which has further implications on labour productivity, economic growth and ultimately the nation’s economic development.
Since 1982, every year the Food and Nutrition Board specifies a theme for the NNW and through its network of 43 Community Food and Nutrition Extension Units (CFNEUs) located in all the four regions of the country, coordinate with concerned department(s) of the State/Union Territory Governments, National Public Health Institutions, Non-Government Organizations, among others. CFNEUs organize State/Union Territory level workshops, orientation training of field personnel/partners/functionaries, awareness generation camps, and community meetings during the NNW on a specified theme. Further, CFNEUs organize workshops, lectures, film and slide shows, exhibitions in collaboration with the concerned Departments of the State Governments, Educational institutions and Voluntary organizations. For instance, with respect to educational programmes, CFNEUs focus on various vital aspects of public health nutrition, including the importance of immunization, breastfeeding, principles of proper sanitation and hygiene, nutrient conservation during cooking, among others.
Although these aforementioned public health initiatives are laudable and have undeniably resulted in considerable decline in malnutrition numbers in India, there is much more to do and rather equally important to undo in the upcoming years. Thus, I am sorry to disappoint my blog reader that looking at the current state of affairs regarding public health nutrition in India, there is not much to celebrate, but that is a topic of discussion for another day and another blog(s)! I say (or rather write) that because malnutrition is an inter-generational and multidimensional phenomenon. The vicious cycle of malnutrition leads to health crisis and is no less than an epidemic. There is no straightforward solution to address this grave public health concern. For that reason, it is important to understand that malnutrition can manifest in multiple ways, the pathways to prevention involves but must not be limited to only nutrition-specific interventions such as adequate maternal and child nutrition; optimal breastfeeding practices; intake of nutritious foods for early childhood development, etc. Public health interventions must encompass a nutrition-sensitive approach, ensure a healthy environment including access to basic primary health services, opportunities for physical activity (now that India is facing a double burden of malnutrition), among others.
To put things in perspective, last year on July 24th, three sisters in a household with low socioeconomic status in the capital city Delhi – Mansi, Shikha, and Parul aged eight, four and two years, respectively, made headlines across India because they succumbed to severe acute malnutrition. The ‘real’ cause of death was certainly not only lack of proper nutrition but also pathetic living conditions and other socioeconomic factors!
Also Read: Three Delhi sisters died of ‘severe malnutrition’, say doctors
Over the past couple decades, India has shown exemplary economic performance. Since 1991, there has been a tremendous progress in India’s Gross Domestic Product, but it is also true that she still remains a country where 195 million people (i.e. approximately five times Canada’s population) are undernourished. The Global Hunger Index 2018 ranks India at 103 out of 119 countries (well below many poorer countries in sub-Saharan Africa) on the basis of three key indicators – the prevalence of wasting and stunting in children under the age of 5; child mortality rate under the age of 5; and the proportion of undernourished in the country’s population.
In essence, just like various other international, national, regional, and local news reports, Government/non-Government agency reports, United Nations reports, policy think tanks’ white papers, etc. sources of information, the Global Hunger Index echoes the fact that India is suffering from a serious problem of hunger and malnutrition.
Ankur Chhabra 