Travelling to countries like Japan and Singapore over the years, I would marvel not just at their sparklingly clean public areas, but also the personal hygiene habits of people. The use of masks, face coverings and hand sanitiser were commonplace among people in public there long before the Coronavirus pandemic made them de rigeur in most parts of the world, including India.
The pandemic has taken a big toll on India, both in terms of lives and the economy, but has also undeniably had the effect of raising awareness of and compliance with public health norms. This had already been happening over the past several years with the increasing traction of the Swachh Bharat public cleanliness campaign, personally championed by Prime Minister Narendra Modi.
From the initial scepticism and apathy, as the campaign picked up steam and started getting global recognition, respect for and involvement in it has led to noticeable improvements in public hygiene. Another of the PM’s exhortations, that for the Beti Bachao Beti Padhao campaign for girl children has also started showing results, in halting and then reversing a skewed gender ratio.
Both these public campaigns have an underlying subtext and common theme. It has to do with eradicating malnutrition in the nation. India has been making steady but slow gains in reducing the percentage of malnourished children, down from nearly one in every two just a decade ago, to about 38 per cent now. That still requires further improvement to be on par with several comparable nations, let alone developed ones. It is thus but natural that the prime minister has launched a slew of initiatives to bring about a drastic reduction of this scourge.
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Malnourishment at infancy and early childhood not only raises the mortality rate —another statistic in which India has made dramatic strides of improvement, but still needs to catch up with other middle-income nations— but also takes a lifelong toll on those who survive into adulthood. Studies have documented the impairment in IQ, lower earnings, poorer health, and shorter lives, of adults who survived malnourishment in infancy and early childhood.
One of the greatest myths about malnourishment is the general public’s impression that it is only about poverty and the lack of food. Of course, those are indeed primary factors. But the great irony is that malnourishment does not decline proportionately with the reduction of poverty and the increased availability of calories. Even as hundreds of millions of Indians have risen above abject poverty, with a dramatic drop in starvation levels, and even as malnourishment has dropped noticeably, it has not dropped linearly.
The reasons for that difference are primarily cultural, which act as a drag on the rate of reduction of malnutrition, despite the economic factors having become more conducive. Of the cultural factors which contribute to childhood malnutrition, four stand out. First, breastfeeding newborns and continuing to do so for the first six months of life is crucial to developing their immune systems, but has been declining as a practice. This has to do with increased use of commercially sold baby food and the high voltage, hugely funded marketing campaigns behind that.
Second, outdoor defecation, which increases the risk of infections, affecting children’s ability to absorb nutrients. Third, the practice of girls in many families being fed last, and the least, at mealtimes. The latter contributes to anaemia among adolescent girls and, in combination with early marriages, makes malnutrition an inter-generational malaise. And fourth, the sharp increase of processed and junk food, even in rural India, including both the worst of western diets, as well as packaged snacks. These contribute to an increase of non nutritious calories, which is also malnutrition and impacts youngsters’ health profiles.
The commensurate decline of traditionally balanced meals compounds these problems. Take for instance my home state, Odisha. Certainly, endemic poverty over generations contributed greatly to the higher levels of malnutrition that had been recorded here in modern times. But though that is being gradually overcome, the state nevertheless simultaneously experiences some of the ills of the modern practices mentioned above.
Thus, the advantages of a diet rich in nutrients and variety, from its long and rich history as a prosperous kingdom from millennia ago, are increasingly lost to its present day denizens. While nationwide campaigns to enhance public hygiene and nutrition practices are helping enormously, additional interventions are deemed necessary by many experts to speed up India’s war on malnutrition.
This is where the modern practice of fortifying commonly eaten foods comes in. Long recommended by public health experts, food fortification got a boost in 2018, with the Food Safety and Standards Authority of India (FSSAI) issuing regulations for mandatory standards for micronutrients. Its guidelines cover staples like rice, wheat flour, milk, edible oil and salt.
With 15 states having already adopted fortification of their chosen commodities, either at district level or more, the war on malnutrition is transitioning into high gear. It has been reported that anaemia levels have dropped by 20 per cent, with 6 per cent being attributed to fortification.
This combination of societal changes led by the Prime Minister himself with targeted governmental campaigns, improving disposable incomes, and the adoption of specific technologies like fortification, will contribute to a sharp improvement in the trajectory of eradicating malnutrition in India.
– Baijayant ‘Jay’ Panda is National Vice-President, BJP