Malnutrition, even in its starkest form, is not simply about lack of calories or food. That’s the central message of two recent research papers written by a team of researchers at Washington University in St. Louis, which have created a buzz in the scientific community.
The complementary research papers, based on trials in Malawi, show how abnormal microbes in the gut could play a key role in the onset as well as in the treatment of kwashiorkor, a severe form of malnutrition. These findings are the latest additions to a gigantic pile of evidence that emphasizes the role of non-dietary factors in causing malnutrition. Several studies have pointed to the importance of two such factors in causing malnutrition in countries like India, where malnutrition affects nearly one in two children. The first factor is the low social status of women in South Asia, which leads to high proportions of low birth weights in the region. The second key factor is inadequate hygiene and sanitation, which leads to rampant spread of diseases such as diarrhoea that diminish a child’s ability to absorb nutrients.
Turning a blind eye to such evidence, the United Progressive Alliance government at the Centre plans to introduce near-universal foodgrain entitlements in the proposed Food Security Act to tackle hunger and malnutrition. This ‘historic’ initiative is misguided and problematic on three counts.
The first problem arises from the Act’s focus on ensuring a regular supply of cereals. While this may be the right way to deal with hunger, it is inadequate to deal with the nutritional needs of adults, and completely ineffective in addressing the needs of the very young. The critical window to address malnutrition is the first 1,000 days of life, starting from the mother’s womb, beyond which the effects of under-nutrition can be irreversible. During this phase, it is not the quantity of food but the quality and frequency of meals that matter for healthy growth. For adults, a balanced diet surely involves much more than cereals.
The Centre’s fixation with aggregate calories and hunger could have still been justified if under-nutrition and hunger co-existed in all affected households. But only 2% of households are affected by hunger whereas nearly half of all Indian children are malnourished, indicating that separate policies are needed to tackle the two problems, as economist Arvind Virmani argued in a recent blog post.
Secondly, the initiative is myopic as it fails to acknowledge what is commonly termed the double burden of malnutrition: the co-existence of under-nutrition and over-nutrition in the same economies, and even in the same households. A growing body of evidence suggests that low birth weight not just stunts growth of a child but also raises the risk of obesity-related disorders much later in life. Although the exact mechanisms of how this happens is still being studied, one widely cited (‘thrifty genotype’) hypothesis postulates that under-nutrition in the prenatal stage programmes the foetal tissues to utilize food efficiently, making it difficult for low birth weight babies to deal with abundance of food in later life. This transition from under-nutrition to obesity is expected to occur quickly in fast growing Asian economies such as India, where birth weights are much lower than elsewhere, and where increased urbanization is changing dietary habits rapidly. The human and economic toll could be dramatic and for many, the exit out of food poverty may be associated with a straight entry into health poverty, warned a 2006 Food and Agriculture Organization report on nutrition transition in developing economies. The food Bill doesn’t address the looming crisis.
Thirdly, by appearing to tackle malnutrition, the food Bill might actually hinder real efforts in tackling India’s nutritional crisis. While the Bill will be brandished as India’s answer to malnutrition, more effective measures to tackle the problem will fail to garner attention and investments. If this sounds far-fetched, consider the history of the Integrated Child Development Services, the world’s largest child nutrition programme and India’s primary anti-malnutrition tool. Started 37 years ago, it has hardly dented overall malnutrition rates. Yet, it continues to be patronized by politicians, judiciary and activists alike, at the expense of better alternatives.
Unless our policymakers develop greater respect for scientific evidence, the fight against malnutrition will continue to be hamstrung by stale ideas, crude populism and defunct policy tools.
After service in the British SAS Regiment the author became a physician and then an orthopaedic surgeon.
He has held professorial positions in Canada, Vietnam and the United States, practiced and taught orthopaedic surgery in three continents and in several wars.
He has extensive experience as an expert witness in court. Somewhere along the way, time was found to operate a four hundred acre mixed farm, a one hundred seat restaurant and to obtain a licence as a flying instructor.
The author's books are available from bookstores, the publishers, or from on-line bookstores such as Amazon, Barnes and Noble, and Indigo/Chapters.