Malnutrition has been one of the persistent problems of India. Despite years of rapid economic growth, India has a higher prevalence of malnutrition among children. Even as malnutrition among children has shown some downfall since 2006, it is still well below the global nutrition targets adopted by the World Health Assembly (WHA) to which India is a signatory.
The Global Nutrition Report 2016 puts India behind African countries like Ghana and Togo. According to the report, India will achieve the current stunting rates of Ghana or Togo by 2030 and that of China by 2055.
Recently, marking the celebration of World Food Day, the Central Government released new standards on the fortification of food envisaging guidelines on the addition of nutrients in food and packaged food. In fact, the FSSAI has formulated a comprehensive regulation on fortification of foods namely ‘Food Safety and Standards (Fortification of Foods) Regulations, 2016. These regulations set the standards for food fortification and encourage the production, manufacture, distribution, sale and consumption of fortified foods.
In 1993, the National Nutrition Policy recognised the importance of food fortification as a key and direct intervention to address micronutrient malnutrition to tackle several major health issues.
Malnutrition and its impact
In its bid to fortify foods, FSSAI has covered five food categories that include wheat flour, rice, milk, oil and salt. As per this standard, fortification of salt can be done with iodine and iron; vegetable oil and milk with vitamin A & D; wheat flour and rice with iron, folic acid, zinc, vitamin B12, vitamin A and some other micronutrients.
“Iodine-fortified salt is exemplary in curbing incidents of deficiency related diseases such as hypothyroidism and goiter. Fortification of commonly-eaten foods, in addition to encouraging balanced diets, would help the country fight this problem,” remarked Ashish Bahuguna, Chairman of the FSSAI.
Over 70 per cent of the Indian population still consumes less than 50 percent of the recommended dietary allowances and micronutrients. Micronutrient malnutrition continues to remain a serious health problem that demands coordinated and massive efforts at the national level. Hameed Nuru, Representative and Country Director, World Food Programme maintained that the cost of ignoring malnutrition is high, an estimated 3.5 trillion dollars annually. “For every dollar spent on fortifying food to combat malnutrition is estimated to give a return of 30 dollars.So, fortifying is the smart thing to do,” Nuru said.
In 2016, the Central Government allocated approximately $5.3 billion to the country’s nutrition-specific programmes such as the Integrated Child Development Services Scheme and the National Health Mission. It allocated 31.6 billion dollars in total to several programmes aimed at improving the underlying determinants of nutrition, such as the Public Distribution System (PDS), which focuses on food security, the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), which focuses on livelihood security in rural areas and the ‘Swachh Bharat Mission’ which is focused on sanitation.
Union Minister of Consumers Affairs, Food and Public Distribution, Ram Vilas Paswan said the BJP-led NDA Government plans to supply fortified foodgrains under the Public Distribution System (PDS) and other social welfare programmes like mid-day meals to ensure nutritional security and address malnutrition.
“We do not have shortage of food grains. The country has surplus wheat, rice and sugar despite that our position is not good on nutritional front. Initially, we are planning to provide fortified food in social welfare schemes such as mid-day meals and ICDS,” the Minister said, adding that the fortification is the most cost effective way to add micro nutrients in food. On the other hand, Pawan Agarwal, Chief Executive Officer of FSSAI, observed that the large-scale production, processing and packaging of some of the food products, especially wheat flour and rice, by the unorganised sector would make implementation a challenge.
“The standards are expected to see minor changes following stakeholder consultations,” Agarwal said. It should be recalled that the FSSAI has already formulated standards for flour fortification. Food products like wheat and rice are already being fortified in some states like Gujarat, Madhya Pradesh, Maharashtra and Karnataka.
The Global Nutrition Report 2016 says nutritional status and progress in India vary markedly across its states. “India urgently needs to take target setting to the subnational level to achieve global nutrition targets and Sustainable Development Goals (SDGs),” the report says.
The report says that Maharashtra is the first state in India to launch its independent state nutrition mission in the form of an autonomous technical and advisory body, in 2005, under the Department of Women and Child Development.Soon five other states 9 Madhya Pradesh, Uttar Pradesh, Odisha, Gujarat, and Karnataka) followed and launched their respective missions based on the Maharashtra model. All six state nutrition missions focus on the 1,000-day post conception period and commit to improving inter-sectoral coordination in order to improve child nutrition.
Poverty triggers malnutrition
Endemic poverty has been one of the major factors for the cause of malnutrition in the country. Although, India runs two of the world's biggest children's nutrition programmes, the ICDS for children under 6 years and the mid-day meal programme for school going kids up to the age of 14, malnutrition continues to haunt India.
In the latest Global Hunger Index (GHI) ranked India a lowly 97th position among 118 developing countries. It stated that poverty, unemployment, lack of sanitation and safe drinking water and lack of effective healthcare are main factors for the sorry state of nutrition in India.
That data reveals that compared with previous years, marked improvement has taken place in child stunting and under-5 mortality rates but the proportion of undernourished people has declined only marginally from 17 percent in 2000 to the current 15 percent.
According to Soumya Swaminathan, Director General of the Indian Council Medical Research, under nutrition is one of the three leading health risks in India currently along with heart diseases and pollution and is a major determinant of health.
Deficiency of micronutrients and commensurate disorders such as Anemia affect large segments of India’s population. Though they can affect all age groups, but young children and women of reproductive age tend to be among those, most at risk of developing micronutrients deficiencies. More than half of all women in the age group of 15-19 years, approximately a quarter of all men in the same age group and seven out of every ten children between 6-29 months of age are Anemic in India.
Apart from human suffering due to morbidity and mortality, malnutrition and micronutrient deficiencies have a high economic cost.
Productivity losses due to poor nutrition are estimated to be more than 10 percent of lifetime earnings for individuals, and 2-3percent of GDP to the nation. Cost of treating malnutrition is 27 times more than the investment required for its prevention.
The claim of the Government to eliminate malnutrition in the country by 2030 might be too ambitious goal to achieve, but at least a start has been made. Food fortification is the first step to combat the prolonged peril of malnutrition in the country.