India - The COVID-19 pandemic has exposed the weakness of food and health systems, disproportionately impacting already vulnerable populations. As inequalities and malnutrition continue to sweep the world and India, the 2020 Global Nutrition Report stresses that the need to address malnutrition in all its forms by tackling injustices in food and health systems is now more urgent than ever. The Report finds that India remains severely affected by malnutrition, with one of the highest rates of within-country inequalities in malnutrition globally. However, some progress has been made to tackle stunting and underweight, and the country has put in place innovative programmes aimed at reaching the most vulnerable.
Double burden: Most countries in the world must now be equipped to fight both sides of malnutrition at the same time.
India has had some success in reducing rates of underweight in child and adolescents. Between 2000 and 2016, rates have decreased from 66.0% to 58.1% for boys and 54.2% to 50.1% in girls. However, this is still high compared to the average of 35.6% for boys and 31.8% for girls in the Asia region.
In addition, 37.9% of children under 5 years of age are stunted and 20.8% are wasted, compared to the Asia average of 22.7% and 9.4% respectively.
Diet-related diseases continue to be an issue, with one in two women of reproductive age experiencing anaemia. On the other hand, rates of overweight and obesity continue to rise, affecting almost one fifth of adults at 21.6% of females and 17.8% of men.
Globally, countries are often unprepared to face the nutrition crisis. Financial commitments also don’t match the scale and nature of the issue: increases in domestic resources for nutrition have been marginal at best, and obesity and overweight have been largely ignored in aid allocations.
New perspective: redirecting resources to communities and people most affected is the right and the smartest thing to do
Global and national patterns hide significant inequalities within countries and populations, with vulnerable groups being the most affected. The Report found clear links between levels of malnutrition and population characteristics like location, age, sex, education and wealth, while conflict and other forms of fragility compound the problem.
Differences across communities and at the sub-national level are striking. India is one of the countries with the largest within-country inequalities in malnutrition, with some Indian states such as Uttar Pradesh recording stunting levels of over 40%. Stunting figures among individuals in the lowest income group are more than double those in the highest income group at 22.0% and 50.7% respectively. In addition, stunting prevalence is 10.1% higher in rural areas compared to urban areas.
The same applies for overweight and obesity, where there are nearly double as many obese adult females than there are males (5.1% compared to 2.7%).
Some positive steps have been made to address inequalities in India. For example, the Transformation Aspirational Districts Program has supported Indian government efforts by focusing policy attention on improving services across health, nutrition, education, infrastructure, agriculture and water resources in districts with pockets of under-development.
Speaking at the Global Nutrition Report online launch, Alok Kumar, special advisor to NITI Aayog (National Institution for Transforming India) will say: “Lack of access to food is only one determinant of malnutrition. Addressing it requires us to act on multiple fronts: promoting equity by working on all the social determinants as well as strengthening the governance and delivery systems. At a time when the COVID-19 pandemic has magnified the challenges manifold, we need much greater resolve and commitment to attain our goals.”
Further action needs to be taken. The effects of the pandemic will only make it harder for vulnerable populations to protect themselves against malnutrition. Malnutrition affects our immune system, leaving us more susceptible to infection, and the socio-economic impact of the pandemic could in turn drive malnutrition globally.
Gaps in food systems: Poor diets are not simply a matter of personal food choices.
The Report calls for a change in food systems. Existing agriculture systems still focus on staple grains like rice, wheat and maize, rather than producing a broader range of more diverse and healthier foods, such as fruits, nuts and vegetables.
Fresh or perishable foods are less accessible and affordable in many parts of the world compared to staple grains. Whereas, processed foods, especially ultra-processed food, are available, cheap and intensively marketed, with sales high and growing fast in many parts of the world including India. These changes demand policy and planning resources to promote desirable nutrition outcomes.
Solutions have started to emerge across the world. These include: increased public investment for healthier food products, support for shorter supply chains for fresh-food delivery programmes, use of fiscal instruments, limiting advertising of junk food, and food reformulation, or the use of front-of-pack labelling (FOPL) to inform consumers and influence industry behaviour. However, much more remains to be done.
Venkatesh Mannar, Co-Chair of the Report and Special Adviser on Nutrition to the Tata Cornell Agriculture & Nutrition Initiative, said: “At a time when COVID-19 has further revealed the gaps in our food systems, we now have a unique opportunity to act in coordination to address them and ensure that healthy and sustainably produced food is the most accessible, affordable and desirable choice for all.”
Universal Health Coverage: an opportunity to make nutrition care universally available as a basic, live-saving and cost-effective health service.
Malnutrition in all its forms has become the leading cause of poor health and death, and the rapid rise of diet-related chronic diseases is putting an immense strain on health systems. But despite this assessment, nutrition actions only represent a minuscule portion of national health budgets although they can be highly cost-effective or even cost-saving solutions.
Recognising the major variations within states in terms of social and economic development indicators, India launched the Transformation of Aspirational Districts programme in 2018. It is one example of successful integration and delivery of equitable nutrition services by focusing policy attention towards addressing inequality, social injustice and exclusion in 115 ‘aspirational districts’ in 28 states. The programme involves a concerted effort to improve the performance of services across health, nutrition, education, infrastructure, agriculture and water resources in districts with pockets of under-development.
Renata Micha, Co-Chair of the Report and Research Associate Professor at the Friedman School of Nutrition Science and Policy at Tufts University said: “Good nutrition is an essential defence strategy to protect populations against epidemics, release the burden on our health systems, deliver Universal Health Coverage and ultimately save lives. The findings of the 2020 Global Nutrition Report make clear that tackling malnutrition should be at the centre of our global health response.”