The United Nations Convention on the Rights of Child, (CRC), signed in 1989, stated that “children’s economic, social and cultural rights are indivisible”.
The Copenhagen Consensus a US-based think tank that researches and publishes the best ways for governments and philanthropists to spend their money says that every dollar spent on nutrition in the first thousand days could benefit an average of US$45. Another one of its studies says that every dollar spent on fighting stunting can generate an economic equivalent of US$18. Yet, today, one out of every third child in the world, under five years of age is malnourished. We are running through an intergenerational vicious cycle, where poverty perpetuates malnutrition, and malnutrition perpetuates poverty.
Asia suffers a GDP loss of an average of 11% from malnourishment. All forms of malnutrition put together have an economic cost of $US3.5 Trillion, i.e. $US500 per individual, 5% of global GDP. Obesity alone causes a loss of US$2 Trillion, i.e. 2.8% of global GDP and is equivalent to the economic cost of smoking and armed conflict.
To drill the data further, 200 million under-five children in the world suffer from undernutrition; while the figure for hidden hunger stands at 340 million i.e. every second child. The world may be strictly segregated into blocks, based on political ideologies, when it comes to its children, their performance realigns. India which claims Pakistan as a failed state performs as good as its neighbour when it comes to stunting. 38% of children in both India and Pakistan suffer from stunting. India fares worse with 8% of its children suffering from muscle wasting, where it is just 2% for Pakistan. When it comes to obesity, they seem to be competing with each other, with India ahead, at 2% in comparison to Pakistan’s 3. The annual number of under-five deaths in India is 882,000, whereas it is 409,000 for Pakistan.
Under-5 mortality rate – Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
Infant mortality rate – Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
Neonatal mortality rate – Probability of dying during the first 28 days of life, expressed per 1,000 live births.
Source: UNICEF report “State of World’s children – Children, Food and Nutrition
As per the UNICEF report, State of World’s children – Children, Food and Nutrition, the statistics present a serious concern that needs immediate redressal. The report, that is based on an exhaustive survey, has called it “the triple burden of malnutrition.” The Triple burden phenomenon also assumes significance from the fact that it finds mentions on at least 19 occasions in the voluminous report. The triple burden as described in the report comprises of undernutrition, hidden hunger, and overweight, of which stunting, wasting and overweight have been classified as the more visible forms.
Stunting and wasting are the results of undernutrition that may lead to poor growth, infection, and death. Stunting, it is claimed in the report, is rising globally, except in Africa, where it has slowed down in recent years, after successful interventions. Yet, Africa shares the burden of stunting, with at least 1 out of every 3 under-five stunting cases being reported from the continent. Wasting, on the other hand, is mostly found in South Asia, with 1 out of 7 cases being reported from the region. The report observes a globally rising trend in obesity, with East Europe and Central Asia sharing the burden with 1 out of 7 under five occurrences. Obesity is a prominent cause of cardiovascular diseases and diabetes. Hidden hunger, the third of the triple burden, is caused by deficiencies in micronutrients and may lead to poor tissue growth.
The triple burden is mostly driven by the poor quality of diet. Two-thirds of the world’s children are not fed a proper diet. Only 1 in 5 children, between 6 to 23 months, from the poorest households, and rural areas, are fed the minimum recommended diet. 44% of children between 6 to 23 months of age do not eat fruits and vegetables, while 59% have no access to eggs, dairy, fish, and meat products. On the other side, 42% of school-going kids drink carbonated drinks once a day, and 46% eat fast food once a week.
When it comes to food quality, the situation is pathetic for the newborns as well. Two-fifths of babies are not breastfed up to 6 months of age. Exclusive breastfeeding, it is estimated, could save at least 820,000 babies from untimely death. At the same time, there has been an exponential rise in the sales of breastmilk substitutes in the market. While the sales for breast milk substitutes have risen 41% globally, the rise has been 72% in upper-middle-income countries like Britain, Turkey, and China. The quality of food intake has also been impacted by the flawed agriculture model. The increased investment in agriculture and the consequent productivity has come at the cost of a fall in the diversity of food crops with the result being that just three crops, Rice, Wheat and Maize occupy two-third of world’s calorie intake.
The nutrition situation is further worsened by globalisation, urbanisation, inequities, humanitarian crisis, and climate shocks. Globalisation has resulted in the consolidation of the processed food business in the hands of a select few. Today, just 100 firms occupy 77% of processed food sales registered globally.
Urbanisation has led to the creation of food deserts and food swamps. There are places in cities that are marked by the absence of healthy food options, and then there are places with an abundance of high calorie and low nutrient processed food.
Further, the inequitable distribution of wealth leads to bad food choices. Poor families tend to consume low quality food that costs less. Therefore, due to poverty the most disadvantaged face the worse form of malnutrition. Climate change, loss of biodiversity and damage to water, air and soil, worsen the nutritional prospects of the children in particular and humanity at large. Also, the humanitarian crisis facing the world take their worse toll on women and children. UNICEF claims to have treated at least 3.4 million children from Afghanistan to Yemen and from Nigeria to South Sudan in 2018.
The agenda of the UNICEF report is laudable, for at the heart of it lies a commitment to nutrition rights. To put the world’s children’s nutrition rights first, the report has placed before us a detailed plan of action which broadly cover demand-side measures, removing supply-side bottlenecks, ensuring a favourable environment, mobilisation of support systems and rigorous progress monitoring. The demand side focus is on empowering people to demand nutritious food, while on the supply side, the focus is on the food suppliers to do the right thing for children. Healthy food environment, on the other hand, can be created by proper communication strategy, legislation and proper marketing. Besides, creating a healthy food environment requires making healthy food options available, convenient and desirable. Mobilisation of support systems is vital for the execution of the above-stated goals.
The UNICEF report is unique, for it advocates a systems approach to solving the nutrition problem. The report identifies five broad systems which are Food system, Health system, Water and Sanitation system, Education system and Social protection system. A holistic approach towards revitalising all the critical components underlying these systems can go a long way in tackling the nutrition problem.
Commercial fortification of complementary and staple foods, like the fortification of salt with iodine, can help in reinforcing our food systems to meet our nutritional needs.
Preventive services, curative care and positive family practices, like breastfeeding, can foster health systems. With active state and central intervention, breastfeeding practice has significantly increased in India, from 24.5% in 2006 to 44.6% in 2014. The success of this approach was more visible in the seven states with the highest percentage of newborn deaths, where the systems approach to tackling nutritional deficiency led to a rise in breastfeeding practice from 12.5% in 2006 to 34.4% in 2014.
Fostering our water sanitation and hygiene systems and boosting them with nutrition intervention can help in controlling the spread of several communicable diseases, like Diarrhea and Dysentery, which prevent absorption of nutrients and become the reason for malnutrition.
Leveraging education systems, as an institutional measure, can have significant outcomes in the fight against malnutrition. Based on this theme of the systems approach, several school-based food and nutrition interventions are successfully running in India, like adolescent anaemia control program, and iron and folic acid supplementation program. The latter which started in 2012 covers 116 million population between 10 to 19 years of age including 40 million boys. The program as on 2016-17 has succeeded in reaching 36% of targeted adolescents.
Conditional and unconditional cash transfers, food rations, and school feeding go a long way in strengthening the social protection system and are an effective way of ensuring means to access and affordable nutritious food.
Over and above the systems approach to solving the nutrition requirements, we must create financial incentives and disincentives, that reorient the entire environment, so as to improve the nutritional intake of the child. The governments must incentivize production, processing, marketing and distribution of healthy and affordable food in the market. Similarly, production of sugary food and beverages should be taxed to discourage the business.
Investment in nutrition is a cornerstone investment in achieving Sustainable development goals by 2030. The report says that with an average annual investment of US$7 billion, over the next 10 years, we would be able to achieve global nutrition targets of reducing child wasting and stunting, reducing maternal anaemia, and improving breastfeeding rates. With this consistent flow of investment, it is expected that in comparison to 2015 figures, by 2025, 3.7 million child lives could be saved, 65 million children could be saved from stunting, 105 million more children could be breastfed and 265 million women could be prevented from anaemia.