Why rich Indians are malnourished too
CHANDRA BHAN PRASAD, Oct 17, 2010, 09.00am IST
India is the world's 10th largest economy with a GDP of $3.57 trillion
and $3,100 as per capita income. Sub-Saharan Ethiopia has the 79th
largest economy, with $900 as per capita income. It's far behind
India. Yet, Ethiopia and a handful of other sub-Saharan nations beat
India in one of the most critical social indices – 35% children in
sub-Sahara are malnourished and the figure jumps to 47% for India.
Does this embarrassing state of affairs mean that the massive wealth
generation in India gets deposited only in a few hundred thousand
pockets? That despite our multi-trillion dollar GDP, nearly half our
population doesn't get basic nutrition? That food-insufficient
sub-Sahara does better in nutritional intake than food self-sufficient
India?
What about the Integrated Child Development Scheme (ICDS), in
operation since 1975, which feeds 23 million children under five and
4.8 million expectant and nursing mothers 300 days a year? In
addition, about 120 million schoolchildren are served lunch for free
under the midday meal scheme (MDMS).
The ICDS and MDMS are the world's largest nutrition supplement
programs. These apart, 160 million families are given food grains at
highly subsidized rates. With about half-amillion fair price shops,
India's public distribution system (PDS) is rated as the world's
largest food subsidy program. But, the evidence shows that all these
welfare measures have not made a difference.
Health experts would clearly blame poverty. Public policy advocates
have been asking that free food be supplied to half the Indian
population. The Right to Food Act (RFA) campaign has gained currency.
Will the RFA work where ICDS, MDMS, PDS etc have not? Or, are we
diagnosing dengue when it is malaria and administering the wrong
pills?
The '47% malnutrition' figure reportedly comes from the National
Family Health Survey (NFHS-3) 2005-2006. Study the NFHS-3's bulky
book, you won't find the 47% figure. A table that has figures for
malnourished children shows an all-India average of '42.5%'. Did
someone read the NFHS-3 findings too casually and invent '47%'? Or did
someone play a prank on public policy enthusiasts?
The figure might have been '48%' but certainly not '47%'. NFHS-3
deploys three criteria to measure undernourishment -- height-for-age,
weight-for-height and weight-for-age. If we take 'height-for-age', 48%
children are malnourished. If we take weight-for-height, only 19.8%
children are malnourished. If we take 'weight-for-age', 42.5% children
are malnourished. But, for the Survey, 'weight-for-age' is the
composite index for height-for-age and weight-forheight. That means
42.5% children are malnourished. This is not to argue that the '42.5%'
figure is a solace. It paints as grim a scenario as '47%'.
On the basic question -- is poverty alone causing malnourishment
amongst Indian children-- NFHS-3 has data that has been ignored so
far. It has a 'wealth index' as well and classifies households into
'lowest' and 'highest'. It says that 19.7% children from the richest
households are malnourished as well. As for the moderately rich, 33.6%
children are malnourished.
This data questions the received wisdom on the causes of malnutrition
in India. The top two quintiles --richest and moderately rich –
comprising 40% of the households NFHS-3 studied – throw up figures
that are moderately better than sub-Saharan Africa. But poverty is not
the only reason for child malnourishment. This raises several
questions. First, if we cannot tackle malnourishment among the rich,
how can we do so for the poor? How can welfare measures such as the
ICDS, MDMS, PDS and RFA take poverty to be the cause of
malnourishment? Second, if not poverty, what is the real cause of
malnourishment among the children of the rich?
Third, is it not possible that the same cause – not poverty - is the
reason both rich and poor children are malnourished?
The Survey reveals that the four southern states of Andhra Pradesh
(32.5%), Karnataka (37.6%), Kerala (22.9%) and Tamil Nadu (29.8%),
have lower malnutrition rates than Haryana (39.6%), Rajasthan (39.9%)
and Uttar Pradesh (42.4%). The data also reveals that consumption of
fish, chicken or meat at least once a week by women in Andhra Pradesh
(69.5%), Karnataka (45.9%), Kerala (89.6%) and Tamil Nadu (66.1%) is
much higher than in Haryana (5.5%), Rajasthan (11%), and Uttar Pradesh
(14.7%). Karnataka fares worse of all the southern states in terms of
malnourishment and intake of fish/ chicken/meat.
Gujarat and Punjab don't present a rosy picture either. In
cash-surplus Gujarat, 44.6% children are malnourished, and in
food-surplus Punjab, the rate is 24.9%. Is it mere coincidence that
women in Gujarat (12.4%) and Punjab (20.1%) have a lower intake rate
of fish/chicken/meat than the national average of 40.9%?
Might food habits be a bigger cause than poverty of malnutrition in
India? As we know, caste rules impose many taboos on food sources and
food habits. Not just non-vegetarian food, there are taboos even on
vegetarian food sources. Do any of the public policy packages
mentioned above target caste-based food morality as one of the prime
causes of malnutrition affecting millions of Indian children? Being
kind-hearted and liberal is good, but being brain dead is worse. It's
time for a policy rethink.
The writer is a columnist and independent researcher
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