Health Sector In India

Health Sector In India– Part 1 Part 2 Part 3

HUNGER

Malnutrition: FAO defines malnutrition as population denied of dietary intake for prolonged period. Chronic malnutrition is defined as hunger.

Quote: “Hunger is quiet violence” – Amartya Sen

Hidden Hunger: Refers to the condition of an individual who is consuming requisite dietary intake but is deficient of micro nutrients.

It can be addressed by diversifying diet to include micro nutrients and by fortifying commonly consumed food that is part of the staple diet of individuals.

Measuring Hunger

Global Hunger Index: Brought out by IFPRI

Parameters: Stunting, Wasting, Child Mortality and Undernourishment (Adults)

India has the largest number of people affected with hunger according to FAO report: 194 million in India are hungry. Although it has improved, the rate of improvement is insufficient.

The Global Hunger and Malnutrition Index also shows that over 40% of the world’s hungry children are from India.

Hungama Report (Nandi Foundation)

Child undergrowth (42%) and Anaemia (63%)

Child stunting in urban areas – 22%

Introduction on Malnutrition or Hidden Hunger

India has a paradoxical mix of obese and malnourished children. It is no longer necessary to focus on adequate nutrition alone. Our policy focus must shift to appropriate nutrition transforming our objective of food securityà nutrition security.

Reasons of Malnutrition

Accessibility/ Affordability to Food: Poverty is the overwhelming reason for hunger and malnutrition in the country as several households are incapable of consumption at sustained levels due to insufficient household income
Lack of Awareness:
- Education among mothers: Hugama report by Nandi Foundation finds a strong correlation between malnourishment in children and educational attainment of mothers
- Balanced Nutrition: Even educated mothers in urban areas are unaware of the difference between right nutrition and calorie intake. This has led to the phenomenon of hidden hunger among children
Lack of Health and Hygiene: A child’s ability of consumption is greatly affected by his health and vulnerability to epidemics and other diseases. Diarrhoea for example drastically reduces child’s capability to intake food and nutrients.
- Provision of clean drinking water, clean environment, sanitation facilities, solid waste management, robust sewerage and drainage networks can reduce vulnerability of children as well as adults to such diseases enabling them to acquire requisite nutrition

Obesity

India is second in the number of Obese children with more than 14 million obese children. The reasons for such alarmingly high levels of obesity in India are:

Lifestyle Problems: Children in urban areas particularly are gorging on junk foods with little focus on exercise, balanced diet and intake of vitamins and micro-nutrients. Excessive fat containing foods are consumed causing obesity
Passive Nature of Children: Obesity’s rise in the modern world has been co-terminus with the rise of technology and other forms of entertainment. They have become couch potatoes in their homes with little outdoor activity contributing to their obese nature

Consequences

Vulnerability to Diseases: Several non-communicable diseases including CVDs, diabetes and cancers are linked to obesity
Social Stigma: Indian society in particular runs a deep running stigma on obese individuals that hinder them from leading a dignified life in society.
Hinders Productivity: Obesity impairs health which affects productivity of the young working population. An obese population is a bane to India’s demographic asset.

[the_ad id=”5735″]

Possible Measures to Control Obesity

Awareness on Balanced Diet: Proper awareness can be propagated among students and parents regarding the importance of a balanced diet. School and local governance bodies can act as focal centre in coordinating such activities along with CSOs
Taxesà Behavioural Change: The rising acceptance for fat containing westernized diet among the youth can be curbed by introducing fat taxes. Such taxes can be a potent disincentive to habitual consumption of fat foods
Regulate Junk Food Production: Junk food producing companies can be regulated to ensure lesser availability of affordable junk food.
Obesity as Health Service: Obesity management should be promoted as a specialised health service within urban areas focussing on youth in particular.

Conclusion

In a country which has surplus food grains and guarantees the right to food for all, it is morally, politically and economically unacceptable that children are denied the right nutrition.

Government Interventions to Address the Issue of Hunger and Malnutrition

National Food Security Act, 2013

Legally secures citizens the right to food security and puts an obligation on the state to ensure the same.

Constitutional inspiration

Article 47: The State shall endeavour to improve the nutrition level of the general public and improve public health and standard of living

NFSA and Targeted PDS

TPDS is simply the executive machinery or framework for implementing the legislation that secures citizens right to food.

NFSA prescribes usage of excluded households in Socio-economic caste census as criterion for beneficiary identification while states implementing PDS still use old classification of BPL families citing unavailability of data.

NFSA is a region targeted legislation after considering recommendations of Shantakumar Commitee to reduce coverage and increase efficiency – Rural Areas(75%) and Urban (80%) whereas PDS has higher coverage

NFSA guarantees entitlement of 5kg per person or 35 per family while PDS varies depending on states

NFSA puts in a grievance redressal mechanism which is absent in PDS

Criticism of NFSA

Not Addressing Issue of Hidden Hunger: Only focus on carbohydrate rich diet and fulfilment of adequate dietary intake, lack of attention on micro nutrients or fortification of staple diet
One-size fits all policy: NFSA prescribes distribution of rice and wheat in general in all regions and does not take into account geographical and cultural variations and preferences of dietary intake
Financial Burden: Fulfilling the right to food in a nation of 194 million hungry can put great pressure on the state’s financial reserves grossly affecting its fiscal deficit
Identification of Excluded Households: Challenge for state governments and required greater coordination between central and state governments
NFSA not applicable during war, natural disasters and famine

New Initiatives Required under NFSA

Covering the excluded but deserving: Old, destitute, immobile and disable sections of population need to provided food security and Door to door delivery should be initiated for the same (Chhattisgarh PDS provides free meals to destitute and homeless)
Addressing Issue of Hidden Hunger: Diversifying nutrient basket and fortification of staple diet to ensure adequate proportion of micro nutrients in dietary intake (Chhattisgarh – Black Gram, Iodised salt)
Administrative Change: Corruption, hoarding and black marketing in fair price shops have necessitated a structural change in management with SHGs and gram panchayats better placed to take over its management (Chhattisgarh – Panchayats and Municipalities)
Provision of social audit
Aadhar linked DBT
Grievance redressal mechanisms should be put in place in all states

National Nutrition Mission – Synergy of schemes eliminating malnutrition and hunger

Multi-sectoral programme to address maternal (pregnant and lactating woman) and child nutrition in all districts beginning with 315 high burden districts
As an apex body, NNM will monitor, supervise and fix targets and guide nutrition related intervention across ministries (synergy between ministries – MWCD, MDWs, MHFW, agri, food processing, food supply, IT)- Robust convergence mechanism
Focus on reduction of under-nutrition, stunting and low birth weight in children
Reduction in levels of anaemia among young children, adolescent girls and women (Folic Acid supplements)
IEC awareness campaigns against malnutrition and ICT based real time monitoring system and incentivizing anganwadi workers for using IT based tools

Health Sector In India