Malnutrition comes in many forms. One has to do with the quantity of food intake, and another with the quality. The much discussed food security Bill holds the potential to contribute significantly to improving India’s poor report card on hunger.
Hunger, however, is only one of the faces of malnutrition; there is another, not so visible face — the ‘hidden hunger’, resulting from deficiencies of vitamins and minerals. The latter does not immediately and noticeably affect you in the manner that the absence of food does; rather, it can get completely missed, even by those affected.
India has been doing poorly on both and much has been written and said about malnutrition levels in India. Paradoxically, within India’s growth story is a story of hunger and malnutrition. A story in which some of the world’s richest people live alongside a quarter of the world’s hungry people, in a country where about 43% of children are underweight and almost 80% of children under the age of three years are anaemic.
Food security is key, and there can be no argument against the need to prioritise that. But focusing only on food access will be an incomplete response to India’s malnutrition problems, which need a prioritisation of food and nutrition security.
Vitamin and mineral deficiencies are emerging as the new public health challenge in India, although as yet a largely hidden public health problem. Iron deficiency anaemia (IDA), vitamin A deficiency (VAD) and iodine deficiency disorders (IDD) have been public health problems for some time. Other micronutrient deficiencies, such as vitamin B group, zinc, folic acid, calcium, and vitamin D are also prevalent in the country and have serious impacts on the health and productivity of the population.
Micronutrient malnutrition is prevalent in all age groups, but its consequences are more severe when it affects children below 24 months of age since they are largely irreversible. About 70% of preschool children suffer from iron deficiency anaemia and 57% of preschool children have Vitamin A deficiency. With almost 75% of children affected with one or more micro nutrient deficiencies, in a country with the largest population of young, these deficiencies hold the potential to severely challenge India’s future.
The question on the table is how these deficiencies can be reduced. The most desirable pathway is through a diversified diet; vitamins and minerals are found in different food types, and maintaining their balance requires a diversified diet.
However, in a context where a large part of the population is unable to eat enough, being able to choose what to eat is not always a real option. Those who do eat enough, don’t always eat right, or are not able to eat right. Expense data (NSSO) reveals that monthly per capita expense on fruit is Rs. 26 for rural and Rs. 63 for urban population.
This implies an average expense of less than Rs. 1 and Rs. 2 in rural and urban areas per person per day. For vegetables, the expense is Rs. 3 and less than Rs. 4 per day. With recent trends in food inflation, it is anybody’s guess what these amounts would buy. Even where food diversification exists, processing often removes much of the goodness of vitamins. Substantial amounts of vitamin A, present in seeds, is lost during the process of refining oil. Double toned/skimmed milk loses vitamin D when fat is removed.
Micronutrient deficiencies can be prevented and even eliminated if optimal quantities of the vitamins and minerals are consumed by populations on a regular basis. There are multiple strategies available to reduce vitamin and mineral deficiencies. Dietary diversification is the most ideal approach, but a long term strategy requires access to a broad food basket.
With food habits transitioning and food prices moving only upwards, this is not an easy challenge to overcome in the short term. It does, however, remain the most desirable, and an aspect that needs much more public awareness. Other strategies include fortification of commonly-eaten staple foods, and supplementation of vitamins and minerals through tablets. Global experience has shown that a combination of all these strategies is required to significantly reduce micronutrient deficiencies.
It is time that these deficiencies got the attention they deserve, as the absence of critical vitamins and minerals in food can contribute significantly to the disease burden, and can compromise the right to a healthy, productive and dignified life.
Sandhya Venkateswaran works with Global Alliance for Improved Nutrition. The views expressed by the author are personal.