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$10 bn: Annual cost of malnutrition in India

Without adequate healthcare, education and training, there is a real danger that most Indians will not get a chance to participate in this prosperity, writes Renuka Bisht.

india Updated: Aug 13, 2007 03:09 IST
Renuka Bisht

Back in 1924, when Jawaharlal Nehru presided over the Allahabad municipal corporation, some of his most ambitious schemes concerned education. On becoming India’s first prime minister more than two decades later, he again gave special attention to this sector, helping develop exemplary educational institutions such as the IITs and the IIMs. Today, we are reaping the fruits of his foresight, most prominently through our internationally celebrated IT sector.

Literacy has quadrupled since independence, rising by 13.7 per cent in the nineties, as compared to 8.6 per cent in the eighties. Also on the good news front, Angus Deaton and Jean Dreze’s balance sheet of social well being in the nineties shows that a greater surge of school participation in the pro-active states is “an encouraging indication of the possibility of effective public intervention in this field.”

Female literacy still trails male literacy by more than 21 per cent, but it has increased by more than 45 per cent between 1951-2001. These improvements in female education have aided in fertility decline, but 65 per cent of the fertility decline of the nineties has strikingly been among uneducated women who are highly motivated to educate their children.

As upbeat as the above numbers are, the constitutional promise of free and compulsory education stands resoundingly broken. Not only are 65 million children not getting any schooling, the number of child labourers has increased from 11.6 to 12.7 million between 1991-2001. In the same period, the female-male ratio among children in the 0-6 age group has declined from 945 to 927 girls per 1,000 boys. India also has the highest number of maternal deaths every year.

In the run up to independence, a forward-looking Health Survey and Development Committee headed by Joseph Bhore had put forth a forward-looking universal healthcare plan covering the whole of India. Six decades later, with public expenditure on health dismally stuck at around one per cent of the GDP, large sections of our population continue to suffer because of poor medical access.

Preventable diseases continue to account for 50 per cent of reported illnesses. TB alone takes 400,000 lives each year, and is the leading cause of death in the 15-45 age group. Increasing HIV infections, which make people more susceptible to this disease, mean it will pose an increasingly serious health hazard. Meanwhile only 44 per cent of children aged 12-23 month receive all recommended vaccinations and, despite more than two decades of immunization, India still has the largest remaining pool of polio transmission in the world.

And we are still struggling against our oldest nemesis: hunger. It is astonishing, as Amartya Sen says, that even famine-stricken Africa manages to ensure a much higher level of regular nourishment than does India. Whether it is maternal undernourishment or the incidence of underweight babies or the frequency of cardiovascular diseases among adults who are poorly fed in the womb, India’s record is among the very worst in the world. A World Bank report estimates that malnutrition costs us $10 billion every year in terms of lost productivity. More significantly, child malnutrition in our country is the result less of food insecurity than of exposure to infection and inappropriate caring practices, which can only be tackled through comprehensive healthcare and education.

India is one of the youngest countries in the world, with the average Indian expected to be only 29 years old by 2020. As has been often said, this demographic advantage has the potential to spin off into increasing prosperity. On the other hand, without adequate healthcare, education and training, there is a real danger that most Indians will not get a chance to participate in this prosperity.