Though belated, Happy new Year to everyone. Hope this year will bring significant advances in public health. I for one, plan to update my blog regularly.
Yesterday, I was at Tata Institute of Social Sciences, Mumbai. As part of their platinum jubilee celebrations they are hosting a conference: 'Globalization and Social Transformation: The Indian Experience'. I attended a day long session on Nutrition, which was a part of the sub-theme: Inequalities, Vulnerabilities, Human Health and Well Being.
The speakers and panelists discussed nutrition at length ranging from severe malnutrition to whether it is time to include 'nutrition security' to food security. In India, it is hard to segregate food security and nutrition security. I found a discussion by Dr. G Subbulakshmi, particularly interesting. She presented the alarming figures of malnutrition in India and the socio- cultural factors affecting nutrition insufficiency. The demand for a male child, its effects on nutrition security of female children, and therefore future mothers, and therefore future generations, were striking. I found hers to be an overarching presentation for the most part. She spoke about empowering mothers with community gardens where they could grow vegetables.
I don't know if it comes with toiling experience of working with malnourished children, or with an immediate understanding of the dire calamity we face in the form of malnutrition. She was open to all types of nutrition ideas. She did not criticize empty calories, she was open to food fortification, she was open to the role of pharmaceutical companies in manufacturing fortified products/ supplements, community gardens, new farming techniques, soil fortification, basically anything! She said that different things are catered to different socio-economic strata and if it helps to tilt the balance towards the positive side, sure. I think it comes from seeing malnourished children and the enormity of the issues that affect this one condition. The task is GIGANTIC!
The discussions that followed were very interesting. Someone from the audience pointed out that working with individuals at a tertiary level and presenting examples of success in village communities are vertical examples, often difficult to replicate. The question was longer, and the discussion routed in the direction of the challenges and priorities. I had hoped that we could route the discussion to another level: how do we address this at a 1.2 billion population level? After all, malnutrition is an epidemic in India. It is great that women in some villages are trying to become self sufficient in nutrition by having a small garden where they grow veggies. However, I don't know how many is 'some'. I don't think anyone does. We don't know the sustainability of these ideas, no matter how great these are for now. In the factors that affect nutrition the most daunting are water supply for agriculture, socio-cultural factors such as lack of nutrition to the female child, socio- economic factors: affordability and accessibility. The poor absolutely cannot afford nutritious food. The quality of fruits and vegetables that reaches some of them is poor.
A family that earns 100 rupees(~ 2 USD) / day will never afford fruits and vegetables. If we double the income of the family, they will still not afford fruits and vegetables. Maybe they will add lentils. I will not shift to poverty and human rights because it will be some light years before those issues resolve themselves. It is estimated that over 50% of the population are facing these SES challenges. How do we then address nutrition insufficiency, today?
I find that societal/ community/ state/ country leadership are missing the responsibility of nutrition for better health and evolution, in India. There was a strong push yesterday, to move the responsibility away from the mother. No data required to state that 'mothers' are burdened with responsibilities. Women deal with poverty to become the second earning members (often underpaid for their work), they deal with household chores and responsibilities, they must rear the children, and now the garden that is required for adequate nutrition. We have not addressed the issues of the mother in the urban slums. No gardens when you are squatting on airport land, are there? It is not surprising that she allows her children to buy 'empty calories' such as cheap junk food. There is an urgent need for division of labor in families and this has to be promoted at a mass level rather than counseling at individual level.
It was discussed that after the green revolution addressed food security in the 1950's, it was not strengthened further. It should have progressed into a nutritional revolution. The agricultural sector and health sector must collaborate in the future so that nutrition can be prioritized at a primary level. The Public Distribution System (PDS) in India played a role in addressing food security. While PDS needs further strengthening, nutrition should be integrated into the existing system.
The Integrated Child Development Scheme (ICDS) addresses nutritional needs of children, especially those living below poverty line. It is a comprehensive project addressing the health of the mother and child, as well as education. The ICDS is run by the Department of Social Welfare in India. It was pointed out that there is a need for collaboration with the Department of Health. Thus, an inter-sectoral approach was stressed upon all the way.
In addition to all of this, I believe that 'health promotion' has a huge role in decisions made by families. This was not discussed but I feel it is the dark horse in the race for nutrition. In India, one hardly sees true health promotion. The private sector promotes 'healthy products' as well as empty calories. However, there needs be regulation at every level. At the level of production, in India, food labels don't mean much. The only thing regulation that succeeded is the 'vegetarian' and 'non vegetarian' labels. If the product has a green dot, then it is vegetarian, and that also means sans eggs. If it has a red dot, it contains eggs or meat. This came from public demand because a large population in the country practices 'vegetarianism'. However, for there to be a demand for nutritious food, as there is in some countries, there has to be awareness. This brings in so many new factors, quality education for one. This could prove to be a slow process. We cannot wait to inculcate nutrition until the day the entire population is empowered to make the right choices in food and demand a healthy supply of food at affordable prices. In the mean time, societies/ communities/ state bodies/ and federal leadership must come into action to provide correct information to the people who largely rely on mass media for information regarding their food choices. An orange juice ad declares that juice can replace eggs and milk at breakfast. A potato chips ad shows that girls will eat as many and talk with their mouths full, if the chips are 'baked'.
A combination of scientific research, applied research, regulation, and inter- sectoral collaboration is an immediate need to begin building in 'nutrition sufficiency' in India.