|Bridging the nutritional divide|
UNDP’s Human Development Report 2001 has introduced a Technology Achievement Index (TAI), an aggregation of four groups of indicators relating to the creation of technology, diffusion of recent innovations, diffusion of old innovations and human skills. Creation of technology has been measured by the number of patents per capita and receipts per capita of royalty and licence fees from abroad. The emphasis is thus on the intellectual property rights (IPRs) of nations, evidenced by the power of proprietary science. The other indicators relate to digital, extension and educational divides. This report, titled ‘Making New Technologies Work for Human Development’, has, however, not drawn attention to the fact that bridging the expanding nutritional divide is fundamental to bridging the other divides, particularly that relating to IPRs.
The Commission on the Nutrition Challenges of the 21st Century, in its report titled ‘Ending Malnutrition by 2020: An Agenda for Change in the Millennium’, has pointed out that some 30 million infants are born every year in developing countries with intra-uterine growth retardation, representing about 24 per cent of all new births in these countries (Philip et al, 2000). Low birth weight (LBW) children are characterised by mental impairment. Worldwide, there are more than 150 million underweight pre-school children and more than 200 million stunted children. At current rates of progress in fighting these maladies, about one billion children will be growing up by 2020 with impaired mental development. What will be the impact on the intellectual property of a nation of such a denial to the child of opportunities for the full expression on its innate genetic potential for mental and physical development? Denying the child an opportunity for mental and physical development even at the foetal stage is the cruellest form of inequity. In contrast, excess weight is the major health problem among children in most industrialised countries and some developing ones (Table 1). Thus, bridging the nutritional divide is the first requisite for a more equitable and humane world.
The nutritional divide is increasing between the rich and the poor within and among nations. The situation is particularly alarming in developing countries. The nutritional paradox of South Asia lies in the coexistence of grain mountains and hungry millions. This is largely due to inadequate purchasing power, arising from the lack of sustainable livelihood opportunities. Famine of income is becoming the most important cause of a famine of food at the household level. Pregnant and nursing mothers and children belonging to the families living below the poverty line (the World Bank poverty line is an income of one US dollar per capita per day or below) suffer the worst. For example, severe anaemia during pregnancy is associated with very high relative risk of maternal death. Maternal mortality rates are as low as 3 to 4 per 100,000 births in industrialised countries, while in many developing countries they are at least 100 to 200-fold higher. Protein-energy malnutrition (PEM) affects nearly 30 per cent of children under five years of age in countries in Sub-Saharan Africa. A comparison of the nutritional status of populations in three Asian countries — China, India and Sri Lanka — provides some interesting insights into the impact of public policy on the nutritional well-being of the population.
Nutrition profile among a few nations in Asia: Role of non-nutritional factors
Four parameters — underweight, stunting, wasting and low birth weight — reflect the nutritional status of children below five years of age. The comparative profile of Sri Lanka, China and India is given in Table 2. The data show the importance of non-nutritional factors like education and healthcare in the nutritional well-being of an individual.
A. Body Mass Index. This indicates the nutritional status of adults. Adults with a BMI under 18.5 are considered to be chronically energy deficient. Body Mass Index over 25 indicates excess weight. Obese persons have a BMI over 30. The situation in Sri Lanka is given in Table 3.
B. Iron deficiency anaemia. In Sri Lanka, 58 per cent of children in the 5-10 age group suffer from iron deficiency anaemia, which affects their cognitive capacity and academic performance. In the case of adults, 45 per cent suffer from iron deficiency anaemia. The proportion of pregnant mothers affected is less — 39 per cent.
C. Mortality rates. Thanks to advances in preventive and curative medicine, mortality has declined in the periods 1970-75 and 1999-2000 in China, India and Sri Lanka (Table 4). IMR and MMR are still high, although there is considerable variability among states within the country. The Indian state of Kerala, for example, has figures similar to those of Sri Lanka.
D. Female literacy and child health. A rapid increase in the rate of female literacy has been achieved in Sri Lanka as a result of the introduction of free education in 1945. It enabled girls to have as much access to education as boys. The situation is similar to that observed in the Indian state of Kerala.
Both men and women have achieved high literacy rates with 83 per cent for women and 90 per cent for men. They also have very low dropout rates: 4 per cent for girls and 6 per cent for boys. There is a significant impact of mothers’ education on the nutritional status of children (Table 5).
E. People power revolution in nutrition. Ultimately, the success of various nutrition-related programmes depends on the efficacy of delivery systems. Hence, Sri Lanka is attempting a community-based nutrition intervention programme. Called the participatory nutrition improvement project (PNP), this programme was started in 1993 with the help of UNICEF. The guiding principle was to mobilise the energies of the community and people’s commitment to their own and their families’ nutritional well-being. PNP is a people-focused project, enhancing the ability of mothers and fathers, through group formation and strengthening, to identify or explore their nutritional problems, identify their nutritional needs and maximise their potential in meeting those needs. Countries like Cuba, China and India also have rich and varied experience in the development of effective delivery systems. In Sub-Saharan Africa, Ghana has made rapid progress in overcoming PEM through community-based nutrition (Gardner and Halweil, 2000). Mobilising people power in the cause of nutritional security is the most effective and sustainable strategy. The example of Thailand illustrates this fact.
F. Thailand’s Nutrition Security Compact. Over the past 10 years, Thailand has achieved remarkable progress in reducing maternal mortality as well as the incidence of LBW children. The strategy consisted of the following components:
n Eliminate severe, moderate and mild protein-energy malnutrition.
n Monitor growth among all pre-school children and provide food supplements where needed.
n Mainstream nutrition in health, education and agricultural policies.
n Retrain and retool existing staff and mobilise community volunteers. Choose one community volunteer for every 10 households and build their capacity.
n Encourage breast-feeding and organise school lunch programmes.
n Promote home gardening, consumption of fruits and vegetables, aquaculture and food safety standards.
n Introduce an integrated food safety net with an emphasis on household food and nutrition security.
The positive impact of the above Nutrition Security Compact is evident from the decline of maternal mortality from 230 per 100,000 live births in 1992 to 17 in 1996 (Philip et al 2000). Thailand’s initiative in organising a Community Volunteer Corps for Household Nutrition Security is worthy of emulation by other nations.
Among the nutritional challenges facing the countries in transition, the following need priority attention.
Low birth weight: For the reasons already mentioned, governments and civil society organisations in developing countries should accord high priority to overcoming maternal and foetal under-nutrition and malnutrition. Future intellectual attainments of nations will depend very much on success in this area.
Under-nutrition and stunting among children: Because of its linkages to mental impairment, stunting should be addressed through an integrated package of healthcare, education and nutritional measures. Early under-nutrition accentuates adult chronic diseases, including diabetes, heart disease, hypertension and cancer.
Undernourished adults: Judged by a body mass index of less than 17 kg/m2, over 240 million adults in developing countries are severely undernourished. The nutritional safety net for this category could include programmes like food for eco-development i.e. food for work and food for nutrition.
Vitamin A and iodine deficiencies: Subclinical Vitamin A deficiency still affects nearly 200 million pre-school children in developing countries. Sustained efforts are also needed to eliminate iodine deficiency disorders.
Pandemic anaemia: Maternal anaemia is pandemic and is associated with high MMR; anaemia during infancy, compounded by maternal under-nutrition, leads to poor brain development.
Lack of access to clean drinking water: This is a serious nutritional problem since contaminated water is a major cause of intestinal infections and diarrhoea in children. Access to clean drinking water is becoming a luxury in many developing countries.
Access to sustainable livelihoods: Ultimately, the lack of purchasing power is responsible for poor access to a balanced diet. In India, the poverty line is defined in nutritional terms. The estimation of poverty is based on the consumption expenditure level below which a household of 5.5 persons, on an average, cannot meet the recommended intake of 2,400 kcal for adults in rural areas and 2,100 kcal in urban areas. In poor households, over 70 per cent of the daily income goes towards buying food. Even by this austere yardstick, over 250 million people in India live below the poverty line. In the area of income poverty, South Asia is the hot spot (Table 6).
M.S. Swaminathan, a founding father of the Green Revolution in India, worked to develop the nation’s food security as Secretary for Agriculture. He has also been Director General of the Indian Council of Agricultural Research and the International Rice Research Institute, Independent Chairman of the FAO Council, and President of the International Union for the Conservation of Nature and Natural Resources. He is a member of the Royal Society, the US National Academy of Sciences, the Russian Academy and the Italian and Chinese Academies. His honours include the World Food Prize, UNEP’s Sasakawa Award and the Tyler and Honda Prizes. He lives in Chennai, where he heads the Centre for Sustainable Agricultural and Rural Developmen