‘India has enormous under-nutrition and over-nutrition problems’

Dr Lawrence J Haddad	Dr Stuart Gillespie

Dr Lawrence J Haddad, is director, food consumption and nutrition division, International Food Policy Research Institute (IFPRI), Washington DC, and Dr Stuart Gillespie is a senior research fellow there. Dr Haddad’s research focus is on the design and impact of policies and programs to reduce poverty and malnutrition. His research interests, which are widely published, include the nutrition and poverty consequences of gender differences in access to resources; how decisions are made within families and the role of individual status and the role of community participation in the performance of poverty programmes. Dr Gillespie’s research interests include the process of nutrition-relevant policy change, the role of capacity in conditioning programme success, the operationalisation of a human rights-based approach to nutrition, and the linkages between HIV/Aids and food and nutrition security. The duo were in India recently to participate in the 13th session of the UN Committee on Nutrition, hosted by M S Swaminathan Research Foundation in Chennai. The modest authors of The Double Burden of Malnutrition in Asia Causes, Consequences and Solutions took some time off their busy scheduleto speak with our correspondent G Sankaranarayanan. Excerpts from the interview:

What inspired you to conduct nutritional studies of Asia?

Asia has the largest number of malnourished children in the world. The Double Burden of Malnutrition in Asia was inspired by the massive challenge that this situation currently poses for Asia. It describes the main driving forces behind the groundswell of under-nutrition, while shedding light on the emerging double burden of co-existing underweight and overweight, and the linkages between these two different forms of malnutrition.

Following our detailed analyses of causes and consequences, we tried to provide evidence-based options for remedial action in differing contexts, all based on the use of a practical approach to conceptualising risks and opportunities through the lifecycle.

Can you elaborate on the ‘double burden’ concept?

There are two types of nutritional problems - one is under-nutrition and another is over-nutrition. Under-nutrition means too little food, too little care and too little health. More emphasis should be given not only to food but also to care and health, the reason being that even if children in the age group of 0-2 years are able to get food, they may have mothers who do not have enough time to pay attention to their children. Similarly, if there is no health-guaranteeing environment, and children suffer from diarrhoeal diseases, no amount of food will help prevent malnutrition.

Over-nutrition, on the other hand, means either too many calories or the wrong types of calories such as saturated fats or highly processed sugar that lead to obesity, vascular diseases, etc. Many developing countries have under-nutrition and those in Europe and North America have over- nutrition problems. There is this in-between category with countries like India that still have an enormous amount of under-nutrition and significant over-nutrition problems. In India, for instance, around 50 per cent of its children under the age of five are undernourished or malnourished. But in urban areas, the over-nutrition problem is shooting up, thanks to the change in lifestyle and food habits. The point is that many countries in Asia face the problem of having to deal with the over-nutrition and under-nutrition simultaneously. As a result, their health systems are under huge stress.

The book argues that there is a connection between over-nutrition and under-nutrition. Can you explain?

Yes, there is a link that is not very obvious. When there is malnutrition, there is a higher level of lower birth rate. One in three babies born in India weigh significantly low because their mothers are undernourished. Some low-weight babies die and some survive and those who survive adapt to malnutrition and scarcity. That is, the biological adaptation is programmed to maximise every calorie the body gets. This adaptation that helped a malnourished baby survive suddenly turns out to be a mal-adaptation when the baby becomes an adult. The adult, who was malnourished in the past, gains extra weight even when he takes only normal amount of food because of the biological adaptation.

Malnutrition is not just a medical problem, but it stems from social discrimination and inequality. Do the policy-makers in developing countries understand this?

We think they are understanding this slowly. There are immediate causes and underlying causes for the malnutrition problems. Non-availability of nutritious food can be termed as an immediate cause. The underlying causes, on the other hand, include poverty, unclean water, absence of democracy, good governance, and economic growth. We are arguing that they should pay more attention to these basic, underlying issues.

We have also been advocating that importance should be given to programmes of indirect intervention like public distribution systems as much as the programmes of direct intervention like Integrated Child Development Schemes (ICDS). India’s PDS system is not a nutrition programme, but actually if it is well-targeted, very well designed for the poor, it will make a quality impact on nutritional status of the citizens at a far less cost.

How effective is the human rights perspective in tackling the malnutrition problems?

The human rights perspective involves community in the process. Thailand had a very big success in the 80s in reducing under-nutrition quite quickly. Thailand’s model is a community-based nutrition programme, whereby locally elected village girl-volunteers (one for every 20 households) underwent high quality training in assessing and understanding the cause of malnutrition. These volunteers engaged the people in dialogue while attempting to spread awareness about the nutritional problems. They visited the homes of severely malnourished people instead of expecting them to come to their places. Creating awareness is as very important as nutrition education should be an integral part of any successful nutrition programme.

What’s your take on the nutrition policies and programmes of India?

The national food security may be politically important for India, but it should understand that the household food security is even more important. If there is no food in village households, it really doesn’t matter if the national food security is commendable. What is also important is getting the food to the child. Even if the child takes the food, his body cannot absorb it unless you provide a clean environment and water. For a country like India, infant growth is as important as economic growth and the politicians should understand that. The first question your Prime Minister should ask his minister is “how are the children growing?” and not “how is the economy growing?”