Mentor’s Comment

Introduce with what is the double burden of malnutrition.

Followed by how it threatens the demographic dividend of India by giving its negative impacts on youths productivity.

Steps taken by government to counter the challenge of malnutrition.

Conclude with suggestions.

Model Answer

Malnutrition in India has always been synonymous with undernutrition. Not anymore. Data from the latest round of the National Family Health Survey (NFHS) shows that obesity among adults is nearly as big a problem in the country as under-nutrition.

The double burden of malnutrition is characterised by the coexistence of under nutrition along with overweight and obesity, or diet-related non-communicable diseases, within individuals, households and populations, and across the life course.

What has led to this?

• Lifestyle and dietary patterns have undergone dramatic changes, especially among urban sections, in the recent decades.
• This has contributed to reduction in physical activity and an increasing prevalence of non-communicable diseases.
• Overnutrition is traced to be the cause for these diseases due to the imbalance between intake and activity.
• Resultantly, over-nutrition is emerging as a concern among the urban affluent segments.

Health threats can drain demographic dividend.

Good health remains a key to reducing youth vulnerability, improving workforce productivity and creating an environment for youth to realize their full potential. With increasing malnutrition there is a threat of demographic dividend turning into demographic nightmare. We all know that optimal nutrition will be the most essential factor propelling proper growth and development of human brain and body

Steps taken by government-

• So far, there are no specific programmes or health policies, focusing on the double burden of malnutrition. Though we have national policies like the National Health Policy (2002), National Population Policy (2000), and programmes including the National Rural Health Mission (NRHM), they are not fully capable of solving or improving the adult health.
• The NITI Aayog has recently shared a 3 year road map for action including a commitment on enhancing the nutritional status of our population.
• National Health Policy, 2017 highlighted the negative impact of malnutrition on the population’s productivity, and its contribution to mortality rates in the country.
• The MoHFW and FSSAI have convened expert panels to prepare reports on related issues but faster, evidence based concrete action needs to emerge and implemented with all sincerity. For example to control access to and affordability of ultra-processed foods, the government needs to firstly have a sound system to screen products in our markets, then devise a method for easy identification of relatively healthier products. This needs to be followed by the rules/policy around sale and advertising of such products. All these action points need strong coordination amongst various government departments/ministries and stakeholders.

Assessment of govt efforts:

1. Child Undernutrition
   22. India is home to the largest number of children in the world. Nearly every fifth young child in the world lives in India. It is estimated that there are about 43 crore children in the age group of 0-18 years. Though, with sincere efforts and policies, proportion of child undernutrition came down from 22.2 to 15.2, a better framework of policies and goals needs to be defined.

2. Stunting & Wasting
   38. While stunting and underweight prevalence has gone down, trends in wasting show an overall increase in the last decade. The decrease in stunting has been from 48% to 38.7%. While the overall prevalence of stunting has gone down, in terms of absolute values, it continues to remain high in Bihar, Uttar Pradesh, Jharkhand, Meghalaya, Madhya Pradesh and Dadra & Nagar Haveli, where more than 40% of the children remain stunted.
   39. Findings from NFHS-4 (2015-16) highlight that wasting in children less than 5 years (weight- for- height) or acute malnutrition is still high, and also since 1991, the proportion of wasting in children hasn’t gone down much. There is a Sharp increase in the incidence of child wasting is seen in Punjab, Goa, Maharashtra, Karnataka and Sikkim.

Over-nutrition and obesity

1. As indicated in the recently released Global Report on Nutrition 2016, obesity and overweight, rising in every region and nearly every country, are now becoming a global challenge.
2. The number of children under 5 who are overweight is approaching the number who suffers from wasting. The number of overweight children under 5 years is increasing most rapidly in Asia.
3. NFHS 3 data also suggests that India is in the process of nutrition transition, where the dual burden of malnutrition – i.e. over nutrition and under nutrition is beginning to be seen in some groups.
4. There is a relatively small, but increasing percentage of overweight children who are at greater risk for non-communicable diseases such as diabetes and cardio-vascular heart disease.
5. These levels of over nutrition significantly compromise health and productivity. NFHS-4 reports that overweight/ obesity has affected almost 20.7% women and 18.6% men, mostly located in urban areas, in wealthier households and among older adults.
6. It is seen that over nutrition is becoming an emerging issue, with Chandigarh and Lakshadweep indicating the prevalence of overweight women or obesity in women by more than 40%.

Conclusion

The environment, agriculture and education ministries have a big role and stake in tackling malnutrition. It should be realised and inter-ministerial committee should be formed for prompt discussion and action. India has public health policies but action /implementation on ground needs to be strengthened multi-fold for meaningful strides in human health and nutrition status of our country. The time to act against the multi-headed malnutrition demon is NOW.