Context

The article focuses on the top three Sustainable Development Goals (SDGs) of the United Nations, namely poverty elimination, zero hunger, and good health and well-being by 2030.

India’s record on extreme poverty, hunger and health

• Decline in extreme poverty: The World Bank’s estimates of extreme poverty- measured as $1.9/per capita/per day at purchasing power parity of 2011- show a secular decline in India from 45.9 per cent to 13.4 per cent between 1993 and 2015.
• Elimination of extreme poverty 2030: If the overall growth process continues as has been the case since, say, 2000 onwards, India may succeed in eliminating extreme poverty by 2030, if not earlier.
• Zero hunger by 2030: Given the overflowing stock of food grains with the government, and a National Food Security Act (NFSA) that subsidises grains to the tune of more than 90 per cent of its cost to 67 per cent of the population, there is no reason to believe that India can also not attain the goal of zero hunger before 2030.
• Health- a real challenge: The real challenge for India, is to achieve the third goal of good health and well-being by 2030. India’s performance in this regard, so far, has not been satisfactory. as per the National Family Health Survey (NFHS 2015-16)-
  • In 2015-16, almost 38.4 per cent of India’s children under the age of five years were stunted.
  • 8 per cent were underweight.
  • 21 per cent suffered from wasting (low weight for height).
  • The situation in some states like Bihar, Jharkhand and Uttar Pradesh is even worse.
• Global Hunger Index ranking of India: No wonder, the Global Hunger Index (GHI) ranks India at 102 out of 117 countries in terms of the severity of hunger in 2019.

What are the various targets set on the nutrition problem?

• Target on reducing the problems of underweight children: The National Nutrition Strategy, 2017, aims to reduce the prevalence of underweight children (0-3 years) by three percentage points every year by 2022 from NFHS 2015-16 estimates.
  • Why this is an ambitious target? This is an ambitious target given the decadal decline in underweight children from 42.5 per cent in 2005-06 to 35.8 per cent in 2015-16 amounts to less than 1 per cent decline per year.
• Targets set in National Nutrition Mission: Similar targets have been set by the National Nutrition Mission (renamed as POSHAN Abhiyaan), 2017.
  • To reduce stunting by 2 per cent.
  • Under-nutrition by 2 per cent.
  • Anaemia (among young children, women and adolescent girls) by 3 per cent.
  • Low birth weight by 2 per cent.

Four areas India needs to focus to achieve the set targets

• India has to focus on four key areas:  If India has to make a significant dent on malnutrition by 2030.
• First- Mother’s education.
  • Multiplier effect: It is one of the most important factors that have a positive multiplier effect on child care and access to healthcare facilities.
  • Increases awareness: It also increases awareness about the nutrient-rich diet, personal hygiene, etc. This can also help contain the family size in poor, malnourished families.
  • Thus, a high priority to female literacy, in a mission mode through liberal scholarships for the girl child, would go a long way towards tackling this problem.
• Second- Access to improved sanitation and safe drinking water.
  • The Swachh Bharat Abhiyan and Jal Jeevan Mission would have positive outcomes in the coming years.
• Third-shift in dietary pattern
  • Shift from cereals to more nutritious food: There is a need to shift dietary patterns from cereal dominance to the consumption of nutritious foods such as livestock products, fruits and vegetables, pulses, etc.
  • But they are generally costly and their consumption increases only by higher incomes and better education.
  • Diverting the food subsidy to nutritious foods: Diverting a part of the food subsidy on wheat and rice to more nutritious foods can help.
• Fourth- Adoption of new agricultural technology
  • Adopt bio-fortifying cereals: India must adopt new agricultural technologies of bio-fortifying cereals, such as zinc-rich rice, wheat, iron-rich pearl millet, and so on.
  • The Indian Council of Agricultural Research (ICAR) has to work closely with the Harvest Plus programme of the Consultative Group of International Agricultural Research (CGIAR) to make it a win-win situation for curtailing malnutrition in Indian children at a much faster pace — and, at a much lower cost than would be achieved under a business as usual scenario.

Examples from the world

• Right public policies make the difference: Global experience shows that with the right public policies focusing on agriculture, improved sanitation, and women’s education, one can have much better health and well-being for its citizens, especially children.
• China’s example: In China, it was agriculture and economic growth that significantly reduced the rates of stunting and wasting among the population and lifted millions of people out of hunger, poverty and malnutrition.
• Brazil and Ethiopia example: According to FAO, Brazil and Ethiopia have transformed their food systems: They have targeted their investments in agricultural R&D and social protection programmes to reduce hunger in the country.

Conclusion

Despite India’s improvement in child nutrition rates since 2005-06, it is way behind the progress experienced by China and many other countries. According to the Global Nutrition Report, 2016, at the present rates of decline, India will achieve the current stunting rates of China by 2055. India can certainly do better, but only if it focuses on this issue.

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Context

China’s handling of coronavirus, in contrast to SARS, has been effective, should be a template for others.

Why lockdown of Wuhan is a big deal?

• A move without precedent: China’s lockdown of roughly 60 million people in Wuhan and other cities in Hubei province for more than a month now is without precedent in the history of public health.
• Best way to stop the virus from spreading: The best way to stop a virus from spreading from person to person, is to give it no place to spread to.
  • This is achieved by isolating those who are infected and quarantining those who might be infected.
• Cordon sanitaire: In China, though, the control has moved beyond traditional quarantine to a cordon sanitaire-an exclusion zone people cannot travel into or get out of.
  • In most countries, this simply would not work for a period this long and a population that large.
• Inconceivable move in other places: Wuhan is a city of 11 million people, slightly larger than Chennai or Bengaluru. It would be inconceivable to think of cutting off transportation in and out of these cities or asking people to stay at home for even a day, let alone a month.
  • No political control nor administrative mechanism: Like India, most countries in the world have neither the political control to impose their will on people this way nor the administrative mechanism to enforce this degree of control.

Human cost and ethic of the lockdown

• The human cost: The human cost of such a strategy is immense.
  • Feeling of being unable to escape: The fear induced by being unable to escape from a place where a new virus is circulating is immense.
  • The worries and stresses of everyday life multiply one hundred-fold when everything from shopping for food to occupying children stuck at home becomes a challenge.
  • The slightest cough, cold or fever can trigger panic.
• Ethics involved in the move: The ethics of the cordon sanitaire in Wuhan, as well as the quarantining by Japanese authorities of the cruise ship Diamond Princess, will be debated for years after this particular outbreak is over.
• Slowing the spread: But whatever its human and financial cost, China’s actions in the first month of the outbreak helped to slow the spread of the virus within the country as well as internationally.

How China’s response this time is different from the SARS

• On December 31, the Chinese government informed the WHO, and the world, of the existence of a form of pneumonia of unknown cause
  • It also told the people of Wuhan to wear masks if they had symptoms and seek medical attention.
• Virus identification: For the world, the big breakthrough from China came on January 7, when researchers in Wuhan identified the virus as a new coronavirus.
• Sharing of the genetic sequence of the virus: Two days later, China shared its genetic sequence with the world.
  • How genetic sequence helped? The sharing of the genetic sequence allowed labs all over the world to develop testing kits to detect the disease.
  • It also put countries on the alert for travellers with the disease, without which the new coronavirus would have spread much quicker and farther than it has so far.
• China’s response to SARS: The Chinese response to SARS in 2003, in contrast to this, was a cover-up.
  • The disease circulated for nearly three months, enabled by government secrecy and censorship.
  • Spread of disease without warning: When travellers from China brought the disease first to Hong Kong and from there to other cities across the globe, there was no warning.
  • It was only after the disease spread in Hong Kong, that scientists and public health experts began to decipher this new virus.
  • Lessons learned: China, fortunately, learned the lessons for SARS and put together systems to identify and respond to this new disease quickly.

What India can learn from China

• Infrastructure with speed: Public health officials all over the world, including in India, should study the speed with which China put together an infrastructure to deal with this new disease.
  • Modern, well-equipped hospitals dedicated to coronavirus patients were constructed in weeks.
• Centralised information and logistic system: Centralised information and logistics systems and systems to ensure coordination between multiple levels of government -from the central government to provincial and municipal governments, were put into place.
  • All the systems seem to have worked reasonably smoothly, given the chaotic and complex atmosphere of a disease outbreak.
• Unique approach: The way China has tackled this disease has been an “all of government, all of the society approach”, in the words of Bruce Aylward, the leader of the WHO team that recently spent two weeks in the country.
  • It was, as he described it, “a very old-fashioned approach”, but one that had “prevented at least tens of thousands, but probably hundreds of thousands of cases.”

Conclusion

• In all probability, it is only a matter of time before India sees new cases. The Indian health system, as in China, is multi-layered. Some states like Kerala have strong public health infrastructure and a strong response capability. Many other states like Uttar Pradesh and Bihar do not have strong public health systems. They will find it difficult to respond and will learn that diseases, like the revolution, can be brutal.

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