Will India’s Food Security offer Nutrition Security?

30 November 2013 | Column | By MilindKokje

Food Security and Nutrition Security are closely interrelated and may appear in a vicious cycle in some cases. There are an estimated 925 million hungry people in the world and around 1.4 billion people live on less than $1.25 a day. A considerable portion of these chronically and clinically undernourished people are living in India who are suffering from lack of food and nutrition security. FAO clearly mentioned that “There is much more to health than carbohydrates”. A country like India should run both Food Security and Nutrition Security side-by-side to reach the target.


“Control food and you control the people,” former US Secretary of State Henry Kissinger once said. If one considers the criticism surrounding the UPA government’s food security Act, one would wonder if the critics feel this is one of the inspirations for the legislation, which of course has some genuine intentions and poor-friendly features to a certain extent.

Most of the criticism on the food security measure is political – “populist measure which is not going to help poor, at whom it is actually aimed” – and from the economic angle – “can the country afford the cost involved in providing food security and will the benefits really percolate to the deserving masses.”
What is missing in this political gaga is the scientific angle of nutrition security. The political, and even economic, pundits have overlooked the angle of actual quantum of benefits to stakeholders as far as nutrition is concerned.

The food security gives right to subsidised foodgrain to 67% of India’s population. It entitles 75% rural and 50% urban population to 5 kg of foodgrains (rice, wheat and coarse) per month. Pregnant women and lactating mothers entitled to nutritious meals and maternity benefit of at least Rs 6,000 for six months.
However, experts claim that an increase in food supplies does not necessarily translate into improved nutrition. “For nutrition in food to be absorbed by the body, its bioavailability should increase,” says Dr Nupur Krishnan, Director, Bio-Logics Nutrition Clinic.

Despite food-based social safety net programmes launched earlier and run for a long time, malnutrition levels continue to exist and children die. It is many times attributed to corruption and inefficiency in the implementing machinery. Similar doubts people have for nutrition security through food security. “I would have said yes (to a statement that food security would bring nutrition security) if it was any other country where ethics and honesty go hand-in-hand. In India, I cannot say a full hearted yes because we all know there is going to be corruption and by the time food reaches the poor, it could perhaps be most unhealthy, diluted foodgrain and will perhaps result in epidemics,” according to Dr Villoo Morawala-Patell, Chairman and Managing Director, Avesthagen.


"A true Public Private marriage can bring nutrition security. Most Food companies are adopting the best practices and bringing good quality food to the market."

- Dr. Villoo Morawala-Patell, Chairman and Managing Director, Avesthagen 

 

Actually, food security is expected to incorporate nutritious food as per the definition of food security made by the World Food Summit at Rome in 1996. The definition said, “When all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.”


How the food security can take forward the nutrition security or the nutrition balance agenda is a crucial point that is not much debated yet. The traverse from food security to nutrition security is the most important journey and it will be better if we move fast to traverse this path. It is essential to remember that the need for a Food Security Act was triggered by an urgent need to fight malnutrition and hunger.

But, the problem of malnutrition, that includes even over nutrition, and nutrition security is much widespread. It is not only connected with poverty and food security, though it looks like that. It is not restricted to only one class of society, i.e., poor and below poverty line, as it appears to be. Undernourishment and malnutrition are issues that have plagued society’s different socio-economic segments due to varied reasons. It is leading to serious health problems.

More than 2.3 billion people world over – almost one-third of the world population – are estimated to have been affected by obesity, diet-related chronic diseases and under-nutrition, making them global public health priorities. Like its major contribution to the world population, India’s contribution is a lot in the statistics of these diseases and malnutrition also. At least one out of every 10 kids in the city is obese and the rate is higher - five out of every 10 children - among elite, high income groups, said a report by leading endocrinologists from Ahmedabad.

Doctors blame ‘excessive nutrition’ for the problem among 90% children suffering from obesity while only in 10% cases genetic disorder is the cause. The percentage of prevalence of obesity is five times more among children from high-income group families than the general percentage.

The problem is so serious that World Health Organisation (WHO) has now declared obesity as ‘global epidemic’. Another serious global health and development challenge, particularly for low-income group countries, is under nutrition. In addition to its impact as a major risk factor for disease and mortality, under nutrition has significant societal implications, including decrease in educational attainment and productivity and increase in healthcare spending.

According to a study in 2010 by Barry M Popkin, University of North Carolina Interdisciplinary Obesity Programme, of the women in the age group of 20 to 49 in rural areas that are underweight and overweight in selected developing countries, in India underweight women were almost 50% while about 4 to 5% were overweight.

Growing problem of obesity is creating a major group in society that is facing health problems linked to overweight and lack key nutrients they need to be healthy. Obese people in many countries, even in rural areas, are outnumbering the underweight people. But efforts for nutrition security, for long-term, have to look into the underlying causes of malnutrition — poverty, food insecurity, low education, limited healthcare and poor hygiene.

This particular phenomenon of overweight population growing in society was explained in Indian Council for Medical Research (ICMR) report of 2009 on ‘‘Nutrient requirements and recommended dietary allowances for Indians’’. It said, “India, being a country in developmental transition, faces dual burden of pre-transition diseases like under nutrition and infectious diseases as well as post-transition, lifestyle-related degenerative diseases such as obesity, diabetes, hypertension, cardiovascular diseases and cancer.” It added, “Currently, India is in nutrition transition with 10% rural adults and 20% urban adults suffering from over nutrition leading to an emerging double burden of malnutrition.”

Agreeing with this observation, Rajesh Kumar, CEO, Sami Direct, warns, “In India we are dealing with two types of problems at the same time - over nutrition and malnutrition. Both needs to be addressed with a lot of awareness and structured efforts in a continued fashion before it shapes up into a major epidemic.”
Not only India, but many countries now have a ‘double burden’ of malnutrition, obesity and diet-related chronic diseases. Inadequate nutrition during early development (in the womb) results in metabolic programming increasing the risk of obesity and diet-related chronic diseases later in life. Both of these challenges are affected by the quantity and quality of food.

The cost of malnutrition is considered to be very high. It generates a vicious cycle of poor health, high death rates, poor quality of life, decreased mental capacity and reduced worker productivity. Productivity losses are estimated at more than 10% of lifetime earnings for individuals and 2-3% of gross domestic product for the nation. This clearly shows that nutrition balance is not only important for a healthy and productive life, but also for continued economic growth and development.


If government can adopt the preventive route then they can save millions of dollars as healthcare cost.

-V S Reddy, managing director, British Biologicals


But nutrition security is a very complex and multidimensional issue. Various factors like poverty, inadequate food consumption, inequitable food distribution, improper infant and child feeding and care practices, limited access to quality health, education and social services and equity and gender imbalances on one hand, mainly affecting the people from lower strata of society. While factors like poor sanitary and environmental conditions, wrong eating habits, lack of proper knowledge about nutritious food and lifestyle are affecting across society.

“We need to start working on nutrition education so as to make people aware about factual scientific information about nutrition. Myths and misconception regarding nutrition should be eradicated from the society,” suggests Dr Krishnan.

"Whatever food or functional food we eat, does not mean that body gets it all. Many consumers don’t know this. Organizations can collaborate
with qualified nutritionists to organise local workshops in this direction."



- Dr. Nupur Krishnan, Director, Bio-Logics Nutrition Clinic

 



What causes malnutrition? It generally results from lack of either protein or micronutrients such as iodine, Vitamin A or iron, which boost immunity and healthy development. William Prout, an English doctor and chemist, identified three principal constituents of food – protein, fat and carbohydrates – that came to be known as macronutrients.

Dr Morawala-Patell claims that malnutrition is generating large swathes of human bodies with not real, proper, physical, emotional, intellectual drive. “This would result in a very poor work force and perhaps unrest of the frustrated masses,” she fears.

Food security is concerned with questions relating to the food supply, but nutrition status depends not only on suitable food but also on good basic health services and, particularly for children, adequate care. Developing countries desperately need nutritional interventions and social protection policies to guide them through the current economic crisis, ensure nutrition security and safeguard vulnerable population.

Ensuring food and nutrition security is a challenge for India, given its huge population and high level of poverty and malnutrition. Food as well as nutrition security is broadly characterized by three pillars: availability, accessibility, and absorption. The absorption clearly indicates that there are gaps in linking the three pillars.

One more important factor is cleanliness. According to Dr Krishnan, “We have a large number of middle class population that prefers street food. We need to educate restaurants and street food vendors about food safety and improving nutritional value of their products.”

There are varied ways to bring in nutrition security. In case of infants, one way could be optimal breastfeeding as it is an important measure to prevent obesity and under nutrition. But if one observes cycle of food, then it would be realised that any step for food as well as nutrition security would begin with agriculture. The country would require to produce adequate foodgrains from its agricultural sector or import it, may be at a heavy cost, to provide it to the population. Should poor be given subsidy or not, and if yes, at what rate and how – these all are subsequent issues once adequate food is available for distribution. And then comes the issue of making the country nutrition secured by ensuring supply of nutrition rich food.

Union agriculture minister Sharad Pawar feels increasing agriculture production is the solution for this problem. In a statement, on the recent World Food Day on October 17, he said, “The only long term solution to ensuring food and nutritional security in the country lies in increasing production and productivity in the agriculture sector with diverse and integrated farming systems to provide nutritious diets to each and every citizen.”

Some other experts in the field too have similar feelings. “Prime challenge in making nutrition affordable and accessible to all is to create crop varieties which are nutritious. We need to improve nutrition profile of staples like wheat and rice so that more people can get access to nutritious food,” according to Rajashree Menon, SBU - Head, Neuvithrah Nutrition Pvt Ltd.

However, one of the major factors, experts fear, that is going to affect agriculture production – quantity as well as quality wise - is climate change. It may not only reduce production, making substantial distribution difficult, but will also decline quality of the food leading to problem of under nutrition across all classes. A changing climate could even make current crops less nutritious, by altering the relative protein content in major staple foods.

In such a situation, while ensuring more production despite problems like lesser water availability and effects of climate change, investing in agricultural science to make crops more nutritious is also vital.

Another way to overcome the problem is to make scientific nutrition available through nutraceuticals, suggests Menon. But for that “the country needs more manufacturing facilities and those facilities need to import good quality source material which increases the product cost. Thus, we need more R&D in this field to bring down the cost. There is also need for making research in the nutrition field available to professionals and to study importance of micronutrients in Indian context. We should focus on developing right and scientific combination of micronutrients,” she adds.

One more problem leading to under nutrition is ‘nutrition transition’ as people are shifting away from traditional diets and generation of knowledge about good diet due to varied reasons including migration from traditional places of living.

Dr Morawala-Patell’s suggestion is the government must work with private sector for distribution of good food, where there will be accountability. She says, ”Also new functional food should be created and disbursed to the public in small sachets where the Government pays the company the cost and overheads. This has to be done on a war footing.”

India’s food security measure surely has a long-term plan of making the country nutrition secured. But widespread and hard efforts are needed to reduce that period and make the country nutrition secured as soon as possible. This is very much essential considering the number of malunourished children suffer and die each year, the number of women become anemic and have to pass the life in anguish, the number of grown-ups unable to work due to weakness leading to productivity losses in one class of people. And equally essential as in the other classes, economically in better position, the problem of under nutrition or over nutrition is leading to serious diseases like obesity, blood pressure, cardiac related problems and other diseases.

The task is difficult and complex. The legendary French leader Charles de Gaulle had described the problem of governance in a ‘foody’ manner when he said, “How can you be expected to govern a country that has 246 kinds of cheese?” If a country with 246 kinds of cheese is finding it difficult to be governed, India with 246 kinds of societies, people, castes and problems across its length and breadth will find it more difficult. Governance though complex requires to be solved.

 

"We, who are involved with food and nutrition domain, know that Nutrition Security is part and parcel of Food Security, but this important link is miserably missing in newly introduced Food Security Bill in India. India is moving to market-oriented production, which promises higher returns to labour, but also incur greater risks for food security due to the less land is available for growing food crops. India need ambitious programs to re-orient its agricultural R&D priorities to make them more nutrition-sensitive involving government bodies with long-term industry partnership."

- Dr. Dilip Ghosh, Director, Nutri Connect, Australia

 

"In India we are dealing with two types of problems at the same time 1) Over nutrition 2) Mal nutrition. Both needs to be addressed with lot of awareness and structured efforts in a continued fashion before it shapes up into a major epidemic.

- Rajesh Kumar, CEO, Sami Direct



"Food security and nutritional security should be treated separately. Most of the time it is assumed that food security will ensure nutritional security which cannot happen because food security means adequate food for everybody. But the issue with ‘quality of food’ is not covered under the food security. So I believe that both food and nutritional security should be treated separately. But alot of efforts are being made at national and international level to address food security issue.Nutritional security is something different, where there is an issue of malnutrition, which is a big problem in our country. We have statistical data available regarding malnutrition. Considering the gravity of malnutrition and its impact during pregnancy and after delivery…we need to address this issue independently." 

- Dr. Prabhakar Ranjekar, Director, Interactive Research School for Health Affairs (IRSHA), Pune



"Prime challenge in making nutrition affordable and accessible to all is to create crop varieties which are nutritious themselves. We need to improve nutrition profile of staples like wheat and rice so that more people can get access to nutritious food. We need to declog the public distribution system and increase its efficiency.At the same time the country needs more manufacturing facilities for nutraceuticals to make scientific nutrition available more easily. However, manufacturing facilities in the country need to import good quality source material which increases the cost of the product. We need more R&D in this field so that the cost can be brought down."

- Rajashree Menon, Sub Business Unit - Head, Neuvithrah Nutrition

 

 

Essential nutrients:

Protein
Protein is a general name of chemical compounds formed by combining the basic building blocks called amino acids in a highly varied and complex chemical manner. When proteins are mentioned, generally emphasis is given on the amino acid content rather than the calories. If you regard carbohydrates or fat as fuel, it’s ok, but not protein. We buy potatoes by weight, but not a microprocessor, for example! The role of protein is very important in the body, which cannot be played by any other nutrient. Likewise a protein’s amino acid content is even more important than the total amount of protein.

Carbohydrates
Carbohydrates are of two types:
The simple carbohydrates and the complex carbohydrates.
Sugar, glucose, fructose, maltose, lactose etc. are examples of simple carbohydrates. For health purposes and for disease control, it is better to avoid them, because they get quickly digested and cause weight gain (read fat gain!), rise in blood sugar in diabetes and rise in LDL cholesterol levels.
Complex carbohydrates are mostly starch and starch-like substances.

Fats
Fats are sometimes called lipids. Chemically fats are called triglycerides because the fat molecules are composed of a glycerol molecule to which three fatty acids are attached. We saw in the table above that 1 gram of fat gives us 9 calories—more than twice the calories given by the same amount of carbs or protein. For disease control less is better in case of fats! There are several categories of fats: The good, the bad and the ugly!


Vitamins
Vitamins are a group of nutrients that are essential for maintenance of normal health. The regulate metabolism, growth and development, vitamins mainly act as a catalyst in our body
All vitamins are natural organic compounds that are found only in living organisms: plants and animals. Except a few vitamins, our body cannot synthesise vitamins. Therefore vitamins have to be consumed via natural food or by taking dietary supplements.



Is Nutrition Security attainable by providing Food security alone? Are these two terms synonyms?

The question of food security hinges primarily upon adequacy and availability of food. It is through the adequacy of food that nutrition security is targeted since the former implies that nutritional needs are met with, both in terms of quantity (energy) and quality (providing all essential macro- and micro-nutrients). However, what needs to be recognized is that nutrition does not refer to availability of food alone. Nutrition is the intake of safe, quality food, containing a good balance between macro and micronutrients, in relation to the body’s dietary needs and may be facilitated by food security at the household level. However, an individual's food preferences and habits are often major factors affecting actual nutrition intake even within a food secure household. Thus, nutrition is influenced by stages in lifecycle, gender, ethnicity and culture, beliefs about food, personal preferences, religious practices, lifestyle, economics, medication and therapy, health and disease condition, substance abuse, advertising, etc. All these factors need to be taken into consideration while planning for nutrition security.

Therefore, food security is a necessary but not sufficient condition for nutrition security. Hence, subsuming nutrition under food security is not entirely desirable. The present conditions of double burden of nutrition in the developing countries warrants the need to focus on nutrition as a separate goal as well as incorporating nutrition related measures with other goals of development. Promotion of agricultural diversity and mixed cropping to include fruits, pulses and vegetables as well as animal sourced products should be an important strategy in this direction. Focus should be especially placed on the introduction and promotion of crops that are more nutritious and sustainable. Stimulating consumer demand for healthy, nutritious products through awareness campaigns and pricing policies; providing nutrition counseling and generating awareness about food safety as well as healthy cooking practices to preserve nutritional value of food; introduction of smart technologies; access to clean drinking water, environmental hygiene and sanitation are some of the potential measures that should be given priorities in all endeavours to attain nutrition security. 


Last but not the least, the question of sustainability also needs to be focused upon which is perhaps best exemplified by the endeavours of local centres of excellence in nutrition like the Coalition for Sustainable Nutrition Security in India. Their primary thrust is attaining sustainability of nutrition security through assisting local bodies, civil society organisations etc. with the knowledge and information relevant to promoting nutrition security based on localfoods, affordable and replicable nutrition and health interventions; corporate social responsibility initiatives; mainstream nutrition considerations in all national missions and ministries; promote nutrition behavior change communication movement through local institutions etc. Therefore promoting and supporting nutrition security is a holistic task that requires moving beyond mere food security and thrives on collaboration across multiple sectors and a willingness to try innovative but sustainable approaches.


- Dr Shweta Khandelwal, Research Scientist and Asst Prof (PHN), Public Health Foundation of India (PHFI), New Delhi




Recommendations of Coalition for Sustainable Nutrition Security in India

Coalition for Sustainable Nutrition Security in India in its report ‘Global Lessons in Achieving Nutrition Security and Their Application to the Indian Context’ has given following recommendations to reduce malnutrition.


a. Start with political will and leadership:
The active role of senior political leaders underscored the importance of nutrition as a national priority and ensured the commitment of funding and other resources necessary for effective programme implementation.

b. Implement a multi-sectoral programme:
Comprehensive national programmes, which adopt a multi-sectoral approach, achieve sustainable improvements in malnutrition. All the reviewed countries implemented comprehensive nutrition security programmes, which included a focus on gender equity, social inclusion, primary education, primary healthcare services, water and sanitation, agricultural reforms and/or local employment to improve incomes.

c. Target the key populations:
National programmes are most effective if they identify and target the population segments that are most important to reach in order to break the cycle of poor nutrition. The critical target populations most commonly selected were pregnant women, lactating mothers, and children below two years of age.

d. Support and empower women as change agents:
Health education and healthcare services for women contribute to a substantial reduction in malnutrition.

e. Create a central coordinating and monitoring mechanism:
Central coordinating agency, with links to the highest governing level and including representatives from relevant ministries, is very important.

f. Involve communities and the private sector, including civil society:
Community engagement and empowerment contributed to achieving nutrition objectives. A partnership between government and civil society was very important to nutrition improvements. Public-private partnerships can serve to increase funding, strengthen monitoring, and/or improve programme implementation, especially at the community level. \

g. Increase accountability:
Good governance and accountability are important factors in successfully improving nutrition.

 

Per capita consumption of foodgrains and edible oils in different countries and regions

Some tends according to Food and Agriculture Organization of the United Nations (FAO) cross country and continents data (latest available only for the year 2007)
It is seen from the statistics that rice was mainly consumed in Asia with an average human consumption of 10 kg per capita per month during 2007 the latest year for which statistics is available. Wheat was consumed across all regions with average world human consumption quantity of 5 kg per capita per month.

Total cereal human consumption per capita per month was averaged around 12 kg per capita per month in 2007 that increased from 11.8 kg per capita per month in the 1980. The human consumption varied from 12 kg per capita per month in Asia and Africa to 11 kg in Europe, 10 kg in America and only 6 kg in Oceania. Compared to human consumption total consumption of cereals variation was much higher, 43 kg per capita per month in America and Europe, 32 kg in Oceania, 19 kg in Asia and 16 kg in Africa. Highest amount of human consumption of cereals in 2007 was in Indonesia (14 kg) while highest amount of total cereal consumption was found in Canada and USA, 84 and 73 kg per capita per month, respectively. In India, human consumption of cereals per capita per month was 12.6 kg and total consumption was 14.3 kg in 2007.

Although India constituted highest share of pulses in total human consumption in the world in quantity, however, per capita consumption of pulses was higher in Brazil compared to India. Per capita human consumption of pulses in the world was measured at 0.53 kg per month. It was highest in Africa (0.82 kg) followed by America (0.74 kg), Asia (0.48 kg), Europe (0.21kg) and Oceania (0.14 kg). India’s human consumption of pulses per capita per month was recorded at 1.06 kg. In the case of edible oils, per capita human consumption was highest in Oceania (0.82 kg) followed by Asia (0.66 kg), America (0.59 kg), Africa (0.41 kg) and Europe (0.24 kg). The aggregate consumption per capita of edible oils was much higher and it was highest 15 kg in America and lowest 1.8 kg in Africa. India’s human consumption was 0.65 kg and aggregate consumption was 3.2 kg per capita per month.

- Dr. Parmod Kumar, Professor & Head, Agricultral Development and Rural Transformation Centre Institute for Social and Economic Change, Bangalore

 

Center to set up committees of Food Secretaries for implementation of NFSA

The Center has proposed a committee of State Food Secretaries under the chairmanship of Union Food Secretaries to short out issues of sharing expenditure towards intra-State transportation and handling of foodgrains, margins to fair price shop dealers and other implementation issues to ensure speedy implementation of National Food Security Act (NFSA).

Besides this another committee at the Ministerial level has been proposed to sort out issues of finance and other infrastructure to provide all required assistance on priority basis for the implementation of the Act, said Prof K V Thomas, Union Minister of Consumer Affairs, Food and Public Distribution, on the sidelines at the conference of State Food Ministers on October 1.

Prof Thomas said that most of the states have already started preparations for launching the scheme under the Act and 50 % States are expected to rollout the Act by this year end. He said that states have been again assured that their foodgrains allocation will be protected at the average of annual off take for the last three years and other concerned will be addressed as per the provisions of the Act.

Prof K V Thomas said, “Successful implementation of this Act is a challenge for all of us and a coordinated approach is required by Central and State Governments to ensure its success. State Governments need to evolve fair and transparent criteria with involvement of all stakeholders for the implementation of the National Food Security Act”.

The Minister further said that door-step delivery of foodgrains is very crucial and it needs to be ensured by State Governments as provided in the Act. States should create infrastructure for doorstep delivery to prevent leakage and diversion of foodgrains. He also stressed the need for creation of scientific storage capacity and intermediate storage facilities at various levels. 

 

What is National Food Security Act?

The National Food Security Act (NFSA) is a historic initiative for ensuring food and nutritional security to the people. It gives right to the people to receive adequate quantity of foodgrains at affordable prices.

It seeks to address the issue of food security in a life cycle approach - separate entitlements for pregnant women and children, from 6 months of age and upto 14 years, besides entitlements to a much larger population to receive subsidised food grains under Targeted Public Distribution System. It will cover about 75% and 50% of rural and urban population under Targeted Public Distribution System as a single category, with uniform entitlement of 5 kg per person per month. They will get rice, wheat and coarse grains at the prices of Rs 3/2/1 per kg.
Entitlement of existing AAY households will be protected at 35 kg per household per month under the Act. Corresponding to the all India coverage, State-wise coverage will be determined by Central Government. But within the State, beneficiaries will be identified by the concern state.

The Act has special focus on nutrition support to women and children. Pregnant women and lactating mothers to be entitled to meals and maternity benefit of not less than Rs 6,000. Children in the age group of 6 months to 14 years to be entitled to meals under Integrated Child Development Services and Mid Day Meal schemes. The Act encourages woman empowerment as it provides that the eldest woman of the household of age 18 years or above to be the head of the household for the purpose of issuing of ration cards.
Grievance redressal mechanism at the district and state levels will ensure effective redressel of grievances.

The Central Government will provide assistance to States in meeting the expenditure incurred by them on transportation of foodgrains within the State, its handling and Fair Price Shop dealers’ margin as per norms to be devised for this purpose. The Act has significant provisions for transparency and accountability. Public Distribution System related records will be placed in public domain, Social audit will be taken up and Vigilance Committees will be set up. Provision for food security allowance to entitled beneficiaries has been made in case of non-supply of foodgrains or meals. Penalty on public servant or authority will be imposed by the State Food Commission, in case of failure to comply with the relief recommended by the District Grievance Redressal Officer.


-MilindKokje

(With inputs from Narayan Kulkarni, Bangalore and Nikita Apraj, Mumbai)




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