Key factor in development

AT THE time of independence the country faced two major nutritional problems: one was the threat of famine and acute starvation due to lack of national and regional food security systems; the other was chronic undernutrition due to low dietary intake because of lack of purchasing power among the poorer segments of the population.

One of the first efforts of the country was to build up a food security system to ensure that the threat of famine no longer stalks the country. Investment in agriculture and the green revolution have ensured that the food production has kept pace with the population growth and by and large India remained self- sufficient in food. Establishment of adequate buffer stocks has ensured availability of foodstuffs within affordable cost even during the times of drought.

Even though self-sufficiency in food production has been achieved, the population still lacks access to balanced food. It is a matter of concern that even though cereal production has kept pace with the increasing requirements and the average per capita intake of cereal has remained satisfactory, there has been a fall in the per capita consumption of pulses. It is important not only to improve pulse production but also make them available at affordable cost. The production and consumption of vegetables and fruit continue to remain low. Specific efforts have to be made to improve production and access to vegetables especially green-leafy vegetables at affordable cost both in rural and urban areas.

Lack of purchasing power

Poverty and lack of purchasing power have been identified as two major factors responsible for low dietary intake. Nobel laureate Prof. Amartya Sen has gone on record that the Bengal Famine was a result of lack of purchasing power and not lack of food availability. So it is the duty of the Government to create a climate in which the poor could get some purchasing power.

The concern over the economic factors resulting in chronic undernutrition led to the use of calorie intake as the basis of estimating poverty and development of the food for work programme as one of the remedial measures. The food for work programme and employment assurance scheme are aimed at improving household food availability in the below poverty line (BPL) families especially in seasons when the employment and food availability in rural areas are low. To some extent these measures have helped but the problem of equitable distribution of available food persists.

PDS system

The public distribution system (PDS) providing foodgrains at affordable prices is one of the key elements of the Government's food security policy. In spite of obvious limitations, the PDS did play a role in improving in regional food security specially in drought-prone areas. In an attempt to improve the availability of food to people living in most vulnerable areas (remote tribal and drought-prone regions) the revamped public distribution system gave priority for the establishment of the PDS in such areas. In spite of mounting food subsidies, evaluation studies indicate that the supply of subsidised food has not resulted in improvement in the household level food security. In an attempt to limit the mounting cost of food subsidy and at the same time ensure that people below the poverty line do get subsidised foodgrains, the targeted public distribution system providing foodgrains only to the people below the poverty line was initiated. If successfully implemented the targeted PDS is expected to achieve better household food security for families living below the poverty line without substantially increasing food subsidy cost.

Inter-relationship between undernutrition and ill-health has been well documented. Low dietary intake and continued heavy physical activity lead to negative energy balance resulting in chronic undernutrition. Chronic undernutrition may be associated with reduction in the work capacity and increased susceptibility to infections. Infections in turn can further worsen the existing undernutrition. Undernutrition and its adverse health consequences are often seen in pregnant and lactating women, infants and pre-school children.

In an effort to reduce chronic undernutrition and its health hazards, food supplementation programmes to identified vulnerable groups such as women and children were taken up initially by the Department of Social Welfare and later the Department of Women and Child Development; in the Integrated Child Development Scheme, an attempt was made to provide essential health and nutrition inputs to the women and children and pre-school education to children both in urban and rural areas. Programmes for prevention of iodine deficiency disorders, anaemia and blindness due to Vitamin A deficiency were initiated by the Department of Health and Family Welfare.

A review of the nutritional scenario in the Eighties showed that there has been a marked elevation in the severe grades of undernutrition and mortality due to it. In addition the existing food supplementation programmes failed to achieve significant reduction in the proportion and number of persons with mild and moderate degrees of chronic undernutrition, because the programmes tried to provide food supplements to the identified segments of the community and not to the identified person/family suffering from undernutrition. Specific micro-nutrient deficiencies such as anaemia (due to deficiency of iron, folic acid), iodine and Vitamin A deficiencies continue to remain major public health problems because they cannot be tackled through food supplementation programmes and the prophylaxis programmes were not aimed at detection and correction of the deficiency in the individuals. With the alteration in dietary intakes and lifestyles newer problems such as obesity and non-communicable diseases have surfaced especially among the urban middle and upper income groups during the last decade. Tackling all these problems through inter-sectoral cooperation among the departments concerned such as Departments of Health, Family Welfare, Women and Child Development, Education, Agriculture, Food Processing, Rural and Urban Development will have to receive due attention.

It is time we take stock of our progress achieved so far in the last five decades. We have to analyse whether the poor have come up in life. Nutrition holds the key for happy life and without nutrition we find infants not having proper growth. The worst affected are women. In a recent WHO conference at Amsterdam I represented India and I was shocked to hear that 30 per cent of the TB patients in the world are in India. And among them the suppressed and oppressed classes are the majority and women often head the list. We have to do something on the nutritional side immediately so that these diseases could be kept at bay.

We cannot afford a system where the elite suffer from obesity while the poor die due to lack of food in slow degrees.

Food intake

Data from the National Nutrition Monitoring Bureau indicate that there has been small but progressive reduction in the intake of cereals, millets and pulses over the last two decades; vegetable consumption has remained unaltered . With regard to the intake of nutrients, there has been a slight decline in energy and protein intake over the years but average national intake for protein or energy has been at or near the recommended dietary allowances. It is a matter of concern that even today the energy intake among landless agricultural labourers, non- agricultural labourers and urban slum-dwellers especially women is below the recommended dietary allowance; in contrast overeating and obesity are emerging as public health problems among more affluent segments of the population.

This is an in-depth assessment of the current status of nutrition in the country. Our Constitution has guaranteed equal rights to everybody but this could be achieved only by proper nutrition and making available balanced diet to the population. At the WHO Amsterdam conference I was pained to hear that 30 lakhs of children go out of schools because of direct attack of TB every year and this illness grows on malnutrition. It is time the Central and State Governments realise the fact that nutrition is the key factor in development.

K. VENKATASUBRAMANIAN

Member, Union Planning Commission

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