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DOUBLE BURDEN OF MALNUTRITION: NEED FOR URGENT POLICY ACTION

  • 2019 was remarkable for nutrition in India as – After years of slow and somewhat tentative action to acknowledge, understand and act on the challenge of undernutrition, India’s National Nutrition Mission brought focus and ambition and a range of actions followed.
  • Changes seen:
    • National and State Governments mobilised
    • District Administrators engaged
    • Private sector mobilised in its own way
    • Civil society continued to push for accountability and action.
  • India’s ‘father of nutrition’, Dr. C. Gopalan invested in connecting science with the policy world.
  • The use of data and science to inform India’s efforts, to track progress and to learn from both successes and failures is very important.
  • In a time where information flows have been dramatically reshaped by technology – the science and evidence community must use these new tools, new networks and new ways to engage the public and the policy community on critical issues such as nutrition.

Background:

  • Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients.
  • The term malnutrition addresses 3 broad groups of conditions:
    • Undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age);
    • Micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess; and
    • Overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes and some cancers).

Key Challenges on Nutrition front for India

  • Progress in maternal and child undernutrition varies tremendously by State.
  • Malnutrition contributes the most to child deaths as well as disability in adults.
  • Saving lives of children under five years of age in India will require a steady focus on nutrition.
  • New data on malnutrition among children from the Comprehensive National Nutrition Survey highlights how challenges of overweight, obesity and even early non-communicable disease, are no longer adult challenges.
  • About 10% of children under 19 years have pre-diabetes.
  • Coherence is needed in areas of public policy across multiple ministries- incentivising the cultivation and consumption of a range of food commodities; using the levers of government financing to buy better nutrition (not just more calories) in programmes such as the PDS, ICDS and school meals; ensuring optimal healthcare of adolescents, pregnant women and young children; restricting the marketing of unhealthy foods and drinks; and expanding efforts to improve nutrition literacy.
  • India’s adults also bear a tremendous double burden of malnutrition.
  • Studies show economic progress is a double-edged sword – reducing underweight among women while also exacerbating the challenge of overweight among others.
  • Today, some districts in India have levels of overweight that are as high as 40%.
  • Studies also demonstrate that social determinants related to gender, education, sanitation and poverty are key drivers of stunting and undernutrition.
  • Early-life undernutrition is an important risk factor for later-life adult disease, along with food environments, physical activity and preventive healthcare.

Way-Forward:

  • India has launched policies and programmes like POSHAN Abhiyaan, Anaemia Mukt Bharat and Eat Right India.
  • However, malnutrition does not exist in isolation – individuals, households and communities share multiple forms of malnutrition.
  • Therefore, it is imperative that policy efforts also come together under a common umbrella and an overarching body is needed to ensure convergence.
  • Given the diversity and complexity of the challenge, an even sharper evidence-based and data-driven approach to diagnosing the challenge of malnutrition in India’s states, districts and communities is needed.
  • A nuanced understanding of the risk factors that contribute the most to the multiple burdens and the use of data on the reach of programmes and interventions to identify critical gaps and fuel rapid action will be useful.
  • The underlying data that is now available to undertake these assessments, such as the Comprehensive National Nutrition Survey, can be made available to the scientific community.
  • Silos in data systems should be broken and community health-workers and anganwadi workers should be provided feedback on areas of good performance and where improvement is needed.
  • On actions, a range of evidence-informed options are available to India as they are to the global community – the World Health Organization’s updated Essential Nutrition Actions Across the Life Course, is a critical guide that can be adapted to India’s needs.
  • Addressing the double burden of malnutrition will take an unrelenting focus in coming years – the challenge is complex, the actions needed must come from different sectors, and data and accountability mechanisms must absolutely inform what happens next. The consequences of poor nutrition are too broad, too deep and too costly for society to ignore.



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September 2022
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