As I write this at the beginning of August 2020, cases in India for COVID-19 have crossed the two million mark. While the fatality remains low at 2.7 per cent, the growth in cases shows that the growth is still on. One of the key aspects that COVID-19 has exposed is our broken healthcare system. Food and diet are one of the key parameters that make or break our health.
While the world focuses on obesity, there is a silent killer in our midst. Obesity is one aspect that is heavily covered in the media in India. There are numerous reports on how the ‘Fight Against Fat’ is the paradigm shift in Indian public health policy. Obesity has been linked to heart diseases, diabetes and hypertension. And the information is all correct.
But I believe in a country of a billion-plus people, a problem affecting 50-60 million people is hardly the concern. Let us take the case of diabetes for example. The situation today affects about 50 million people with another 30-40 million undetected cases.
The silent killer is malnutrition.
India’s greatest challenge is malnutrition.
Yes, you heard it right. It is malnutrition!
According to a report by the UN and the World Bank, India is ranked second in the number of children suffering from malnutrition. The country ahead of us is Bangladesh. Almost 47 per cent of children in India are affected by this condition. The icing on the cake is the 2019 Global Hunger Index (GHI) where India is ranked 102 out of 117 countries. Some of the other countries on the list are way smaller in size and population and much poorer than us but are still showing improvement. Sri Lanka, for example, has an index score of 14, while India lands an alarming 23.7. Even Niger has a score of 23.
All those basic biology classes on a balanced diet are the need of the hour for India. This has become more apparent at this critical time of COVID-19 as the foundational health of the individual has implications on his or her recovery rate.
According to a report by the UN and the World Bank, India is ranked second in the number of children suffering from malnutrition, next to Bangladesh. Almost 47 per cent of children in India are affected by this condition. Another alarming statistic is that India has about 150 million children which contribute to almost 18 per cent of the population. Four children die every minute from preventable diseases like diarrhoea, measles and typhoid; usually made more severe due to the prevalent malnutrition.
The icing on the cake is the 2019 Global Hunger Index (GHI) where India is ranked 102 out of 117 countries. Some of the other countries on the list are way smaller in size and population and much poorer than us but are still showing improvement. Sri Lanka, for example, has an index score of 14, while India lands an alarming 23.7. Even Niger has a score of 23.
But media and industry continue to focus on obesity. The reasons are very simple. The obese population is also the one with a higher disposable income and hence a good target market for these companies.
With the liberalisation of the economy, gyms, clinics, supplements and diets have grown manifold. A recent quest for a personal instructor by my wife saw numerous coaches show up at our doorstep, some with their assistants.
But what about hungry kids? Malnutrition is a serious threat and a stumbling block to India’s progress; with diseases, disability and economic backwardness on the horizon for almost 20 per cent of India’s future.
India continues to grapple with the predicament of inadequate nutrition. The problem is more acute with children across the different strata of society. On one hand, we have children in some economic strata that do not have access to a balanced diet due to the economic situation of the parents. They depend on the mid-day meal provided by the school or cheaper carbohydrates-laden diet that is cheaper and something which their parents can afford. On the other end of the spectrum are children like my daughter who are overexposed to marketing from various FMCG companies and love to snack on a carbohydrates-laden diet. In our case, we have introduced the concept of a balanced diet early on, and thankfully my daughter seems to balance her fondness for snacks with fruits. Of late, she is also very receptive to nutritional supplements.
In India, by World Bank estimates, 60 million children are malnourished. This means they do not have the right balance between carbohydrates, minerals, vitamins, proteins, water and fats. This nutritional deficiency affects them in various ways and eventually leads to issues like mineral deficiency, hormonal dysfunction, obesity, muscle pains, skeletal disorders and mental health. This number also hides the number of malnourished children in affluent families who risk losing growth due to lack of proteins.
Knowing all this, parents need to think through the nutritional intake of their children and focus on lost growth. Before we jump into that, you might be wondering how to measure the growth of your child against the health standards prescribed by the Indian Medical Association (IMA) and the World Health Organization (WHO).
These are some other aspects:
I think it is very important for children across India to balance their diet and catch up on lost growth. These are some key facts:
- Most children grow till the age of 18-21. In most cases, this is the last growth spurt for height before the epiphyseal plates close on the long bones and there can be no more increase in height normally.
- In India, by World Bank estimates, 60 million children are malnourished. This means they do not have the right balance between carbohydrates, minerals, vitamins, proteins, water and fats. This nutritional deficiency affects them in various ways and eventually leads to issues like mineral deficiency, hormonal dysfunction, obesity, muscle pains, skeletal disorders and mental health. This number also hides the number of malnourished children in affluent families who risk losing growth due to lack of proteins. Adding to this already complex platter of health issues are Vitamin D deficiency and thyroid that accumulate due to our lifestyle of staying indoors.
- It is estimated that India has around 80 million diabetics, and this is spreading at such an alarming rate that it is tied back, in most cases, to nutritional imbalance as children. Most diabetic patients are unable to adjust to a new lifestyle. Some researches in the West have found that nine out of ten bypass surgery patients go back to their old lifestyle even when knowing that it is that unhealthy lifestyle that got them into trouble in the first place. And adding sugar to the diet has created further complications as most diets and processed foods have added sugar.
- The age group of 3-9 years is the most crucial in India. Most Indian diets are rich in carbohydrates but low in proteins. The situation is slightly worse in the otherwise healthy vegetarian diet. As children are attracted to tasty or instant food, it is impossible to feed them protein only through egg white, soy milk or chicken. Milk-enabled nutritional supplements are a solution in this space.
So what can we do?
- Educate yourself. Understand what you are eating and how it affects your health and that of your family. Educating yourself will help you make informed buying decisions when in the market.
- Encourage mid-day meal schemes started by some of the government schools. The novel idea was the brainchild of the former Tamil Nadu Chief Minister, M G Ramachandran. This resulted in increased literacy and also improved nourishment. Today, as most schools are shut, the onus is back on the parents to provide the required diet for their children. But this remains the cornerstone for our fight against malnutrition.
- Contribute to institutions like Akshaya Patra Foundation. It is a leading voice on nutrition. They run schemes to feed underprivileged children. I am not saying we need to focus our contributions solely on them as there are other NGOs also working in the field, but Akshaya Patra is the largest provider of mid-day meals for children.
- Thirdly, encourage local community programmes on nutrition. A good place to start with is with your domestic help and their wards by educating them and ensuring they have a balanced diet. This can be done from the confines of your home, then spread the awareness at the apartment and block level.
Unfortunately, there are no quick fixes for the malnutrition issue. It is a deep socio-economic problem, but a beginning has to be made somewhere, and it is better to start late rather than not start at all.
A nation is only as strong as the health of its children
After a recent grocery shopping experience, I was left wondering as I glanced at my bill on how my fellow citizens from the lower economic strata were managing to buy food. My grocery bill has gone up drastically since the birth of my kids, and I am sure members of the poorer sections of the society would have felt the pinch if they have children. Given that almost all economic activities have come to a halt due to the pandemic, it will become even more difficult for families to buy food and provide for their children.
Finally, I would like to conclude by saying a nation is only as strong as the health of its children. So let’s think about this very basic issue for once and come up with innovative solutions. I would like to hear from you as well. How do we tackle malnutrition?
Dr Vikram Venkateswaran is the Founding Editor of Healthcare India, a Bangalore- based Healthcare Think Tank. He is also the author of several papers on health and technology. He serves on committees of various industry bodies. For more details, please visit www.healthcare-in-india.net