The article “A misleading hunger index” (Dec. 4) could have been ignored for its wrong understanding of both epidemiology and nutrition if it wasn’t for the fact that its authors are members of the NITI Aayog. The authors, unhappy about the Global Hunger Index (GHI) put out by the International Food Policy Research Institute, ranking India 100 out of 119 countries, said we should have been somewhere around 77, as though that would make India proud.
The first flaw in the article is the assumption that, with a 26% increase in per capita food production in the last decade, and a doubling in the last 50 years, hunger must have automatically come down. In reality, hunger is not related as much to the production of food as to access and distribution. Do the urban poor, who depend predominantly on PDS, have the same access as the urban rich? There is also a gender, caste, religion, regional variation in access.
The authors say that the GHI is neither appropriate nor representative of hunger since more weightage (70.5%) is assigned to children less than five years, who constitute only a minor population. Children’s requirement for calories is 2-3 times (80 calories/kg/day for children versus 35-45 calories/kg/day for adults) the adult requirement. This makes them more vulnerable to undernutrition and its consequences.
The statement that “weight and height of children are not solely determined by food intake but are an outcome of a complex interaction of genetics, environment, sanitation and utilisation of food intake” is mischievous at best and dangerous at worst. The role of genetics in determining adult height is significant only after two or three generations of adequate food availability. When children have deficits of 600 calories (they are recommended 1200-1500 calories), neither can the argument for wholesome food be ignored nor the fact that these children are more vulnerable to infections due to lowered immunity and possibly malabsorption.
For data to be comparable, representative indicators are chosen. The nutrition status of children under five is a sensitive measure of the overall nutrition of a country. Similarly, maternal mortality rate as an acceptable indicator of health system function does not mean that pregnant women constitute the largest share of the population. The authors need to understand the difference between bias and representation before they level charges of bias against the GHI.
They claim that “there is still inconclusive debate on the cut-off for minimum energy requirement calculation” and suggest that a lower Food and Agriculture Organisation norm of 1,800 kcal should suffice for calculating hunger. Why should India settle for a ‘minimum’ energy requirements when it has worked out a recommended dietary allowance that addresses the energy needs of all populations based on gender, occupation, weight and special conditions like weight gain during pregnancy and growth of children?
Veena Shatrugna is a clinical nutritionist and former deputy director of the National Institute of Nutrition and Sylvia Karpagam is a public health doctor and researcher
