Last year was a remarkable one for nutrition in India. 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. National and State governments were mobilised, district administrators engaged, the private sector mobilised in its own way, while civil society continued to push for accountability and action.
As researchers committed to evidence-informed policies and programmes, we welcome India’s nutrition efforts. We call for even stronger systems to support the use of data and science to inform India’s efforts, to track progress and to learn from both successes and failures.
The mission of using evidence to inform policy in nutrition in India goes back to the days of India’s ‘father of nutrition’, Dr. C. Gopalan, someone whom both of us had the privilege of knowing and working with closely. He invested in connecting science with the policy world, but he also served in a world where information systems limited the reach and connect between science and policy. Today, that world has changed, 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.
Key challenges
What are some challenges that face India on the nutrition front as we approach the decade of action for the SDGs?
First, work led by ICMR and published recently in the Lancet Global Health shows that progress in maternal and child undernutrition varies tremendously by State. It also highlights how malnutrition contributes the most to child deaths as well as disability in adults. Saving lives of children under five in India will require a steady focus on nutrition.
Second, 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.
Third, India’s adults also bear a tremendous double burden of malnutrition. Recent work from IFPRI and Emory University, has highlighted how 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%.
Fourth, a range of studies published by researchers in India and abroad, 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.
Programmes and policy
Today, India’s efforts in tackling malnutrition have already come a long way – a range of programmes and policies have been launched against child undernutrition (POSHAN Abhiyaan), anaemia (Anaemia Mukt Bharat) and healthy eating (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, we call for an even sharper evidence-based and data-driven approach to diagnosing the challenge of malnutrition in India’s states, districts and communities. We call for a nuanced understanding of the risk factors that contribute the most to the multiple burdens. And we call for the use of data on the reach of programmes and interventions to identify critical gaps and fuel rapid action.
The underlying data that is now available to undertake these assessments, such as the Comprehensive National Nutrition Survey, must be made available to the scientific community. Silos in data systems should be broken and community health-workers and anganwadi workers 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 must 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.
(Soumya Swaminathan is Chief Scientist at the World Health Organization and is based in Geneva, and Purnima Menon is Senior Research Fellow with the International Food Policy Research Institute, and is based in New Delhi, India.)
