Sunday, November 11, 2007

Too much & not enough

The Times of India, Saira Kurup

The Sensex has hit 20k. Lakhs have become lakhpatis overnight. Yet, every night millions of our children go to bed hungry, without having a single full meal of the day. Our glittering growth is still unable to feed a majority of our kids.

India has among the highest numbers of hungry children in the world — nearly double that of sub-Saharan Africa. Even Ethiopia is placed ahead of India (94th) in the Global Hunger Index 2007 of 118 countries, by the International Food Policy Research institute. The index looks at progress by countries on three indicators for two UN millennium goal targets for 2015: the proportion of calorie-deficient people, child malnutrition and child mortality.

How can these children get enough to eat when their families are not just poor but are also predominantly from marginalised sections like SC/STs and Dalits? Most are agricultural labourers, don't own any land, have no regular livelihood and little access to food and health programmes. Pradeep Narayanan, deputy GM, policy & research, Child Rights and You, says, "The government gets adequate information on hunger deaths, where it is likely to happen, and has adequate food storage facilities to combat it. But it's the redistribution that is not working."

According to the National Family Health Survey 3 (2005-06), 46% of our children are underweight, (because largely, their mothers are also undernourished) 19% wasted or too thin for height and 38% have stunted growth. Around 79% of those under the age of three are anaemic.

All these only raise the risk of developing fatal diseases and infection. But still, says Professor Mohan Rao, Centre of Social Medicine and Community Health, JNU, "Hunger finds no mention in the national health policy."

There's a lot of focus on childhood diseases like diarrhoea and polio but little on the real culprit. How much can immunisation help an undernourished child?

Prof Rao says the immediate need is to put hunger back on the health agenda. "The Integrated Child Development Scheme is not adequately monitored and is thinly spread. An improved ICDS, the rural employment guarantee scheme and better access to the public distribution system will do a great deal in reducing hunger," he says, adding there's need for universal coverage too.

There are also calls for introducing a Right to Food. Narayanan says if the right is to be effective, it should not be relief-based but rights-based and accountability has to be fixed. "The way children are forced to work in order to eat, one should aspire for food security, though the goal of nutrition security is best. The mid-day meal scheme has helped but it should have been linked less with the schooling system and more with the hunger pattern," he adds.

But wait, the country's also facing a dramatic increase in another form of malnutrition among children, in the form of obesity arising from unhealthy diet and lifestyle in urban areas. Sandeep Malhotra, bariatric surgeon, Artemis Health Institute, Gurgaon, says, "Most obese people are malnourished. Imbalance in diet, consumption of more fat and carbohydrates leads to deficiency of micronutrients and anaemia."

Increasing fat intake accompanied by rising physical inactivity is contributing to obesity in children. Dr Malhotra says, "Obesity is rising more among middle class kids." It raises the risk of early onset of heart disease, diabetes and cancer. Overweight girls tend to attain early puberty and face higher risk of cancer of the breast, ovaries and uterus, as also infertility and polycystic ovarian disease later in life.

Adds Dr Malhotra, "A lot of resources are spent on combating diarrhoea, TB etc but not on this issue. The danger is of obese kids growing up to be morbidly obese adults. We already spend more than 50% of our healthcare expenses on obesity-related problems." According to a recent study of 1,155 kids in classes 3 to 5 by Delhi Diabetic Research Centre, one in five schoolchildren in Delhi are overweight/obese. Experts believe it's the parents who need counselling on better nutrition for their kids.

The paradox of these two Indias and the widening rift between them is disturbing. The challenge is to find solutions for bridging the gap and for this double burden of malnutrition.

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