Issue

Context:

• Global Nutrition Report 2018 reveals malnutrition as unacceptably high and affecting every country in the world, but there is also an unprecedented opportunity to end it.
• The report puts forward five critical steps that are needed to speed up progress to end malnutrition in all its form.
• Sustainable Development Goal 1 (No Poverty) and Goal 2 (Zero Hunger) invariably provide greater contextual and focused action towards sustainable nutrition plan.

About:

• The Global Nutrition Report was conceived following the first Nutrition for Growth Initiative Summit (N4G) in 2013 as a mechanism for tracking the commitments made by 100 stakeholders spanning governments, aid donors, civil society, the UN and businesses.
• Malnutrition can take many forms and presents a large-scale and complex problem across the world.
• Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
• Malnutrition covers 2 broad groups of conditions. One is ‘under nutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals)
• The other is overweight, obesity and diet-related non communicable diseases (such as heart disease, stroke, diabetes and cancer). 
• Global Nutrition Report 2018 is It referred to a study by the International Food Policy Research Institute (IFPRI) which used district-level aggregate data from the 2015–2016 National and Family Health Survey, covering 601,509 households in 604 districts in India, to understand the causes of the spatial variation.
• This study is important in the sense that it reinforces the multi-sectoral nature of stunting by highlighting the differences between districts which is explained by multiple factors associated with gender, education, economic status, health, hygiene, and other demographic factors.

Background:

• Malnutrition is responsible for more ill health than any other cause.
• Children under five years of age face multiple burdens: 150.8 million are stunted, 50.5 million are wasted and 38.3 million are overweight. Meanwhile 20 million babies are born of low birth weight each year. Overweight and obesity among adults are at record levels with 38.9% of adults overweight or obese.
• To end malnutrition in all its forms, we must understand the nature of the problem we are dealing with.
• The report collates existing data, presents new innovations in data and conducts novel data analysis, focusing on five areas: the burden of malnutrition, emerging areas in need of focus, and diets as a common cause of malnutrition in all its forms, financing of nutrition action, and global commitments.

Analysis

Global Nutrition Report 2018 and India

• India has one third of world’s stunted children (low height for age).
• Stunting is caused by long-term insufficient nutrient-intake and frequent infections.
• India also accounts for 25.5 million children who are wasted (low weight for height), followed by Nigeria (3.4 million) and Indonesia (3.3 million).
• India also figures among the set of countries that has more than a million overweight children. The other nations are China, Indonesia, India, Egypt, US, Brazil and Pakistan.
• Researchers used mapping and descriptive analyses to understand spatial differences in distribution of stunting. The mapping showed that stunting varies greatly from district to district (12.4 to 65.1 percent), with 239 of 604 districts having stunting levels above 40 per cent.
• Some important factors which affected malnutrition were: Women’s’ low BMI, maternal education, age at time of marriage, antenatal care, children’s diet, asset composition(property, access to resources),open defecation and household size.
• The uncomfortable question with respect to India is not that 'why are things so bad' but 'why are things not better when we know so much more than before,"

Some important pointers:

• Stunting in children less than five years of age is declining at a global level (In Asia - from 38.1% to 23.2% since 2000) but, due to population growth, the actual number of stunted children has risen.
• At global level, progress in addressing underweight and anaemia among women has been extremely slow while overweight and obesity among adults is getting worse, with higher rates of obesity among women than men. Overweight (body mass index (BMI) ≥25) and obesity (BMI ≥30.
• Different forms of malnutrition continue to compound one another. Coexisting burdens bear down on millions of children, with 15.95 million children affected by wasting and stunting, which increases the risk of child mortality, and 8.23 million children affected by stunting and overweight.
• In situations of crises arising from conflict, fragility, violence and environmental change there is an urgent need to treat and prevent multiple burdens of malnutrition while also building nutrition resilience. An estimated 86% of international humanitarian assistance goes to countries affected by long and medium-term crisis, yet it is mostly in the form of short-term programming.

Other commitments to override malnutrition:

• More countries are committing to nutrition by establishing national nutrition policies and action plans.
• At the Global Nutrition Summit 2017 in Milan, the donors pledged an additional US$640 million to nutrition. All financial commitments were SMART (specific, measurable, achievable, reliable and timely). Looking across all official development assistance (ODA), a modest step was been taken in spending on obesity and diet-related NCDs.
• Countries are spending most of their financing on nutrition-sensitive investments. More governments are taking steps to monitor the levels of spending.

Need for Improved diet to end malnutrition:

• People are eating unhealthily, the latest data on infants’ diets shows the proportion of babies who are exclusively breastfed (up to 6 months of age) has increased but only to 41% (from 37% in 2012), and sales of infant formula are growing rapidly.
• Feeding practices of infants and young children are a problem everywhere. Regardless of wealth, school-age children, adolescents and adults are eating too many refined grains and sugary foods and drinks, and not enough foods that promote health such as fruits, vegetables, legumes and whole grains.
• The World Health Organization Global database on the Implementation of Nutrition Action (GINA) includes more than 1,000 national policies in 191 countries in support of healthy diets. For example, many countries have adopted sugar-sweetened beverage taxes in recent years, and these are proving effective, as are product reformulation policies.
• Large-scale food fortification is another area where there has been progress – but also exemplifies that there remain many barriers to change.
• By increasing nutrients in diet to meet the demands of pubertal growth and brain maturation of adolescents. Evidences show that addressing nutrition problems and adopting healthy dietary habits during adolescence can be important for potential ‘catch up’ growth, improved cognition and reduced risk of non-communicable diseases (NCDs) later in life.

Way forward (5 pronged solution pathway):

• Break down silos between malnutrition in all its forms. What is required is an integrated approaches and cohesive work to address them. Different communities – the humanitarian, obesity, NCD and micronutrient communities for example – must work together to ensure the different burdens are tackled efficiently and effectively.
• Prioritize and invest in the data needed and capacity to use it. Geospatial data on who is affected by what form of malnutrition, where and why offers promise to support all decision-makers in designing actions for impact. Data on nutritionally vulnerable populations – such as people in poverty, women, adolescent girls, young children and people who are marginalized and geographically isolated – is vital.
• Scale up financing for nutrition – diversify and innovate to build on past progress.
• Galvanize action on healthy diets – engage across countries to address this universal problem.
• Make and deliver better commitments. Only SMART commitments designed for impact that signatories consistently report on and deliver will be fit for purpose to end malnutrition in all its forms.

The report projects way out, an actionable plan, which can be implemented. If India has to capitalize on its “demographic dividend” and “Window of Opportunity” then it must act faster in an integrated way. It has to collaborate schemes such as POSHAN, Swachh Bharat Abhiyan, Mission IndraDhanush and targeted food subsidy programme within the orientation of “outcome” budgeting.

Learning Aid

Practice Question:

Utilization of demographic window of opportunity requires multi-pronged action on nutrition front. With reference to Global Nutrition report, analyze India’s position on nutritional front and suggest some inclusive –innovative solution.