The 2020-21 report of Global Hunger Index (GHI) has placed India at 101 among 116 countries with a hunger score of 27.5 which is specified as serious. There were animated discussions in the press and the electronic media on the sufferings of our hungry children who are supposed to be our future. But such animated discussions have quietened down amidst more digestible and sensational news. It is a tragedy of epic proportions that we care so little about the state of health of our children outside our immediate family circles while shouting from the rooftops about India’s demographic dividend.
Unless we sit up and think how to provide wholesome nourishing meals to more than 50 per cent of our children who grow up in abject poverty in our rural areas and urban ghettos, we shall soon land up with a majority of Indians who are short in height, intellectually underdeveloped, and with a sense of anger and frustration towards a society that has denied them their right to minimum living conditions and a decent upbringing. But in the second most populous country on earth (soon going to be the first) we are more satisfied discussing electoral gains and losses or wars in distant lands than concerning ourselves with the sordid spectacle of our neglected children.
The haves that control our present and the future across the political spectrum tend to be quite satisfied with around a quarter of our young generation living in comparative luxury and often growing obese as reflecting our prosperous future. We do not ask ourselves such dangerous questions as why most patients, both young and old, coming for treatment at low-cost Government hospitals even in the nation’s capital are suffering from acute tuberculosis. As per WHO, India has the world’s largest concentration of tuberculosis patients and in 2020, 26 per cent of the worldwide cases were accounted for in India.
Such unpalatable questions are best left unanswered. Coming back to classification made in the GHI, those countries with a score below 10 are specified as having ‘low’ hungry children, those with a score of between 10 to below 20 are ‘moderate’, those with score between 20-34.9 as ‘serious’, those between 35-49.9 as ‘alarming’ while those with 50 and above as ‘extremely alarming’. It may be mentioned here that most of the developed countries, including USA and Western Europe, are not counted in the index as they are assumed correctly or incorrectly by all-powerful western sources as having hardly any significant number of hungry children.
The GHI index is based on four components ~ a) the proportion of undernourished as a percentage of the total population; b) the proportion of children under 5 years suffering from wasting i.e. low weight for height; c) proportion of under 5 children suffering from stunted growth i.e. low height for age and d) child mortality under age of 5 years (U5 MR). Each of these components are attributed a score on a scale of 0-100 based slightly above a threshold of the worst score observed among all countries given a score of 100 and the scores go down as the figures improve. Finally, each of the four components is given a weightage in the overall tally being 33 per cent or one third on percentage of undernourished population, one third on U5MR, one-sixth on wasting and onesixth on stunting. If we analyse the GHI trend for India on a time scale the index shows that we had an overall score of 38.8 in 2000, 37.4 in 2006, 28.8 in 2012 and 27.5 in 2021.
According to the UN Food and Agricultural Organisation (FAO) deprivation or under nourishment means consumption of food lower than about 1,800 kilocalories a day ~ the minimum that a normal human being requires to lead a healthy and productive life. But GHI’s concept of undernutrition goes beyond calories and signifies deficiencies in any one or more of the following ~ energy, protein, essential minerals and vitamins. In other words, undernutrition means inadequate intake of food either in terms of quantity or quality. In the case of India, it is suspected that the high percentage of undernourished population represent not so much lack of cereals as absence of quality inputs like protein, essential vitamins, minerals and energy or fats.
So far as wasting of children under 5 years is concerned the GHI time scale shows it goes almost at par with undernutrition of the general population. Thus in 2000, the prevalence of wasting was 17.1 per cent of the child population, in 2006 it was 19.6, in 2012 it was 15.1 but rose again in 2021 to 17.3 per cent. The concept of wasting in GHI indicates the percentage of under-five child population who have low weight according to their height reflecting acute undernutrition. As per GHI, India has the highest percentage of wasted children in the world among all the 116 countries surveyed with an increase of 2.2 percentage points between 2012-2020.
This presents a very dismal picture of our child health scenario and calls for urgent policy decisions. However, GHI shows relative improvement in child stunting on the time scale. In 2006 the percentage of stunting among the under five population was 54.2, in 2006 it was 47.8, went down to 38.7 in 2012 and further came down to 34.7 per cent in 2021. As per UNICEF, child stunting is defined as the percentage of under five children whose height and weight ratio are below minus two standard deviations (moderate and severe stunting) and minus three deviations from the median of WHO Child Growth Standard.
Stunting causes irreversible physical and mental damage to children and reflects severe chronic under nourishment during the most vital period of growth and development in early life. It is also diagnosed as the main cause of child deaths globally. The last parameter in GHI is the Under 5 Mortality Rate (U5MR). On a time scale, the U5MR in India was 9.2 per cent in 2000, 7.1 in 2006, 5.2 in 2012 and 3.4 in 2021. Thus, in the case of U5MR also we have been showing steady progress but are still far behind developed countries like USA (.7%), UK (.4%) or France (.5%). In the case of our immediate neighbours, the U5MR figures are ~ China (.8), Pakistan (6.7), Sri Lanka (.7), Bhutan (2.9), Nepal (3.1) and Bangladesh (3.1). Thus, except Pakistan all our neighbours have better U5MR than us.
Coming to the validation of data, the Sample Registration System (SRS) which conducts six monthly sample surveys by the Registrar General and Census Commissioner India, provides only IMR (mortality rate among 1000 live births under the age of 1) among the four parameters mentioned above. As per the latest SRS Bulletin published in October 2021 IMR in India is 3.01 in 2019 and only slightly differs from the GHI. Unfortunately, however, SRS does not publish any data on general undernourishment, child wasting or stunting. For that we have to depend on the sample National Family Health Survey (NFHS) started from 1992-93. NFHS has so far published 5 survey reports between 1992-93 and 2019-2021.
If we consider NFHS 4 (2014-16) and 5 (2019-21) we find that in case of U5 Stunting (Height for age) it was 38.4 per cent under NFHS 4 and slightly improved to 35.5 in NFHS 5. In case of wasting (weight for height) it was 21 per cent in NFHS 4 and slightly improved to 19.3 in NFHS 5. But in the case of severe wasting, data for NFHS 5 shows that it has marginally increased to 7.7 from 7.5 in NFHS 4. In case of U5 Under Weight (weight for age) it was 35.8 in NFHS 4 but has reduced to 32.1 per cent in NFHS 5. A matter of even more serious concern is the prevalence of severe anemia among the U5 children being 58.6 in NFHS 4 but substantially increased to 67.1 in NFHS 5.
It is therefore evident that there is not much difference between GHI data for India and the NFHS data. Both the data sets present a very dismal picture of the state of child health in India. It is universally agreed among specialists that the ages between 3 and 8 are the most vital period of growth in the life span of a person and decide the ultimate height and weight that she/ he will attain into adulthood. It also determines the development of her/his future intellectual and mental abilities. According to WHO, globally 149 million U5 children were estimated to be stunted in 2020, 45 million were estimated to be wasted, and 38.9 million were overweight or obese.
It is pathetic that we pay so little attention to the improvement of health or general wellbeing of most of our future citizens. We spend so many hundreds of crores of rupees for building new places of worship, statues and spectacular vistas but debate even increasing by one rupee the per head costs of Mid-Day-Meals in school (MDM) to improve the protein and vitamin content of the meals we feed to school going children.