By Sylvia Karpagam & Veena Shatrugna
Instead of accepting that millions of Indians need better nutrition, the organisation’s economists have argued that the Global Hunger Index is flawed
The Global Hunger Index put out by International Food Policy and Research Institute was released on October 2017 and tracks the state of hunger worldwide. India’s Global Hunger Index score is placed at 100 out of 119 countries.
Instead of reflecting on the state of food security in India, Ramesh Chand and Shivendra Kumar Srivastava, both members of the Niti Aayog, called the Global Hunger Index “a misleading hunger index” in an article of the same name published in The Hindu on December 4. The article is of particular concern, coming as it does from an important arm of the government
Taken by surprise with the Global Hunger Index, the authors are desperately trying to pick holes by tweaking numbers in an attempt to show nutritional standards of Indians in better light. They claim that if child health indicators are not included in the Global Hunger Index, India will move to the 77th spot as though, that number is something for the country to feel proud about. The reality of hunger is much worse than what any number can capture.
Fallacy: Growth rate in food production will reduce hunger significantly over time
The authors claim that per capita food production in India has increased by 26% in the last decade and doubled in the last 50 years, and go on to make a simplistic association that as food production increases, hunger will automatically come down. This shows a poor understanding of how hunger operates and that it is related more to access than to food production. It is important to have a breakdown of how much food is exported, used as cattle feed by the industry, wasted and, importantly, the nature of distribution between groups. Would the two experts believe that the urban rich and urban poor have the same access to food? Do those who depend predominantly on the public distribution system have the same control on access as those who are able to procure it from markets? Is there no gender, caste, religion, regional, and urban/rural variation in access?
The Global Health Index report states that 60% of the world’s hunger is of women, often the result of deep rooted social structures that deny women access to education, healthcare, and resources. It also says that minorities are often victims of discrimination, poverty, and hunger. There is a high possibility that using gender and ethnicity as measures of hunger will show India in an even poorer light.
Fallacy: The Global Hunger Index is neither appropriate nor representative of hunger
The authors state that “closer scrutiny shows that it (GHI) should not be taken at face value as it is neither appropriate nor representative of hunger prevalent in a country….In addition the GHI assigns 70.5% weightage to children below five who constitute only a minor population share and 29.5% weightage to the population above five, which constitutes 81.5% of the total population.”
The reason for a higher weightage to children below 5 years is because their demands for nutrition are two to three times higher than adults. (Adults require about 35-45 calories per kg body weight per day while children need 80-100 calories per kg body weight per day). Children are obviously more vulnerable to undernutrition and its associated morbidity and mortality.
Their statement that “weight and height of children are not solely determined by food intake but are an outcome of a complex interaction of factors related to genetics, the environment, sanitation and utilisation of food intake” must be examined carefully because of its larger implications. The role of genetics in determining adult height comes into play only after two or three generations of plenty, without any constraints to food intake and growth. The case for food cannot be ignored when children have deficits of about 600 calories, while their Required Dietary Allowance is between 1,200 and 1,500 calories.
Adequate food intake provides better immunity and protects a child from infections and mal-absorptions, while an undernourished child falls prey to infections more easily.
For comparability of data across countries and regions, indicators are chosen that are most representative. For instance, the infant mortality rate and maternal mortality ratio are sensitive indicators how health systems function. It does not mean that infants or pregnant women constitute the largest share of the population. They are used as representative of the overall health of the population, based on the assumption that if these most vulnerable groups have good access to healthcare, then it ensures coverage of the rest of the population. Similarly if under-five nutrition is good, it can be a sensitive measure of overall nutrition. Instead of saying that the hunger index is highly biased towards undernutrition of children, the authors would do well to understand that a representative sample is not the same as a biased sample. By committing to the United Nations Sustainable Development Goals to eradicate hunger and reduce inequality by 2030, India has also accepted the standard measures for calculating hunger and cannot now disown the report.
The authors claim that “There is still inconclusive debate on the cut-off for minimum energy (cals) requirement calculation”.
India cannot afford to talk about minimum energy requirements. Citizens have a right to a Recommended Dietary Allowance that meets the energy and nutrition requirements of an active healthy person. RDAs are calculated based on the energy needs for different activities. Energy at rest, is also called the basal metabolic rate, which is the energy needed for optimal function of organs like the heart, lungs, intestines etc. when a person is not involved in any activity. Additional energy is required for occupational work, which may be categorised into heavy, moderate or light. A third important component of energy need is for performing the daily tasks like cooking, cleaning, child-care, personal needs and maybe leisure activities. Children and pregnant women have additional energy needs for growth and foetal development. It is believed that in an industrialised country, eight hours are spent on each of the above three categories (sleep, occupation, and other activities of daily living).
With reduced food intakes and severe calorie deficiency a person’s ability to do occupational work may be restricted. In addition it results in weight loss. It is important to understand that Indians from a lower socio-economic background are already subsisting on very low calorie intake ranging from 1,600 to 1,700 which they deploy mainly to work for income. Not surprisingly they end up losing weight.
With chronic energy deficits, and multiple vitamin and mineral deficiencies, adult women and men from the low socio economic group weigh 45 kg and 51 kg on an average, instead of reaching their ideal weights of 60 kg and 75 kg respectively. This is a shocking 15 kg deficit. It is these populations who experience chronic fatigue and generalised weakness, often ignored by doctors and loosely characterised as psychosomatic. In Karnataka, doctors call it MKKS or “mai kai kal susthu” syndrome, meaning weakness in a mother’s hands and legs. The consequences for pregnant women and newborns are more serious, contributing to poor weight gains in pregnancy and low birth weight babies.
With this magnitude of chronic calorie deficit, it is incomprehensible why the authors suggest that lower levels of calorie intakes would suffice and further state that “either the ICMR-NIN norm is on the higher side or these people voluntarily chose to eat less than what the ICMR-NIN considers normative”. There is nothing voluntary about staying hungry..
While the authors suggest using the lower Food and Agriculture Organisation norms of 1,800 calories, they also confess that “it overestimates the proportion of food crops used as food and underestimates the share going for non-food uses such as feed and industrial use”. By their own admission the “FAO approach underestimates hunger and undernutrition.”
What happens when an indicator (cost-benefit analysis) developed by economists to maximise profits in business is deployed to address malnutrition in India? At one end, reducing entitlements to wholesome food in an attempt to find least cost solutions leaves the poor emaciated and stunted. At the other end, it results in a catastrophic rise in chronic diseases like diabetes and hypertension among the middle classes.
The authors also undermine the scientific validity of the work of the National Institute of Nutrition, a 100-year-old organisation with many path-breaking achievements to its credit, with studies on energy requirements of different population groups being just one of them. The authors seem to feel that undermining the credibility of National Institute of Nutrition’s work will somehow mysteriously make hunger disappear from India.
Strategies the Niti Aayog can consider
When damning statistics are presented, denial is not too far behind. Maybe the calculations for opening doors to multinationals do not sit so well when hunger is the staring face of the country. The two policy makers would do well to take on board some of the recommendations in the Global Hunger Index, which includes holding multi-nationals and corporates to account while ensuring meaningful participation of citizens around their own food choices.
Sylvia Karpagam is a public health doctor and researcher.
Veena Shatrugna is a clinical nutritionist and former deputy director of the National Institute of Nutrition.
This response to the Niti Aayog argument is a more detailed version of an article by the same authors published in The Hindu.