The NITI Aayog published nutrition charts on 17 January this year. As India recognises nutrition as a national issue and gears up for the National Nutrition Mission (NNM), publishing such data helps a wide variety of persons associated with the healthcare and nutrition ecosystem in our country to get into action mode and aid in the implementation of the mission.
The Global Nutrition Report 2015 estimates that investment in nutrition has a cost-benefit ratio of 1:16 for 40 low- and middle-income countries. Moreover, such an investment is recognised globally as both a critical development imperative and a pathway for the fulfillment of human rights.
The Aayog data represents the current state of nutrition in our country. Data collection from across national and district levels paints a real-time picture of progress and outcome assessment. This transparency is a huge welcome step; it will help in such ways as providing a data-driven approach to problem-solving, analytical and timely choosing of appropriate policy intervention, drawing of best practices introduced in different states in achieving targets, involvement of relevant non-governmental organisations (NGOs) for grassroots information dissemination and improving cooperative and competitive federalism by corresponding incentivisation of the best-performing states.
This data calls for an urgent and well thought-out plan of action to improve the nutritional outcomes of the country.
Indicators Used
The key indicators that the report includes are ‘stunting’, ‘wasting’ and ‘underweight’.
Stunting (low height for age), a direct consequence of malnourishment, is a key indicator to understand the nutrition status of various states and districts. The overall stunting rate of the country is 38.4 per cent, and the United Nations International Children’s Emergency Fund (UNICEF) places this at “High” as it is between 30 per cent and 40 per cent. Kerala is the best-performing state with 19.7 per cent stunting, and Bihar records the highest stunting rate, at 48.3 per cent.
The stunting map suggests that the states in the middle region, namely Rajasthan, Madhya Pradesh and Uttar Pradesh, have high levels of stunting, the plateau states have reasonably low levels, and the northernmost and southernmost states seem to be performing well. Including Maharashtra and Gujarat, the picture is similar to that seen in the ‘underweight’ indicator.
While stunting is a chronic problem, ‘wasting’ is a relatively short-term issue that can be rectified with the help of a proper nutrition plan. Without cure, however, this could lead to ailments like tuberculosis and chronic diarrhoea. The northeastern states have reasonably low rates of wasting while western India has high levels of it. Mizoram is the best-performing state for this indicator, and Jharkhand records the highest wasting rate.
Anaemia is still a major cause for concern, with India being among countries that have a very high percentage of anaemic people. While the northeastern states, Kashmir, Kerala and Tamil Nadu are better off, Jharkhand, Madhya Pradesh and Haryana register a high prevalence of anaemia. It is especially alarming among children in the age group of six to 59 months. Assam records the highest rate of change with 33 per cent improvement.
The prevalence of anaemia among women in the northeastern states is quite less, while Jharkhand and Haryana record more than 60 per cent prevalence.
We see from the various visualisations that states in the northeast score reasonably high on the Nutritional Index, indicating a healthier population, while a few states like Jharkhand, Uttar Pradesh and Haryana require a strong nutrition plan in place.
When trying to tackle the problem on a large scale, it’s convenient but also risky to adopt a quick-fix solution to boost nutrition levels. The Ministry of Women and Child Development was proactive in issuing a notification that the ready-to-use therapeutic food (RUTF), which is a mixture of peanut, oil and other ingredients, does not have scientific backing and therefore cannot be accepted as a policy of the government. This happened when some states were trying to use it to tackle nutrition problems.
It would be interesting to go beyond these numbers and analyse contributing factors like healthcare support and budget, pre-natal care and so on in each of these states to make the data more robust.
Now that we have data that offers us a good picture of the problems, what could be some potential solutions?
The NITI Aayog has detailed key strategies to tackle the nutrition problem in their “Nourishing India” document. It highlights the role of multiple stakeholders including the panchayats, service delivery models and specific interventions to boost nutrition. What could make the solution more locally and globally optimum is:
a) Encouragement of local food cultivation that will ensure sustainable consumption combined with nutritional benefits
b) Integration of insights from yoga and Ayurveda as these Indian systems offer concrete insights and frameworks to understand the state of the health of an individual and a collective society, and can provide scalable health solutions.
In these areas, the involvement of the AYUSH Ministry in designing a comprehensive nutrition plan will prove highly beneficial.
The NITI Aayog data has great potential to become the basis for an all-round nutrition plan. What would be important at this stage is to involve multiple stakeholders, including successful civil societies, holistic health systems experts and local community experts, among others, to design a plan that helps tackle the problem organically. While quick-fix standardised solutions can improve indicator numbers in a short period of time, for long-term and robust health benefits of children and expectant mothers, a holistic solution is necessary.
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Petrol in India is cheaper than in countries like Hong Kong, Germany and the UK but costlier than in China, Brazil, Japan, the US, Russia, Pakistan and Sri Lanka, a Bank of Baroda Economics Research report showed.
Rising fuel prices in India have led to considerable debate on which government, state or central, should be lowering their taxes to keep prices under control.
The rise in fuel prices is mainly due to the global price of crude oil (raw material for making petrol and diesel) going up. Further, a stronger dollar has added to the cost of crude oil.
Amongst comparable countries (per capita wise), prices in India are higher than those in Vietnam, Kenya, Ukraine, Bangladesh, Nepal, Pakistan, Sri Lanka, and Venezuela. Countries that are major oil producers have much lower prices.
In the report, the Philippines has a comparable petrol price but has a per capita income higher than India by over 50 per cent.
Countries which have a lower per capita income like Kenya, Bangladesh, Nepal, Pakistan, and Venezuela have much lower prices of petrol and hence are impacted less than India.
“Therefore there is still a strong case for the government to consider lowering the taxes on fuel to protect the interest of the people,” the report argued.
India is the world’s third-biggest oil consuming and importing nation. It imports 85 per cent of its oil needs and so prices retail fuel at import parity rates.
With the global surge in energy prices, the cost of producing petrol, diesel and other petroleum products also went up for oil companies in India.
They raised petrol and diesel prices by Rs 10 a litre in just over a fortnight beginning March 22 but hit a pause button soon after as the move faced criticism and the opposition parties asked the government to cut taxes instead.
India imports most of its oil from a group of countries called the ‘OPEC +’ (i.e, Iran, Iraq, Saudi Arabia, Venezuela, Kuwait, United Arab Emirates, Russia, etc), which produces 40% of the world’s crude oil.
As they have the power to dictate fuel supply and prices, their decision of limiting the global supply reduces supply in India, thus raising prices
The government charges about 167% tax (excise) on petrol and 129% on diesel as compared to US (20%), UK (62%), Italy and Germany (65%).
The abominable excise duty is 2/3rd of the cost, and the base price, dealer commission and freight form the rest.
Here is an approximate break-up (in Rs):
a)Base Price | 39 |
b)Freight | 0.34 |
c) Price Charged to Dealers = (a+b) | 39.34 |
d) Excise Duty | 40.17 |
e) Dealer Commission | 4.68 |
f) VAT | 25.35 |
g) Retail Selling Price | 109.54 |
Looked closely, much of the cost of petrol and diesel is due to higher tax rate by govt, specifically excise duty.
So the question is why government is not reducing the prices ?
India, being a developing country, it does require gigantic amount of funding for its infrastructure projects as well as welfare schemes.
However, we as a society is yet to be tax-compliant. Many people evade the direct tax and that’s the reason why govt’s hands are tied. Govt. needs the money to fund various programs and at the same time it is not generating enough revenue from direct taxes.
That’s the reason why, govt is bumping up its revenue through higher indirect taxes such as GST or excise duty as in the case of petrol and diesel.
Direct taxes are progressive as it taxes according to an individuals’ income however indirect tax such as excise duty or GST are regressive in the sense that the poorest of the poor and richest of the rich have to pay the same amount.
Does not matter, if you are an auto-driver or owner of a Mercedes, end of the day both pay the same price for petrol/diesel-that’s why it is regressive in nature.
But unlike direct tax where tax evasion is rampant, indirect tax can not be evaded due to their very nature and as long as huge no of Indians keep evading direct taxes, indirect tax such as excise duty will be difficult for the govt to reduce, because it may reduce the revenue and hamper may programs of the govt.
Globally, around 80% of wastewater flows back into the ecosystem without being treated or reused, according to the United Nations.
This can pose a significant environmental and health threat.
In the absence of cost-effective, sustainable, disruptive water management solutions, about 70% of sewage is discharged untreated into India’s water bodies.
A staggering 21% of diseases are caused by contaminated water in India, according to the World Bank, and one in five children die before their fifth birthday because of poor sanitation and hygiene conditions, according to Startup India.
As we confront these public health challenges emerging out of environmental concerns, expanding the scope of public health/environmental engineering science becomes pivotal.
For India to achieve its sustainable development goals of clean water and sanitation and to address the growing demands for water consumption and preservation of both surface water bodies and groundwater resources, it is essential to find and implement innovative ways of treating wastewater.
It is in this context why the specialised cadre of public health engineers, also known as sanitation engineers or environmental engineers, is best suited to provide the growing urban and rural water supply and to manage solid waste and wastewater.
Traditionally, engineering and public health have been understood as different fields.
Currently in India, civil engineering incorporates a course or two on environmental engineering for students to learn about wastewater management as a part of their pre-service and in-service training.
Most often, civil engineers do not have adequate skills to address public health problems. And public health professionals do not have adequate engineering skills.
India aims to supply 55 litres of water per person per day by 2024 under its Jal Jeevan Mission to install functional household tap connections.
The goal of reaching every rural household with functional tap water can be achieved in a sustainable and resilient manner only if the cadre of public health engineers is expanded and strengthened.
In India, public health engineering is executed by the Public Works Department or by health officials.
This differs from international trends. To manage a wastewater treatment plant in Europe, for example, a candidate must specialise in wastewater engineering.
Furthermore, public health engineering should be developed as an interdisciplinary field. Engineers can significantly contribute to public health in defining what is possible, identifying limitations, and shaping workable solutions with a problem-solving approach.
Similarly, public health professionals can contribute to engineering through well-researched understanding of health issues, measured risks and how course correction can be initiated.
Once both meet, a public health engineer can identify a health risk, work on developing concrete solutions such as new health and safety practices or specialised equipment, in order to correct the safety concern..
There is no doubt that the majority of diseases are water-related, transmitted through consumption of contaminated water, vectors breeding in stagnated water, or lack of adequate quantity of good quality water for proper personal hygiene.
Diseases cannot be contained unless we provide good quality and adequate quantity of water. Most of the world’s diseases can be prevented by considering this.
Training our young minds towards creating sustainable water management systems would be the first step.
Currently, institutions like the Indian Institute of Technology, Madras (IIT-M) are considering initiating public health engineering as a separate discipline.
To leverage this opportunity even further, India needs to scale up in the same direction.