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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