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Hunger alarm by TK Rajalakshmi

The Global Hunger Index report paints a gloomy picture of South Asia and Sub-Saharan Africa.

WITH the deadline for achieving the Millennium Development Goals just five years away, the 2010 Global Hunger Index report prepared by the International Food Policy Research Institute (IFPRI) paints a gloomy picture of South Asia and Sub-Saharan Africa. Some 29 countries in these regions, it says, have levels of hunger that are alarming or extremely alarming. In Sub-Saharan Africa, the alarming hunger index score is also because of persistent conflict and political instability.

The global hunger index was calculated for 122 countries on the basis of the child mortality rate, the prevalence of underweight children and the proportion of undernourished people in a country. Data on these parameters were sourced from the Food and Agriculture Organisation (FAO), the United Nations Children's Fund (UNICEF) and the World Health Organisation (WHO). Among South Asian countries, India (67) was ranked lower than Pakistan (52) on the index and only Bangladesh (68) was ranked below India. Bangladesh, India and Timor-Leste have the highest prevalence of underweight children, at around 40 per cent, in Asia.

The report recommends that interventions, using evidence-based and locally appropriate approaches, are required from the conception stage up to the age of two in order to bring down hunger levels. These include improving the nutrition of pregnant and lactating women, promoting sound breastfeeding practices, improving hygiene and sanitation, giving essential vitamin supplements where necessary, and promoting universal salt iodisation and immunisation. From time to time, corporate solutions have been offered to tackle undernutrition, but what is more important is the will of governments to put this on their political agenda.

The report suggests that governments should adopt policies that deal with the underlying causes of undernutrition such as food insecurity, lack of access to health services, and poor caring and feeding practices, which are exacerbated by poverty and gender inequity. But in a country like India, where poverty can be said to be a man-made feature, undernutrition is a cause and not an outcome of the inability of people to make themselves food secure or have access to health services.

The few case studies mentioned in the report express clearly the helplessness of the people to combat hunger in the absence of resources. However, the report fights shy of specifying the real cause of hunger; it describes hunger as “the discomfort associated with the lack of food”. It points out that undernutrition signifies deficiencies in protein, energy, essential vitamins and minerals and says this is caused by the inadequate intake of food – either in quantity or quality. It is also significant to note that the word malnutrition is no longer used to denote hunger per se or the condition of the poorly nourished. Instead, it is used to mean both undernutrition (problems of deficiencies) and overnutrition (problem of unbalanced diets caused by over-consumption of calories or low intake of micronutrient-rich foods). Clearly, nations in Sub-Saharan Africa and South Asia will fall not in the overnutrition category but in the “hungry” and, to an extent, “undernutrition” categories.

Defining undernutrition to mean a micronutrient deficiency-related state somehow reduces the seriousness and impact of the deficiency in overall food intake. Put simply, children are undernourished not because they do not eat a balanced diet but because there is not enough food to eat. It is important to note that the measures taken by countries such as Brazil or Malaysia to reduce hunger may be worth replicating, but their efficacy will depend on how they are applied in the socio-economic context of each country.

The report rightly focusses on child undernutrition as a contributor to persistent hunger. In the computation of the hunger index, it has taken three indicators into account – the proportion of the undernourished in the population, the prevalence of underweight children and the mortality rate of children under the age of five. However, the data span a period of five years, from 2003 to 2008, and do not take into account the latest changes in the indicators used.

For want of adequate data, the index excludes countries such as Afghanistan, Papua New Guinea, Iraq and Somalia, which suffer from moderate to severe hunger. Considering that at least two of these countries are under occupation by Western forces, the lack of availability of data is surprising. The report also does not include the impact caused by the effect of recession and the reduced financial commitments, if any, of the well-off nations in addressing the deleterious effects of the global meltdown.

Asian scenario

Within Asia, the responses to this problem have been different. The rate of reduction of the numbers of underweight children has been slower in India than in other countries. In 12 years, between 1990 and 2002, China reduced child malnutrition from 25 per cent to 8 per cent in what the report calls a highly successful poverty alleviation programme, large-scale nutrition, health and family planning interventions and increased spending on water, sanitation and education. Between 1990 and 2008, the prevalence of underweight children in that country dropped from 60 per cent to 44 per cent and the under-5 mortality rate fell from 12 per cent to 7 per cent.

In Malaysia, the proportion of children who were underweight decreased from 22 per cent in 1990 to 7 per cent in 2005; the rate of decline, which was as fast as China's, has been attributed to rapid economic growth and interventions among women and children. The report says policies that deal with poverty; food insecurity; lack of education; low status of women; and lack of access to health services, water, sanitation are needed for a sustained improvement in child nutrition. It can be argued that the very notion of child nutrition is contingent on the existence of these factors.

Taking the example of Thailand, the report says the government took the view that investments in nutrition were no welfare measure but investments in development. The government invested heavily in health, sanitation and education in the 1980s and this resulted in its child malnutrition getting halved, from 50 per cent to 25 per cent, in less than a decade. These investments helped improve the factors that were behind child undernutrition, namely, mothers' nutritional status, birthweight of children, maternal literacy, access to health care and reduced fertility rates and poverty.

Brazil's success story, apart from its much quoted cash-transfer programme, was because of increased social spending, including on food, sanitation, health care and education. Its conditional cash transfer programme, or Bolsa Familia, got a fillip with all these other interventions.

“We would like to feed our children better, but because of lack of income and high prices of cereals, we don't have the possibility to do it. Sometimes, even lactating and pregnant women do not have enough kilocalories to produce enough breast milk for their babies,” says Haja Adam Mohamed from North Darfur, Sudan.

Articulating a different but related dimension, a nutrition technician from Madagascar says: “The usual food consists of too many carbohydrates because of the abundance of rice. Frequently, it is not possible for people to follow our recommendations and recipes because the required food isn't available or they don't have enough money to buy it.”

These voices from the IFPRI report could belong anywhere – to an agricultural worker in Bangladesh or to an anganwadi worker in India, who is sometimes forced to show better nutrition levels at the centre. The problems they articulate are the same everywhere with minor differences, if any. But is anyone listening?