Public Health And Nutrition Agenda For A Suposhit India

About 11 million deaths were attributed to poor nutrition globally in 2017. Unhealthy diets have been shown to claim lives of people and cause disabilities across all age groups, especially during their productive prime, impact productivity of individuals, thereby slowing the nation’s development and economic stride.

Evidence suggests that more deaths were caused by diets lacking protective foods, like whole grains, fruit, nuts and seeds than by diets with unhealthy elements like trans fats, sugary drinks, red and processed meats etc. Additionally, hunger and food insecure people, especially in low and middle -income group countries like India, exacerbate the nutrition-related disease and death burden statistics.

India ranks 103rd - out of 119 countries - as per the 2018 Global Hunger Index.  While India is still home to 46.6 million stunted and 25.5 million wasted Under-5 children, surveys and studies are also reporting unprecedented levels of increase in overweight and obesity, as well as hypertension, diabetes and many cancers in the past two decades. In short, our country is really facing multiple challenges in the area of public health and nutrition (PHN), which needs urgent attention and timely action.

As the new government takes over for the next 5 years, a broad vision for S-U-P-O-S-H-I-T Bharat is outlined for their perusal.

1.  S – Synergize, creative cooperation is a must

This is the most important pillar on which the whole vision of Nutrition rests. India is quite diverse and needs tailored approaches for region-specific Nutrition issues. But overall we need visionary leadership, committed accountable governance with harmonized efforts to attain collective progress and alignment with other Sustainable Development Goals (SDGs) to steer the PHN agenda in our country. This requires teamwork, open-mindedness and collective experience and expertise on the table. Niti Aayog’s National Nutrition Strategy 2017 was a landmark step to recognize multiple forms of malnutrition and talk about the need for much stronger committed and accountable inter-sectoral coordination among various departments and ministries to work in tandem. But this needs further work.

 2.   U – Undernourishment needs to be tackled urgently 

There is enough work done by several agencies to track, map and publish data on undernutrition and its various forms from national and sub-national levels. This should be more widely used, and targeted nutrition specific, sensitive and enabling environment interventions should be implemented as appropriate.

 3.   P- People-oriented programmes and policies

This feature resonates with the Prime Minister’s Jan Andolan (people’s movement) vision. Not only should there be substantial focus on awareness generation and empowerment of masses about what all can be done at individual and societal levels to stay nourished, dedicated efforts to build healthier food environments, provide healthier choices at public places should also be demanded. Food and service industries must comply with these in principle and offer a variety of health-promoting foods. The role of media is immense in this space and must be used wisely.

 4.    O – Overweight and obesity needs to be arrested

Rising trends in unhealthy weight gain fueling several chronic diseases in India is worrying. This is heavily linked with the food environment offering and promoting cheap high fat, sugar and salty foods (HFSS) as easy choices. Eating home cooked meals, physical activity promotion, limiting screen time, staying away from tobacco, alcohol and drugs etc may help young minds stay sharp and productive in later life.

 5.     S – Simple but similar message for all to improve their diets, increase physical activity

All national or sub-national programmes, policies and schemes need to harmonize their messaging. Appropriate and adequate nutrition for all at all stages of life should be aimed for. We may include a special focus on vulnerable periods like first 1,000 days, puberty, elderly etc but in general food and nutrition security for all from Womb To Tomb must be attained.

 6.     H – Hidden Hunger must be eliminated

Indians suffer from multiple micronutrient deficiencies across age groups and varying socio-economic strata. Anemia, especially among pregnant women, has been plaguing our country for eons but we have had only limited success. Perhaps using effective behavior change communication strategies in conjunction may work better than nutrition education alone.

Other factors like women empowerment and decision-making abilities also impact their health and nutrition status. Currently, there has been an emphasis on food fortification for basic food items like oil, wheat flour, rice, salt and milk, but data on their uptake, costing, impact on long term health are warranted.  Also, a simultaneous and continuous effort to improve our food systems needs to be underway. This requires engaging other stakeholders from agriculture, environment, finance etc more actively. Doing one-off intervention may not suffice. We may need multiple but complementing strategies from multiple platforms to make a meaningful impact on the PHN status of our population. 

7.   I – Information- technology (IT) should be strengthened and made purposeful

In today’s time, technology is not only a time saver, but also a life saver. In PHN sector, huge volumes of data are being collected and generated each day. What we will do with the data must be planned a priori for ethical and practical reasons. Periodic monitoring and evaluation of the quality of data being collected are also key to ensuring that we don’t end up making faulty or non-evidence-based decisions. All these are critical components which need to be woven within the IT bed from day one. Optimal data use and timely analyses may guide policy and programmes for ensuring PHN among our masses.

 8.   T– Telescope the transition to prepare and act effectively

Recent reports tell us that the density of doctors and nurses and midwives per 10,000 population is 20.6, according to the National Sample Survey (NSS). Health workforce density, especially in rural India and eastern states is lower than the WHO minimum threshold of 22.8 per 10,000 population.

More than 80% of doctors and 70% of nurses and midwives are employed in the private sector. Approximately 25% of the currently working health professionals do not have the required qualifications as laid down by professional councils. Efforts to make researchers and academia stay engaged may need better prospects and remunerations. Investment in rigorous multidisciplinary research and high-quality academic offerings will be critical if we need good data to help us guide our programmes and policies.

 This will need dedicated funds and resources in the forms of grants, schemes, fellowships etc from government and donor agencies. Also, short-term training for building/ strengthening capacity of trained staff to deliver PHN to our population will also help to promote, prevent and manage the burgeoning nutrition-related disease and disability burden.

We hope this list can help to provide some direction to the concerned authorities. While most of the above appears straightforward, actual implementation may unravel the complexities. The need to break down each pointer into several actionable items may be useful.

But the need to have bolder, inclusive dialogues, targeting forward-looking action on ground to strengthen PHN are inevitable. I hope our aspirational Suposhit Swastha Swachha Bharat slogan turns into a sustainable reality in the coming years.

Let our passion, commitment to PHN fuel this mission and stop at nothing short of achieving a nourished nurtured India. 

(Dr Shweta Khandelwal, is Head, Nutrition Research and Additional Professor, Public Health Foundation of India (PHFI). Views are personal.)