There's A Need To Promote Nutrition-Sensitive Food System

Despite the rise in family incomes in India and more food on the platter, the intake of micronutrients in the daily diet for most Indians continues to remain far from satisfactory.

Micronutrient deficiency leads to factors like hidden hunger, including lack of energy, and thereby a resultant loss in GDP. Strategies need to be devised to ensure a sustainable increase in total food intake, besides a greater variety in food. For this, agriculture and food systems need to be made more nutrition-sensitive so that it can lead to better diets and improved nutritional outcomes.

While India has experienced remarkable economic growth during the last two decades along with subsequent transformation in social, economic and food systems, the globalisation of agrifood has brought with it remarkable shifts in diet patterns in India. In spite of this, diets in India generally lack essential nutrients, especially micronutrients (hidden hunger), including energy (inadequate amounts of food, with 14.8 per cent of undernourished people in India [1].

Consider this: More than two-thirds of Indians consume insufficient micronutrients, particularly iron and Vitamin A, and to a lesser extent zinc [2].

In India, evidence from DALY (Disability-Adjusted Life Year, a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death) estimates and their monetisation show that micronutrient deficiencies result in overall economic loss of 0.8 per cent to 2.5 per cent of the GDP, which could even rise to 3.9 per cent. The corresponding absolute losses in monetary terms amount to US$5.8–26.8 billion. Iron-deficiency anaemia is responsible for over 40 per cent of the total loss, while zinc deficiency causes 30 per cent of the loss and vitamin A deficiency 25 per cent loss.[3]

The improvement in household incomes in India has been shown to be associated with increased consumption of animal products, and consequent changes in the dietary pattern and lifestyle – a major factor behind the increased prevalence of obesity and associated non-communicable diseases (NCDs).

Food quantity and quality are the most direct links between agriculture, nutrition and health. The diets of around a fifth of young children (6 to 23 months) and half of women (14 to 49 years of age) reflect inadequate dietary diversity and nutrient adequacy, with marked implications for nutrition and health[4].

Concerted efforts to leverage agriculture for nutrition are urgently required to address the challenges of food and nutrition security across the life span, especially with a focus on the first one thousand days of life.

In India, more than a third (38 per cent) of children under five years are stunted, 21% wasted and 36 per cent underweight. Anaemia affects 59 per cent of children under five and 53 per cent of women of reproductive age.

At the same time, the country is also experiencing rising overnutrition -- 21 per cent of women of reproductive age are overweight or obese and 23 per cent underweight [4].

Malnutrition is a complex problem that requires integrated action across sectors, but good nutrition must begin with food and agriculture[5]. A healthy diet with the right combination of safe, nutritious and diversified food is the foundation for good nutrition, human health and well-being. A diet deficient in good quality protein and micronutrients can impede physical and cognitive development, and economic productivity.

What are Nutrition-Sensitive Interventions?

Broadly, three main causes of malnutrition are identified: immediate (inadequate dietary intake and health status); underlying (household food insecurity, caring capacity, environment and health services); and basic (inadequate financial and human resources, inadequate access to services, and socio-cultural, economic and political context) [6].

The immediate causes of malnutrition can be addressed through nutrition-specific interventions --- adequate food and nutrient intake, feeding, care giving and parenting practices, and low burden of infectious diseases. The underlying or basic causes can be addressed through nutrition-sensitive interventions -- by incorporating nutrition goals and actions from a wide range of sectors like agriculture and food security; social safety nets; early child development; maternal mental health; women's empowerment; child protection; schooling; water, sanitation, and hygiene; health and family planning services. Nutrition-sensitive programmes serve as delivery platforms for nutrition-specific interventions, potentially increasing their scale, coverage, and effectiveness[7]. Women’s diets needs attention across the reproductive age from 14 to 49 years given their role in healthy motherhood and pregnancy outcomes.

Agriculture, Food Systems and Nutrition Opportunities

Shaping agriculture and food systems to make them more nutrition-sensitive can lead to better diets and improved nutritional outcomes. This requires an understanding of the different elements of the food system that covers the entry points from primary production to the plate or from the farm to fork. This calls for designing, planning and implementing programmes and policies to create an enabling environment for leveraging the food system to produce as well as demand safe and diversified diets.

Nutrition-sensitive agricultural programmes can help improve a variety of nutrition outcomes in both mothers and children. Nutrition education needs to be integrated through the production, processing and consumption linkages in the food system as well as agriculture extension services. National dietary guidelines and food composition tables can serve as useful policy tools to guide healthy agriculture and food planning, and enhance both the supply and demand of healthy foods. Appropriate food and nutrient labelling are needed for making wise food choices and to improve consumption. A positive impact on child nutritional status can be achieved when health and water, sanitation and hygiene interventions are coupled with boosting the consumption of nutrient-rich foods, and also improving access to and the consumption of high-quality diets for all household members.

Issues of Food Safety and Climate Change

Urban food production is another area the government needs to explore through technologies like hydroponics. Documenting best practices from food production, programmes - like bio-intensive gardening and vegetable gardening need to be included alongwith backyard poultry, goat raising and fish ponds. The provision of technical, material, and financial assistance, veterinary extension services, protective and hygienic housing of poultry and the regular vaccination and monitoring of livestock need to be key elements of policy attention.

Other options for improving nutrition and food safety through food production include organic and bio-farming, food that is minimally processed and improvement in the nutritive value of food. Principles of Good Agricultural Practices (GAP) should consider food safety and also environmental concerns. This is particularly important in the light of numerous food safety risks in agriculture and food production, like illegal pesticide compounds and inappropriate use of agrochemicals. Scaling up Integrated Pest Management (IPM) with focus on minimal use of pesticides and providing appropriate training to farmers needs to be regularly made part of agricultural extension services.

Given the increasing demand for processed foods in urban as well as rural areas, attention also needs to be paid to the quality of processed and fresh food. Food standards need to be made stringent, especially for fresh food produce such as fruits, vegetables, meat, dairy products, fish and seafood products, which are prone to food safety risks. While food quality and safety are emphasised more in urban markets and upper income groups, it is an issue that has implications for the health and nutrition of all consumers. Public and Private Partnership (PPP) should be strengthened to improve the capacities of both public and private sector institutions in areas of food safety control.

Nutrition Sensitive Investments

Investment also needs to be scaled up in agriculture-based nutrition research to make a significant contribution to improving health and nutrition.

Preventing and controlling food waste and loss is another area that needs to be addressed, given that it contributes heavily to climate change -- around 8% of total global greenhouse gas emissions. If food waste and loss are reduced by 20% in industrialised Asia and South and Southeast Asia, around 250 and 150 million tonnes of carbon dioxide could be avoided respectively[8].

There is also need to consider research in the understanding of how rising CO2 levels affect food and nutrition. Taking an example of neighbouring Bangladesh, where climate change is rapidly taking a toll on its economy and agriculture, among others, the fall in availability of agricultural land has been 0.45% per annum over the last decade. The approach to intensive cropping and intensive crop production that is both highly productive as well as environmentally sustainable needs to be adopted and expanded (9). An eco -friendly approach should be adopted to the needs of small holders, who combine traditional and conservation agriculture with modern technology and protect the depletion of natural resources. Besides animal source food production contributes to climate change through increased carbon dioxide emissions(10).

There is need to recognize that producing food sustainably is only part of the challenge. On the consumption side, there is need for a shift to nutritious diets with a smaller environmental footprint, and a reduction in food losses and waste, currently estimated at almost 1.3 billion tonnes annually.

Thus a nutrition-sensitive food system needs to be promoted to contribute to economic efficiency, and for enhanced quality and diversity of diets, and thereby boost nutritional outcomes.

(Dr Lalita Bhattacharjee is a senior nutritionist with FAO with a professional career in nutrition spanning 42 years. She is the recipient of FAO’s biennial B.R. Sen Award for 2014 in recognition of outstanding contribution towards improvements in nutrition in Bangladesh.)

References

1. FAO, IFAD, UNICEF, WFP and WHO. 2018. The State of Food Security and Nutrition in the World 2018. Building climate resilience for food security and nutrition. Rome, FAO.
2. Rao, Narasimha D., et al. "Healthy, affordable and climate-friendly diets in India." Global Environmental Change 49 (2018): 154-165.
3. Stein, Alexander J., and MatinQaim. "The human and economic cost of hidden hunger." Food and Nutrition Bulletin28.2 (2007): 125-134.
4. International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS.
5. FAO (2013). The State of Food and Agriculture: food systems for better nutrition.
6. UNICEF (2015). Stop Stunting in South Asia. A common Narrative on Maternal and Child Nutrition: UNICEF South Asia, Strategy 2014-2017.
7. The Lancet (2013), Volume 382, Issue 9891, Pages 536 - 551, 10
8. Parry, A., K. James, and S. LeRoux. "Strategies to achieve economic and environmental gains by reducing food waste." WRAP, London, UK (2015).
9. FAO (2011) Save and Grow: A policymaker’s guide to the sustainable intensification of smallholder crop production.
10. Bangladesh Country Investment Plan: Nutrition sensitive food systems (2016-2020)