Why India isn't a hungry nation but a society of full, yet undernourished bellies
Lack of nutrition is the biggest silent killer in a country that also records food grain surplus.
- Total Shares
The Reserve Bank of India (RBI), in its annual report August 2020, said, “India has now reached a stage in which surplus food grain management has become a major challenge.”
Often thought of as ‘hungry’, the government claims of being a net surplus food exporting nation with record grain production in the past decades. Food has deep ties to culture, religion, ethnicity and most Indians regard food as sanctified or holy. We celebrate, mourn, express, entertain, donate and thrive on food, boasting of countless regional delicacies, inherited recipes, as we Indians continue to seek pride in our spicy curries and rich sugary deserts. Warehouses of Food Corporation of India (FCI) operate at near full capacity and the scenes of farmers discarding excess produce on streets is an annual affair.
Then why does the Global Hunger Index 2019 ranks India 102 out 117 qualifying countries with ‘serious’ hunger and nutrition concerns? Globally, there were 673 million undernourished people, of which nearly 190 million (30 per cent) were in India in 2017-19, as per the combined report of UNICEF and WHO. Though there seems to be no absolute calorie scarcity on account of surplus production, malnutrition continues to be the largest underlying epidemic in our society and the coronavirus outbreak further compounds the situation.
The problem does not seem limited to the countryside and gets further complicated in developed areas which perceivably have enough food on the table. As PM Narendra Modi has kicked off ‘Poshan Maah 2020’ (month of nutrition) and Parliament has unblocked the long due agriculture reforms, let’s try to evaluate our food choices and its economic impact on India’s productivity.
Though there seems to be no absolute calorie scarcity on account of surplus production, malnutrition continues to be the largest underlying epidemic in our society and the coronavirus outbreak further compounds the situation. (Photo: Reuters)
So, what determines our food choices?
Religion and culture
The vegetarian vs non-vegetarian identity for an Indian is usually determined by religion, irrespective of body type and nature of work. India reportedly has more vegetarians than the rest of the world put together. Now, this does not directly imply that vegetarian food lacks nutrition, but this is where the problem of culture kicks in. We produce surplus grains, but not enough pulses, which are the primary sources of protein for vegetarian consumers. Hence, grains such as rice and wheat preparations comprise over 60 per cent per capita calorie intake. This permeates the culture, commercial and domestic culinary experiences that usually occur over choices with carbs and fats.
For instance, a variety of every day, as well as festive delicacies, are prepared just with rice (lemon rice, masala rice, sweet rice) while a myriad of packaged products that are part of popular culture are loaded with sugar and rarely have any nutrition.
So the idea of being a modern-day vegetarian in India is not of eating a rainbow food basket with fruits, greens, nuts and whole foods. On the contrary, it is invaded with French fries, refined carbs and sugar. As far as non-vegetarians are concerned, their daily meals look no different and lack consistent involvement of poultry, fish or meat-based proteins as they don’t eat it enough due to cultural, social and religious norms. Another nuance to note is that Indian culture does not differentiate between poultry (eggs, chicken) and red meat. Often consumption of egg is as big a taboo as beef is, while one can consume sugar all day long and be religiously compliant. Families and regions continue to follow and add to food choices with high fats over protein, though the physical nature of lifestyle declines.
Just like education or economy, the public policy framework has a large impact on our food choices. The national food security approach has been hung up in a ‘defeat the famine’ mode, which aims to provide gross calorie availability via the National Food Security Act (NFSA) or state-level Public Distribution Schemes (PDS) ensuring a supply of cheap grains. In order to ensure that agriculture is paid for and prices are stable the government provides a subsidy in the form of minimum support price (MSP) to farmer and works with the states to centrally procure rice and wheat yields.
For instance, farmers in Punjab or Chhattisgarh cultivate millions of tonnes of rice, the government procures this rice every year with an assured MSP value, the middlemen traders make a cut in the transaction and this cheap/free rice makes its way to our plates through the countrywide PDS network of ‘fair price shops’. This twin objective approach of aid to consumers and farmers has over the years evolved into a mechanism with large political economy and an intertwined supply chain with strong lobbies, political influence and financial gains resulting in a status quo that restricts the motivation to grow, procure and distribute anything beyond grains (rice and wheat).
While this stable and subsidised policy has helped counter the problem of absolute hunger, it limits the food choices and does not provide the needed nutrients and micro-nutrients. As a further consequence, programmes with nourishment objectives such as mid-day meal in schools or rice to households a Re 1 per kg become a mere channel to drain the bulk procured, excess produced carb-rich grains. The millets (Jowar, Bajra) are clearly the best buy in terms of calories per rupee. Yet studies by Angus Deaton and Shankar Subramanian show only about two-thirds of the total spending is on these grains, while 30 per cent is on rice or wheat which is more than thrice as expensive per calorie.
Research and intervention studies have well established that eating does not get better with income in India. Randomized control trials by Noble laureates Abhijeet Banerjee and Esther Duflo have shown that for a poor family, seven per cent to 10 per cent of expenditure is on sugar, which is more expensive as a source of calories and adds no nutritional value. Also with every one per cent rise in food expenditure, half of it goes towards tastier or sugary inputs. Poor families also have entertainment, festive and matrimonial expenditures which often gain priority over nutrition.
India is a massive domestic economy with a retail shop in every alley with offerings ranging from tobacco, candies and beverages for an average consumer to spend the money, there is always something tempting and cheap around. Conceptually, we think of this as a lack of self-control and problem of bad choices, but human behaviour can be sceptical of the long-term and continues to focus on living here and now, as pleasantly as possible with enjoyable and cheap calories. Even when people have enough money they tend to gravitate towards expensive food and indulging in calories, like modern confectionary or fats and the expenditure on nutritional items shows no positive trend across all five sections of income tiers. The Deaton-Subramanian study makes it evident that in both rural and urban areas the only nutrient that has seen an increase in consumption consistently over the past 25 years is ‘Fat’, with the increase in per capita income levels.
So, what is the cost or economic impact of eating badly as a nation?
India is projected to have 134 million people with diabetes by 2025 (20 per cent total impacted globally). Field studies validate that for a low-income Indian family, with an adult with diabetes, as much as 25 per cent of family income may be devoted to diabetes care. Similarly, we have around 60 million people with heart diseases, responsible for one in four deaths with a total cost entitlement of $2.17 trillion (from 2012 to 2030).
From a productivity standpoint, India ranks 158 (out of 195) in the Lancet human capital study owing to the anaemic, underweight or obese workforce. We often refer to the young demographic dividend (65 per cent under age 35) with children under the age of five constituting to 10 per cent of the population. The National Family Health Survey (NFHS 2016) highlights that every second child in India suffers from at least one form of nutrition failure. In 2019, India accounted for 28 per cent (40.3 million) of the world’s stunted children (low height-for-age) and 43 per cent (20.1 million) of the world’s wasted children (low weight-for-height). Implying we are breeding a potentially weak and less competent generation which will have impacted cognitive abilities needed to be the workforce of the future.
What is the path forward?
The National Nutrition Mission (NNM) aims to reduce stunting, underweight and low birth weight each by two per cent per annum, and anaemia among children, adolescent girls and women, each by three per cent per annum by 2022. However, The Global Burden of Disease Study 2017, which studied data from 1990 to 2017, has estimated that if the current trend continues, India cannot achieve these targets under NNM by 2022. Below are some multidimensional ideas which have proven to be effective over the past century across countries that can be helpful:
Sugar tax policy: Strategic tax policy on sugary product categories (not limited to carbonated beverages) is a time-proven economic tool which drives the consumption slower. Going a step further, favourable tax benefits towards nutritional products can promote manufacturers to incur the high material cost of richer ingredients and nudge customers to avail them at a similar price point vs having to spend a premium for nutrition.
Promote poultry: Building upon Shiv Nadar’s remarks at the RSS convention in 2019, we need to build a culture to embrace poultry products and get past the barriers of sanctimonious attitudes. This will require an investment of political and social capital by the current regime and can prove to be the single largest driver to boost protein consumption.
Diversify food basket: The recent agro reforms which promote contract farming and scraps the archaic colonial tyrannical essential commodities act laid down by Winston Churchill seem to be policy steps in the right direction. States level agro agencies need to ensure effective implementation of these reforms and assist with appropriate means to cover for the need for fruits, micro-nutrients, pulses.
Women education: Women are the decision-makers for most Indian households as far as food expenditure and composition is concerned. Women’s education has a multiplier effect not only on household food security but also on the child’s feeding practice and hence we need to promote initiatives like free bicycle, free insurance, etc. to ease the economic burden and facilitate the path to better education.
PDS+: Learning from other low-income societies with successful micro-nutrient based interventions, we need to redefine the scope and mechanism of the PDS programmes to extend beyond funnelling cheap or free grains and generate higher fidelity using the vast local network. Promising lessons can be seen in Mexico’s distribution system of nutrition pouches and the SMS-based digital PDS in the Indian state of Chhattisgarh where the distribution involves pulses andmillets in addition to rice and salt.