Starving Our Future

[Republished at Kafila on 30th September 2011]

This piece was written for my blog at work in August (and is copyrighted to Pratichi), but couldn’t be published since the data was not officially in the public domain yet. The statistics quoted here are the initial findings of the ‘child tracking’ system very recently instated by the local administration via elementary schools, to create a comprehensive database about the educational and health status of our future generations. We hope this resource will be used for more informed and effective policmaking, and not slide into obscurity as bureaucratically-managed data sometimes does.

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Urja aehi, swadha aehi, sunrita chirawatyehiti
[Come nutrition, come food, come truth, come security]
Atharvasamhita 8.10.4

“Come nutrition, come food, come truth, come security”, invites the Atharvasamhita. Clearly, this is not the expensive military view of security we are encouraged to take these days. What, then, is this security?

This is the security that comes from having access to regular and adequate nutrition. From not having to starve, or suffer chronic hunger. There is no violence in this idea of security, except the quiet, steady violence done to generations of ‘common’ people by making something as basic as daily nutrition unavailable to them.

Unfortunately, centuries after the Atharvasamhita was composed, undernourishment is still the norm rather than the exception in our state. The Department of School Education of the Government of West Bengal has begun work on a database, called Project Dipankar, collecting data on all children enrolled in government and government-aided primary schools in the state. Aside from data related to schooling, this database also records the children’s level of nutrition. The survey is yet to be made public, but by virtue of its work with public nutrition, Pratichi has been able to access the preliminary findings.

Even at this initial stage, the data is extremely alarming. Of the 1, 63, 860 children of Standard 1 from arguably the most affluent districts of the state – Howrah, North 24 Paraganas, South 24 Paraganas and Kolkata – 90% (89.76% to be exact) were found to be underweight (body mass index below 18.5). 7.67% were within the normal/healthy weight range, while 2.58% were overweight. If this is the nutritional status of children in these ‘developed’ districts, one shudders to imagine the fate of our future citizens in the geographically, socially and economically marginalised areas. With such a crippling deficit right from childhood (children in Standard 1 are usually 5-6 years old), can we really demand excellence of them, in any field at all?

And this deprivation will only multiply with every new generation. Ill-health amongst babies and very young children are related directly to undernourishment and labour-patterns of their biological parents, especially of the mother during pregnancy. Women who cannot afford to lay off hard labour during pregnancy, and have been either socially or economically prevented from accessing sufficient nutrition all their lives, will give birth to less healthy girls and boys. And thus the circle expands.

Now, there is the question of veracity of this data, which was recorded by teachers, under the supervision of the Department. While some think teachers, who interact with these children everyday and know them individually, are the best people for the job, others have questioned their ability to accurately record age and weight. Even if one attempts to accommodate dissent by reducing the figures by half, as a possible margin of error, undernourishment is still at an alarming 45% amongst 5 year-olds.

This data is also supported by the latest National Family Health Survey data on child nutrition (NFHS 3, 2005-06), although at first glance it appears to differ. NFHS finds that the rate of undernourishment is 38.7% (-2SD). However, this data is the aggregate of children between 0-6 years, and is based on household sampling, whereas the Department of School Education focuses on the smaller, and more exhaustive, demography of entry-level children in public schools. Besides, the average height and weight of male and female adults in West Bengal (about 5’ 5” and 5’ respectively) supports the certainty of extensive undernutrition in the region.

Genuine methodological concerns are, of course, vital to designing and conducting research, but a mature civil society – especially one that prides itself on its democracy – should perhaps not question research findings merely to divert attention from a shameful and uncomfortable reality that it does nothing to change.

Next comes the inevitable question of responsibility. Who is responsible for this state of affairs in Bengal?

Certainly, the Integrated Child Development Services (ICDS) has failed to live up to its potential in West Bengal. The comparison of Anganwadis in West Bengal and, say, Tamil Nadu, serves to emphasise how effective Anganwadis can be in promoting health and elementary education in suburban and rural areas, and how far behind West Bengal is in taking advantage of this.

Municipalities and the Department of Health and Family Welfare must also be held accountable. While nutrition is absolutely vital to the development of these children and overall performance of their families, it is undeniable that the Health Department has failed almost universally in delivering such basic requirements as clean, contaminant-free drinking water and better public hygiene. The state’s primary urban centre Kolkata — which is also one of the nation’s four metropolitan cities — suffers months of overflowing sewers, stagnating water on main streets, and the spread of water-borne or vector-borne diseases during the monsoon. The monsoons are not a new and unexpected phenomenon in West Bengal. Unfortunately, neither are preventable public health problems.

Since being underweight is directly related to available nutrition (or lack thereof), the culpability of the Department of Food and Supplies cannot be ignored. The supply-chain for food-aid programmes — like the Mid-day Meal programme — in the state has been consistently inadequate (with very high rates of diversion of supplies to the open market), and yet we have not yet managed to — some might say even attempted to — devise an effective delivery model. Outstanding deliveries and payments, as well as below-par quality of the supplies, continue to plague our nutrition programmes.

However, we, the people, are just as responsible for the current catastrophe as our government. We have not demanded our children be better taken care of, that our adults have food security and safe living environments. We have been far too busy speaking of our economic growth to discuss what that growth has failed to achieve for us. If we want to change the reality we live in, we will have to involve ourselves in that change. After all, as Amartya Sen put it last year at a public address on hunger at Delhi University:

Public action includes not only what is done for the public by the State, but also what is done by the public for itself. It includes what people can do by demanding remedial action and through making government accountable.
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11 comments

    • We are. We’ve just started a programme to evaluate the state’s health performance this month, plus a programme designed to improve the performance of nutritional programmes (like the mid-day meal, for example, which most urban middle-class Indians think is a robbery of their tax money).

  1. But BMI is a very misleading measure – since it is based on datasets that pertain to specific populations at a specific period in time – not taking into account genetic variation in average height and weight. I’m a puny 5’4” and considered tall by Bengali standards – that’s absurd!

    • Since BMI is the predominant marker of individual nutrition available to us, and also since it is globally accepted in Census and sample surveys as the standard measure of malnourishment, we cannot refuse to work with it if we want to work with nutrition, despite personal reservations. Unless we produce a more foolproof, viable alternative and have it approved with health administrations at every level, BMI it will have to be.

    • Also, as a few attending doctors pointed out at the Eastern India Regional Health Assembly we co-hosted last July, the perceived correlation between specific populations (say, ethnic groups) and average height/weight is in large parts a constructed myth.

      Shorter heights, in particular, are a result of generational malnourishment and an adaptation to conditions of scarcity. It is not, as it were, a genetic inevitability. I had always thought my 5 feet zero inch frame indexical of my Bengaliness — because aren’t Bengali women supposed to be short and plump? — but this new interpretation makes more sense than mere ethnicisation.

  2. This is a startling piece at the very least.

    One imagines poverty as something far away and removed from the supposedly saner environs of our cities. Malnutrition must happen in those desolate little villages they show on DD, not where WE live and work and crib about ‘city’ issues like corruption and cultural decay.

    Disturbing.

    • We’re not a ‘developed nation’, we’re still quite firmly third world 🙂

      I agree too, in part. But as I said above, I really can’t help it at all. One must work within industry standards or let these children slip back into social apathy. We’ll have to choose ‘working with’, when the other option is ‘not working at all’.

  3. Rimi, my children have BMI less than 18.5. And I can assure you that they are not deprived of nutrition. Their pediatrician is not concerned – they are rosy cheeked dervishes. Many of my Indian friends’ kids are likewise. I understand that you have to conform to an absolute framework if you wish to work in this field. But I do think that measures of nutrition really have to be specific to a demography.

    • Glad to hear it, Shinjinee, but please also take a look at the reasons cited to my second reply to Swati. When the attending docs said the myth of ‘demography specific anthropometry’ was normative, they did include paeditrician’s lack of concern with lower BMI.

    • On the other hand, it’s entirely possible to be quite healthy yet have borderline low BMI, but only in the case of people who know how to — and can afford to — eat healthy. The lack of nutritional information even amongst people who can afford to eat healthier than they do is, in fact, part of our study 🙂

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