This blog is about food security. And what I mean by food security, I’m referring to the situation where all people at all times have social, economic, and physical access to food that is nutritious and safe and plentiful. Why food security is so important, and that’s really because of nutrition. And when we think about the range of health problems with which nutrition plays a prominent role, there are impacts at every age group and across many of the different kinds of conditions that will be discussed in this blog.
So, if we just took two examples of global problems, we can think about obesity as one extreme and at the other extreme under-nutrition. And if I asked you from a global perspective which one of these is responsible for more mortality, more premature mortality, you might be surprised to know that it’s actually obesity.
And more than half of the world’s populations live in countries where obesity kills more people than under-nutrition. That being said, there are 850 million people globally, largely in developing countries, that suffer from under-nutrition or hunger. And that’s one in eight. And if I asked you how many of those people are actually in South Asia, it’s whooping 35%. And that is higher proportion than was the South Asia proportion back in 1990s.
Let’s unpack this and talk about what we mean exactly by under-nutrition. And there’s two components we should differentiate. One is Macronutrients, and the other is micronutrients.
Macronutrients are needed in larger quantities (in gram range). They normally include water, carbohydrates, fat and protein. Macronutrients (except water) are also called energy-providing nutrients. Energy is measured in calories and is essential for the body to grow, repair and develop new tissues, conduct nerve impulses and regulate life process.
Micronutrients: These nutrients include minerals and vitamins. Unlike macronutrients, these are required in very minute amounts. Together, they are extremely important for the normal functioning of the body. Their main function is to enable the many chemical reactions to occur in the body. Micronutrients do not function for the provision of energy.
The impact of macro deficiency or micro deficiency or both is really realized in people in terms of how severe are those deficiencies, how acute is their onset, what is the duration, and what is the susceptibility? And when we think about susceptibility, we know that children, adolescents, and pregnant women and women of reproductive age are most vulnerable.
And in fact, if we were to just think of the premature mortality — mortality in children under five years old — globally, about 45% of that mortality is either directly or indirectly related to undernutrition. If we think of let’s say an example of a morbidity, we can think of anemia from iron deficiency in pregnant women.
And in more than half the countries in South Asia, the rates of anemia in women of childbearing age exceed 50%. So these are just two examples. What if we wanted to step back and try to describe the health of a population? What would be the measures we would use? And interestingly, it would be three measures:
· Under Five prevalence of underweight: i.e. thin for age
· Under Five prevalence of wasting: i.e. thin for height, and wasting reflects a more acute condition
· Under Five prevalence of stunting: i.e. short for age. And stunting is actually felt to be one of the best indicators for overall undernutrition, and it’s irreversible. So even when nutrition improves, it takes a while for the prevalence of stunting to decline.
And we’re going to see in South Asia that we have relatively high rates of all three of these indicators. If we just take the cluster of countries in South Asia for underweight is 32%. So, 32% of children under the age of five on average are underweight, and about 15% of those are severe. In terms of wasting, it’s about 16%. And in terms of stunting it’s about an average of 38%.
Well, if we thought about the variation between those individual countries of South Asia, what would we find? And what we would find if we just said, well, what is the worst performer? Which country actually has the worst values? And the answer would be for underweight India, for wasting India, and for stunting India’s second place, only to be beaten out by Afghanistan. So, Afghanistan is the worst, followed by India.
And to give you an example of how high those values would be, while the average of underweight is 32%, in India it’s about 45%. And if I looked at the poorest states or the lowest wealth quintile in the poorest states or I looked at the rural regions, these rates can exceed 60%.
By Food availability, I’m referring here to, is there an adequate supply of food and is the type of food, the quality and diversity of that food, sufficient? And if we think globally, availability on these two dimensions has improved. The countries in South Asia a little bit less so have received a little bit less of this benefit. And an example would be Bangladesh, where the majority of the population still gets most of their energy from cereals.
By Access, we’re really thinking about two different kinds of access. The first is economic. And what I mean by economic access is, do families and communities have disposable income to be able to purchase their food? So, when we see that in poor regions of the countries of South Asia 75% and 80% of the income to a household is being spent on food, they are a vulnerable household. So economic access might also mean, is there a social safety net for those families that cannot afford food? The other kind of access is physical. And by physical access I’m referring to infrastructure, adequate roads, adequate communication such that that food supply, that supply chain is intact to get food to people. So if we just consider, for example, Nepal and the mountainous regions where there’s very poor road density network, this is a challenge in particular.
Third dimension is Utilization. By utilization, it’s referring to the circumstances that even if you have that food available to you and you have access to the food, you’re unable to utilize it to maintain health. So, an example would be if we look at a population and we see underweight and wasting and stunting but there is available food, we know that there’s an issue with utilization. And you sometimes see this with children with repeated episodes of infectious disease. Another domain of utilization is the circumstances with which food is prepared. Whether clean water is available? Do you have a place where sanitation is separate from the area that you prepare your food? All those circumstances or social determinants are also important to whether we can utilize the food to maintain our health.
And the final dimension, Stability, actually has kind of two components:
· Stability of the food supply: So, when we think of a country that is subject to droughts or uneven weather patterns, as are many of the countries in South Asia, this is a challenge in terms of stable food supply.
· Food price: And the stability of food prices at the global level has an impact not directly at the household level but through a series of ripple effects that happen when countries react to changes in global prices.
These are certain points which one may ponder upon while strategizing any interventions to tackle food insecurity in South Asia. Please provide your inputs and feedback regarding the blog.