The burden of malnutrition in India is multi-faceted. Under-nutrition in the form of stunting and wasting along with micronutrient deficiencies persist at unacceptable levels. Over a third of India’s children under five years of age are stunted, over half the children in that age group are Vitamin A deficient, and one in two women of reproductive age are anaemic. .
At the heart of malnutrition is poor diet quality, which contributes to six of the top 10 burden of disease factors in India. Food systems, which shape dietary choices have not focused sufficiently on nutritious foods. Resultantly, while food availability has increased, it has not diversified much in the last 50 years. Despite the excellent progress made in agricultural productivity, the Indian food system needs to do much more to deliver nutrition along with food security.
There are several factors that contribute to poor nutritional diversity in the foods we consume. There is not enough focus on increasing productivity and storage of foods rich in minerals and vitamins. To make the scenario more worrisome, too much food, especially fresh food, is lost during storage and transport,. This has greater implication in making healthy fresh foods affordable and accessible, especially for vulnerable low-income populations.
While India inherits incredible food diversity, there was a clear shift towards unhealthy diets. With greater urbanization, there is increased availability, marketing, and consumption of processed foods high in fat, salt, and sugar, and lower than recommended consumption of fruits, vegetables, and legumes.
The Covid-19 pandemic has contributed to undermining people’s nutrition, more acutely for those already vulnerable to nutritional deficiencies, such as the poor, infants, and pregnant and nursing women.
Food systems approach for better diets
A food systems approach affords several opportunities to achieve impactful health, immunity and nutritional outcomes for all. A focus on food and agriculture policies on securing diet quality especially for the poor and vulnerable is a crucial first step making fruits, vegetables, pulses, nuts, and seeds more available, affordable, and safer. More investments are required toprocure and store fresh foods so that they can be made available till the last mile without loss of its goodness. Provision of nutritious and fortified staples through safety net schemes holds much potential and already government schemes are servicing on these aspects.
A consultative and collaborative approach towards partnerships among government, private sector, civil society, research, and academic institutions to increase food safety, improve product formulation and labelling, and minimise food loss would positively impact the quality and nutritious profile of foods.
Curbing marketing of unhealthy foods, particularly targeting children is required. Concerted efforts are needed in creating consumer awareness for better dietary choices (less sugar, less salt and less trans fats) and more mineral rich fresh foods and fortified staples. Finally, better national, state and district level data are needed on food safety, food loss and waste for informed decision making.
Efforts in the right direction
The Government’s focus on nutrition through POSHAN Abhiyaan with commitment to nutritional outcomes, particularly in the aspirational districts is a targeted approach that holds much promise. Additionally, efforts to scale up fortification of staple foods led by the Food Safety Standards Authority of India (FSSAI), and supported by state governments, development sector organisations, and technical institutions in collaboration with the private and public sector to make available essential micronutrients such as vitamins A & D through fortified edible oil and milk; vitamin B-12, iron and folic acid through fortified wheat flour and rice; and iodized salt with iron, to the extent of 25-30 per cent of the required daily allowances are proven strategies for mitigation of micro-nutrient malnutrition and particularly more relevant during Covid times.
The Eat Right India initiative led by FSSAI adopts an institutional approach to promoting eating safe, eating healthy (including eating fortified staples), and eating sustainably. The production and commercialization of naturally bred mineral rich crop varieties such as wheat rich in zinc, and pearl millet rich in iron appear promising. Strengthening our food testing and regulatory mechanism is ongoing.
Also, small and medium-sized private industries hold significant potential in ensuring access to affordable nutritious food, particularly in peri-urban, rural, and hard to reach geographies. There is additional opportunity to augment rural livelihoods through nutritious food retail by micro-enterprises and women entrepreneurs.
(The writer is County Director, India, for the Global Alliance for Improved Nutrition (GAIN). Views are personal.)