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A cost we can’t afford: The human and economic costs of malnutrition and how India can end this scourge

February 26, 2017

I spent a lot of time in Bangalore and Delhi recently, talking with people about their hopes for India and its future. Most conversations began with the incredible success India has achieved reducing maternal mortality, lifting families out of poverty, and turning the tide against infectious diseases. We also talked about the urgent need to protect that hard won progress. And that means making the battle against malnutrition a national priority.

I remember Bill Gates saying last year that if he could wave a magic wand to solve any global health problem, he would use it to end malnutrition. It’s easy to understand why. Almost every challenge we face in global health and development is made worse by malnutrition. It makes sick children sicker and poor countries poorer. It robs young people of the opportunity to reach their full potential. And it traps communities in cycles of poverty.

India faces a unique development paradox: It is at once among the fastest growing global economies and home to the largest number of malnourished children in the world. There are regions where malnutrition is not the exception but the norm. And across the country, malnutrition is the cause of death for roughly half the 1.3 million children who die before their fifth birthday each year.

Even those children who survive suffer permanently from the damage that has already been done to their bodies and minds from not getting enough of the right foods and nutrients. Around 44 million Indian children under 5 are stunted. That makes it harder for them to learn in school and subsequently earn a living as adults. Their lifetime earnings potential is almost a quarter less than that of their healthy peers.

And these lost wages could cost the Indian economy a staggering $46 billion by 2030, according to one study. What we give our children to eat, and the strength of our economies, are inextricably linked. Indeed, we’ve seen that when a country conquers malnutrition, its GDP can rise by 2-3% per year.

The good news is that we know more about combatting malnutrition than ever before. Proven solutions for all children – wherever they live, whatever their circumstances – include encouraging mothers to breastfeed their babies immediately after birth, and introducing nutritious and safe foods at six months while still breastfeeding.

But these ‘nutrition-specific’ interventions are only part of the answer. They work best when coupled with ‘nutrition-sensitive’ programmes like girls’ education, delaying marriage and first pregnancy, access to safe drinking water, increased vaccination, and making sure that the agricultural system produces safe, affordable, nutritious foods year round. In short, we need a multifaceted solution. That’s not easy. Even so, we know that progress against malnutrition is possible because we see it happening already.

Every country that has made significant progress on this issue has followed a similar playbook. They’ve made ending malnutrition a national priority. They’ve coordinated across ministries. They’ve developed measurements and mechanisms to hold themselves accountable. And they’ve refused to let the problem fall off the agenda. Brazil’s efforts, for example, virtually eliminated malnutrition and dramatically reduced stunted growth and development by 80% within a generation.

There are many reasons to be optimistic for India too. India is already taking important steps with dramatic improvements in salt iodization, vitamin A supplements and deworming twice a year, improving breastfeeding, and committing to large-scale food fortification. And for all the wonderful and insightful conversations I had during my visit, one that stands out is my meeting at the Ministry of Women and Child Development. It was incredibly exciting to hear about the ministry’s plans to harness the potential of social and behaviour change communications, to use technology for more effective communication and reporting, and its work linking better nutrition to improved sanitation.

The government of India has already demonstrated through the success of the Swachh Bharat Mission that when the country chooses to make an issue a national priority, results follow. If India is willing to commit similar attention and resources to fight malnutrition – and insist that we will no longer accept the unacceptable – it will be a turning point in the health and prosperity of the country. Malnutrition was once called India’s “national shame.” Ending it will be a national triumph.

This article is originally published in The Times of India, on October 20, 2016

 
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