Humanising nutritional condition: An integrated perspective - part I

Dr. Chinthaka Batawala, Dr. (Mrs.) Ruwanthi Abhayagunaratne

Child malnutrition is the most imperative problem of the world, damaging to both children and nations. Malnutrition is costing poor countries up to 3 percent of their yearly GDP. The pessimistic scenario suggests that child malnourishment will increase from 166 million to 175 million children by 2020.

Therefore, a detailed analysis of the plight of these children, and the root causes of malnutrition, are of paramount importance. The underlying causes of undernutrition vary from poverty, low levels of education and poor access to health services. The high levels of undernutrition in children and women in South Asia and Sub-Saharan Africa pose a major challenge for child survival and development. The examples of Thailand, Vietnam and China show that the problem of malnourishment is entirely preventable. Areas of intervention that will be most successful and the key policy priorities for each major developing region need to be identified.

Eradicating such a situation of malnutrition across the globe will require an ambitious and coherent mix of policies, covering agriculture, trade, aid, environmental protection, research, investment and more. The correct balance will help provide the conditions for a general rise in prosperity - which is what puts food in people’s mouths.

Countries are modifying policies and programs to bring about the changes needed to meet those targets. As these efforts get under way, any evaluation of progress should consider that participatory policy action takes time as the flow of developments unfolds from abstract goals to policy change to investment, implementation, and outcome.

Evaluating the progress along this spectrum would therefore involve keeping track of transitions from development-friendly rhetoric, to binding documents specifying commitments, to concrete policy designs backed up by appropriate budgetary allocations, and finally to implementation activities that have impact on the ground. Throughout the process, we must be cognizant of the political and economic realities that accompany major changes. Thus, expectations of rapid developments must be tempered by recognising that policy change requires time, yet in the end real outcomes must be evident.

Since only some years have elapsed after the declaration of Millennium Development Goals, most associated actions currently fall between the “declarations” and “initiatives” stage. Policy actors have made suitable progress at these initial stages to promote the roles of agriculture and food and nutrition stability in the development process. However, in terms of progress towards achieving the Millennium Development Goals, we have yet to see concrete results and we may fail to reach a number of targets at the current pace of change. Transition to the “actions and investments” stage is now critical.

Hunger and poverty

Hunger, which usually follows food shortages, is caused by a complex set of events and circumstances [social, economic and political factors] that differ depending on the place and time. Although hunger has been a part of human experience for centuries and a dominant feature of life in many low-income countries, the causes of hunger and starvation are not very well understood. Our understanding of the main causes of hunger and starvation has been hampered by myths and misconceptions about the interplay between hunger and population growth, land use, farm size, technology, trade, environment and other factors.

Also poverty cannot be defined simply in terms of lacking access to sufficient food. It is also closely associated with a person’s lack of access to productive assets, services and markets. Without access to these, it is unlikely that production and income-earning capacities can be improved on a sustainable basis. Rural poverty is related to food insecurity, access to assets, services and markets: income-earning opportunities; and the organisational and institutional means for achieving those ends.

Rights and Needs

Aspects of life which cannot be reduced to mere commodities - including capability, opportunity and choice - are among the main goals of poor people. Poverty thus defined relates more strongly to human rights than to welfare. A rights-based view stresses the poor person as a subject or an actor, while basic needs approaches tend to view the poor as objects. The Report of the Independent South Asian Commission on Poverty Alleviation established at the 1991 SAARC Summit in Colombo states that:

“In the past ten to fifteen years, a sufficient body of new experience has matured at the micro-level in South Asian countries, to demonstrate that where the poor participate as subjects and not as objects of the development process it is possible to generate growth, human development and equity, not as mutually exclusive trade-offs but as complementary elements in the same process.”

The basic needs approaches of the past have tended to co-exist with conventional trickle-down economic growth strategies and to emphasize the consumption of the poor (as objects) rather than their productivity (as subjects). Poverty alleviation, often in the form of tacked-on, self-standing programs, is thus seen as a means of compensating for inequities in growth, rather than being embedded within the growth process as a main driving force. Equitable growth strategies, with the poor as subjects, are likely to be more efficient at alleviating poverty than compensatory poverty alleviation programs which are expensive, difficult to target and administer, and which in any case depend on economic growth for their sustainability.

Food distribution

It has been argued that throughout the developing world there is a preferential allocation of food to adult men at the expense of adult women and children. This has been observed in various countries in the developing world, but it is not a universal phenomenon. Many different food distribution patterns have been observed, including biases favouring all adults, male adults, female adults or children or equitable distribution. The relative distribution is usually measured by energy or protein intake compared with estimated needs, although some studies examine the distribution of quality foods or the pattern of serving order, the serving of second helpings, etc.

There are two key reasons that knowledge of intrahousehold food distribution is important. First, for aid efforts, food distribution programs, and research involving distribution of food supplements, workers must have an understanding of how food is distributed within households. Second, recent studies mention that malnourishment exists because of inappropriate distribution of food within households in places where the food supply is apparently sufficient. It is imperative that genuine cases of insufficient food supply be recognized as such and not dismissed as cases of “inappropriate distribution.”

Consumer subsidies and income transfers

The supply of food is not a major determinant of malnutrition in the developing world. Rather, it is a lack of purchasing power of some households (and nations) that prevents them from securing adequate diets. But in the classical articulation of the diet problem, that malnutrition is more than a problem of insufficient income to purchase enough food. Indeed, many households, especially in developing economies, probably spend more on food and other consumer items than would be needed for the minimum required diet. Yet many of them remain malnourished, in part because of ignorance about nutrition and in part because of subjective tastes or preferences that may lead to nutritionally undesirable diets.

Consequently, “ignorance” and “tastes” must be considered explicitly in food policies and programs that in most instances attempt to modify human behaviour by changing incomes and relative prices in the short term, while relevant health education and health promotion takes root.

Price subsidies and income transfers have been major policy options available to governments to augment household purchasing power and alleviate malnutrition. Both income transfers and subsidies, largely confined to a market economy, are, however, innately problematic in that some “leakage,” i.e., support to some “wrong” people and for some “wrong” commodities, is inevitable.

In spite of these shortcomings, income transfers and subsidies have major attractions. Compared with the alternatives (e.g., feeding programs), subsidies and transfers are most effective according to the studies. They also rely on market rather than on administrative mechanisms.

This makes them appealing in developing economies where the share of the market economy is growing but administrations may still be weak.