Healthy India Campaign

2018 Wimpfheimer-Guggenheim Essay Competition Winner

By: Rupal S. Shah, MSc, CDE


The dual burden of malnutrition and obesity is the biggest global nutrition and dietetic problem. Recently, there has been a renewed discussion around nutrition in India. A few months ago, the Ministry of Health and Family Welfare released the National Health Policy, 2017.[1] It highlighted the negative impact of malnutrition on the population’s productivity and its contribution to mortality rates in the country. Malnutrition affects chances of survival for children, increases their susceptibility to illness, reduces their ability to learn, and makes them less productive in later life.[2] Recent estimates show that in developing countries, like India, nearly half of children less than five years of age die each year due to poor nutrition.[3] The middle class population, meanwhile, shows a different trend.[4] Forty years ago, obesity was not very common in most developed countries. However, food choices are highly sensitive to price. The first item to drop out of the diet during financial crises is usually the healthy foods such as fruits, vegetables and high quality protein. And at the same time, increased availability of fatty-or sugar-filled processed foods becomes the cheapest way to fill hungry stomachs and seems a tastier option too. This is the reason why low and middle classes are also increasingly found to be overweight and obese. To tackle this problem, there is a need to change our thinking from food security to nutrition security. While the issues are complex, the solutions are largely the same.

Many attempts and steps have already been taken to curb the under- and over- nutrition, but the pace is slow. Such problems will continue unless greater efforts are made to strengthen the existing initiatives (such as the Public Distribution System, Mid-day Meal Scheme, ICDS, Village and Child Development Centers).[5] There is also the Integrated Child Development Services (ICDS) Scheme that has benefitted India’s over 100 million persons including children, pregnant women and lactating mothers.[6] However, problems are being observed in ensuring a supply of quality food and its uniform distribution.[7],[8] This calls for a country and state customized action plan to address local nutritional needs. A holistic approach is needed to tackle this rather than just focusing implementation of country and state level program. The current Union Health Minister of India, JP Nadda, has also urged to find “solutions for accelerating action to prevent malnutrition at the State level.[9]

Change is difficult. Habits, routines, and learned behaviors make adjusting difficult at the individual level and hard at the country level. Whether a change takes the shape of a new system or process, or a complete overhaul of the way things function at the root level, driving a lasting change is easier said than done. The aim of the Healthy India Campaign is to promote a decentralized approach with greater flexibility and decision making at the state, district and local levels. Further, the strategy aims to strengthen the ownership of urban local bodies over nutrition initiatives. This is to enable decentralized planning and local innovation along with accountability for nutrition outcomes.

The following pointers from countries that were successful in prevention of malnutrition will be taken into consideration

  • Reducing malnutrition by investing in crisis prevention
  • Giving nutrition a top priority
  • Encouraging nutrition research to expand fortification and other nutrient enrichment program.

Thus, Healthy India Campaign will work to bring change at following levels:

Country Levels

  1. Programs, laws and policies carried out at country level help in minimizing duplication of resources and is more effective.
  2. A need for strong coordination amongst various departments/ministries and stakeholders especially environment, agriculture and education ministries has a big role to play.
  3. High quality regular screening, monitoring and surveillance of health and nutrition indicators/parameters: This will identify the part of population who need nutrition intervention the most.
  4. Stringent laws and policies if adopted at country level will give faster results. For example to control access to and affordability of processed foods, the government needs to firstly have a sound system to screen products in our market, then devise methods for easy identification of relatively healthier products. Existing laws for fortification of most commonly consumed food with needed vitamin or mineral, like iodine with salt, is running successfully. However, post-fortification monitoring and documentation is lacking to check for excess.
  5. Multi-stakeholder partnerships, involving public and private actors, have become key instruments in global food and nutrition governance. For example, Incorporating legumes (nutritious grains slowly disappearing from Indian markets) into the highest selling product of a reputed food and beverage company.
  6. Increasing fresh fruit and vegetable produce as well as high protein dairy and pulses in the food production. Most Indians are stuffing their plates with high carbohydrate in major meals. Availability and awareness regarding pulses consumption can be helpful. Increasing taxes on high carbohydrate (sugar laden), high fat, and unhealthy food products may be considered to discourage their usage.
  7. Keeping an eye on sales and advertising of unhealthy products.
  8. Giving incentives to the poor. For example, an incentive for bringing a child to ICDS or a mid-day meal program (it serves healthy protein rich food to children).
  9. Solving adverse climatic calamities and crises. Decreases in nutrient quality of our produce is associated with poor air quality and pollution.
  10. Investing in mass awareness campaigns using digital technology.

State Levels

  1. Focusing on leaderships to deliver interventions for nutritional deficiencies to those in greatest needs. These interventions already exist. They are cost effective and may bring spectacular results. Here, the need is for leadership and innovative in devising delivery systems.
  2. Monitoring the goals to be achieved and providing documentation.
  3. Checking on the quality of food being served along with hygiene and sanitation.

Community Levels

Community health workers, university professors, community and religious leaders, celebrity and other influential member of the community can support recommended practices and help establish a supportive environment by addressing cultural norms. Integrating nutrition messages and counseling into ongoing non-nutrition related community activities; interactive radio programming and television. Also absent are sufficient health and nutrition awareness among the people (about wholesome, balanced and natural diets; healthy child-feeding and caring practices). It is an imperative therefore to run an effective nutrition communication campaign (in schools, public places, print and social media) that would help children and communities, regardless of their income and education levels, in understanding how they should respond to their nutritional needs.

Household Level

The Healthy India Campaign strives to “influence the influencer” by reaching key people
who influence caregiver practices, particularly household members. Through this campaign, we aim to engage these “key influencers” as partners to ensure support for optimal practices within the household. Activities that target these key household members include: training parents on infants and child nutrition needs, geriatric care, how to tackle nutrient deficiency and establishing dialogue groups for parents and elderly.

Through these activities, grandparents and parents will receive targeted messages. For example, parents are encouraged to bring different color fruits home for children. The father is encouraged to take up any form of physical activity on weekends. Use smaller dishes to achieve portion control. Buy fruit and vegetables. Increasing awareness on decoding the label for packaged food.

Individual Level

Individuals are more likely to try and then continue adapting healthy practices if they recognize the benefits, believe they can overcome perceived and actual barriers and feel supported.

Use the following activities to support and encourage optimal practices: individual counseling, support groups, home visits, health talks, monitoring body mass index (BMI) and promotions, healthy cooking demonstrations, recipe books, interactive media programs, printed material and multiplexes.

Many of the reasons for the occurrence of malnutrition, as well as the solutions to overcome the challenge are known. Attention, however, needs to be paid to understanding what prevents the nation (India) from achieving its goals related to nutrition. Undoubtedly, the agencies of State governments have to adopt a comprehensive and coordinated multi-sector approach which is formulated by taking into account the varied nature of local -level challenges. The time to act against multi-headed malnutrition demon is NOW.


References

  1. National Health Policy, 2017, Ministry of Health and Family Welfare, India. Accessed March 16, 2017.
  2. Helping India Combat Persistently High Rates of Malnutrition, The World Bank. May 13, 2013. www.worldbank.org/en/news/feature/2013/05/13/helping-india-combat-persistently-high-rates-of-malnutrition.
  3. UNICEF, WHO, World Bank Joint Child Malnutrition dataset, updated May 2017. Available from: data.unicef.org/topic/nutrition/malnutrition/
  4. Giri, Rujuta and Vanisha S. Nambiar. ‘Dietary habits, parental history and dual burden of malnutrition among affluent school going children’, International Journal of Current Research 2016;8(5):31446-31451.
  5. Planning Commission. Addressing India’s Nutrition Challenges, Report of the Multistakeholder Retreat, p. 25, 7-8 August 2010.
  6. Human Rights Council. ‘Third Universal Periodic Review of India’, p. 17, 18 January 2017.
  7. Press Information Bureau. ‘Bad quality food supply for Aanganwadis’, 7 August 2013. pip.nic.in.
  8. The Pioneer. ‘Thumbs down to packaged food under ICDS’, 22 February 2015.
  9. The Times of India. ‘Malnutrition down, but not enough’, 11 December 2015. timesofindia.com.