Unfortunately and shockingly, health has not been in the forefront of political debate in India and hence has never been the govt’s priority.
In the din and disruption that has held the recently concluded Budget Session hostage, it is easy to forget the serious ongoing challenges that India faces. Complex realities of India’s continuous nutrition woes, for instance (we are a country that hosts a third of the global 2 billion that suffer from malnutrition), are lost in the frenzy of parochial politics, leaving stakeholders and other solution providers justifiably miffed at the paralysis within the current government.
Today, the occasion of World Health Day offers an opportune moment to review our interventions to address India’s malnutrition quagmire, an issue that I have been working closely with several stakeholders to address.
In India, our understanding of improving nutrition is commonly limited to increasing access to food. But while access to food is an integral aspect of ensuring nutrition, it is only a part of the solution. Let us not forget that by definition, malnutrition broadly includes not just ‘undernutrition’—which comprises stunting, wasting, underweight and micronutrient deficiencies—but also overweight, obesity and diet-related non-communicable diseases, such as diabetes and cancer, which are on the rise in India.
While the government has acknowledged the underlying causes and consequences of malnutrition, government programmes and investment have tended to restrict themselves to ensuring availability of food. Understanding the impact of micronutrient malnutrition on other aspects of development and broadly on the country’s economic growth is critical to build a cohesive narrative and recognise food fortification as a long-term strategy. It is a sustainable and cost-effective measure, which has successfully addressed micronutrient deficiencies in many countries worldwide. And we know it works, having made initial experiments as early as 1953, for instance, to fortify vanaspati: I recall the Dalda tins in my mother’s kitchen when I was a child, each fortified with Vitamin A.
In order to address these vitamin and mineral deficiencies, the focus of our government has largely been on mass supplementation programmes. Yet, more than half our population consumes less than 50 per cent of their daily micronutrient needs— and the existing gap in implementing sustainable and long-term national policy solutions has not helped.
With the launch of the National Nutrition Policy in 1993, the government recognised food fortification as a policy instrument to improve nutrition in the country. However, the policy was not translated into action and fortification was not prioritised as a key strategy towards ensuring nutrition. Since then, efforts towards fortification have been scattered, and largely focused on salt iodisation.
In 2017, positive developments at the national level have shown some promise of creating a conducive environment towards fortification, with the Food Safety and Standards Authority of India (FSSAI) launching guidelines for food fortification, which were subsequently followed by the ambitious National Nutrition Mission (this has set a target of reducing under-nutrition and low birthweight by 2 per cent each year). In a similar development, the Niti Aayog launched the national nutrition strategy, recommending food fortification as part of a comprehensive strategy to address micronutrient deficiencies, especially vitamin A deficiency disorders.
But in our federal model of government, implementation of fortification is a state subject and measures undertaken towards food fortification have largely been fragmented and poorly coordinated. Moreover, in India, varied nutrition interventions have been housed under different ministries, leading to an unclear division of roles and responsibilities within the bureaucracy. This is not just an administrative concern: it creates obstacles to policy formulation, implementation and accountability.
I have been working very closely with decision makers at the national level to raise awareness about fortification. In particular, I have met twice on this issue with Ram Vilas Paswan, union minister of consumer affairs, food and public distribution. But our system means that though we are indeed talking about food, the Indian consumer and public distribution, there are two other ministers whose consent Paswan needs before a food fortification policy can be adopted. With encouraging responses from him and J.P. Nadda, minister of health and family welfare, as well as Maneka Gandhi, minister for women & child development, I am confident that we will get there, through coordinated efforts between concerned ministries.
Having said that, the narrative around micronutrient malnutrition will not change unless it is made a political priority, at the centre and in the states. The truth is that it is not. How many elections have been fought and won on health issues? Our public and our politicians tend to think of health as a specialist subject for experts to deal with; voters don’t question them on it or oppose them because of their indifference to it.
In a country with the second largest population (and one of the most youthful ones at that) in the world, our people are our greatest asset. But this demographic dividend can very easily become a demographic disaster. Our people cannot be productive if they are malnourished and burdened with micronutrient deficiencies. Unfortunately– shockingly– health has not been in the forefront of political debate in India and hence has never been in the forefront of the government’s efforts and initiatives towards holistic development.
No country can achieve its potential for growth and development until nutrition deficiencies and related disorders are eliminated. This will require both urgent and long-term measures. There is considerable interest and recognition of the urgent need to scale up efforts for food fortification. I urge our government to strengthen food safety-net schemes like the Targeted Public Distribution System (TPDS) and Mid-Day Meals (MDM), which have the potential to reach over 800 million of our most vulnerable men, women and children. We must implement fortification, ensure accountability and move towards political prioritisation of health so that every citizen has the chance to lead a healthy, malnutrition-free life.
Dr Shashi Tharoor is a Member of Parliament for Thiruvananthapuram and former MoS for External Affairs and HRD. He served the UN as an administrator and peacekeeper for three decades. He studied history at St. Stephen’s College, Delhi University, and International Relations at Tufts University. Tharoor has authored 17 books, both fiction and non-fiction; his most recent book is ‘Why I am a Hindu’. Follow him on Twitter @ShashiTharoor