The Commission on the Nutrition Challenges of the 21st Century, in its report titled ‘Ending Malnutrition by 2020: An Agenda for Change in the Millennium’, has pointed out that some 30 million infants are born every year in developing countries with intra-uterine growth retardation, representing about 24 per cent of all new births in these countries (Philip et al, 2000). Low birth weight (LBW) children are characterised by mental impairment. Worldwide, there are more than 150 million underweight pre-school children and more than 200 million stunted children. At current rates of progress in fighting these maladies, about one billion children will be growing up by 2020 with impaired mental development. What will be the impact on the intellectual property of a nation of such a denial to the child of opportunities for the full expression on its innate genetic potential for mental and physical development? Denying the child an opportunity for mental and physical development even at the foetal stage is the cruellest form of inequity. In contrast, excess weight is the major health problem among children in most industrialised countries and some developing ones (Table 1). Thus, bridging the nutritional divide is the first requisite for a more equitable and humane world.
The nutritional divide is increasing between the rich and the poor within and among nations. The situation is particularly alarming in developing countries. The nutritional paradox of
Nutrition profile among a few nations in
Four parameters — underweight, stunting, wasting and low birth weight — reflect the nutritional status of children below five years of age. The comparative profile of
A. Body Mass Index. This indicates the nutritional status of adults. Adults with a BMI under 18.5 are considered to be chronically energy deficient. Body Mass Index over 25 indicates excess weight. Obese persons have a BMI over 30. The situation in
B. Iron deficiency anaemia. In
C. Mortality rates. Thanks to advances in preventive and curative medicine, mortality has declined in the periods 1970-75 and 1999-2000 in
D. Female literacy and child health. A rapid increase in the rate of female literacy has been achieved in
Both men and women have achieved high literacy rates with 83 per cent for women and 90 per cent for men. They also have very low dropout rates: 4 per cent for girls and 6 per cent for boys. There is a significant impact of mothers’ education on the nutritional status of children (Table 5).
E. People power revolution in nutrition. Ultimately, the success of various nutrition-related programmes depends on the efficacy of delivery systems. Hence,
- Eliminate severe, moderate and mild protein-energy malnutrition.
- Monitor growth among all pre-school children and provide food supplements where needed.
- Mainstream nutrition in health, education and agricultural policies.
- Retrain and retool existing staff and mobilise community volunteers. Choose one community volunteer for every 10 households and build their capacity.
- Encourage breast-feeding and organise school lunch programmes.
- Promote home gardening, consumption of fruits and vegetables, aquaculture and food safety standards.
- Introduce an integrated food safety net with an emphasis on household food and nutrition security.
The positive impact of the above Nutrition Security Compact is evident from the decline of maternal mortality from 230 per 100,000 live births in 1992 to 17 in 1996 (Philip et al 2000).
The estimation of poverty is based on the consumption expenditure level below which a household of 5.5 persons, on an average, cannot meet the recommended intake of 2,400 kcal for adults in rural areas and 2,100 kcal in urban areas. In poor households, over 70 per cent of the daily income goes towards buying food
Among the nutritional challenges facing the countries in transition, the following need priority attention.
Low birth weight: For the reasons already mentioned, governments and civil society organisations in developing countries should accord high priority to overcoming maternal and foetal under-nutrition and malnutrition. Future intellectual attainments of nations will depend very much on success in this area.
Under-nutrition and stunting among children: Because of its linkages to mental impairment, stunting should be addressed through an integrated package of healthcare, education and nutritional measures. Early under-nutrition accentuates adult chronic diseases, including diabetes, heart disease, hypertension and cancer.
Undernourished adults: Judged by a body mass index of less than 17 kg/m2, over 240 million adults in developing countries are severely undernourished. The nutritional safety net for this category could include programmes like food for eco-development i.e. food for work and food for nutrition.
Vitamin A and iodine deficiencies: Subclinical Vitamin A deficiency still affects nearly 200 million pre-school children in developing countries. Sustained efforts are also needed to eliminate iodine deficiency disorders.
Pandemic anaemia: Maternal anaemia is pandemic and is associated with high MMR; anaemia during infancy, compounded by maternal under-nutrition, leads to poor brain development.
Lack of access to clean drinking water: This is a serious nutritional problem since contaminated water is a major cause of intestinal infections and diarrhoea in children. Access to clean drinking water is becoming a luxury in many developing countries.
Access to sustainable livelihoods: Ultimately, the lack of purchasing power is responsible for poor access to a balanced diet. In
Meeting the Challenges
A food-based approach to nutrition security would involve the following steps.
Food availability: This is a function of both home production and imports. In many developing nations, the gap between potential and present yields is high in most farming systems, even with the technologies available off the shelf. High priority should hence be accorded to bridging the productivity gap through a mutually reinforcing blend of technologies, services and public policies. Also, mainstreaming the nutritional dimension in the design of cropping and farming systems is essential. There is no time to relax on the food production front. The present global surplus of food grains is the result of inadequate consumption on the part of the poor, and should not be mistaken as a sign of over-production. Developing nations should aim to achieve revolutions in five areas to sustain and expand the gains already achieved. These are:
1. Productivity Revolution: The scope is great since average yields are still low in most cropping and farming systems. However, the production techniques should be environmentally sustainable, so that high yields can be obtained in perpetuity.
2. quality revolution: This can be achieved through greater attention to post-harvest technologies and bio-processing, as well as to sanitary and phytosanitary measures and Codex Alimentarius standards.
3. income and employment revolution: This will call for integrated attention being directed at on-farm and non-farm livelihoods and at farming systems intensification, diversification and value addition. Post-harvest processing offers scope for generating additional livelihoods through micro-enterprises supported by micro-credit.
4. small farm management revolution: Institutional structures which will confer upon farm families with small holdings the advantages of scale at both the production and post-harvest phases of agriculture are urgently needed. For example, thanks to the cooperative method of organisation of milk processing and marketing,
In relation to factors of production, water is likely to become the key constraint during this century. Hence, every effort should be made to enhance productivity and income for every drop of water.
5. enlarging the food basket: During the last century, there has been a rapid decline in the number of crops contributing to global food security. In the past, local communities depended upon a wide range of crops for their food and health security. It is important that we revive the old dietary traditions. Particular attention needs to be paid to leafy vegetables, which are rich in micronutrients (Table 7).
Food access: Inadequate livelihood opportunities in rural areas result in household nutrition insecurity. Today,
Food absorption: Lack of access to clean drinking water, as well as poor environmental hygiene and health infrastructure, lead to a poor assimilation of the food consumed. Nutrition security cannot be achieved without environmental hygiene, primary healthcare and clean drinking water security. Culinary habits also need careful evaluation. Some methods of cooking may lead to the loss of vital nutrients.
Transient hunger: Ferro-Luzzi et al (1994) have carried out a detailed study of seasonal cycling in body weights related to changes in weather. Any strategy for nutrition security should provide for steps to meet such transient hunger. Almost 25 years ago, The Indian state of
Fortification and synergy among dietary component: Our understanding of low-cost and high-synergy nutritional systems is growing. Fortification of flour with folic acid and genetic enrichment of staple grains with beta-carotene and iron are now receiving attention.
Knowledge relating to the metabolic interrelationships among micronutrients is also growing, as for example among Vitamin A, protein, zinc, iron, folic acid and Vitamin C. However, in the absence of dietary interventions, iron-folate supplementation often fails to bring about a complete correction of anaemia. Hence, the attack on under-nutrition induced hunger and micronutrients deficiency-caused hidden hunger should be an integrated one. Such an integrated strategy should accord concurrent attention to food availability, access and absorption. In addition, there should be provisions in the strategy for overcoming seasonal or transient under-nutrition caused by loss of opportunities for livelihood during seasons of drought, floods or other natural calamities.
Genetic enrichment of nutritional quality: While the problems relating to the food and environmental safety aspects of genetically modified foods are yet to be fully resolved, there is little doubt that an integrated approach involving Mendelian and molecular breeding is likely to make a food-based approach to nutrition even more effective in the future. The quantity and quality of proteins, carbohydrates, fats, vitamins and minerals can all be improved now. The scope for the genetic enhancement of nutritional quality will be evident from the following examples:
- Quality protein maize (QPM). Scientists have long had an interest in improving maize protein quality. Quality protein maize (QPM) refers to enhanced levels of the two ‘essential’ amino acids, lysine and tryptophan, in the endosperm protein. Using Mendelian breeding methodologies supported by rapid chemical analysis of a large number of samples, scientists led by S. Vasal and Evangelina Villegas of the International Maize and Wheat Research Centre (CIMMYT) in Mexico were able to slowly accumulate modifier genes to convert the original soft opaque-2-endosperm into the vitreous hard endosperm type (Vasal et al, 1984). This conversion took nearly three decades. These remarkable new varieties look and taste like normal maize but the nutritive value of their protein is nearly equivalent to cow’s milk. They also produce yields as much as 10 per cent higher than the best local hybrid maize varieties and are more tolerant of biotic and abiotic stresses. QPM, which is a product of Mendelian breeding, promises improved nutritional value and cost savings for a wide array of products ranging from infant food to corn chips and feed for non-ruminant livestock. The impact of this breakthrough is likely to be felt throughout the food industry and has great promise in the developing world, both for human and animal nutrition.
- Beta-carotene rich rice. A promising development in the field of genetic engineering is the success in breeding a nutritionally enriched rice variety now popularly referred to as ‘golden rice’. This genetically modified rice contains genes that produce high levels of beta-carotene and related compounds, which are converted in the human body into crucially needed Vitamin A. Vitamin A deficiency (VAD) causes more than a million childhood deaths each year and is the single most important cause of blindness among children in developing countries. Rice plants do produce cartenoid compounds (that our body converts into Vitamin A) but only in the green parts of the plant, not in the part of the grain normally eaten. Dr Ingo Potrykus and Dr Peter Beyer of the Swiss Federal Institute of Technology inserted genes from a daffodil (Narcissus pseudonarcissus) and a bacterium (Erwinia uvedovora) into rice plants to produce the modified grain, which has sufficient Beta-carotene to meet total Vitamin A requirements in a typical Asian diet (Ye et al, 2000). If golden rice, which is still in the laboratory stage, becomes a success in the field, it will help to strengthen the food-based approach to nutrition security.
- Iron enrichment. Iron-deficiency anaemia is the most widespread nutrient deficiency in the world, affecting an estimated 2 billion people worldwide. Between 40 and 50 per cent of children under the age of five in the developing countries are iron-deficient and iron deficiency accounts for up to 20 per cent of all maternal deaths. It also impairs immunity and reduces the physical and mental capacities of people of all ages. In short, iron deficiency is a major public health problem worldwide with enormous social and economic costs. Rice fortified with iron was created through the introduction of proteins from kidney beans (Phaseolus vulgaris) by the same researchers at the Swiss Federal Institute of Technology (Lucca et al, 2000). It is reported that the iron content increased two-fold in the modified crop, which is now in the testing stage. Japanese scientists have also succeeded in enriching the rice grain with iron. The International Rice Research Institute (IRRI) has developed rice-breeding lines high in iron and zinc using traditional plant breeding techniques. This rice is currently being tested by novitiates at a convent in the
to see how well the nutrients are absorbed in the human body. Philippines
- Designer potatoes. Advances in plant tissue culture techniques and gene transfer technology have opened up possibilities for modifying the amino acid contents of plants. The potato, which is the most important non-cereal food crop, ranks fourth in terms of total global food production. Besides, it is used as animal feed and as raw material for the manufacture of starch, alcohol and other food products. This crop was genetically modified using the seed albumin gene Ama1 from Amaranthus hypochondriacus by researchers of Jawaharlal Nehru University (JNU),
(Chakraborty et al, 2000). The Ama1 protein is non-allergenic and rich in all essential amino acids. Its composition corresponds well with WHO standards for optimal human nutrition (Raina and Datta, 1992). The JNU team was able to use a seed albumin gene with a well-balanced amino acid composition as a donor protein to developing a transgenic potato. The genetic enrichment of protein quantity and quality in potatoes can make a significant contribution to child and adult nutrition, since mashed potatoes can be fed to young children. New Delhi, India
The above are a few examples of the work in progress in improving, through conventional and molecular breeding techniques, the quantity and quality of protein in important food crops. Consumer confidence based on an appreciation of the scientific evidence and the regulatory checks and balances will ultimately decide whether or not genetically modified foods (GMOs) will make a significant contribution to feeding the 8 billion people who are likely to inhabit our planet by 2020. Marker-aided selection and transgenic approaches are two powerful tools to accelerate plant breeding to produce crop varieties with improved nutritional traits and qualities. An intelligent integration of Mendelian and molecular breeding techniques will help to enhance the nutritive value of staples. By integrating pre-breeding in laboratories with participatory breeding in farmer’s fields, it will be possible to breed location-specific varieties and maintain genetic diversity in crop fields.
Building a Sustainable Community Nutrition Security System
Conferring the right to food — and thereby an opportunity for a productive and healthy life — on those who go to bed undernourished now, is the fundamental duty of the State and the more fortunate sections of the population. Thanks to technological advances and the spread of democratic systems of governance at the grassroots level, we now have a rare opportunity to foster a community-centred and controlled nutrition security system. Such decentralised community management will help improve delivery of entitlements, reduce transaction and transport costs, eliminate corruption and cater to the twin needs of introducing a life-cycle approach to nutrition security and meeting the challenge of seasonal fluctuations in nutritional status. The basic guidelines for such a system are:
Adopt a whole life-cycle approach to nutrition security
- Pregnant mothers. Overcoming maternal and foetal under-nutrition and malnutrition is an urgent task, since nearly 30 per cent of children born in
South Asiaare characterised by low birth weight (LBW), with the consequent risk of impaired brain development. Ramalingaswamy et al (1997) have pointed out that half the world’s malnourished children are in India, Pakistanand . LBW is a proxy indicator of the low status of women in society, particularly in terms of their health and nutrition status during their entire life-cycle (Rama Narayanan, 2001). Bangladesh
- Nursing mothers. Appropriate schemes will be necessary to provide support to enable mothers to breast-feed their babies for at least six months, as recommended by WHO. Policies at workplaces, including the provision of appropriate support services, should be conducive to achieving this goal.
- Infants (0-2 years). Special efforts will have to be made to reach this age group through their mothers, since they are the least served at present. Eighty per cent of brain development is completed before the age of two. The first four months in a child’s life are particularly critical, since the child is totally dependent on its mother for food and survival.
- Pre-school children (2-6 years). A well-designed, integrated child development service will help cater to the nutritional and healthcare needs of this age group (Measham and Chatterjee, 1999).
- Youth (6 to 20 years). A nutrition-based noon meal programme in all schools (public and private, rural and urban) will help to improve the nutritional status of this group. However, a significant percentage of children belonging to this age group are not able to go to school due to economic reasons. Such school ‘push-outs’ or child labourers need special attention.
- Adults (20 to 60 years). The nutrition safety net catering to this category should consist of both an entitlements programme like food stamps and the Public Distribution System (PDS), as well as a food for eco-development programme (also called ‘food for work’ programme). The food for eco-development programme can promote the use of food grains as wages for the purpose of establishing water harvesting structures (Water Banks) and for the rehabilitation of degraded lands and ecosystems. Thus, many downstream benefits and livelihood opportunities will be created. In designing a nutrition compact for this age group, persons working in the organised and unorganised sectors will have to be dealt with separately. Also, the intervention programmes will have to be different for men and women, taking into account the multiple burdens on a woman’s daily life.
- Old and infirm persons. This group will have to be provided with appropriate nutritional support, as part of the ethical obligations of society towards the handicapped.
The above whole life-cycle approach to nutrition security will help ensure that the nutritional needs of everyone in the community and of every stage in an individual’s life are satisfied.
Adopt a Holistic Action Plan to achieve sustainable nutrition security at the level of each individual
The major components of such an integrated action plan are the following:
- Identification: Identify those who are nutritionally insecure through local communities. Trained Community Volunteers of the kind mobilised in
will be useful for this purpose. Thailand
- Education and information empowerment: Empower those who are not aware of their entitlements about the nutritional safety nets available to them and also undertake nutrition education. An entitlements database can be developed for each area and household entitlement cards can be issued, indicating how to access nutritional, healthcare and educational programmes. The educational programmes should also stress the conservation of essential nutrients in cooked food.
- Overcome protein-calorie under-nutrition: The various steps indicated under the whole life-cycle approach will have to be adopted. The problems of child labour and of persons working in the unorganised sector will need specific attention.
- Eliminate hidden hunger caused by the deficiency of micronutrients in the diet: Introduce an integrated approach, including the consumption of vegetables and fruits, millets, grain legumes and leafy vegetables and the provision of fortified foods like iron and iodine-fortified salt and oral doses of Vitamin A. The basic approach should be a food-based one, with an emphasis on home and community nutrition gardens, wherever this is socially and economically feasible (Gopalan, 2001).
- Drinking water, hygiene and primary healthcare: Attend to the provision of safe drinking water and to the improvement of environmental hygiene. Also, improve the primary healthcare system.
- Sustainable livelihoods: Improve economic access to food through market-linked micro-enterprises supported by micro-credit. Also, create an economic stake in the conservation of natural and common property resources. Ensure that agreements under the World Trade Organisation (WTO) provide a level playing field for products coming from decentralised small-scale production (production by masses or farmers’ farming) as compared to those emerging from mass production technologies or factory farming. Promote job-led economic growth and not jobless growth.
- Pay special attention to pregnant and nursing mothers and pre-school children: Measure progress through monitoring MMR, IMR, incidence of LBW children and male-female sex ratio. Iron-folate supplements during prenatal care should be accompanied by steps to overcome protein-energy deprivation. Mina Swaminathan (1998) has proposed a maternity and childcare code, which if adopted, will help to bring down speedily MMR, IMR, LBW and stunting. The sex ratio is a good index of the mindset of a society in relation to the girl child.
Community Food Bank as an instrument of sustainable food and nutrition security
Community Food Banks (CFB) can be started at the village level, with initial food supplies coming as a grant from governments and donor agencies like the World Food Programme. Later, such CFBs can be sustained through local purchases and from continued government and international support for food for eco-development and food for nutrition programmes. CFBs can be the entry point for not only bridging the nutritional divide, but also for fostering social and gender equity, ecology and employment. They can also be equipped to cater to emergencies like cyclones, floods, drought and earthquakes.
The CFBs can be organised with the following four major streams of responsibilities.
1. Entitlements: The benefits of all government and bilateral and multilateral projects intended for overcoming under-nutrition and malnutrition can be delivered in a coordinated and interactive manner (as for example those intended to overcome deficiencies of macro and micro-nutrients.)
2. Ecology: Food for eco-development with particular reference to the establishment of Water Banks, land care, control of desertification and afforestation. Thus, grain can be used to strengthen local-level water security.
3. Ethics: This group of activities will relate to nutritional support to old and infirm persons, pregnant and nursing mothers and infants and pre-school children.
4. Emergencies: This activity will relate to the immediate relief operations following major natural catastrophes like drought, floods, cyclones and earthquakes, as well as to meet the challenge of seasonal slides in livelihood opportunities.
Each of the above four streams of activities can be managed by four separate self-help groups of local women and men. This will help to generate a self-help revolution in combating hunger. The overall guidance and oversight may be provided by a multistake-holder Community Food Bank Council.
Resource centres for CFBs
For the CFB movement to succeed there is need for training managers of such food banks and for building the capacity of the Community Oversight Council to plan and monitor the different programmes. Training modules will have to be prepared for this purpose. Accounting and monitoring software will have to be developed and the members of the self-help groups will have to be trained in the use of the software and in managing computer-aided knowledge centres linked to CFBs. Four training modules relating to entitlements, eco-development, ethics and emergencies will have to be developed, so that each SHG is headed by a professionally trained woman or man. A network of institutions which will provide the necessary managerial, technical and training support to managers of self-help groups and CFBs will have to be organised in every country where there is a strong political commitment to ending the nutritional divide as soon as possible.
Agenda 2007: A hunger-free
The Prime Minister and the Government of India are to be commended for three important recent initiatives for dealing with the mounting grain stocks in a socially and environmentally meaningful manner. First, the Prime Minister announced on August 15 the initiation of the Sampoorna Gramin Rozgar Yojana, with an initial allocation of 5 million tonnes of food grains for organising food for work programmes. Second, a million tonnes of food grains has been offered to Afghanistan through the World Food Programme, the largest assistance of this kind given by any nation to a people in deep distress. Third, the government has decided to launch a Grain Bank Scheme (GBS) in tribal areas, with an initial allocation of one million tonnes of food grains and Rs 66 crore in cash for meeting transportation costs.
While the manner of use of the grains offered to
As mentioned earlier, the Community Grain Banks can perform multiple functions depending upon local needs and opportunities. In the area of health, the control of tuberculosis and leprosy can be speeded up if food grains can be given to those whose economic circumstances do not permit taking drugs regularly over many months. The Tuberculosis Research Centre at Chennai is initiating an imaginative programme in collaboration with the UN World Food Programme, for using food grains to encourage the regular intake of the needed drugs. Similarly, in the area of education, economic and social conditions prevent many children, belonging to the category of child labour, as well as adolescent girls, from continuing their school education. By introducing carefully designed food for education programmes, substantial progress can be made in reducing the prevalence of such school push-outs.
Another area of nutrition security which can be strengthened through CGBs is the introduction of a whole life-cycle approach to overcoming malnutrition during various stages in one’s life, ranging from pregnant mothers and infants to old and infirm persons. This will help to bring down speedily the incidence of low birth weight children and infant and maternal mortality rates. This will call for steps which can foster the integrated implementation of numerous ongoing nutrition intervention programmes.
Strengthening ecological security will be another lasting benefit of the use of grains for the conservation and enhancement of natural resources. The new tribal area grain bank programme should be structured in such a manner that food grains are used to establish field-level gene banks to conserve local agro-biodiversity, seed banks and water banks. CGBs can then promote concurrent progress in achieving desirable goals in conservation, education and nutrition. The storage bins can be designed according to local climatic conditions and separate bins can be fabricated locally for different grains. The Save Grain programme of the government can be used for training and capacity-building in storage methods. The Rural Godown Scheme can be integrated with CGBs.
Grain Banks already exist in different parts of the country, set up and operated by both government and non-governmental agencies. The Madhya Pradesh government has institutionalised the grain bank (Anna Kosh) programme. The government of Rajasthan is planning to integrate the CGB initiative with the ongoing Gandhi Gram Yojana, which has several social and ecological objectives, including local-level water security. The available experience stresses the need for community control and involvement to ensure sustainability and replicability. Otherwise, the grain banks will vanish when government support ends.
CGBs should become central to community-managed nutrition and ecological security programmes. Only then will transaction costs become affordable and the programme replicable. CGBs provide opportunities for achieving convergence and synergy among the numerous yojanas initiated in recent years, including the Annapoorna and Antyodaya Anna Yojana. The time is opportune for unifying all of them under the supervision of Gram Sabhas into a community nutrition security system based on a whole life-cycle approach.
Food for Peace (PL-480) — started in 1949
Food for Progress — started in 1985
Food for Education — started in 2000
Other than the
This unique initiative may be continued and consolidated with the launching of three programmes soon:
- Food for coastal ecological security: One million tonnes of grains may be made available to coastal states as well as to the Andaman and Nicobar and
Lakshadweepadministrations for food for work programmes designed to restore mangrove wetlands, coral reefs and sea grass beds, and to control sea erosion and organise agro-aqua and agro-forestry programmes.
- Food for the security of mountain ecosystems: About 2 million tonnes of food grains may be made available to states in the Himalayan (including Northeastern states) and Western and Eastern Ghats regions for the eco-restoration of hydrologic and biodiversity "hot spots", for preventing genetic and soil erosion and for establishing field gene banks through in situ on-farm conservation.
- Nagarpalika Rozgar Yojana: Two million tonnes of food grains may be made available to urban local bodies for undertaking scientifically designed treatment and recycling of all solid and liquid wastes, including conversion of wastes into organic manure, urban water harvesting and for the bio-environmental management of mosquitoes. With a slump in construction activities, urban unemployment leading to urban crime is increasing and it will be useful to use the opportunity provided by grain availability for improving sanitation and environmental hygiene in towns and cities, in addition to converting a public health problem into public wealth.
Thanks to the impressive grain stocks, which may go up to 100 million tonnes next year, if the consumption capacity of the poor does not improve, we have for the first time in the history of independent
This article is based on a plenary lecture delivered at the 17th International Congress on Nutrition,
M.S. Swaminathan, a founding father of the Green Revolution in India, worked to develop the nation’s food security as Secretary for Agriculture. He has also been Director General of the Indian Council of Agricultural Research and the International Rice Research Institute, Independent Chairman of the FAO Council, and President of the International Union for the Conservation of Nature and Natural Resources. He is a member of the Royal Society, the