Improvement in nutritional status of people has always been at the heart of our national policies, but not in actions. Debates are galore as to who is to ensure nutritional improvement. There was a time when the agricultural ministry thought that only growth of food production was its main motto, not eradication of malnutrition. The Health and Family Planning Ministry accepted nutritional improvement as an objective but with microscopic importance attached to it. It all happened in a regime of 'health is wealth' and nutritional development seen as cozy wishes in a country when basic food was missing.
Article 18 of the Constitution explicitly ensures that "The State shall regard raising the level of nutrition and improvement of public health as among its primary duties." The second Sustainable Development Goal (SDG) points 'to end hunger, achieve food security and improve nutrition and promote sustainable agriculture'. It specifically seeks to 'end all forms of malnutrition, including achieving by 2025 the internationally agreed targets on stunting and wasting in children under 5 years of age and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons'. The reality on the ground is that 36 per cent of children under-5 are stunted against 45 per cent in 2000, 14 per cent wasted and 33 per cent under-weight. Admittedly, the rates have fallen over time but not at a desired pace.
While there have been a number of researches on nutrition, very few seem to address 'nutrition governance' - a grievously missing mileage in the march towards nutritional improvement. The BRAC Institute of Governance and Development (BIGD) of BRAC University organised a seminar on September 12 last to deliberate on this hitherto unattended (or mildly attended) aspect of nutritional development and the consequences thereof.
The discussion was kicked off with a keynote speech from Howarth Bouis. He is a Food Laureate, co-winner of World Food Prize, and wears the hat of Harvest Plus - the world renowned fighter for bio-fortification. Howarth was perhaps the first to hypothesise that income elasticity of demand of food may be high but that of nutritious food is low indicating that with a rise in income, people tend to spend no less on nutritious food. Howarth's another path-breaking idea has also opened up eyes in the realm of nutrition: nutrition is not simply a deficiency of calorie but a deficiency of micronutrients- such as vitamins, minerals - that go to impinge insurmountable malnourishment. In fact, through his earnest endeavours both in theory and action, he emerged as the father of research on bio-fortification. He reckons that the green revolution has appreciably greased growth rate of cereal crops above that of population growth rate, thus denying Malthusian Doomsday. Comparing the rise in prices of both staple and non-staples, he showed that rice price has been reduced by 40 per cent thus allowing the poor to benefit from who spend about 40 per cent of the budget on these items. This has helped overcome the lack of calories while malnutrition remained pervasive in the wake of doubling of prices of non-staples like fish and lentils. The scenario also applies to India where rice prices fell and non-rice prices soared thus putting national balance in peril. Another observation of Howarth is that the poor and the non-poor thinly differ in consumption of calories, both in per capita consumption and expenditure but the difference widens, as income grows, with non-staples say fruits, vegetables and even fish. More disconcertingly, a cross-substitution effect of a rise in rice prices seems to cause a more damaging imbalance in nutritional intake when the poor, to keep calorie consumption constant, forgoes consumption of other nutrient crops. Thus a rise in rice price by, say, 50 per cent may not be reflected in the quantity of food consumed but in the quality of food.
The solution to the paradox of more malnutrition following more food lies in agriculture itself. The policymakers should see that prices of non-rice crops come down to enable the poor to access them from the market. While in earlier times, the primary goal of agriculture remained to augment supply of cereals, the role now should be to increase supply of non-staples. This would require a big shift in traditional mindset in terms of infrastructure, research and governance. Researches should see that all developed rice varieties have zinc. As an example, Bridhan 62 is a short-matured (100 days) crop that could provide space for another crop in between in a country where 70 per cent of the people lack zinc.
Ms Anuradha Narayan (Chief, Nutrition Section, UNICEF-Bangladesh) presented a situation analysis on under-nutrition in Bangladesh with an equity eye. Echoing a positive trend in nutritional indicators as has been claimed, Anuradha tried to look into the dynamics of the trend across geographical space and social segments. She observed that there was a sharp inequality in the positive outcomes. For example, malnutrition was severe in Sylhet and Khulna; stunting was more prevalent among children with less educated mothers, poor and food insecure households, aged 18-23 and stunting going down less intensely in poor families. By and large, she reckons that a multi-sectoral approach, rather than a single sectoral, needs to be developed to hasten the process of reduction. In another presentation from Shanawaz Hossain and Iffat Zahan, the major implementation challenges are reported to be as follows: coordination challenge among multi-sectors, difficulty in reaching remote areas, poor quality of programmes and detection and management of cute malnutrition. By and large, the authors argue for increased budgetary allocations, strengthening capacity of institutions, prioritising vulnerable areas, focusing on urban nutrition and expanding nutrition-sensitive interventions.
The bottom line needs to be underlined. First, nutritional status, especially pertaining to children, improved over time but at snail's pace so that attainment of SDGs could be in jeopardy. Second, most of the solutions to malnutrition lie in agricultural sector perhaps pointing to the fact that agriculture, despite its lower share in gross domestic product (GDP), has not outlived its utility. Third, National Nutritional Council, headed by the Prime Minister, needs to be more proactive with a watch on coordination of different ministries and organisations. Finally, to erase the impression of 'Asian Enigma', policymakers should accord priority to hitherto neglected agricultural sector in terms of resource allocation for research and training, extension work and building infrastructure in areas of non-staple crops.
The writer is former Professor of Economics at Jahangirnagar University.