Dr Shweta Khandelwal, Associate Professor, Public Health Foundation of India , elucidates on the accelerating global attention and efforts towards enhancing nutrition and highlights how prevention is better than cure.
The UN decade of action on nutrition 2016-2025 has been earmarked for accelerating global attention and efforts towards achieving progress on the six indicators: 40 per cent reduction in the number of children under five who are stunted; 50 per cent reduction of anaemia in women of reproductive age; 30 per cent reduction in low birth weight; no increase in childhood overweight; increase the rate of exclusive breastfeeding in the first six months up to at least 50 per cent; reduce and maintain childhood wasting to less than 5 per cent.
As public health and nutrition (PHN) professionals, it is very critical to emphasise that good nutrition in the 1000 days (between a woman’s pregnancy and her child’s second birthday) sets the foundation for all the above-mentioned targets. Studies show that if the child is born low birth weight, he/she will be preferentially predisposed to several risk factors for chronic diseases in adult life. Evidence also suggests that much of the brain’s irreversible development occurs during this period. All this will impact human potential, productivity and the nation’s economy in long run.
No wonder the Government of India has several programmes and policies to ensure that the maternal child population is taken care of appropriately. We have the national level Food security act, Integrated Child Development Services (ICDS) and Mid Day Meal (MDM) programmes in addition to supplementation interventions (iron folic acid, Vitamin A) which focus on vulnerable populations like pregnant lactating women, infants and young children. However, what is worrisome is the poor implementation and monitoring of these schemes on ground. India is way behind on most of the marks owing to its poor public health and nutrition situation as revealed in the latest NFHS-4 and RSoC surveys. Some progress has been made in the last few decades but at an extremely slow pace which is bound to hinder our attaining the World Health Assembly’s goals for 2025.This is partly because of the absence of one strong nodal body looking after or being completely accountable for the nutrition issues as a whole. We have divided up most of the nutrition pieces amongst several ministries (Women and child Development and Ministry of Health and Family Welfare mainly). Inter-sectoral coordination and action is always a challenge and therefore the results are not something we are proud of. Trained and motivated PHN professionals are also scarcely found because of limited academic and employment opportunities. Investing in capacity building of and then creating suitable employment options for this nutrition cadre will also go a long way in alleviating the burden of nutrition related morbidity and mortality. Several other factors impede our progress in PHN issues. The biggest challenge is our failure to accord high-priority to appropriate and balanced nutrition in a life-course approach by decision makers. We always act in response to a problem but still not gearing ourselves to prepare for preventive action.
Innovative strategies to enhance nutrition of children in short and long term so as to have a positive impact on human lives and economic potential of our country are urgently needed. In addition to the nutrition, direct interventions like breastfeeding promotion, feeding programmes, supplementation etc, also work on underlying causes (like education, agriculture, women empowerment, sanitation) and enabling environment (nutrition governance and leadership issues). These may include but not limited to- incorporate healthy lifestyle coaching in school education and curriculum right from early ages; organise mass awareness campaigns using modern digital technology on good eating habits and hygiene, how to recognise and seek help for malnourishment; invest in periodic capacity building and refresher training of professionals to invigorate motivation and improve PHN indices; strengthen our health care infrastructure and surveillance; devise methods for regular high quality data collection and action; improve nutrition governance and inter-sectoral coordination for collective action; test and scale up successful community interventions for improving maternal child health and nutrition; promote local fresh fruits and vegetables consumption for fighting off micronutrient deficiencies etc.
We can definitely prevent the vicious malnutrition, poor growth and compromised immunity cycle by focusing on a combination of the above outlined strategies. Multiple small but concerted actions early on (especially during the first 1000 days) will show a profound impact in the life of the individual. Only acting in emergency to cure or treat PHN problems will no longer suffice. We need to urgently rise to also embrace the preventive action mode so that our vision of a healthy India with well-nourished and nurtured population is translated into a reality.