Written by: Valan A., Student, Tamil Nadu National Law University
Introduction
Amid the Global Pandemic (COVID 19), the World Health Organization (WHO) has released the Global Nutrition Report on May 12, 2020[1]. The first-ever Global Nutrition Report(GNR) was formulated during the Nutrition for Growth Initiative Summit in the year 2013[2]. The report has divulged the relationship between the levels of malnutrition and the characteristics of the population such as location, age, sex, education and wealth etc. But, the report hasn’t stuck the attention of the public including media and passed by as two-liner news.
Indeed, the GNR is important stuff that sets the indicators for the countries to realign its track of healthy well-being of the people. The relevance of publishing the status report on health during the pandemic goes in line with the WHO’s nutrition advice for adults during the COVID-19 outbreak i.e., Proper nutrition and hydration are vital. People who eat a well-balanced diet tend to be healthier with stronger immune systems and lower risk of chronic illnesses and infectious diseases[3].
At this juncture, nutrition and the immune system play a significant role in reducing the mortality rate and to effectively combat COVID 19. Hence, it becomes significant to keenly review the GNR with the view to ensure the highest standard of physical and mental health during the present crisis of pandemic.
Where is India in GNR, 2020
In 2012, the World Health Assembly has identified six targets of nutrition towards infant, maternal and young child to be achieved by 2025. They are:
1. To reduce stunting in children under 5 by 40%
2. To reduce the prevalence of anaemia among women in the age of 19-49 by 50%
3. To reduce the low-birth weight by 30%
4. To ensure no increase in childhood overweight
5. To increase the rate of exclusive breastfeeding in the first six months by 50%, and
6. To reduce and maintain childhood wasting by less than 5%
However, The GNR, 2020 reveals that India is one of the 88 countries that have the highest rates of domestic inequalities in nutrition missing the targets of four major nutritional indicators i.e. stunting among under-5 children, anaemia among women of reproductive age, childhood overweight and exclusive Breastfeeding.
Stunting Level India has identified as one of the three worst countries, along with Nigeria and Indonesia. 37.9% of children under 5 years are stunted and 20.8% are wasted. The Stunting level among the lowest income group is more than the highest income group at 22.0% and 50.7%, respectively. Further, stunting is 10.1% higher in rural areas than the urban areas.
Overweight and Obesity The rate of overweight and obesity continues to rise, affecting almost one-fifth of the adults, at 21.6% of women and 17.8% of men. Gender inequity in malnutrition is noted i.e., the obesity among adult females is almost double than the males (5.1% compared to 2.7%).
Anaemia As per the report “one in two women of reproductive age is Anaemic in India”
Underweight Children Between 2000 and 2016, rates of underweight have decreased from 66.0% to 58.1% among boys and 54.2% to 50.1% in girls. Further, 37.9% of children under 5 years are stunted and 20.8% are wasted.
Nutrition Programmes in India and its Target Beneficiaries
National Nutrition Policy (NNP) was adopted in 1993 by the Department of Women and Child Development. The NNP adopted a multi-sectoral strategy for eradicating malnutrition and achieving optimum nutrition for all.[4]
National Nutrition Monitoring Bureau (NNMB),1972 was established under the aegis of Indian Council of Medical Research. The objective of NNMB is to evaluate the ongoing National Nutrition Programmes to identify their strengths and weaknesses and to recommend appropriate corrective measures and thereby ensures the proper implementation of NNP.[5]
Integrated Child Development Services (ICDS) Scheme, 1970 was objectified to improve the nutritional status of children (0-6 years old) and women in 15 to 44 years and strives to supplement nutrition and to conduct immunization and health check-up programme etc., at the school level[6].
National Programme for Prevention of Nutritional Blindness due to Vitamin A deficiency, 1970 had short term goals to intervene on the administration of mega-doses of vitamin A to children between the age of 6 – 59 months periodically, while the long term strategy accentuated on dietary intervention to increase the intake of rich vitamin A foods.[7]
National Nutritional Anaemia Prophylaxis Programme (NNAPP), 1970 aimed to considerably reduce anaemia among women under the reproductive age group (especially pregnant and lactating women) and pre-school children in the age of 1-5 years.[8]
Special Nutrition Program (1970 - 1971) provided supplementary feeding of about 300 calories and 10 grams of protein to preschool children and about 500 calories and 25 grams of protein to nursing mothers (six days a week) in urban slums, tribal areas and drought-prone rural areas.[9]
Balwadi Nutrition Programme (BNP), 1970 of Central Government gave supplementary nutrition of 300 calories and 10 g of protein per child (age group of 3 to 5 years) per day for 270 days a year. [10]
Mid-Day Meal Scheme (MDMS), 1995 served every child a Mid Day Meal with a minimum of 300 calories of energy and 8-12 grams protein per day for a minimum of 200 days at every Government schools, Government aided primary in the state of Gujarat and Tamil Nadu since 2007[11].
National Food Security Act, 2013
The enactment of the Act marks a paradigm shift in the approach to food security from welfare to the rights-based approach. The Act legally entitles up to 75% of the rural population and 50% of the urban population to receive subsidized food grains under the Targeted Public Distribution System.[12] Chapter II of the act cover the provisions of food security exclusively:
Section 3: ensures the Right to receive five kilograms of food grains per person per month at subsidised prices.[13]
Section 4: describes nutritional support to pregnant women and lactating mothers through the local Anganwadi and maternity benefit of not less than rupees six thousand as prescribed by the Central Government[14]
Section 5: entitles the nutritional support to children of different age groups:
Below the age of six months - exclusive breastfeeding shall be promoted;
Age-group of six months to six years - the appropriate meal at free of charge, through the local Anganwadi to meet the nutritional standards specified in the Act
Under the age of fourteen years or children, up to class VIII -. one mid-day meal at free of charge, every day, except on school holidays, in all schools run by local bodies, Government and Government aided schools, so as to meet the nutritional standards specified in the Act.[15]
Section 6: obligates the State Government to identify and provide meals, free of charge, to children who suffer from malnutrition, to meet the nutritional standards through the local Anganwadi.[16]
COVID 19 Pandemic Calls for an Inclusive Nutrition Policy for Aged
Renata Micha, Co-Chair Research Associate Professor from the Friedman School of Nutrition Science and Policy, Tufts University speaks, "Good nutrition is an essential defence strategy to protect populations against epidemics,…. and ultimately save lives”[17]. On the contrary, amidst the battle against COVID 19 pandemic, the government and media hardly considered the recent GNR, 2020 that would affect the immunity of the people who are vulnerable to the viral infection and thereby affects the long-term growth of India.
During the nationwide lockdown, the government has not taken due measures to address the food and nutritional shortage in India. With the view to contain the pandemic virus spread, the government has stopped the school nutrition programmes and other nutrition programmes in which the most marginalised children relied upon. Moreover, the aforementioned National Nutrition Policy had no room for implementation due to the national lockdown. Hence, the accessibility and affordability of healthy and nutritious food are even more challenging for the vulnerable population including children, pregnant & lactating women and the aged. This would exponentially double the level of hunger and malnutrition in a short span of time.
On the other hand, advocating the distribution of proper nutritional support becomes irrelevant, as the poor and vulnerable population have been struggling hard to hold their last breath amidst the loss of income, increased food price and irregular food supply. To summarise, during the quarantine period, the production, supply and import of goods are very much disturbed which ultimately resulted in the non-equitable distribution of essential food among the vulnerable population. This added fuel among the malnourished and aged amidst the spread of COVID 19 pandemic.
Currently, The Union Ministry of Health has confirmed that the people of above 60 years old are the most affected section of the population, i.e, 63% of COVID-19 deaths[18]. The virus affects the elderly population fatally because the weakening of the immune system and age of a person is naturally directly proportionate. Hence, it is significant to the boost up the immune system of senior citizens regularly through an inclusive and comprehensive National Nutrition Policy. But, the bitter reality is that the benefits of various nutrition programmes cover only children, pregnant & lactating women. The COVID 19 pandemic is a blessing in disguise, that draw the attention of the government and the policymakers to rethink of the inclusion of elderly population within the National Nutritional Policy to save them against the virus infections including COVID 19.
Scope of improvement in Nutrition Policy in India
Operational Guidance of WHO may be reviewed and considered while preparing a comprehensive Nutritional Policy
Nutrition-related health products may be prioritised as essential medical supplies during the pandemic
Strengthen the existing community health service structures for supplementation of nutrition with the view to prevent and control for COVID-19
Decentralised programs may be initiated with community participation in terms of volunteers and Non- governmental organisation to combat the issue of malnutrition.
Linking of Gram Panchayats and Women’s SHGs in building the health awareness and proper administration of the nutrition supplements
Exclusive Nutrition policies may be evolved for elderly people to ensure the National Nutrition Policy more inclusive
Conclusion
The right to food is a human right recognized by the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the United Nation Convention on the Rights of the Child (UNCRC). It also encompasses the right to be free from hunger and the right of everyone to access adequate, safe and nutritious food. Hence, the GNR, 2020 should not be overlooked during the pandemic. Proper review and mid-course correction would achieve the health targets of 2025 decided in the World Health Assembly, 2012. However, even the World Health Assembly has yet to include the targets of nutrition for the aged, which would be more inclusive in attaining the vision of WHO – “to envision a world in which everyone can live healthy, productive lives regardless of who they are or where they live”.[19]
References
[1]India May Miss Nutrition Targets, The Hindu, 2020, available at https://www.thehindu.com/news/national/india-may-miss-nutrition-targets/article31568549.ece, last seen on 28/05/2020. [2] About The Global Nutrition Report - Global Nutrition Report, Global Nutrition Report, 2020, available at https://globalnutritionreport.org/about/, last seen on 27/05/2020. [3] WHO EMRO, Nutrition Advice for Adults during the COVID-19 Outbreak, Emro.Who.Int, 2020, available at http://www.emro.who.int/nutrition/nutrition-infocus/nutrition-advice-for-adults-during-the-covid-19-outbreak.html, last seen on 28/05/2020. [4] National Nutrition Policy, Business-Standard.Com 2020, available at https://www.business-standard.com/article/government-press-release/national-nutrition-policy-115120400712_1.html, last seen on 27/05/2020. [5] National Nutrition Monitoring Bureau in India-An overview, National Centre for Biotechnology Information , available at http://www.ijcm.org.in/text.asp?2007/32/1/7/53380, last seen on 27/05/2020. [6] Integrated Child Development Services (ICDS) Scheme, National Centre for Biotechnology Information, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925843/, last seen on 28/05/2020, last seen on 27/05/2020 [7]Massive dose vitamin A programme in India - Need for a targeted approach, National Centre for Biotechnology Information, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818610/#ref27, last seen on 27/05/2020. [8] National Nutritional Anaemia Prophylaxis Programme, Foundation of Health Technologies Society, available at http://fhts.ac.in/policy-brief/national-nutritional-anaemia-prophylaxis-programme-nnapp/, last seen on 27/05/2020. [9] Special Nutrition Programme, National Institute of Health and Family Welfare, available at http://www.nihfw.org/NationalHealthProgramme/SNP.html, last seen on 27/05/2020 [10] Balwadi Nutrition Programme, National Institute of Health and Family Welfare, available at https://web.archive.org/web/20130707064113/http://www.nihfw.org/NDC/DocumentationServices/NationalHealthProgramme/BALWADINUTRITIONPROGRAMME.html, last seen on 27/05/2020 [11] Mid-Day Meal Scheme, Department of School Education & Literacy, available at https://mhrd.gov.in/mid-day-meal, last seen on 27/05/2020. [12] National Food Security Act, (NFSA) 2013, Department of Food & Public Distribution, available at https://dfpd.gov.in/nfsa-act.htm, last seen on 27/05/2020 [13] S. 3, National food security Act, 2013. [14] S. 4, National food security Act, 2013. [15] S. 5 National food security Act, 2013. [16] S. 6 National food security Act, 2013. [17]Global Nutrition Report 2020 stresses on need to address malnutrition in all its forms, Express Healthcare, available at https://www.expresshealthcare.in/news/global-nutrition-report-2020-stresses-on-need-to-address-malnutrition-in-all-its-forms/420311/, last seen on 28/05/2020. [18] Special Reports, Health Analytics Asia, available at https://www.ha-asia.com/63-of-covid-19-deaths-in-india-are-of-60-age-group/, last seen on 29/05/2020. [19] Vision Statement, World Health Organization, available at https://www.who.int/dg/vision, last seen on 29/05/2020.
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