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Malnourished, stunted and wasted, can this be India’s Demographic Dividend?

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Malnourished, stunted and wasted, can this be India’s Demographic Dividend?
Veena S Rao, Dr R Shankar,
NOV 05 2020, 00:24 IST
file77k7vq1kw29ylbgpm33-911434-1604517088.jpg


India is proud of its current demography -- 67.3% of our population is between 15 and 59 years of age, a demographic advantage that will continue for at least another three decades. This we believe is a great powerhouse for economic growth and our aspirations of becoming a world power – our demographic dividend.

Let us take a look at what sort of a powerhouse it actually is. Findings from a succession of reports during this decade -- NNMB 3rd Repeat Survey (2012), NFHS 4, 2015-16, NNMB Technical Report Number 27, 2017, continuously record that at least 40% of our population of all age groups has a huge dietary deficit, covering protein, calories and micronutrients, as compared with Recommended Dietary Allowance (RDA) for Indians.

The situation among children below six years, our future demographic dividend, is even worse. Stunting, wasting and anaemia rates are high and a mere 14.3% infants below two years receive adequate diets necessary for proper physical and cognitive growth, meaning thereby that 85.7% children in India will never achieve their complete physical and cognitive potential, will have lower immunity, higher infections, and permanent stunting. Scientific evidence establishes that inadequate nutrition among infants below three years, which is a period of rapid growth of their brain cells, can result in slower and lesser development of cognitive ability.

As for school children and adolescents, our intermediate demographic dividend, high rates of undernutrition, anaemia and micronutrient deficiency again result in slower physical growth, reduced ability to learn, play and do physical work. This translates into poor numeracy and learning ability, and lower educational achievement as they grow, school dropouts, lesser ability to acquire professional skills and lower-income generation capacity as they enter the workforce. Additionally, undernourished adolescent girls become undernourished and anaemic mothers, thereby completing the intergenerational cycle of undernutrition and poverty.


What about adults, our present demographic dividend? Dietary deficit, Chronic Energy Deficiency (CED) and anaemia result in reduced energy to work and earn, quick fatigue, lower earnings and a permanent poverty trap. The body systems of such adults become programmed to function in scarcity, creating a negative balance where muscles don’t build and existing muscles become thinner. This adversely affects protective mechanisms of the body and reduces immunity and life expectancy.


The late Prof RW Fogel, Nobel laureate, has explained the consequences of dietary deficit in the simplest and most lucid manner in his paper, The Conquest of High Mortality and Hunger in Europe and America, 1990, “The First Law of Thermodynamics applies as strictly to the human engine as to mechanical engines. Since the overwhelming share of calories consumed among malnourished populations is required for BMR and essential maintenance, it is quite clear that in energy-poor populations such as those of Europe during the second half of 18th century, the typical individual in the labour force had relatively small amounts of energy available for work.” This logic of 18th century Europe very aptly applies to the energy situation of our workforce in India today.

This Dietary Deficit is compounded by an Information Deficit at household level, especially among the lower-income families about what are balanced diets, why they are important, and how to have the most balanced diet within their family budgets. Every village in India has valuable and affordable greens, vegetables and local fruits, but they do not form part of the diets of the agricultural or construction labourers. Apart from poverty and ignorance, their diets, which normally consist of watery dal and roti/rice in the morning, and the same in the evening, are also rigidly governed by custom, generational tradition and taboos.

Finally, we have an inequitable Market Deficit for affordable, fortified energy food which can be consumed by children, adolescents and adults in lower-income families to bridge their dietary deficit. While the market has stacks of expensive fortified energy food and beverages for higher-income groups, there is nothing affordable for low-income groups except junk kurkuras and chips costing Rs 5. It is perfectly possible to produce a low-cost nutritive fortified energy food for children within Rs 5 from wheat, defatted soya, green gram and ragi malt, providing around 380 calories from 25 grams.

A feasibility study conducted through KPMG in 2018 under the Karnataka Multi-sectoral Nutrition Pilot Project, calculates a market demand of 42 million tons of low-cost energy food per year, but strangely, no private entrepreneur wants to enter this field. One can only conclude that there is a quiet understanding between multinationals monopolising this market and our F&B sector, that this market vacuum for affordable energy food will not be disturbed and protein imperialism will continue. This, despite the firm finding in the feasibility study that there is a direct correlation between high incidence of low weight, stunting and wasting among children; low body mass index and stunting among adolescents, and lack of low-cost fortified energy food in the market.

So, how does India overcome this triple deficit to create a smart demographic dividend? First and foremost, by acknowledging the problem, and including it in the public policy domain, as an unaddressed goalpost for development. So far, this has not happened, either in the Niti Aayog, or the Poshan Abhiyaan, though the New Education Policy 2020 devotes some space to it.

Only after acknowledging the problem, and throwing it open to public debate, will the best innovative solutions emerge to overcome the triple deficit -- of reform and improved coverage by ICDS, new outcome-oriented interventions by our vast pool of women power through SHG groups and panchayats, who can be trained to work as village volunteers for spreading awareness and information, or even starting energy food production units under existing livelihood programmes, if our F&B sector continues to be inequitable. Finally, the mindset of policymakers and programmers, down to field workers and families, that subsistence diet equals food/nutrition security, must change.

Raising the diet of the people from subsistence level to a higher level of nourishment and overcoming the triple deficit is the only way that the health, education, skills, employability and earning capacity of our demographic dividend can improve. They are our greatest asset for building a new India, expanding our economy, raising our GDP, and becoming the world power that we aspire to be. We have started the process of creating smart cities and villages. We must now create our greatest asset -- the smart demographic dividend.

 
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That is really sad, India needs to be broken up. Money is wasted on nationalistic military, kickbacks and corruption. A free India is a divided up India.
They get what they deserve, it’s a democracy after all

All these kids will grow up to be nothing and will vote in more stupid leaders.



Not that Pakistan is doing much better though...
 
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That is really sad, India needs to be broken up. Money is wasted on nationalistic military, kickbacks and corruption. A free India is a divided up India.
We spend 2.4% of our GDP on defence while you spend 4.2% on defence, shows the priorities.
 
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Why India has a high infant mortality rate? only 1.5% of its GDP on healthcare

October 8, 2020, 11:18 AM IST Javaid Sofi in Poverty of Ambition | India | TOI

Developing health policies in India is a complex process, and one of the reasons is India’s burgeoning population. India has more people than the US, Australia, Russia, Canada combined. It only has 4% of the world’s surface but has around 16% of the world population. It would be a challenge for any country to provide reliable healthcare access to so 1.3 billion people, especially if it is a developing country like India. The lack of reliable data to make policy decisions also impedes efforts to improve access to care. India has a federal political structure, and Healthcare is a state subject; this creates bottlenecks while framing policies and spending the approved budget. Additionally, limitations such as poverty and caste make it difficult for millions to access Healthcare due to discrimination.

India is divided into two parts: one is urban India, and another in rural India. We have hospitals that deliver high-quality health care to the urban rich, and on the other end, we have people that cannot access basic necessary healthcare facilities. The private sector hospitals in India mainly cater to the urban rich while the rural poor have no option but to visit local health centers. Even during COVID, these private hospitals provided telemedicine facilities to their customers. Simultaneously, the poor and rural population continued to suffer as they could not avail of any such facility due to the lack of resources. Many local health centers do not have the necessary amenities such as beds, wards, drinking water facilities, clean labor rooms for delivery, regular electricity, and 47% of doctors’ vacancy remains unfilled due to budget constraints. These centers often have only one doctor for more than 51,000 people.

India has one of the highest infant mortality in the world at 721,000, which is 1975 deaths daily on average. India’s IMR is worse than that of its neighbors, such as Bangladesh, Bhutan, Sri Lanka. Even though India performs economically well then in these countries, in 2019, India spent only 1.5% of its GDP on Healthcare. According to UNICEF, 50% of all deaths below five can be prevented by providing skilled health care at birth and quality postnatal care for the mother and baby. Undernutrition is associated with 50% of all under-five deaths. 53% of women in India have anemia. Good governance and adequately trained healthcare staff can together reduce neonatal deaths by an average of 24%.

The numbers are high due to lack of facilities at primary health centers, such as doctors, beds, clean water, bathrooms, and even shortage of transport to urban hospitals where specialized care can be given to the infants. The majority of these deaths (58%) are neonates- newborns younger than 28 days. 60% of primary health centers in India do not have a stabilization unit for newborns, and these centers have a shortage of specialist doctors from 75% to 95%. IMR also gives us information about the urban-rural healthcare divide, while urban India has a score of 23, rural India has a score of 23.

India’s public health system is ailing, under-funded, and non-responsive. India spends one of the lowest amounts of 1.1% of its GDP as a country on Healthcare. Around 75% of healthcare spending comes from out of pocket expenditure, and healthcare expense is a fundamental cause of destitution.

Other factors, such as low educational status, poor literacy, and inadequate government investment for health, are some reasons why millions in India do not have access to Healthcare. The role of public finance in health care has been declining over the years and is now mostly based on out of the pocket expenditure.

In 2016, 2.4 million people died in India due to a lack of Immunization is an extremely cost-effective way of reducing IMR. Yet, it remains low in India due to which India has the record number of unvaccinated children in the world and has the second-highest population of children that are not vaccinated for measles after Nigeria. Millions of infants were saved from measles, polio, diarrhea, and pneumonia worldwide with vaccines’ help.

Around 45% of girls in the age group of 20-24 are married before the legal age of 18, and 20% have already given birth at 18. Motherhood at such an early age increases the chances of neonatal deaths, infant morbidity, and mortality. Women who reported child marriage have more excellent infant mortality rates than women who did not register child marriage. Children born to minors are susceptible to malnutrition compared to married women later in life. In the cultural context, minor girls are dominated by their husbands and in-laws; they cannot advocate for their rights. Uttar Pradesh, a state in India with a population of 200 million people, has the highest number of minors who have become mothers 1 million and unsurprising has the worst health care indicators in the country.

It might be argued that we need stringent laws to curb child marriage, but India officially banned it in 2006, and to protect child brides, sex with minors is considered rape. Even though these laws passed, it is hard to implement these laws because of the social and cultural norms. The shortage of access to education and health services perpetuates it.

Culturally it is considered a norm to marry daughter young to secure their future socially and financially. Parents do not view the future of their girls outside of housework and having children. Currently, India has 15 million child brides officially and many more unofficially as most people do not register their marriages until they achieve the legal age to marry.

 
.
Why India has a high infant mortality rate? only 1.5% of its GDP on healthcare

October 8, 2020, 11:18 AM IST Javaid Sofi in Poverty of Ambition | India | TOI

Developing health policies in India is a complex process, and one of the reasons is India’s burgeoning population. India has more people than the US, Australia, Russia, Canada combined. It only has 4% of the world’s surface but has around 16% of the world population. It would be a challenge for any country to provide reliable healthcare access to so 1.3 billion people, especially if it is a developing country like India. The lack of reliable data to make policy decisions also impedes efforts to improve access to care. India has a federal political structure, and Healthcare is a state subject; this creates bottlenecks while framing policies and spending the approved budget. Additionally, limitations such as poverty and caste make it difficult for millions to access Healthcare due to discrimination.

India is divided into two parts: one is urban India, and another in rural India. We have hospitals that deliver high-quality health care to the urban rich, and on the other end, we have people that cannot access basic necessary healthcare facilities. The private sector hospitals in India mainly cater to the urban rich while the rural poor have no option but to visit local health centers. Even during COVID, these private hospitals provided telemedicine facilities to their customers. Simultaneously, the poor and rural population continued to suffer as they could not avail of any such facility due to the lack of resources. Many local health centers do not have the necessary amenities such as beds, wards, drinking water facilities, clean labor rooms for delivery, regular electricity, and 47% of doctors’ vacancy remains unfilled due to budget constraints. These centers often have only one doctor for more than 51,000 people.

India has one of the highest infant mortality in the world at 721,000, which is 1975 deaths daily on average. India’s IMR is worse than that of its neighbors, such as Bangladesh, Bhutan, Sri Lanka. Even though India performs economically well then in these countries, in 2019, India spent only 1.5% of its GDP on Healthcare. According to UNICEF, 50% of all deaths below five can be prevented by providing skilled health care at birth and quality postnatal care for the mother and baby. Undernutrition is associated with 50% of all under-five deaths. 53% of women in India have anemia. Good governance and adequately trained healthcare staff can together reduce neonatal deaths by an average of 24%.

The numbers are high due to lack of facilities at primary health centers, such as doctors, beds, clean water, bathrooms, and even shortage of transport to urban hospitals where specialized care can be given to the infants. The majority of these deaths (58%) are neonates- newborns younger than 28 days. 60% of primary health centers in India do not have a stabilization unit for newborns, and these centers have a shortage of specialist doctors from 75% to 95%. IMR also gives us information about the urban-rural healthcare divide, while urban India has a score of 23, rural India has a score of 23.

India’s public health system is ailing, under-funded, and non-responsive. India spends one of the lowest amounts of 1.1% of its GDP as a country on Healthcare. Around 75% of healthcare spending comes from out of pocket expenditure, and healthcare expense is a fundamental cause of destitution.

Other factors, such as low educational status, poor literacy, and inadequate government investment for health, are some reasons why millions in India do not have access to Healthcare. The role of public finance in health care has been declining over the years and is now mostly based on out of the pocket expenditure.

In 2016, 2.4 million people died in India due to a lack of Immunization is an extremely cost-effective way of reducing IMR. Yet, it remains low in India due to which India has the record number of unvaccinated children in the world and has the second-highest population of children that are not vaccinated for measles after Nigeria. Millions of infants were saved from measles, polio, diarrhea, and pneumonia worldwide with vaccines’ help.

Around 45% of girls in the age group of 20-24 are married before the legal age of 18, and 20% have already given birth at 18. Motherhood at such an early age increases the chances of neonatal deaths, infant morbidity, and mortality. Women who reported child marriage have more excellent infant mortality rates than women who did not register child marriage. Children born to minors are susceptible to malnutrition compared to married women later in life. In the cultural context, minor girls are dominated by their husbands and in-laws; they cannot advocate for their rights. Uttar Pradesh, a state in India with a population of 200 million people, has the highest number of minors who have become mothers 1 million and unsurprising has the worst health care indicators in the country.

It might be argued that we need stringent laws to curb child marriage, but India officially banned it in 2006, and to protect child brides, sex with minors is considered rape. Even though these laws passed, it is hard to implement these laws because of the social and cultural norms. The shortage of access to education and health services perpetuates it.

Culturally it is considered a norm to marry daughter young to secure their future socially and financially. Parents do not view the future of their girls outside of housework and having children. Currently, India has 15 million child brides officially and many more unofficially as most people do not register their marriages until they achieve the legal age to marry.


RSS says hinduvta is a 2020 supa powa, so this must be fake news
 
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India is the world biggest weapon imported by a huge margin for the last decade, the government doesn't care about people's life and death, this is what they called democracy.

Better to be malnourished and free than to have a full belly living in a communist police state
 
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Should start a program distributing free cereal bars fortified with protein and vitamins.

It would cost a lot of rupees bit well worth it.
 
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Only if you're an idiot such as yourself. Are you really that ashamed of your Indian flag? I don't blame you.

Why would I be ashamed of an Indian flag when I'm not an Indian citizen? I was born in Canada, live in Canada and am a Canadian citizen. I don't believe in patriotism or displaying flags, it's just the way this forum is set up you are asked your country of citizenship and current location and the flag of that country is displayed. I take no pride in any flag.

Having said that, why is it shameful to display the Indian flag and not the Pakistani flag? As I recall, Pakistan lost every war it fought with India, so shouldn't it be shameful to display the Pakistani flag (going by your logic)?
 
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