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Is malnutrition in India a bogey?

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In an interview with Tehelka, Arvind Panagariya, professor of Economics at Columbia University and former chief economist at the Asian Development Bank, argues that malnutrition figures for India may be wrong. He sets out the problem first:

When two sets of indicators lead to diametrically opposite conclusions, you either have a reasonable explanation for it or must reject one set of indicators. When we compare Indian children to those from sub-Saharan Africa (SSA) in terms of life expectancy, infant mortality rate (IMR), under-five mortality rate and maternal mortality rate (MMR), they look significantly healthier than the latter. But the picture turns on its head when we compare them in terms of incidence of stunting (low height for age) and underweight (low weight for age). The contrast is nothing short of dramatic.

I’m not an expert on health, let alone child nutrition, by any stretch of imagination. But soon after my 2008 book India: The Emerging Giant, in which I reported vital health statistics with approval, I began to notice the exceptionally poor child nutrition statistics and felt they could not be reconciled with the former. But I seriously focussed on the issue only when I took upon myself to write the chapter on health in a jointly authored book on the performance of Indian states. That is when I noticed that Kerala showed worse child nutrition statistics than many [Sub-Sahara African] countries.

He goes on to give examples of child-health indicators in which India does better than the control group of Sub-Saharan African nations:

Compare India with Chad, which has half of India’s per capita income. Using 2009 data, Chad has life expectancy at birth of 48 compared with India’s 66, IMR of 124 per 1,000 live births relative to India’s 50, MMR of 1,200 per 1 lakh live births in relation to India’s 230 and under-five mortality rate of 209 per 1,000 live births in contrast to India’s 66. Every one of these indicators places the health of Indian children miles ahead of those from Chad. Yet, child malnutrition indicators say that the proportion of children stunted and underweight is higher in India than in Chad!

It must be remembered that India’s child health statistics is far from what is required to achieve the Mileenial Development Goals. However, it sets a baseline for the argument that Prof. Panagariya develops:

We have been applying a uniform World Health Organisation (WHO)-specified height to decide whether or not a child of a given age and gender is stunted. And similarly, a uniform WHO-specified weight to decide whether or not the child is underweight, regardless of the child’s race, socio-cultural background, geographical location or time or vegetarian versus meat diet. Any failure to meet the WHO-specified standard is attributed to malnutrition and the child classified as malnourished.

But what if Indian children are on average genetically shorter and lighter than the population from which the WHO standards are derived? Then, even perfectly healthy Indian children would be classified as malnourished just because they fail to meet the height and weight standards derived from the WHO population that is taller and heavier on an average.

My reading of the evidence is — not by a long shot. Japanese men and women are about 12 cm shorter than their Dutch counterparts.

The differences are not limited to adults. A 2006 study of infants born to Indian mothers in the US during 1995 to 2000 finds higher incidence of low birth weight and small-for-gestational age, and yet lower infant mortality rates for most part than the children of white mothers.

He goes on to develop this theme of improper standards with regard to adult malnutrition:

The claims of widespread adult hunger are principally based on the decline in calorie consumption observed in the surveys conducted by the National Sample Survey Organisation (NSSO). But there are good reasons to be sceptical that this decline reflects increased hunger. The decline has occurred across all consumer classes, including the richest ones. This points to factors other than access that have led to reduced calorie consumption across all category of consumers, rich and poor.

One obvious such factor is reduced need for calorie consumption due to improved absorption of calories consumed as well as reduced physical work. The former (improved absorption) has occurred due to improved epidemiological environment and access to healthcare.

Finally, measured calorie consumption is probably understating actual calorie consumption because it does not properly record midday meals, which too have progressively expanded.
These observations are consistent with the answers people give in the NSSO surveys when asked whether they had enough to eat on all days of the year. In the 2004-05 survey, 97.4 percent of the respondents in rural and 99.4 percent in urban areas replied to this question in the affirmative.

Here is an academic debate with political consequences, but which remains academic. On the one hand, there is enormous amounts of data, analyzed according to certain fixed standards laid down across the world. On the other hand there is a reasoned argument that the standards of analysis are based on faulty beliefs of physical uniformity of all ethnic groups. This has all the hallmarks of a reasoned debate.

However, the political issues do not depend crucially on the outcome of this debate. By no means is India anywhere close to the standards of living of northeastern Asia or northern Europe; this is an argument about whether we are destitute or poor.

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Written by Arhopala Bazaloides

November 26, 2012 at 4:12 am

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