Dr. Rajan Sankar, Programme Director- Nutrition, TATA Trusts speaks to Outlook on nutrition, food fortification and how can both corporates and communities help in eradicating malnutrition.
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00:00 I am Dr. Shankar.
00:07 I am a physician by training.
00:10 I work with the Tata Trust Nutrition Division.
00:16 I am the Director of Programs for Nutrition.
00:23 At the outset I would like to very clearly and emphatically mention that India has the
00:37 wherewithal and the means to really achieve SDG 2.
00:43 Now if you look at the different aspects of the question that you ask, I think food security
00:52 is a household level concept and if you say hunger, it is an individual level concept
01:00 though they are all related and a chronic food insecurity is what leads to malnutrition,
01:07 one of the causes and there are several other things and all this is in some way related
01:13 to what you the agricultural economy and the produce.
01:21 So the question is can we achieve SDG 2, I think definitely yes and the way that the
01:31 country is moving, I am very confident that we will be able to eliminate hunger and we
01:39 have achieved quite a bit of food security at household level and we should be able to
01:45 substantially reduce the level of malnutrition.
01:48 Yeah, when you take, I would like to face it as how do we tackle malnutrition, you know
02:05 to tackle malnutrition we need to understand there are different dimensions to it.
02:12 One is when you eat much less than what you need and you result in what is called undernutrition,
02:20 the other extreme is when you consume more than what is required, you end up with overweight
02:25 and obesity.
02:26 What straddles both this form of malnutrition is what is the vitamin and mineral deficiency
02:32 what we also known as micronutrient deficiency.
02:36 There are three dimensions to malnutrition, one is undernutrition, the other is overnutrition
02:45 and what straddles both this form of malnutrition is what we call micronutrient deficiencies
02:53 or what is also known as vitamin and mineral deficiency.
02:58 Each one of them require a separate strategy, though they are all at the implementation
03:04 level, they are all related and they will all be done in one way.
03:16 See vitamin and mineral deficiency is a very widely prevalent nutritional disease and numerically
03:25 probably this is the most widely prevalent nutritional disorder.
03:30 One example is the prevalence of anemia in India and across South Asia.
03:36 Now there are different ways by which you can address this, the ideal would be for people
03:43 to eat a balanced diet and eat right, but unfortunately that is not possible because
03:51 the food is either not available or affordable as well as there are huge behavioral challenges
03:57 in eating right.
03:58 So the second way to tackle this at a national level is identify those who are deficient
04:05 or at least those in the high risk category like pregnant women or very young children
04:12 and give them the supplements say iron folate supplement or zinc supplementation to what
04:19 is required.
04:20 But that is again cumbersome in the sense it requires a complete delivery channel and
04:25 you have to contact those who are deficient and provided.
04:30 And the third commonly used strategy is identifying the commonly eaten food and adding these missing
04:39 vitamins and minerals into the commonly eaten food and this is what we call as food fortification.
04:46 Food fortification has played a major and significant role in virtual elimination of
04:53 many nutritional disorders from the developed countries such as in the whole of North America
05:00 and Europe diseases like beriberi, vitamin you know rickets, goiter they have all been
05:06 virtually eliminated because of food fortification.
05:11 Countries like India, this is one strategy which is grossly underutilized and it is time
05:18 that we use this for the benefit of the population.
05:22 See malnutrition is a very complex problem, you know there are multiple level of causality
05:34 at the closest level we talk about it is about what you eat and how healthy one is, you should
05:41 eat right and eat right amount of food and one should be in good health to digest or
05:48 assimilate and use this food.
05:52 This is at the most proximal level.
05:54 There are two other levels where you talk about several other factors such as food security,
06:02 food security at a national level, food security at household level and then the ability to
06:09 use the available food, the intra-household sharing that is where comes about the intra-household
06:16 dynamics, empowerment of women, literacy of women and so many other factors.
06:22 Then you have the environment that talks about you know the disease in the environment, you
06:28 know it is water and sanitation, hygiene, these are other important issues.
06:34 So it is a very complex and interrelated problem.
06:39 As we can see in India for the phenomenal progress that the country has made, you know
06:46 in several fronts malnutrition remains as a very big challenge.
06:51 So it clearly shows we need multiple sectors to come together to play a role and corporates
07:00 or businesses are one of the important pillars of any economy.
07:06 So they also should play the role that they can.
07:11 Another important thing the role that they can play is more and more with the rapid urbanization
07:20 that is happening with more women getting into the workforce and more of the population
07:27 getting into cash economy, they are all dependent on the market for their daily food needs.
07:33 So the businesses that are in food and beverage business, they have a big role to play as
07:40 well as a very big responsibility to carry on their shoulders for the right nutrition
07:46 and health of the population.
07:48 So one has what direct role that these companies who are in food and beverages business can
07:53 play and then anyone in the business or anyone in the corporate sector can play a role by
08:01 making, see nutrition and health are fundamental drivers of growth.
08:08 Unless you have healthy people, you will not have a healthy economy.
08:13 So they must get all sectors of the society to be part of this fight against malnutrition.
08:24 See that is a very important question.
08:28 I think it has also been one of the real missing pieces in our country.
08:33 It has always been viewed as the responsibility of the government.
08:38 I completely agree that the government has to be in the driver's seat to improve the
08:43 population health, population nutrition.
08:46 But a lot of nutrition occurs at home.
08:49 You know at the individual level, at family level, at community level, people will have
08:54 to take on that responsibility to improve their health and nutrition.
09:00 You have built Anganwadi centres but they are of use only if people go and utilize them.
09:07 They often give that excuse that the delivery of services are poor but only by increasing
09:14 the utilization, taking ownership by the community of all these health and nutrition centres
09:21 that will only put pressure on the service delivery to improve service delivery.
09:27 So I think that is important and also a lot of nutrition has to happen at home.
09:33 You know the decision of a mother to adopt and breastfeed the child, take the child and
09:39 get the child immunized and go and get the child attended to as and when the child has
09:48 you know medical illness or any health issues, all that requires a kind of you know health
09:57 seeking behaviour that would improve the health and nutrition of the child and the society
10:05 as a whole.
10:06 So the community participation and community's ownership I would say and taking the responsibility
10:13 for health and nutrition would constitute a very important part for us to succeed in
10:19 this fight against malnutrition.
10:21 There have been some great successful examples, you know there are many examples across the
10:30 country, several NGOs have done.
10:33 For example I work with Tata Trust now and we have a project called Making It Happen
10:38 in Rajasthan and Andhra Pradesh and in Palgat district in Maharashtra.
10:44 In these places where you work with the community, create that awareness and also get the PRIs
10:53 you know the Panchayati Raj institutions and self-help group women and adolescent girls,
10:58 take the leadership and use the community health facility as well as the Anganwadi
11:05 centres, things improve remarkably.
11:09 There are several examples of such successful models, but the problem is many of them are
11:16 working either slowly or at very small scale and the real issue is to take these models
11:26 to scale and at speed and for that we need mass mobilisation and mass mobilisation where
11:34 the communities take the ownership and drive the agenda.
11:40 With this India's growth story and all that has been written about that inequity, there
11:55 are sections of the population who are very rich and many of them are also setting up
12:01 their own philanthropic foundations and we also have a legal mandate for the corporates
12:10 to donate or you know implement the corporate social responsibility where a certain proportion
12:21 of their profit for the social benefit.
12:25 So we have a lot of resources coming, quite a bit of it is going towards education and
12:33 quite a bit to curative medicine, but somehow nutrition has not attracted these donors and
12:42 I think it is very important for the nutrition community to project to the philanthropists
12:49 as well as the CSR resources that nutrition and health are foundational blocks for human
12:58 development and the link between optimum and nutrition at the right age what we call as
13:06 a critical window of opportunity, the first 1000 days that is from conception to the first
13:12 2 years of the child is where most of the brain development occurs and that is what
13:18 determines how well the child is going to be, how much of the true genetic potential
13:24 the child can reach.
13:26 So investing in nutrition in early life or in the first 1000 days is one of the foundational
13:36 investments for a bright future of the country.
13:40 So therefore the philanthropists and CSR funding should also focus on this if they want their
13:47 later investment in education to really fructify.
13:52 So I think it is a big role and the nutrition community has to project this very well and
13:58 drawing more resources for nutrition.
14:07 I think it is fantastic and I really appreciate the group that has come forward to do this.
14:18 The media has generally played a role as a watchdog and has only been pointing out where
14:25 there have been hunger, there have been hunger deaths, where there have been serious problems
14:30 and that has played its role and that has you know really always had the whip in its
14:36 hand and beaten those in slumber.
14:38 But I from the little that I know from this initiative, this is likely to be a comprehensive
14:46 platform to bring you know all the stakeholders on board and give a lot of positive stories
14:56 because eventually it is only the positive stories from which people can learn how to
15:01 expand and cover the entire country.
15:05 So creating a platform for action by showing a lot of positive stories, keeping all the
15:11 key stakeholders interested in it is I think a phenomenal initiative and I wish all the
15:20 success for it.
15:21 [Music]