Investing in nutrition

Pakistan faces a great deal of challenges to cater to the health needs of its growing population. Recent studies conducted by leading health organisations provide substantial evidence of the declining access to quality health services in Pakistan.

The most common factors contributing to poor health conditions include water contamination, low-quality food intake, stress and a sedentary lifestyle. Easily curable diseases, such as malaria, diarrhoea and hepatitis are among the top killers due to the lack of access to affordable quality health services. Lifestyle-related diseases – such as cardiovascular ailments, diabetes and hypertension – are rampant among young people, placing Pakistan among the world’s impoverished nations of Sub-Saharan Africa.

Pakistan’s population has the highest risks of chronic degenerative diseases, such as cancer, obesity, childhood obesity, diabetes and cardiovascular diseases in the region. These diseases – especially coronary heart disease (CHD) – are some of the leading causes of death and reduced quality of life. In Pakistan, around 30 to 40 percent of all deaths are caused by cardiovascular diseases (CVD). CHD deaths in Pakistan have reached about 200,000 per year ie 410/100,000 of the population.

Children are vulnerable too. The risk for CVDs can begin before birth during foetal development and further increase during childhood following exposure to unhealthy diets, lack of exercise and smoking.

The major risk factors are tobacco use, high blood pressure, high cholesterol, obesity, diabetes, physical inactivity, stress and unhealthy diet. The more risk factors we have, the stronger the likelihood that we will suffer from chronic degenerative diseases, unless we take action to modify our risk factors and prevent them through lifestyle and dietary changes.

Pakistan has one of the highest levels of malnutrition in the world with over 40 percent of children suffering from stunted growth (as per the National Nutritional Survey). This means stunted immune systems, stunted brain development and stunted overall life chances. All this adds up to stunted economic development as a sizeable population of the working-age population suffers due to malnutrition.

The rates of stunting in Pakistan are higher now (at 44 percent) than they were in 1985 (42 percent). This means the number of stunted children has doubled in that period – from six million to 12 million, or 547 stunted children a day. In recent times, especially in the aftermath of 2010 floods and the persistent disastrous situations, Pakistan has seen the worst conditions in terms of nutrition and food security. People from rural areas and low-income groups are more susceptible to this situation. Repeated episodes of flooding have hampered food availability and worsened the food consumption capacity of children, leading to chronic malnutrition.

According to the National Nutrition Survey of 2011, the lack of sufficient food supply, the quality of diet, suboptimal infant and young child feeding practices and limited knowledge about nutritious foods has compounded the issues of food security and the nutrition situation in the country.

The survey highlights five key issues. First, about 30 percent of the population lives below the poverty line, leaving many households unable to afford nutritious foods. Second, women give birth 6.8 times in their lives on average, indicating high fertility rates and a lack of birth spacing. This, combined with the poor nutritional status of women, results in an intergenerational cycle of malnutrition where malnourished women give birth to malnourished babies.

Third, malnutrition contributes to almost 35 percent of deaths in children under five years of age. Fourth, about 15 percent of children under the age of five suffer from acute malnutrition (children with a z-score of weight-for-height less than minus two) whilst 44 percent suffer from chronic malnutrition (children with a z-score of height-for-age less than minus two). Fifth, around 42 percent of households in Pakistan are food-insecure and 18 percent of women of reproductive age are underweight (with a BMI below 18.5) 

Pakistan’s population projections show that the ratio of the working-age population to those who are not of working age will peak in 2030. There will be two people of working age for every person who is either too young or too old to work, creating a demographic dividend ie working people will have to support fewer people than ever before.

There is one crucial assumption in the use of the word ‘dividend’: that people entering the labour force will be able to get jobs and those jobs will lift them out of poverty. But the reality is that these new labour market entrants are stunted. As adults, they will not be able to get the jobs that can drive the Pakistani economy and lift them and their families out of poverty. We need to prevent them from being stunted now, not in 2030.

The Economic Growth Framework, formulated by the Planning Commission, outlines the significance of balanced food and requisite nutrition provisions to reduce malnutrition for a socially active and economically vibrant life that can enable an individual to participate in the growth of the country. The framework proposes a multi-sectoral, cost-effective approach to address nutritional issues through programmatic integration and linkage building to enhance nutritional awareness down to the grassroots level.

The framework suggests a multi-sectoral and multidisciplinary nutrition policy to achieve the nutrition-related sustainable development goals (SDGs) targets. The framework also provides a broad-based perspective for nutritional amelioration beyond 2017 and it may be seen in terms of the SDGs of ensuring sustainable food security and nutritional enhancement for the poor households in particular. 

The framework prioritises key policy areas in that a healthy life can be achieved and maintained by addressing the basic food and nutritional needs of the population by maintaining food self-sufficiency and availability up to the household level. This entails designing food and nutrition interventions at all levels with better coordination, monitoring and management mechanisms in line with the Economic Growth Framework. This framework also envisages the optimal utilisation of existing infrastructure in different sectors for nutrition interventions to reach targeted population groups.

The key rationale behind this policy framework is that nutrition investments not only stops child mortalities but also ensures a healthy population with enhanced an intellectual capacity and improved productivity as key drivers of economic growth. In other words, nutrition investment is one of the top policy priorities to give an impetus to economic growth and high economic returns in the long run. In line with this new realisation, the government of Pakistan established the Nutrition Wing (NW) in the Ministry of Health and launched a five-year programme, titled ‘Improvement of nutrition through primary health care and nutrition education/public awareness’.

Though it is in its embryonic stage, the NW is deemed instrumental in steering the development of a national nutrition strategic plan for the country. Barring a few fancy campaigns, there is no tangible outcome in terms of integrating nutrition with the overall development agenda as envisaged in the policy framework. Having said this, after the 18th Amendment provincial nutrition strategies are being devised and a number of projects and initiatives have been launched during subsequent years with support from development partners. These initiatives, though well-intended, suffer from a lack of technical and financial resources and a lack of political will on the part of provincial governments. 

In 2010, the Scaling Up Nutrition (SUN) Movement was launched globally to support the national leadership to promote collective action towards improving nutritional intake at the national level. The Ministry of Planning, Development and Reforms – together with the Ministry of National Health Services, Regulation and Coordination, the Ministry of National Food Security and Research and nutrition development partners – officially launched the SUN Movement in Pakistan and signed a declaration of commitment in December 2014.

There was optimism and hope that the objective of reducing malnourishment will be achieved through policy reforms and the engagement of key private and public stakeholders to scale up the agenda of nutrition. Unfortunately, this does not seem to be happening in the foreseeable future. If we do take action now, we will be left with an ailing generation facing a bleak future.

The writer is a freelance columnist based in Islamabad.

Email: ahnihal@yahoo.com