Nutrition remains one of the least-talked-about sectors in Pakistan, even though it has the most debilitating impact on poverty and the quality of life. The nutrition debate has been submerged in a medically-crafted discourse of health and a set of somatic pathologies with clinical significance for treatment.
This reminds us of Michel Foucault’s cogitations about madness. According to Foucault, madness has been reduced to a discipline of psychiatry or clinical psychology even though madness itself is seen only as a risk to social conformity.
Nutrition has been reduced to a clinical discipline and a technical subject as a domain of medical specialists and health practitioners and has lost the side of the broader development dimensions of food security, distribution, management and governance. Malnutrition in Pakistan is not only about the physical state of an individual. Instead, it is also about the lack of education, awareness, faulty distribution, bad governance, primitive agriculture, low-quality agricultural inputs and economic greed.
A balanced intake of carbohydrates, fats, proteins, water, vitamins and minerals may require technical advice. But this will work only if we have invested enough to educate our population to maintain a healthy life. Non-medicated, cheap, indigenous and accessible sources of nutritious food are the only sustainable solutions to an increasingly stunted population in the country. Even the abundance of food is not necessarily a condition of nutritional adequacy as it is the content of food that matters more than what we eat in our daily life.
Nutrition, therefore, is not only about the availability of food. Instead, it is also about the suitability of food for human growth and health. This requires education, behavioural changes, lifestyle adjustments and a health-seeking social environment in addition to food supply. Nutrition is, therefore, not only about the poverty of means but also about the poverty of minds and development practitioners should address these concerns. It is also about the economic and political choices that we make in food distribution, governance and production that, in turn, determine the quality of food content we use.
According to Cheryl Ritenbaugh, a nutritional anthropologist, diet, biology and social organisation have been intimately linked to one another and food served both a physiological and social function from the earliest hominids of the hunting age to the evolution of modern homo sapiens. Even today, our dietary habits are linked with social organisation, institutional mechanisms, our economic life and social behaviour.
Decisions about food intake are based on budget, time availability, marketing and the societal norms of the peers and community. If cheap, convenient and processed fast food items are readily available to satisfy our craving for fat, salt and carbs, why should we bother about its nutritional value? The lifestyle that we have been accustomed to in the urban areas is one of the major impediments towards creating a nutrition-conscious society. In the rural areas that are plagued by extreme poverty, people face acute malnourishment owing to poor distribution mechanisms and a macroeconomic policy that does not consider agriculture as a sector of priority for investment.
When production is driven by an economic proposition of profitability rather than the social and nutritional needs of the people, the issue of malnourishment will continue to exist in a country where 42 percent of children suffer owing to stunted growth and acute malnourishment. In the northern part of Pakistan, traditional sources of nutrition – wheat, corn, organic vegetables, livestock and fruits – are no longer used by the local population. Instead, they are produced for the market and chemical fertilisers and pesticides are used for short-term economic gains. In the long run, these fertilisers and pesticides destroy soil fertility and local biota.
The indiscriminate use of chemicals and pesticides are poisoning food supply and the environment. Around 80 percent of the antibiotics that are used on farms give origin to the danger of antibiotic-resistant superbugs. This has devastating effects on public health and the local economy whereby people have become vulnerable to fatal diseases.
According to local research sources, the prevalence of lifestyle-related diseases like diabetes, hypertension, cancer and cardiovascular complications have increased by 80 percent during the last 20 years in relatively healthy societies like Hunza. Dietary patterns have seen a significant shift from the consumption of locally-produced organic food to the low-quality and unhygienic products that are available in the market. According to a senior agriculturalist of the GB government, the staggering challenge posed by health issues is linked with the increasing reliance on low-quality and adulterated food items that are sold in the local markets in collusion with corrupt government officials.
The waste of food is another important dimension that causes food insecurity. More than 50 percent of food items produced for the market is wasted due to systemic inefficiencies and the primitive means of food production, processing, packaging and distribution in Pakistan. Crops such as sugarcane and cotton, which have high prospects of return on investment, are grown on vast expanses of land while Pakistan is not self-sufficient in wheat and corn cultivation despite being a predominantly agricultural economy.
In other parts of Pakistan, there is an obnoxious nexus among poverty, food insecurity and institutional mismanagement that has resulted in an ever-increasing ratio of stunting, starvation and famine. Pakistan contributes to the most severe acute malnutrition (SAM) burden worldwide after India. With a high rate of SAM cases – which amount to 5.8 percent of the national average – Pakistan has crossed the international emergency threshold owing to poor institutional mechanisms, low-quality service delivery, misplaced economic policy and the lack of political accountability.
An important case is the drought-hit region of Thar where more deaths are recorded due to institutionally-induced malnourishment rather than droughts.
According an assessment report by the UN, the main cause of recent deaths in Thar is the surge in morbidity and mortality rates among children and adults. In the absence of basic facilities like rainwater management, food distribution OPT services, stabilisation centres and poor local governance, the people of Thar, particularly children and lactating mothers, have suffered a great deal in the recent past.
Some NGOs have been brave enough to respond to this nutrition emergency in Thar through well-designed projects. The Thardeep Rural Development Programme (TRDP) and Welthungerhilfe (WHH) initiated a programme in Umerkot through which 2,400 lactating mothers, who have been identified as malnourished, are supported with a cash grant of Rs33.2 million. Under this scheme, 175 water facilities will be constructed to provide wages worth 6,000 working days to 2,400 households in 105 villages.
In addition to these facilities, households will also receive vaccination and de-worming for their livestock against seasonal diseases. Around 4,500 individuals from these poor households will be trained to conduct vaccination and provide community-based solutions to improve access to safe drinking water and sanitation. These integrated programmes will be vital to address the multidimensionality of malnutrition and the government should help such initiatives to combat the nutrition emergency.
Nutritional problems in Pakistan are multifarious. They range from issues pertaining to governance, institutional mismanagement and distribution to low productivity, lack of awareness and the inflow of low-quality and adulterated food items. The most debilitating impact of malnutrition is faced by infants, lactating mothers and children. These issues are mostly triggered by poverty, unconducive hygiene conditions, poor maternal nutrition and the lack of understanding among mothers about the weaning process.
We need to come up with a pragmatic development model to demonstrate locally viable solutions in combination with cutting-edge development approaches to address malnutrition. What the TRDP and the WHH have demonstrated through their integrated multi-sector support to improve the resilience of communities against food insecurity and malnourishment is an example of development pragmatism. It is now the responsibility of the provincial governments to help knit together such initiatives through policy incentives and an enabling institutional network of governance and accountability.
The writer is a freelance columnist based in Islamabad.
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