Tuesday July 16, 2024

The menace of malnutrition

By Dr Salman Shah
July 09, 2018

History serves as a testament to the fact that the greatest contributor to the wealth, prosperity and development of a nation isn’t its natural resources but the stock of its brain power.

Nurturing brainpower requires an all-encompassing and comprehensive effort that starts in a mother’s womb and ends in a retirement home. It is a value chain that has to be cultivated from the conception of a child, to its birth and first 1,000 days, to its primary education to its secondary and tertiary education. This is followed by a meritocracy in the world of business and government, and the recognition and rewards that a country bestows on exceptional talent.

Demographically, Pakistan is among the youngest countries in the world, with almost 90 million people under the age of 15 – larger than the entire population of Germany. This group of young people is our best hope for the future. Unfortunately, we are oblivious to the role that they can play in our development. We aren’t investing in them to ensure that they are equipped for the future. We aren’t even providing them the basic minimum levels of nutrition.

According to the WHO, poor nutrition is the single most important threat to the world’s health. According to the Food and Agriculture Organization (FAO) of the UN, the number of undernourished people in the world stood at 841 million in developing countries in the early 2000s. These statistics suggest that fighting hunger is an important and essential issue, and there is an immediate need for international cooperation on addressing malnutrition.

Investing in nutrition and health should be a ‘basic human right’ and ought to be the priority of the development plans of any country. People who receive better nutrition not only live healthier lives but are also more productive. Despite this common knowledge, the amount of development aid spent on combating malnutrition globally is equal to only one percent or between $0.25 billion and $0.3 billion annually. Every country suffers from one of the three major malnutrition problems: under nutrition, overweight/obesity, and micronutrient deficiencies.

Investing in nutrition should also be a matter of smart economics because malnutrition affects various aspects of a child’s life, such as education, physical and mental growth and stunting. Giving priority to nutrition has shown significant economic gains. According to the Alliance to End Hunger, an international NGO, every dollar spent in scaling up nutrition interventions targeted towards the first 1,000 days, yields a return of $16 on the initial investment.

In addition, every addition in adult height due to proper nutrition has been associated with a 4.5 percent increase in wage rates. From a purely economic perspective, investing in nutrition is a good idea.

A recent study has revealed that investing $1.2 billion annually on micronutrient supplements, food fortification, and the biofortification of staple crops for five years can reap annual benefits worth $15.3 billion – a benefit-to-cost ratio of almost 13 to 1 – and would result in better health, fewer deaths and increased future earnings.

The consequences of malnutrition – including lost labourers, healthcare expenses and lower productivity – cost Pakistan $7.6 billion (or three percent of GDP) every year, according to a new report launched by the Pakistan Scaling Up Nutrition (SUN) Secretariat at the Ministry of Planning Development and Reform.

The consequences of stunting on education are also dramatic. Various studies show that child stunting is likely to impact brain development and impair motor skills. According to Unicef, stunting in early life is linked to 0.7 grade losses in schooling, a seven-month delay in starting school, and a reduction in lifetime earnings that falls between 22 percent and 45 percent. Stunted children become less educated adults. This makes malnutrition a long-term and intergenerational problem.

Malnutrition also slows down economic growth and perpetuates poverty. Mortality and morbidity associated with malnutrition represents a direct loss in human capital and productivity for the economy. At a microeconomic level, it is estimated that a one percent loss in adult height as a result of childhood stunting equals to a 1.4 percent loss in the productivity of the individual. In total, the economic cost of malnutrition is estimated to range from two percent to three percent of GDP

A recent study conducted on students across the world to highlight the proportion of bright people in a specific country revealed that the highest percentage of gifted students was in Singapore, with a total ratio of 9.1 percent. Taiwan scored 5.85 percent, Japan and South Korea scored over four percent, Switzerland scored 4.25 percent and the US scored 1.67 percent. Meanwhile, Brazil scored the lowest at 0.01 percent.

When these percentages were applied to the total population of these respective countries, the results showed that the US has the largest stock of brain power, which stood at 5.5 million people. Pakistan, with a population of 210 million, could have a stock of bright people that exceeds the US if it achieves Singapore’s ratio. However, some countries have a high ratio of gifted students because of their excellent schooling system and the efforts made by their governments in the child health sector.

Although Pakistanis are gifted and highly intelligent, the shameful efforts made by the system are preventing them from reaching their full potential. It is heartbreaking that our human development systems are worse than the Brics nations (Brazil, Russia, India, China and South Africa) – a group of countries with a large population that are destined to become the next economic powers in the world.

Pakistan is among countries that have a population of almost 90 million of children below the age of 15, which is larger than the entire population of Germany. With regard to the steps being taken in Pakistan against malnutrition, Punjab has established two organisations – the Punjab Food Authority (PFA) and the Global Alliance For Improved Nutrition (GAIN) Pakistan – to improve the nutrient component of food through fortification.

The Sindh government passed the Compulsory Iodisation of Salt Act in 2013, prohibiting the manufacture, processing or import of edible salt with an iodine content less than 30 parts per million (ppm). Khyber Pakhtunkhwa and Balochistan have yet to pass any relevant legislation in this regard.

Prior to 2011, Pakistan lacked a national nutrition policy because the National Nutrition Strategic Plan of 2002 was never implemented. No political party had nutrition on their list of agendas till the 2013 elections.

Recently, the Ministry of Planning Development and Reform launched the Pakistan Multi-Sectoral Nutrition Strategy (PMNS) in collaboration with the World Food Programme (WFP). The aim of this nutrition policy is to address the alarming nutrition crisis being faced by the country. A meagre budget of Rs10 billion has been assigned for the year 2018-2019. The nutrition strategy was developed through a consultative process, which includes support from national and sub-national level stakeholders, and the policy is aligned with the Pakistan Vision 2025. This initiative intends to provide high-quality and equitable nutrition services in order to reduce malnutrition. But it falls short of resources to achieve the desired results.

It is critical that a national strategic effort spearheaded by the federal and provincial governments, working together with the civil society, is developed with effective implementation mechanisms to overcome the menace of malnutrition.

Pakistan is one of the emerging economies of the world with a notable economic growth potential that is threatened by the burden of pervasive malnutrition. Unless immediate action is taken, the crisis of malnutrition will continue to negatively affect Pakistan’s economic performance. It also has the potential to condemn future generations to a catastrophic future of deprivation and poverty.

The writer is a former finance minister.