Food for afterthought

LAHORE: Provinces after the 18th amendment are enjoying huge federal transfers effortlessly and feed those funds to futile interests like there’s no tomorrow, paying no heed to the poor, who can't even afford food that can keep them in working health.

Given the low income of the working class one cannot expect them to consume nutritious food that is expensive. Most of the poorer and lower middle class families satisfy their hunger by eating low-cost staple foods that have also become costly now. They however must consume edible oil (small quantity) and salt to make the food palatable. Items like beef, mutton, and now even poultry meat is out of their reach. Eggs, another high protein food are now selling at Rs15 a piece and have also gone out of their reach.

The main staple food in Pakistan is wheat flour. It contains a high quantity of carbohydrates. Consuming baked wheat flour bread in adequate quantities provides the poor with the daily needed calories. But it does not provide the nutrients essential for maintaining a healthy body. They might even get proteins from various sources like pulses and occasional consumption of poultry meat. Essential micronutrients that are vital for maintaining good health in adults and promoting growth in children are missing from these foods.

We are a poor country, but these micronutrients are also missing in the diets of people even in affluent economies. To overcome these micronutrient deficiencies even the affluent economies have made it mandatory to add vital micronutrients in the stable foods before they are presented in the market for sales. Some of these micronutrients include iron, the deficiency of which is the main cause of anemia among the children and women of this country. Then there are elements like zinc, vitamins A and D and iodine that are supplemented in edible oil, salt and other commonly used foods to mitigate the impact of their deficiencies.

Micronutrient deficiencies are playing havoc with the health of Pakistanis; yet planners fail to adopt extremely low-cost micronutrient fortifications in staple foods; even anemia preventing fortification of iron has been suspended as provinces regulate food after the 18th amendment. There is a need to fortify edible oil with vitamin A to eliminate blindness in children due to its deficiency. Iodine should be added to table salt, which expecting mothers can start before birth, as its deficiency jeopardises children’s mental health and often their very survival. Zinc deficiency results in stunted growth in children, which could be prevented through its adequate supplementation in staple foods. Moreover, iron needs to be added to wheat flour as its deficiency is the major cause of anemia particularly in women and children. It is mandatory for all edible oil producers to add Vitamin A and D in their products. Some do it, others don’t. This is an issue of proper regulation. Rock salt in Pakistan is available with or without fortification of iodine. The iodised salt is slightly expensive. The poor go for a slightly cheaper variety that is not iodised. Wheat flour offers the greatest opportunity to get rid of anemia. Unfortunately, iron fortification is not mandatory in Pakistan, while it is in countries like India and Indonesia. The initiative to fortify wheat flour with iron in Pakistan was taken in 1997 by the then federal government. Iron transports oxygen into the body and plays an important role in muscle strengthening. Its deficiency reduces the working capability of a person and results in laborious breathing.

After various experiments, a suitable combination of folic acid and iron salt was recommended by local and international nutrition experts. By the end of 2010 around 176 flourmills across the country were fortifying flour. After three months of this fortification there was an appreciable decline of anemia among the women and children. These studies were conducted in villages around Lahore and Faisalabad where iron fortified wheat flour was distributed. The fortification discontinued after 18th amendment as the fortification additive supplied by an international NGO to the federal government was withdrawn by it. The provinces took over food issues from the federal government.

The provinces, awash with huge cash inflows from the federation, never bothered to look into the fortification issue. The fortification never needed a free fortification additive as it is very cheap.

A study by a PhD candidate at Punjab University revealed that 52 percent women and 56 percent children suffer from mild or severe anemia in Pakistan. More than 22,000 women in Pakistan have died because of anemia in the last one decade. The study further revealed that anemia-free population could accelerate the GDP growth by 2 percent.

The fortification cost is very low. It costs Rs0.20-0.25 per kg to fortify flour with iron and folic acid. For a 20 kg bag costing over Rs1,000 the additional cost would be only Rs5. The benefit to the economy and health of the nation would be enormous. The government should spell out a clear policy. Either the provincial governments supply the fortification supplement or allow the mills to fortify the flour and charge an additional amount of Rs5 per 20 kg bag from the consumers. If for instance the government of Punjab bears the fortification cost for its population the total amount would not be more than Rs1.25 billion.