The child malnutrition hoax: Why jholawallas are wrong

Due to a fundamental error in the way malnutrition is measured by WHO, India's child malnutrition levels appear worse than sub-Saharan Africa. It is a myth.

R Jagannathan May 02, 2013 11:55:27 IST
The child malnutrition hoax: Why jholawallas are wrong

The bad news for India’s jholawallas is getting worse. With every passing day, as more evidence pours in from the real world, it appears that the Food Security Bill—an act of faith for Sonia Gandhi and her NAC cohorts—will become a costly voter indulgence rather than a necessary antidote to extreme poverty and child malnutrition.

The stock myth our poverty-mongers have drummed up is that "malnutrition levels in India are worse than in sub-Saharan Africa." Since this raises fears of children with sunken eyes and bow-shaped legs, opposing over-subsidised food for 65 percent of the population is a strict no-no for anyone with an ounce of conscience.

But the truth is that both hunger and malnutrition are on the wane and grossly exaggerated by the jholawallas.

The child malnutrition hoax Why jholawallas are wrong

Not the right diet. AFP

In March this year, Firstpost had reported results from the National Sample Survey (NSS, 66th Round) on Perceived Adequacy of Food Consumption in Indian Households, which showed a clear drop in hunger levels. The proportion of rural households saying they are getting two square meals a day throughout the year increased from 94.5 percent to 98.9 percent between 1993-94 and 2009-10. The proportion of urban households saying the same increased from 98.1 percent to 99.6 percent."

In short, very few people are going hungry in rural areas and practically none in urban areas. Not that hunger is abolished, but it is certainly far less severe – in what people themselves perceive to be the case.

But now comes another big myth exploder from Arvind Panagariya – that Indian malnutrition levels are worse than sub-Saharan Africa’s. Apparently, this is bunkum.

Writing in The Economic and Political Weekly, Panagariya, Professor of Economics at Columbia University, USA, concludes: “This narrative (of child malnutrition in India being worse than in sub-Saharan Africa), nearly universally accepted around the world, is false. It is the artefact of a faulty methodology that the World Health Organisation (WHO) has pushed and the UN has supported. If appropriate corrections are applied, in all likelihood, India will be found to be ahead of sub-Saharan Africa in child malnutrition, just as in other vital health indicators.” (Read the full EPW article here).

The poverty-wallahs will be shocked and will surely challenge Panagariya. But the EPW is no right-wing propaganda tool. It is one of India's most respected publications and especially revered by the Left.

So what is Panagariya basing his conclusions on?

To show that comparisons with sub-Saharan Africa are bogus, Panagariya uses several examples to prove the WHO definition wrong.

Take India’s figures as compared to the sub-Saharan country of Chad. Life expectancy in India (as in 2009) was 65 compared to Chad’s 48. Infant mortality (per 1,000 live births) in India was 50 against Chad’s 124. Maternal mortality per 1,00,000 live births was 230 in India versus 1,200 in Chad.

As against this, when Chad is worse in every parameter of child and maternal care, it’s malnutrition data is just marginally below India’s: the percentage of children below five shown as stunted (in 2000-09) was 47.9 in India versus just 44.8 in Chad.

Would you not expect a country with two-and-a-half times India’s infant mortality rate and five times maternal mortality rate to be significantly worse on child malnutrition?

Panagariya says the gross distortion in India’s malnourishment data comes from a wrong standardised definition. He says: “The central problem with the current methodology is the use of common height and weight standards around the world to determine malnourishment, regardless of differences that may arise from genetic, environmental, cultural, and geographical factors. Though medical literature recognises the importance of these factors, the World Health Organisation totally ignores them when recommending globally uniform height and weight cutoff points against which children are compared to determine whether they suffer from stunting (low height for age) or underweight (low weight for age) problems.”

We all know that Indians are shorter and smaller built than Americans and Africans, but we use the former’s height and weight measures to determine our malnutrition levels. By American standards, even the Japanese would be severely stunted since they are shorter and more slightly built on an average.

It is commonsense to adjust for these genetic differences that result in height and weight differences while computing our levels of malnutrition. And our malnutrition data is built on such fundamental errors.

Panagariya gives another example by comparing Kerala—an Indian outperformer in human development indices—with Senegal.

Kerala’s life expectancy was 74 in 2009 against Senegal’s 62; its infant mortality (per 1,000 live births) was one-fourth the Senegalese rate, and under-five mortality one-sixth that of the sub-Saharan country.

So one should logically have expected more stunted children in Senegal than in Kerala, right?

Surprise! The percentage of children below five recorded as stunted is 25 in Kerala to Senegal’s 20. The percentage of underweight children in Kerala is 23 against 15 in Senegal.

Sorry, dear Mallus, you have to feed your under-five kids more.

So is everybody from The Economist (read what the mag said in Panagariya's EPW article) to Manmohan Singh wrong about India’s acute child malnutrition problem?

The answer is yes and no. They are wrong about the extent of malnutrition—and we are certainly not worse than sub-Saharan Africa—but we may still have a problem that needs conquering. To repeat: India has not licked the child malnutrition problem, but no purpose is served by exaggerating the problem and hyping it. The problem may, in fact, need targeted and localised remedies rather than something universal.  The problem, in any case, cannot be solved by using the WHO's wrong metrics.

Says Panagariya: “Today, virtually all headline figures on child malnutrition, including the ones that led Manmohan Singh to declare the phenomenon a national shame, are based on height and weight. In view of the multidimensional nature of child malnutrition, this singular focus on low height and weight should itself be a source of concern.”

The author does not deny the problem, only its extent, and concludes: “The underlying question is about the validity of applying uniform height and weight norms around the world as the basis for determining whether a given child is well-nourished or malnourished. This focus does not deny in any way the importance of a full medical examination to determine whether or not a child is malnourished. But it addresses the deficiencies of the measures that are the source of virtually all discussion on child malnutrition in the public policy space.”

The short-point is this: even Gulliver would look like a severe case of stunted growth in Brobdingnag. One would have thought WHO could have applied better commonsense to the issue. Maybe, Panagariya’s effort will prompt them to.

Our jholawallas, though, are sure to go ballistic. Without poverty, they will be out of business.

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