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wHile Health is not a priority for the 2025 budget, it seems nutrition is. In the upcoming fiscal year, two union government plans will receive higher allocations – Saksham Anganwadi and Poshan 2.0. But will this solve India’s nutritional challenges?
Nutrition in India involves not only food insecurity, but also dietary habits shaped by culture, caste and gender relations. There is only one aspect of the nutritional challenge that accepts most of the policy priorities–malnutrition for women and children. At reproductive age, women outside men and older adults rarely have any image in the discussion of national nutrition policy. More importantly, we ignore non-communicable diseases caused by diabetes, hypertension and other lifestyles, which is indeed another manifestation of nutrition. One type of nutritional deficiency is because some people don’t have enough food, and the other is because people don’t eat enough nutritious food. The results are outrageous in a unique way.
India has the highest share of malnourished children and women with anemia. According to the National Family Health Survey 5, 36% of children under the age of five suffer, while 11% of breastfeeding diets have adequate diets. 57% of women aged 15-49 are anemia. The share of people suffering from diabetes, hypertension and other non-communicable diseases (NCDs) induced by this lifestyle has increased. 24% of women in India and 23% of men are overweight or obese, and 14% of women take diabetes medications.
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A comprehensive agenda
Poshan 2.0 and Saksham Anganwadi offer more of the same solutions – with housework, supplemental food, tracking severe and acute malnutrition cases, iron and folate tablets, etc., with POSHAN 2.0, and more focus, with other focus on the aspiring zone and the Northeast. However, these programs reinforce the notion that malnutrition is a problem only in certain parts of India and only in certain sectors of the population. Instead, what we need is a comprehensive nutrition agenda where nutrition is identified as a public health issue that affects people across the social class.
A comprehensive agenda will recognize the nutritional needs of all sectors of society. It must include: First, the clear identification of nutritional needs besides reproductive and child health; second, a broad suite of solutions, especially rooted in local food systems; third, the clear identification of local embedded facilities to provide nutritional services. We need most of the work to determine the local agency contacts on the agenda. Who will implement this every day in our community? The clear answer is: Health and Wellness Center (HWCS).
Currently, we provide supplemental nutrition to teen girls at Anganwadi Centers (AWCS) through bringing home rations, iron and folic acid tablets; and lunch for school children. We need to systematically expand nutrition-centric activities to other parts of the population and involve HCW and ACW. The nutrient content of poor women is related to pregnant women from all walks of life. The middle class also needs to emphasize the use of locally available low-cost, nutritious and concentrated agricultural products, which also require consumption of sugary, fiber-poor packaging commodities.
In order for HWC to carry out this agenda, they need enough numbers to cover the entire population. Each of them must have a detailed nutritional service to cover the entire catchment area. Currently, the propagation of HWC is unbalanced. There seem to be too many rural areas compared to urban areas. In rural areas, HWC concentrations are higher in some areas.
Nutritional services in HWC are limited. HWC should provide nutritional advice for pregnant women, as well as breastfeeding women, adolescents and children, the elderly population, and those recovering from illness, disasters and trauma. But these are not implemented consistently or systematically.
We also need dedicated staff to provide nutrition services at HWCS. In existing designs, nutrition is a small part of the responsibility of multifunctional workers.
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Factors of success
The success of the nutrition agenda will depend on two factors: interacting with local elites; and connecting nutrition practices with local cuisine. Professor Prerna Singh of Brown University showed in his study of small acne vaccination that in the 1950s, there were large differences in vaccination volumes in equivalent regions such as India and China. Some people have a population earlier and faster vaccination than others. Those are indeed countries where vaccination interventions are openly owned by local elites and are related to local health practices and ideas.
India is a rapidly changing society. We must imagine health and wellness through HWC, not just lack of disease. The primary health system provides a local, comprehensive nutrition agenda of all social classes that are provided by major health systems is the first step in this direction.
publishing – March 17, 2025 12:22 AM IST
