 Hello and welcome to NewsClick. Today we have with us Dr. Vandana Prasad. She's a community pediatrician and a public health professional. She's been an activist in the social public health sector for around more than 25 years and we are today going to discuss about the recent global hunger index that just came out and what are the implications of it, how India did as in comparison to other countries. So welcome ma'am and could you tell us what is this global hunger index and what are the parameters that we measured it with and the impacts and what is its significance for us. Hunger and malnutrition are measured through various modalities and as you know there are national indicators and national surveys like the NFHS and so on that tell us about these things and the global health index is one of those fairly recent one. We have three measures over 2000, 2008 and now 2016 and there were some earlier as well. It's quite a comprehensive measure so it looks at the wasting and stunting amongst children and also under five mortality. So the significance of these are slightly different from each other and maybe I can just tell you briefly what it means. So since stunting is an indicator of kind of an acute hunger or acute food insecurity it tells us something about the short term, sorry wasting would be something about the short term. Stunting reflects more a chronic situation so it tells us a little bit more about the chronic food security or insecurity and under five mortality is a very significant indicator in fact because it's considered to be a kind of symbolic of overall development of a country not just to do with children. In fact all these three indicators they function as a kind of a tip of the iceberg indicator so they signify a much deeper complex set of circumstances which finally result in the malnutrition of children under three or the death of children under five. So it's very important to understand that this is nothing, it's not simply to do with the situation of children but it's to do with the overall situation of development of a country comprising of many complex determinants, health, education, food insecurity, livelihoods, economics, water and sanitation and coming to more proximal measures, facilities for care, gender are very critical determinants so it's a complex set of things that finally result in these indicators. India has ranked pretty low, it's below Bangladesh and Sri Lanka and only above Afghanistan and Pakistan which is not something to be proud of so if you could tell us more about that, what that signifies and implies. Firstly this is not news to us at all, I mean we've had, there's a huge amount of evidence that's been saying again and again over the years that India is continuing to do very badly as compared to its neighbors and pretty badly as compared to itself as well even though there are small advances for example in this particular index in the year 2000 we were at 83 and then we really went down to a terrible low of about 102, 103 in 2008 and then we slightly crept up to 97 so there's been a very very tiny improvement from 102 to 97 but a drop across from 2000 to 2016 in 15 years we've gone from ranking 83rd to 97th whereas other our neighbors have sort of crept upwards so and like I said this is not a new story and this is not new evidence at all there are many many reports as much data to say that and the reasons are pretty clear because unless you invest in a situation if there's no input I mean where do you expect to get outputs and outcomes and very notoriously the country has been grossly neglectful of the social sector in particular so like I had mentioned the two main issues here are food insecurity which are further determined by the economics and so on and the situation of health and health care which goes beyond disease and illness and sickness to the social determinants of health as well and the one other very critical indicator which is gender again where India fares particularly badly so if you're looking at investments from you know malnutrition is understood or malnutrition interventions are understood as being nutrition sensitive and specific so or the causes can be considered proximal or distal you know so proximal causes would require making sure that children actually fed that adolescents are not anemic and so there's an intervention for them that your Anganwadi system is working that if children get diarrhea and pneumonia then they are treated well these are the closer to the issue proximal kind of determinants now there we failed quite miserably because as you know in the last budget the ICDS budget was cut down by almost 50% and then slowly brought up a little bit and in various states the impact has been dramatic so there have been no payments of honor area to the Anganwadi workers the S&P supply has been disturbed quite a lot the quality of food has always been in question with you know contractors playing a role and the Supreme Court has been trying to get rid of contractors and so on we've been arguing for better quality food such as eggs for example in the Anganwadi's but then politically socially culturally there's been a kind of a protest against that and you know that it's been claimed that India is a vegetarian country which it is by no means so we haven't really made that kind of an investment at the downstream kind of issues and upstream I think you know very well that unemployment seems to be on the rise iniquity enormous iniquity very recent data very alarming data that is saying that even in a country like China for example the growth rate of the lowest quintile is higher than the growth rate of the highest quintile in India it's the exact opposite so in India the rich are getting richer at the cost of the poor and food prices have gone up nearly three-fold and off the food prices what has gone up it's basically pulses three-fold rise in you know in cost over the last few years and so protein and sources of protein are now absolutely unapproachable for the poor so how do we expect malnutrition to improve so that's really the situation you know which we are in just now very poor public investments on all these fronts and a very severe gross iniquity and in fact now we have a very peculiar situation that the rich are also facing a kind of malnutrition because they're becoming obese so we have a double burden of malnutrition in India that the poor are highly malnourished the urban poor are also getting obese because of this prepackaged food and you know these kinds of things and the middle class is also getting fairly obese so when we talk about the public health sector and with this coming in of FDI and so what is the commercial and political aspect in all this yes it's a it's a very strange phenomenon that we're seeing so like I mentioned that we have a disinvestment on the public side this is the case in health as well as in food because I might also mention that we passed a national food security act this was three years ago but we've seen no implementation and there's no budget line really for that to go forward we had talked in terms of maternity entitlements which is another critical issue for the food security of young babies and breastfeeding and support to breastfeeding and so on again there's been no advance on that front so a refusal to invest more on the public side at the same time if you look at the you know the market then there's another very peculiar and very significant trend that's happening which is of allowing what we would call big food to come in as major players so we are now anticipating the same problems that we had for instance with big pharma except that pharmaceuticals are something that you know are required as a company product because you know you can't make medicines in your kitchen but food is something that every household is able to produce and should be able to produce so here the the influx of big companies making big claims of for example hollocks and comp land have been around for ages saying that your child will grow taller if you if you give comp land at the same time with a completely unwarranted claim because if a child got good rich balanced diet at home then the child would grow equally well so we are seeing this big influx which also seems to have recent more and more government support you know saying that you use quick fix solutions of pre-packaged food which would have micronutrients and which would be labeled and so therefore standardized say if that that kind of an approach is being taken to both malnutrition and of course is contributing to obesity at the same time because at the at one end of that spectrum is junk food then in the middle of that spectrum you have nutraceuticals which would be these protein supplements for example for the elderly and even for children that are you know talked about and then at the other end of the spectrum we have therapeutic foods for malnutrition so covering the entire you know ground of normal people elderly people young people adolescents and also malnourished people in some way claiming that of all good food for this entire spectrum I mean the entire population can only come from big food companies who know better than you know a grandmother or a teacher or a person at home and so that is really now a critical battle that we need to reclaim these spaces and we need to retain control over food at the same time make a critical you know value investment also because it is not as though everything that was going on was fine so we need to invest in a greater kind of food awareness food education but also making food available because you know as I said prices are making good food even more unavailable the lack of control over forest resources is also you know making that happen because in other areas for example a lot of the nutritional component actually came from forest produce that also is now gone commons are gone there is an agricultural crisis on so at every end of it from you know from the public's point of view we are not gaining anything and the public money seems to be rooting through public programs and schemes or at least as an attempt to favoring big big food yes private players yeah you mentioned therapeutic food so there's this new therapeutic food policy in Andhra that came so if you could tell us about it it's important to note that we don't have a national nutrition policy that talks about how to tackle severe acute malnutrition that's the context has been severe acute malnutrition a particular form of malnutrition and we have been asking for the ministries to put forth a national policy so that it could be openly and transparently debated and discussed meanwhile globally coming from experience largely in Africa there has been a fair amount of pushing also by the multinationals W H U and UNICEF for this particular condition of severe acute malnutrition to be dealt with through the use of patented company produced products such as Plampina at easy pace now coming from compact a country in India and there's been a kind of a move to spread these products into various districts and blocks this this move was countered some years ago where the ministry said no to this kind of policy but now recently has we see that it's happening in Maharashtra in Rajasthan in Andhra Pradesh very recently it has been announced so slowly this seems to be coming up again now the major issue is again this that the feeling is that just by distribution of a product whatever that product might be we don't really comprehensively tackle malnutrition so we are looking for a much more comprehensive program that allows the communities to participate that does that does not disempower communities that protects livelihoods and the agricultural practice of a community and the local produce is used and so on where prevention is also you know part of the whole program rather than just just curing children enough to save them from you know mortality but then they go back into the same situation which led to the malnutrition in the first place so we have been arguing for more comprehensive programs why why do you feel that the government is not making any public investment the only answer one can find for why a government steadfastly refuses to invest in the in the well-being and the growth and the lives of children of women of adolescents of poor people is that they just don't care and I mean there's no other answer that can be made because there was a time when you know it would be said that India is a poor country we don't have the money now we're a growing economic giant now where is the excuse for not investing in health not investing in people's food security these are our brothers and sisters who are you know languishing and malnutrition where children are dying to the tune of you know hundreds a day if not thousands a day every single day and a country and a government that refuses to take action thank you so much ma'am for giving us your time on this and we'll be coming back to you on this topic and we hope things get better in the future so this is all the time we have a news click thank you for watching and keep watching our interviews