Scaling up core micronutrient interventions: It’s $12 bn vs $574 mn

By Amit Kapoor

Buzz Aldrin, the second man on the moon, was quoted as saying: "If we can conquer space, we can conquer childhood hunger." Sadly, even today 248 million children across the globe are suffering from one or the other form of malnourishment -- stunting, wasting and obesity. It accounts for 45 per cent of child deaths.

The significance of the problem is relatively higher in India as, with 20 per cent of the world's child population, it has one of the world's highest malnutrition rates. The root of the problem lies in gross negligence of public investment in healthcare facilities, let alone a focused intervention in child health amenities. Public expenditure on health, as a percentage of total health expenditure, has hovered between 25 and 30 percent in the last decade, while the world average stood at 60 percent. As a matter of fact, only 16 countries have a lower public expenditure on healthcare than India.

The inadequacy of government intervention is clearly reflected in the country's performance on child health indicators. As an extension of the fact that the country has the highest levels of malnutrition, India also has the highest number of stunted children in the world. The other aspects of malnutrition are no better off. A high proportion of children with anaemia, low weight, lower levels of breast feeding and evolving problems of obesity are also equally of concern. The percentage of anaemic children, although depicting a declining trend, is still at 58.4; the percentage of overweight children increased to 6.1 in 2014; and finally, there has also been a rise in wasted children by 1.2 percentage points during the last decade.

Over the years, India has suffered heavy economic losses due to such absurd levels of malnutrition. Any aspect of malnutrition directly impacts a person's productivity levels, affecting his economic viability. According to World Bank estimates, productivity losses due to malnutrition are more than 10 per cent of lifetime individual earnings or about 2-3 percent of the GDP. Annually, India loses over $12 billion in GDP to vitamin and mineral deficiencies.

This is because children who are undernourished show lower activity levels and reduced attention. Studies show that low weight at birth and stunting can reduce a child's IQ by five points. In addition, anaemia and other deficiencies can have irreversible damage on a child's ability to learn. A recent World Bank study found that stunting among children in India reduces their per capita income by 13 per cent. Since two-thirds of India's current workforce was stunted in childhood, the economic losses that the country has borne due to it through generations is unimaginable.

The issue gets even more complicated for nutritional deficiencies in a girl child. Malnourishment in a girl, combined with the Indian trend of early marriage, has a cascading effect of health complexities across generations. Data by National Family Health Survey suggests that 26.8 per cent of the women in India are married before 18. Childbearing at an early age can cause nutritional deficiencies in the womb and increase the risk of death by 2-10 times. Moreover, 41.4 per cent of the mothers do not receive any antenatal care during their first trimester. This induces other risks associated with mineral deficiencies in the womb such as blindness, dwarfism and also chronic diseases like diabetes in adulthood.

There is also a tendency among Indians to avoid hospitals due to the high out-of-pocket expenditure during delivery. The average out-of-pocket expenditure per delivery in a public healthcare system in rural areas is almost Rs 3,000 ($47), where 75 per cent of the population earns less than Rs 5,000 a month. Such excessive costs of child and maternal care lead to a widespread inclination to evade hospitals for childbirth, which results in health complications among children and even death.

The potential gains from addressing these issues will far exceed the costs incurred. As against the $12 billion that the country loses to nutritional deficiencies each year, scaling up core micronutrient interventions would cost less than $574 million annually. Research suggests that $1 spent on nutritional interventions in India could generate $34.1 to $38.6 in public economic returns, three times more than the global average. This makes boosting nutrition levels across the country one of the biggest low hanging fruit in the Indian public policy sphere.

(Amit Kapoor is chair, Institute for Competitiveness, India. The views expressed are personal. He can be contacted at amit.kapoor@competitiveness.in and tweets @kautiliya. Manisha Kapoor, senior researcher, Institute for Competitiveness has contributed to the article)