Just five years away from 2025, the year that was targeted to achieve World Health Organisation’s Global Nutrition targets, 88 countries in the world, including India, are off track to achieve even one of the targets. The Global Nutrition Report (GNR) 2020, released on Tuesday, revealed that malnutrition continues to bog down India, and populations rendered vulnerable in India and across the world due to their diet and nutrition are even more at risk of COVID-19.

The criteria for the ten 2025 global nutritional targets are: anaemia, low birthweight, exclusive breastfeeding, childhood stunting, childhood wasting, childhood overweight (including obesity), adult obesity (men, women) and adult diabetes (men, women), level for salt intake, and raised blood pressure. The Global Health Report measured countries’ progress only on the first eight of these criteria due to data constraints, and found that four was the maximum number of targets that any country was on track to meet by 2025. Only eight countries were on track to meet four targets.

 “The trend is clear: progress is too slow to meet the global targets. Not one country is on course to meet all ten of the 2025 global nutrition targets and just 8 of 194 countries are on track to meet four targets,” the report said.  

Malnutrition in Indian children

When it comes to India’s country profile, a snapshot of the data reveals that as of 2015, the national prevalence of overweight in children under five years is 2.4%, which has increased slightly from 1.9% in 2006. The national prevalence of under-five stunting (impaired growth and development in children due to poor nutrition, repeated infection and insufficient psychosocial stimulation), meanwhile, is 37.9%, which is greater than the developing country average of 25%. Further, wasting (low eight for height) is seen in 20.8% of children under five which is also greater than the developing country average of 8.9%.

According to data from WHO, UNICEF and World Bank, prevalence of wasting in boys (21.8%) is higher than in girls (19.8%). The national average is 20.8%; and the cumulative stunting in the 0-23 months age group is much higher at 25.1%. Stunting in both boys and girls has seen a reduction from 2007 to 2015 across age groups. However, overweight has increased in both boys and girls in the same time period, with a significant difference between the genders.

There was a clear relation found between child feeding practices and household characteristics globally. “Continued breastfeeding up to 1 or 2 years of age is less common for children in wealthier households, urban areas or with a more educated mother. In contrast, rates of solid food introduction and minimum diet diversity are substantially lower for children in the poorest households, in rural areas or with a less educated mother,” GNR said.

This was true for India too. For instance between urban and rural areas, exclusive breastfeeding, as well as continued breastfeeding at two years and one year were higher in rural areas i.e. in poorer households. The same was seen for introduction to solid, semi-solid and soft foods.

While the incidence of underweight between five to 19 years has gone down among both boys (from 66% in 2000 to 58.1% in 2016) and girls (54.2% in 2000 to 50.1% in 2016), obesity and overweight have increased, in boys more than girls.

Nutrition among adults

In India, half of the women of reproductive age (WRA) are anaemic, GNR 2020 said. However, there has been some progress in reducing anemia in women of reproductive age in 2016 as compared to 2000. However, between 2012 and 2016, prevalence of anaemia has increased in WRA.  

The report also talked about India's National Nutrition Mission and measured the progress it has made in various aspects. Between the two surveys that have happened under it from 2018, there has been a significant increase in pregnant women registering for antenatal care (over 15% increase), however, there was only a small increase in the number of registered pregnant women who received four or more antenatal care checkups (less than 5% increase).

The incidence of diabetes has increased in both men and women from before 2002 to 2014, with more men being diabetic, the incidences of both overweight and obesity were higher in Indian women than men.

Global context

Using the lens of equity to look at nutrition, the report looked at what were the inequalities that determined opportunities and barriers to attaining healthy diets and lives that ultimately lead to unequal nutrition outcomes. For instance, in India, stunting makes apparent the inequalities that exist in the society, with its prevalence being 10.1% higher in rural than urban areas.  

Globally, one in nine people in the world is hungry, and around 33% of the world’s population is overweight. Meanwhile, underweight persists in poorer countries at 10 times higher rate than wealthier countries. Obesity and overweight are found in richer countries at five times higher rates than poorer ones. 

The report also stressed on the need to “integrate nutrition into universal health coverage as an indispensable prerequisite for improving diets, saving lives and reducing healthcare spending, while ensuring that no one is left behind.”

While written before the COVID-19 pandemic, GNR 2020 contextualised the inequalities it found in the light of it. “Undernourished people have weaker immune systems, and may be at greater risk of severe illness due to the virus. At the same time, poor metabolic health, including obesity and diabetes, is strongly linked to worse Covid-19 outcomes, including risk of hospitalisation and death,” GNR 2020 said.

Some people who already suffer because of the inequalities are the poor, women, children, those living in conflict-ridden zones, minorities, refugees and the unsheltered. The report also points out that the pandemic has shed light on the “vulnerability and weakness” of our food systems in terms of food shortage, the lockdowns reducing social services like school nutrition programs (like mid-day meals in India) that the underprivileged are dependent on.

“Looking beyond the present pandemic emergency, there is a need for well functioning, well-funded and coordinated preventive public health strategies that pay attention to food, nutrition, health and social protection. We must learn from the challenges posed by Covid-19 and turn them into opportunities to accelerate actions needed to address inequities across malnutrition in all its forms,” the report states.