Hid­den Pangs

Hunger has many man­i­fes­ta­tions.

Southasia - - CONTENTS - By Sam­ina Wahid

Ac­cord­ing to a Food and Agri­cul­ture Or­gan­i­sa­tion study, around two bil­lion peo­ple suf­fer from hid­den hunger – a de­fi­ciency caused by mi­cronu­tri­ents (vi­ta­mins and min­er­als needed in small amounts to live and thrive). Of the many un­der-de­vel­oped coun­tries that suf­fer from hid­den hunger, Bangladesh has been af­fected by it the most. More than 20 mil­lion peo­ple in­clud­ing women and chil­dren, in Bangladesh suf­fer from chronic de­fi­cien­cies of vi­ta­min A, iron and zinc. This stunts their growth and in­hibits their brain devel­op­ment and cog­ni­tion. As a re­sult, chil­dren are un­able to per­form at school while women find it dif­fi­cult to work within and out­side their homes. While Bangladesh may have achieved its tar­get of hav­ing al­most enough food to feed its peo­ple, it has yet to over­come the in­sid­i­ous prob­lem of hid­den hunger.

Rice is the coun­try’s sta­ple food but un­for­tu­nately, it is miss­ing the vi­ta­mins and min­er­als needed to main­tain a healthy, bal­anced diet. If any­thing, the mal­nu­tri­tion rate in Bangladesh is alarm­ing – around 41 per cent of chil­dren un­der five are stunted while 36 per cent are un­der­weight. Add to this poverty and re­stricted ac­cess to ed­u­ca­tion hin­ders the abil­ity to learn and per­form, says Rud­aba Khond­ker who works with the Global Al­liance for Im­proved Nu­tri­tion (GAIN) in Dhaka. Khond­ker ex­plains that th­ese chil­dren would never be able to ex­plore their full po­ten­tial as stunt­ing has long-term phys­i­o­log­i­cal and neu­ro­log­i­cal con­se­quences af­fect­ing height and cog­ni­tion. Ac­cord­ing to a GAIN study, turn­ing the stunted child into a nor­mal one in­creases the present value of their life­time in­come by $2,311. Thus, spend­ing on mal­nu­tri­tion — for gov­ern­ment and non-gov­ern­ment alike — makes sense.

The causes of mi­cronu­tri­ent de­fi­cien­cies are mul­ti­ple and in­ter­con­nected. At the most ba­sic level, the prob­lem is re­lated to an in­ad­e­quate diet, ei­ther in quan­tity (easy to de­tect)

or qual­ity (not so easy to de­tect un­til the dam­age has been done). Through­out the world, peo­ple living in poverty do not con­sume suf­fi­cient amounts and va­ri­ety of nu­tri­ent-rich foods, such as meat, eggs, fish, legumes and veg­eta­bles, to cover their daily needs, which in­crease in pe­ri­ods of growth, preg­nancy or lac­ta­tion. And it is not a prob­lem only for the poor­est. Mi­cronu­tri­ent de­fi­cien­cies are also fre­quent in emerg­ing and high­in­come economies, where over­weight and obe­sity rates are ris­ing, mul­ti­ply­ing the bur­den of dis­ease and dis­abil­ity.

While Bangladesh, seek­ing to join the club of mid­dle-in­come na­tions, has lifted it­self from the 'Noon-pan­tha' stage (fer­mented rice soaked in salt, the prover­bial sta­ple of the ex­tremely poor in the coun­try), there are ma­jor gaps in nu­tri­tion one can­not over­look. Fifty per­cent of the salt pro­duced in Bangladesh is not ad­e­quately iodized, rice dom­i­nates the diet and its low nu­tri­ent den­sity per­haps con­trib­utes to the high rates of zinc de­fi­ciency. Ex­perts in­di­cate, even for­ti­fy­ing meals as hum­ble as noon-pan­tha can sig­nif­i­cantly help GDP growth and it is high time Bangladesh did what it takes to over­come hid­den hunger.

In fact, ad­dress­ing mi­cronu­tri­ent de­fi­ciency as a pri­or­i­tized post-2015 agenda is cru­cial be­cause not do­ing enough to fight that means "a loss of an es­ti­mated $7.9 bil­lion in na­tional GDP,” ac­cord­ing to the Na­tional Mi­cronu­tri­ents Sta­tus Sur­vey 2011-12.

There are sev­eral ways in which both gov­ern­ment and non-gov­ern­ment or­ga­ni­za­tions can tackle the prob­lem in Bangladesh, notwith­stand­ing a strong po­lit­i­cal com­mit­ment. One way to deal with hid­den hunger is find­ing the right proven in­ter­ven­tions for a pop­u­la­tion and en­sur­ing their avail­abil­ity, es­pe­cially for the most vul­ner­a­ble. Sup­ple­men­ta­tion (iron and folic acid tablets dur­ing preg­nancy), industrial for­ti­fi­ca­tion (salt iodiza­tion), point-of-use for­ti­fi­ca­tion (mi­cronu­tri­ent pow­ders), bio­for­ti­fi­ca­tion (high-iron rice) and homestead gar­den­ing (rais­ing chicken, grow­ing veg­eta­bles) are some of them.

On the other hand, aware­ness and ac­tion are im­por­tant too. Fam­i­lies, care­givers, pol­i­cy­mak­ers and health­care providers from the public and pri­vate sec­tors can all de­mand ac­tion and ac­cess to sup­plies. For farm­ers, bio­for­ti­fied crops need to be prof­itable enough for small­holder farm­ers to adopt and to grow at min­i­mal risk. The pri­vate sec­tor and the gov­ern­ment needs to pro­vide in­cen­tives to sup­port mi­cronu­tri­ent in­ter­ven­tions and slant food sys­tems to­wards healthy foods.

Farm­ing ought to be es­pe­cially good for nu­tri­tion. If farm­ers pro­vide a var­ied diet to lo­cal mar­kets, peo­ple seem more likely to eat well. Agri­cul­tural growth is one of the best ways to gen­er­ate in­come for the poor­est, who need the most help buy­ing nu­tri­tious food. In Bangladesh, women do most of the farm work. They also have most in­flu­ence on chil­dren's health. Prof­itable farm­ing, women's in­come and child nu­tri­tion should there­fore go to­gether. A rise in farm out­put should boost nu­tri­tion by more than a com­pa­ra­ble rise in gen­eral eco­nomic well-be­ing, mea­sured by the GDP.

Pol­i­cy­mak­ers can also try to in­crease women's con­trol over farm­ing de­ci­sions (in most cases, only men can own land or get agri­cul­tural credit, for in­stance). They could boost re­search into more nu­tri­tious non-sta­ple crops; and pro­vide clean wa­ter and bet­ter trans­port, which es­pe­cially benefits kitchen gar­den­ers, be­cause their pro­duce goes off. More data should be gen­er­ated on mi­cronu­tri­ent sta­tus and di­etary in­take to help guide pro­gramme and pol­icy de­ci­sions. This in­volves the col­lec­tion and anal­y­sis of di­etary data and bi­o­log­i­cal sam­ples – a task that new tech­nol­ogy has made much eas­ier.

On the flip side, stud­ies show that mal­nu­tri­tion does the most dam­age in the first 1,000 days of life. In those months, ma­ter­nal health, breast­feed­ing and in­fant care, not agri­cul­ture, mat­ter most. Bet­ter farm­ing can mean more calo­ries and higher in­comes. But with nu­tri­tion, it of­fers only a few steel bul­lets, not a sil­ver one.

Hid­den hunger in Bangladesh can be over­come, but a con­sis­tent and co­or­di­nated ef­fort is re­quired. Gov­ern­ment and non-gov­ern­ment or­ga­ni­za­tions must come to­gether and attack this prob­lem to­gether be­cause the health and well-be­ing of mil­lions of peo­ple in the coun­try de­pends on it.

The writer is a free­lance jour­nal­ist who con­trib­utes reg­u­larly to var­i­ous lead­ing pub­li­ca­tions.

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