A nutrition disaster

Ammar Habib Khan
Sunday, May 28, 2023

One-third of the total children's population in Pakistan, or 34 million children, is deemed as malnourished. This number is bigger than most countries in the world. To make things more severe, more than 44 per cent of children – or roughly 12 million children – who are less than five years old are stunted. Stunting refers to children being too short for their age as a result of chronic malnutrition. Stunting is a major risk factor for child mortality, and stunted children fail to reach their true physical and cognitive potential. The failure of the state starts from the day a child is born, wherein inability to get appropriate nutrition sets back their cognitive and physical development.

Fifteen per cent of children who are less than five years old are wasted. Wasted here means that a child is too thin or too short for their age and has failed to gain weight due to chronic and recurring malnutrition. Millions of children failed by the state will never have opportunities available for them, all because of lack of nutrition – something that could have been fixed through the right low-hanging interventions but could not be fixed due to the apathy of the state and its functionaries.

The recent population census estimates a population growth rate of 2.48 per cent, making Pakistan one of the fastest growing populations in the world. Meanwhile, the recently published GDP growth numbers suggest that the country’s economy grew at a dismal rate of 0.29 per cent during the last fiscal year, and there are doubts even regarding that. As the economic growth rate of the economy remains lower than the population growth rate, overall income levels deteriorate, affecting disproportionately the most vulnerable segments of society, further heightening the nutrition crisis.

Food inflation in Pakistan has exceeded the 50 per cent mark on a year-on-year basis, which means that food in Pakistan is 50 per cent more expensive than it was last year. As incomes fail to keep up pace, this means that the budget of households continues to shrink in real terms, and they can afford much less food than compared to last year. The inability to afford food further heightens the nutrition crisis, which may push up the number of children who are either malnourished or stunted or wasted.

A country can recover from a political crisis or an economic crisis. It cannot recover from a demographic crisis or a nutrition crisis if it gets too late. A malnourished child today will not be able to develop cognitive abilities to become a productive member of society in a few years. As the number of malnourished children increases, so does a demographic crisis.

We have a youth bulge with a significant proportion of the population comprising children or young adults. The inability of the state to feed them can lead to a situation where they cannot develop their cognitive abilities, and hence cannot contribute to economic growth through an increase in productivity.

The inability of the economy to grow at a rate that exceeds the population growth rate means that the country can be stuck in a disastrous loop wherein incomes across the board will continue to decline, while availability and affordability of foods will get even scarcer.

More importantly, if a significant portion of that population is malnourished or stunted, it cannot even be educated or trained, such that any long-term gains productivity can be realized through education, or human capital development. Simply put, the physiological need of hunger needs to be addressed first for survival – before education can be imparted.

More than 90 per cent of children have inadequate iron in their diet, as per the School Age Children, Health & Nutrition Survey (SCANS), 2020 – with iron deficiency being one of the more critical reasons for malnourishment in children aged less than five years. Similarly, more than 80 per cent of children do not have sufficient intake of Vitamin A, zinc, and calcium, relative to recommended intakes for their age groups.

Increasing food prices and reducing real incomes will further decrease the macronutrient, and micronutrient intake across the country, further pushing millions of children in the malnourished territory and increasing incidence of malnutrition and stunting in the country.

The inability of the government to come up with a coherent agricultural policy that prioritizes access to nutrition and affordability is pushing the country to a nutrition, and demographic disaster. Recovery from such a disaster would be extremely difficult, or impossible if we subjected a full generation of children to malnutrition.

Both direct and indirect financial consequences are associated with malnutrition. Increased hospitalization and additional strain on the already vulnerable healthcare system are two examples of direct medical expenditures.

The strain on the healthcare system can be reduced with the appropriate initiatives in place. Children's limited physical and cognitive development has indirect economic costs because it limits their ability to learn and prevents them from pursuing more advanced education at the same time. This limits productivity gains not only on an individual or household level but also on a macro level.

A comprehensive national nutrition strategy must be in place to ensure that everyone has access to cheap nourishment, including grains, vegetables and animal protein, without being affected by price fluctuation. In order to facilitate this, the agricultural supply chain and incentives must be fixed.

To increase the nutritional content of the food that is readily available and treat micronutrient deficiencies, it is crucial that food be fortified for consumption by young children. These are small, inexpensive initiatives that have great potential for success. Through numerous generations, the state has failed to function. The extent of the failure also grows in proportion to the population. We can either save our future generations and enable a sustainable broad-based path for growth, or we can make a population of 250 million individuals vulnerable to a systemic and irreversible disaster.

The writer is an independent macroeconomist.