Despite historically high levels of food production in India, undernutrition and micronutrient deficiencies persist. At present, 22.5 percent of adults are underweight, and 38 percent are still stunted. While undernutrition persists, based on the latest data from the National Family Health Survey-4, more than 20 percent of Indians are overweight or obese. India joins many other countries in grappling with the double burden of malnutrition. Overweight and obesity rates have doubled over the past decade in all Indian states, registering rapid growth in both rural and urban areas. Women are more likely to be overweight or obese than men, especially those living in urban areas.
To understand the causes of this problem, we need to look at people’s diets, where they are eating, and how this has evolved over time. Diets in India are traditionally cereal-based and usually lack diversity. This kind of dietary practices coupled with food insecurity in the past led to high levels of under-nutrition and widespread micronutrient deficiencies. As production of food increased and access improved, the issue transitioned from being one of food security to that of nutrition security. Now, there is a need to improve the diversity of Indian diets as reliance primarily on cereals for energy may lead to macro nutrient over-nutrition coupled with micro-nutrient deficiencies arising from the lack of diversity in the diet which is reflected in the rising levels of obesity. Another factor that contributes to the multiple burdens of malnutrition, that is, high levels of under-nutrition, micronutrient deficiencies and rising obesity is the increased availability and higher consumption of highly processed and packaged food rich in carbohydrates, fats, sugar and salt, increased levels of eating out and snacking. Considering Sustainable Development Goal 2: End Hunger and Achieve Food Security and Improved Nutrition, it is imperative to support the production and availability of, and accessibility to, a nutritious diet for the Indian population. The following are salient in India’s dietary transition, according to the 68th and other rounds of the National Sample Survey:
- Decline in consumption of coarse cereals
- Rising consumption of meat, salt, and fat
- Rising rates of eating out, or away from the home
- Sharp increases in consumption of snacks
These dietary changes are occurring alongside increases in wealth and sedentary lifestyles. If left unchecked, these trends will result in an increased disease burden for the country. India has a high burden of undernutrition and infectious diseases, and now with rising levels of overweight and obesity and DR-NCDs, it becomes critical to pay attention to the entire spectrum of malnutrition. Policies and programs are needed to address the underlying determinants of anaemia, stunting, wasting, and underweight, but to also face the challenge of overweight and obesity in both children and adults.
The centrality of nutrition for better health outcomes is well recognized. The nutritional status of individuals, families, and communities depends on the food they consume. This is in turn determined by the availability, acceptability, and affordability of food. Thus, improving the health of the people requires improving their nutrition through better and more nutritious food. This is where agriculture plays an important role not only as a means of producing diverse, nutritious, safer food that is affordable but also through pathways like improved household access to nutritious food, improved income, women's empowerment (see Leveraging Agriculture for Nutrition in South Asia for more information on these pathways in India).
Efforts to improve nutritional outcomes should be placed in the larger context of a food system, that is, the full set of actors, processes, and activities involved in getting food from where it is grown to those who will eat it. Interaction between elements of the food system, including production, processing, marketing, consumption, and policy that affect these elements, can results in increasing levels of malnutrition if the food system actors are not mindful of the health and nutrition impacts.
Long characterized by food deserts owing to persistent food scarcity, such as insufficient cereals to meet calorific needs, the situation in several regions in India is fast turning into one of nutrient deserts. In India, obesogenic foods such as snack foods are getting to places that fresh and nutrient-rich foods are not. The interdependence of geographic access to food and the consumption of adequate and healthier diet is not well understood generally, but particularly in India. Unhealthy diets are crowding out healthy ones, yet without access to healthy choices, consumers sometimes have no alternatives. How can farmers, transporters, regulators and market actors work together to widen the reach of nutritious and healthier foods?
Strengthening the agriculture-nutrition pathway when considering food system development in India will be key to addressing these challenges. Critical components include:
- Ensuring agriculture is represented in national nutrition policy,
- Creating market-based solutions for producers by creating the incentives that are aligned with choices of nutrition-dense products,
- Creating incentives for consumers through price and non-price mechanisms, and
- Addressing safety and other issues along the value chains for healthy, fresh foods.
It is thus important to adopt a systems approach while determining the interventions to improve the nutrition and health outcomes of the population. Implementing this food system approach to ensure availability of more nutritious, safer, and affordable diets presents challenges. The sheer expanse of the food system that includes farmers (who are overwhelmingly smallholders); their choice of crops; post-production issues; supply chain management; unorganized food processing systems; informal food value chains; and social, economic, and cultural aspects of dietary habits requires a deep micro- and macro-level understanding of the Indian food system to make policy decisions.
Devesh Roy is a Senior Research Fellow with A4NH, based in New Delhi, India.