Poverty and Malnutrition
Poverty and malnutrition are closely related. As noted before, many elementary aspects of being poor like hunger, inadequate health care, unhygienic living conditions, and the stress and strain of precarious living tend to reflect on a person’s nutritional status. In consequence, being poor almost always means being deprived of full nutritional capabilities i.e., the capabilities to avoid premature mortality, to live a life free of avoidable morbidity, and to have the energy for work and leisure. The study of poverty is thus very much a study of people’s state of under-nutrition. Malnutrition refers to the two sides of nutritional imbalance viz. under-nutrition and over-nutrition. While the former usually characterises poverty, the latter refers to intake of energy dense food items (or overeating) which the body, in terms of its physical and mental activities performed, cannot metabolise completely. This leads to unburnt carbohydrates getting accumulated in the body as fats. Although a certain amount of fat, which serves as reserve energy is needed for the body, its excess tends to disturb the balance in the body system causing diseases specific to its accumulation (e.g. hypertension, diabetes, etc.). In the context of poverty, however, only aspects of under -nutrition are discussed. Under-nutrition is idely prevalent among the socially and economically deprived sections of the population around the world. It is associated with a cluster of related, often coexistent factors.
These factors together constitute the ‘poverty syndrome’. The major attributes of this syndrome are:
(i) Income levels that are inadequate to meet the basic needs of food, clothing and shelter;
(ii) Diets that are often quantitatively and qualitatively deficient;
(iii) Poor environment, poor access to safe water, and poor sanitation;
(iv) Poor access to health care; and
(v) Large family size and high levels of illiteracy especially female illiteracy.
Among the most undernourished population groups, these factors often coexist, though their relative severity and extent may vary in different locations. In the evaluation of under-nutrition, and in its progression and perpetuation, these factors often act synergistically (Gopalan, 1992). The assessment of the magnitude of poverty has been discussed in the other units of the programme (Unit 4 of MEC 005). Here, we shall confine to discussing the assessment of under-nutrition only. Also, as under-nutrition is related to poverty, we shall consider under-nutrition as synonymous with ‘malnutrition of the poor’. As said before, the magnitude of under-nutrition is generally assessed by comparing the food energy intake of persons with established norms. However, the widely accepted norms based on the intake of calories are not without debate. These norms require to be periodically reset in view of the changes in the life styles. It is also argued that the food energy intake is a poor measure of the nutritional status. This is because, health in its composite form, depends not only on the intake of certain amount of calories but also on the required nutrients. Further, it also depends on the non-nutrient attributes of the body which are outside the food and nutrition domain.
It is noteworthy that some states in India with low food energy intake (e.g. Kerala,Tamil Nadu) have lower incidence of malnutrition compared to some states (e.g Rajasthan and U.P.) which have higher per capita calorie intake but also higher burden of malnutrition. Further, in spite of a decline/stagnation in food energy intake across all classes in the 1990s in India, malnutrition has declined during this period. Studies have revealed that conditions of malnutrition depend on the conversion efficiency of food into energy which, in turn, depends on factors like access to safe drinking/potable water and the standards of environmental and personal hygiene habits. In view of this, it is hypothesised that severe malnutrition is attributable to inadequate diet while moderate to mild malnutrition could be due to environmental factors (Seckler, 1982). Increase in food intake would therefore reduce malnutrition only when other variables are controlled.
The implications of poverty and malnutrition for policy planning are significant. The effect of malnutrition on productivity carries serious implications for economic growth. Research has demonstrated a link between protein-energy malnutrition, iron-iodine deficiency, and lost productivity in adults. Children born to malnourished mothers or who are malnourished during childhood can suffer cognitive losses that are associated with lower productivity in adulthood. Malnourished children also place additional burdens on health and education systems. They need greater health care and more intensive teaching at school. Concerted efforts by planning are therefore needed to break the vicious circle of mother-child-mother malnutrition among the poor. Reduction of child mortality would depend on delivery of effective and sustainable interventions for children and mothers. Direct nutritional intervention is the short term answer for combating severe malnutrition. Broad-based, growth-supplementing and employment oriented food-for-work programmes are the principal instruments commonly adopted to reduce moderate malnutrition. Improvement of incomes of the poor and supply of environmental and health services are the long term solutions to the problem of malnutrition in general.