Monday, December 10, 2012

Inequality deprives children their access to health, education and better life



More and more reports, published recently, indicate that the world is witnessing surge in inequality, both income and wealth, barring a few Latin American countries (such as Brazil). Yet inequality has been termed as necessary fallout of economic growth. According to conventional economics, rise in inequality provide incentives to those who are more capable of managing the resources. It is the fittest (in this case- capitalist) who survives in this race.

However, a lesser known report entitled Born Equal: How reducing inequality could give our children a better future (2012), which has been released recently by Save the Children shows that growing gaps between the richest and the poorest children actually threatens children’s health and development. After studying 32 countries, the report demonstrates that children born into the richest households have access to 35 times the resources of the poorest. Children born in rich households get better healthcare, more nutritious food and improved access to school. Such children do not have to start work at an early age. Thus, they are less likely to become child labourers. The report has, therefore, stressed the need for addressing inequality so as to accelerate progress towards achieving the MDGs and to deliver the promise to eradicate extreme global poverty.

While commenting on India, the report mentions that rise in inequality has been quite stark because in 2002 India had four billionaires ($US), which grew to 55 presently. Factors like the country where one is born, one’s skin colour, one’s gender, wealth of one’s parents and other such dimensions determine to a large extent a person’s future and the quality of life s/he would live. A person born as a dalit in India will be twice as likely to live one's entire life in poverty. Dropout rates among children in the scheduled tribe and scheduled caste categories are substantially higher. Save the Children report alleges that India has witnessed reductions in social spending overtime.

Key findings of Save the Children report:

  • Gini coefficient [which takes a value of 1 (or 100 on the percentile scale) for perfect inequality and 0 for perfect equality] increased from 32.0 percent in 1980 (or earliest available) to 36.8 percent in 2012 (or latest available) in India. On the contrary, in Brazil, Gini coefficient declined from 55.3 percent in 1980 (or earliest available) to 52.0 percent in 2012 (or latest available).

  • India and China, home to huge numbers of the world’s poor, are increasingly sheltering some of the world’s richest people. In 2002, India was home to four billionaires ($US); presently the number is 55. In 2002, China claimed only one billionaire. In Forbes’ 2012 survey China recorded 115–more than Germany, France and Japan combined.

  • In India, while the country’s average poverty rates were falling in the 2000s, in the state of Orissa poverty increased from 41% to 50%; absolute poverty among lower castes in Orissa increased during that decade from 57% to 74%.

  • In India, recent census figures reveal that the sex ratio dropped to 914 females per 1,000 males–the lowest since India attained independence in 1947. In China, while aggregate data show that the influence of women in the household has significantly improved over the past 20 years, there has been little progress in terms of women’s influence in the workplace or in the political sphere.

  • In India, the worst 25 districts in terms of infant mortality (as per the 2011 census) are concentrated across three states–Assam, Bihar and Madhya Pradesh. Not surprisingly, these states are amongst the poorest in terms of per capita SDP, ranking 27, 30 and 28 respectively out of 30 states in the state domestic product data available for 2009–10.

  • India’s income inequality, meanwhile, has been shown to result in higher levels of both undernutrition and obesity in children. Subramanian et al show that state level income inequality was strongly associated with the levels of Body Mass Index (BMI). A change of one standard deviation of the Gini coefficient (which amounts roughly to a 3% change) increased the risk of being underweight by 19% and the risk of being obese by 21%, depending on the direction of change. The study concluded that the simultaneous existence of both undernutrition and overnutrition suggests the blame lies with inequality (a skewed distribution of food), rather than general poverty (an overall shortage).

  • Moving from targeting towards more universal systems–for example, with India’s food distribution system and Integrated Child Development Scheme–would be likely to improve reach and impact on inequality.

  • In 1990, the vast majority–93%–of people in poverty in the world lived in low-income countries. Today, despite the fact that inequalities between countries remain high, more than 70% of the world’s poorest people–up to a billion–live in middle-income countries.

  • In 2011 under-five mortality stood at 6.9 million–down from 12 million in 1990. Although we are only half way to reaching the child mortality goal of Millennium Development Goals (MDGs), the rate of progress to reduce under-five child deaths more than doubled in the 2000s.

References:

Born Equal: How reducing inequality could give our children a better future (2012), Save the Children,

Born Equal? How reducing inequality could give our children a better future by Núria Molina-Gallart, 1 November, 2012, http://blogs.worldbank.org/developmenttalk/born-equal-how-reducing-inequality-could-give-our-children-a-better-future

The threat of inequality to children by Robbie Lawrence, 23 November, 2012, http://www.generation-c.org/the-threat-of-inequality-to-children/

Monday, October 15, 2012

India’s nutrition and hunger data is too old




Two important international reports on undernutrition i.e. 2012 Global Hunger Index (GHI) report from IFPRI, Concern Worldwide & Welthungerhilfe and The Nutrition Barometer report from Save the Children & World Vision (published in 2012) have criticized the Indian government for not monitoring the state of malnutrition and hunger since the time the last National Family Health Survey-3 (NFHS-3) got published in 2005-06. At home, the Government has throttled one of the most authentic and revered survey, which used to collect and collate health and nutrition related data. It has, however, taken insufficient measures so far to compensate for the inadequacy of such data.

The 2012 Global Hunger Index report has confessed that India’s latest Global Hunger Index (GHI) score (=22.9 and rank: 65) is based partly on outdated data: "although it includes relatively recent child mortality data from 2010, FAO’s most recent data on undernourishment are for 2006–08, and India’s latest available nationally representative data on child underweight were collected in 2005–06". The 2012 GHI report has stated that due to dearth of child nutrition data, "any recent progress in the fight against child undernutrition cannot be taken into account by the 2012 GHI". India is in need to produce data at regular intervals by monitoring systems for child undernutrition and related indicators, recommended the 2012 GHI report. 

The Nutrition Barometer report (2012) while finding that India, Democratic Republic of Congo (DRC) and Yemen have performed the worst in reducing malnutrition, with frail commitments and frail outcomes, has asked for a new population-based, nationally representative survey to check what has happened to nutrition since 2005–06.

The National Family Health Survey (NFHS) has met a similar fate like NCEUS reports after the Ministry of Health and Family Welfare decided to discontinue the Health Survey, the fourth round of which was about to take place in 2012-13. The same Ministry now wants to launch an integrated national health survey (NHS) thereby replacing the three existing ones—NFHS, the district-level health survey (DLHS) and the Annual Health Survey (AHS). Despite objections being raised by leading economists, health activists and nutrition experts, the Government has taken off the Internet all the data pertaining to NFHS-1, NFHS-2 and NFHS-3. The official website of NFHS is no more working, but people may try downloading the data from the website: http://www.rchiips.org/NFHS/factsheet.shtml (last accessed on 12 October, 2012). All this clearly points to the fact that Government is not eager to disclose information to its own citizens proactively.

NFHS-1 (1992-93), NFHS-2 (1998-99) and NFHS-3 (2005-06) provided information on fertility, mortality, family planning, HIV-related knowledge, and important aspects of nutrition, health, and health care. All the three surveys were coordinated by the International Institute for Population Sciences (IIPS) under the aegis of the Government of India.

Some of the major findings of NFHS-3 are presented below:

•    Almost half of children under five years of age (48 percent) are stunted and 43 percent are underweight. The proportion of children who are severely undernourished is also notable: 24 percent are severely stunted and 16 percent are severely underweight. Wasting is quite a serious problem in India, affecting 20 percent of children under five years of age.

•    The NFHS-3 estimate of infant mortality is 57 deaths per 1,000 live births, compared with the NFHS-2 estimate of 68 deaths per 1,000 live births and the NFHS-1 estimate of 79. Still, more than one in 18 children die within the first year of life, and more than one in 13 die before reaching age five.

•    In 2001-05, the infant mortality rate was 50 percent higher in rural areas (62 deaths per 1,000 births) than in urban areas (42 deaths per 1,000 births).

•    Almost 7 in 10 children age 6-59 months are anaemic, including 40 percent who are moderately anaemic and 3 percent who are severely anaemic.

•    The prevalence of anaemia among children 6-35 months has increased from 74 percent in NFHS-2 to 79 percent in NFHS-3.

•    In India, only 44 percent of children aged 12-23 months are fully vaccinated, and 5 percent have not received any vaccinations. More than half of women are married before the legal minimum age of 18. Among women age 20-49, the median age at first marriage is 17.2 years.

•    More than one-third (36 percent) of women age 15-49 in India have a body mass index-BMI (a measure of nutritional status, BMI is defined as weight in kilograms divided by height in metres squared, kg/m2) below 18.5 indicating chronic nutritional deficiency, including 16 percent who are moderately to severely thin.

•    Nationally, 34 percent of men age 15-49 have a BMI below18.5, and more than half of these men are moderately to severely undernourished. The highest proportions of undernourished men, two in five, are in Madhya Pradesh and Rajasthan.

•    Anaemia is a major health problem for adults as well as children, affecting 55 percent of women and 24 percent of men.

Source: NFHS 3 Summary of findings






Corrigendum: Through my interaction with Dr. Prema Ramachandran (Director, Nutrition Foundation of India, New Delhi, http://nutritionfoundationofindia.res.in/) during the National Conference on Right to Food, organized by National Human Rights Commission (NHRC) on 4 January, 2013, I came to know that Annual Health Survey (AHS) done under Ministry of Health & Family Welfare in collaboration with the Registrar General of India (RGI) would be covering all the districts in 9 states of India to assess health and nutrition status of Indian population. The District Level Household and Facility Survey (DLHS) will be undertaken in rest of the states/ UTs where Annual Health Survey (AHS) is not being done. It has been decided that DLHS-4 would cover Clinical, Anthropometric and Biochemical (CAB) component as in AHS. The AHS and DLHS would fill the current void of nutrition related data.


References:

2012 Global Hunger Index-The Challenge of Hunger: Ensuring Sustainable Food Security under Land, Water, and Energy Stresses,

Nutrition Barometer: Gauging national responses to undernutrition (2012), Save the Children and World Vision,

NFHS 3 Summary of findings

NHFS data off official website, funds crunch suspends future surveys-Nitin Sethi, The Times of India, 9 May, 2012, http://articles.timesofindia.indiatimes.com/2012-05-09/india/31640657_1_health-ministry-future-surveys-jairam-ramesh

Government to discontinue National Family Health Survey-Pramit Bhattacharya, Live Mint, 11 April, 2012,