To get health right, India must focus on nutrition

Indians over-consume carbohydrates and under-consume protein. This doesn’t help build immunity

The key priority for India now is the nutrition battle. Good nutrition not only provides energy, but also immunity to the body. It is thus appropriate that in the current context — as citizens battle the coronavirus pandemic — we pause and reflect on India’s nutrition challenges.

The average Indian consumes about 2,225 calories a day, about 10% less than recommended. However, the bottom 25% of Indians consume only 1,800 calories and are undernourished. Tragically, at least 10% —some estimates indicate 40% — of food grown in India is wasted due to lack of post-harvest storage, poor market linkages, low levels of food processing, and an inadequate cold chain. Once these problems are solved, we will be in a better position to address the challenge of malnutrition.

While, based on consumption data, it is debatable whether Indians have increased calorie intake, when examined from the production side, the data is unequivocal. The Food and Agriculture Organization estimates that between 1960 and 1980, India produced about 2,000 calories per person. From 1980, with per capita GDP growth rapidly increasing, the country has been producing an extra 100 calories per person per decade. Today, at 2,450 calories per person, India produces what it needs, and with better food processing and less wastage, it can solve its calorie-deficit problem.

However, India faces a second challenge, which is the quality of nutrition. Using the EAT-Lancet report on what adults should consume, a leading newspaper estimated that while Indians should be getting 850 calories from carbohydrate sources, we get 1,200 from it. And while we should be getting 900 calories a day from protein sources, we get only 310 calories from them. Interestingly, Indians get 232 Kcals from fats against the recommended 450 Kcal. We under-consume fats, especially the good unsaturated variety.

On the protein front, while there is a divergence of opinion on how much protein we should consume, there is consensus that Indians consume too much simple carbohydrates (rice and flour), and not enough complex carbohydrates or proteins.

The consequences of lack of protein on public health are stark. Underweight children, wasting, stunting and anaemia, all caused by lack of protein, are worse in India compared to not just the world, but even the rest of south Asia. For instance, wasting levels (low weight to height ratio caused by low muscle mass, which is, in turn, caused by low proteins), in India are 21% compared to 11% in the rest of south Asia and 7% globally. Protein and iron deficiencies are big public health issues in India.

The causes for the lack of protein in the Indian diet is probably less cultural (more than 70% of Indians are non-vegetarian and the milk culture more than compensates for the lack of a meat culture in the vegetarian parts of India), and more economic. Even if one were to casually open the websites of leading e-tailers in India and Britain, one will see that the price of milk and chicken is equal or greater in India compared to Britain, while the price of rice and wheat in India is half of that in Britain. If one then factors the vast amount of rice and wheat that is sold in the public distribution system, carbohydrates in India are cheap. Relative to the world, our protein prices are high, and our carbohydrate prices are lower. Little wonder that we under-consume protein and over-consume carbohydrates.

The reason for this disparity can be attributed to the focus on bridging the calorie deficit through rice and wheat that Indian policy makers have rightfully had over the last few decades. Most of the subsidy given to food and agriculture goes to rice and wheat through minimum support prices and the public distribution system. This makes wheat and rice attractive not only compared to milk and meat, but also compared to coarser grains like jowar and bajra, which are inherently cheaper to grow. On the other hand, a combination of low productivity and high import duties on meat and milk have kept protein prices among the highest in the world.

The bigger issue in our country, therefore, is the poor quality of nutrition and immunity driven by low protein, low fat, high carbs, high sugar and low micronutrients. Our nutrition policy has served us well in the quest for calorie sufficiency, there is now an urgent need to pivot from quantity of calories to quality of calories. There is a need for us to move to the next frontier in the battle for a healthy and safe India.