- India facing the double burden of both undernutrition and overnutrition has taken several steps to address the same. The article discusses the need for more evidence-based policymaking.
- Malnutrition, according to the World Health Organisation (WHO), refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients.
- The term malnutrition covers 2 broad groups of conditions. One is ‘undernutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes and cancer).
- The condition where some sections of the population are suffering from undernutrition while other sections are suffering from issues like obesity and overweight condition is often referred to as the double burden of malnutrition.
Issue of malnutrition in India:
- Reports of National Health & Family Survey, United Nations International Children’s Emergency Fund, and WHO have highlighted that rates of malnutrition among adolescent girls, pregnant and lactating women, and children are alarmingly high in India.
- There is ample evidence to show the ill consequences of poor nutrition practices on individuals, families, society and the country at large. Despite the evidence, there was very little action taken to acknowledge, understand and act on the challenge of undernutrition in India.
Programmes and policy in India:
- India’s efforts in tackling malnutrition have received a new impetus. A range of programmes and policies have been launched.
- POSHAN Abhiyaan is primarily against child undernutrition. But given the interdependence of a child’s nutritional status on the maternal health condition, it also strives to work towards improving the nutritional status of adolescent girls and mothers. Read more on Poshan Abhiyaan.
- India’s National Nutrition Mission has brought focus onto the issue of malnutrition. Targets have been set and all stakeholders have been involved in the fight against malnutrition.
- National and State governments have mobilized all their resources, district administrators have been involved given the fact that they work at the grassroots level, the private sector has mobilized its own resources, while the civil society has continued to push for accountability and action.
- Anaemia Mukt Bharat focusses on the issue of Anaemia. Given the comparatively poor nutritional status of women and their special health needs, the programme envisages major interventions to reduce anaemia in India.
- Eat Right India movement focusses on improving nutritional literacy in India. It aims to promote healthy eating in India given the importance of food on the health profile of an individual.
- Despite the laudable progress made against malnutrition, there is still scope for further improvements.
- India’s National Family Health Survey (NFHS) shows that there has been a decline in child malnutrition numbers in the country, but various studies show that the rate of decline is very slow.
Regional imbalance in improvements:
- A report published in The Lancet Global Health Report with respect to a study made by the Indian Council of Medical Research, observes that the progress made in India in maternal and child undernutrition varies tremendously across the States. There have been uneven improvements.
Issue of malnutrition:
- The above report also highlighted how malnutrition was the largest contributor to child deaths in India as well as disability in adults. Malnutrition can thus be said to be a major impediment in the socio-economic development of India.
- Saving the lives of children under five in India will require a steady focus on nutrition.
Challenge of Over-nutrition in India:
- The Comprehensive National Nutrition Survey data reveals the worrying trend of the conditions of overweight, obesity and even early non-communicable disease becoming challenges even to children. About 10% of children under 19 years have pre-diabetes.
- This challenges the notion that overnutrition is a challenge for only adults.
The double burden of malnutrition:
- A recent study of the International Food Policy Research Institute and Emory University has highlighted how economic progress has helped reduce underweight condition among women but has also introduced the challenge of overweight condition among others.
- India’s adults bear a tremendous double burden of malnutrition. Some districts in India have levels of ‘overweight’ that are as high as 40%. Diabetes and increasing incidence of cardiovascular diseases in India point towards the increasing burden of over nutrition.
Effect of social determinants:
- A range of studies published by researchers in India and abroad demonstrate that social determinants related to gender, education, sanitation and poverty are key drivers of stunting and undernutrition.
- Early-life undernutrition is an important risk factor for later-life adult diseases. Poor nutrition in the first 1,000 days of a child’s life can also lead to stunted growth, which is associated with impaired cognitive ability and reduced school and work performance.
- Thus a vicious cycle of poverty leading to undernutrition and undernutrition perpetuating poverty leads to an impediment in the social development of the society. This is more of a challenge in a country like India.
- Addressing these underlying factors needs to be considered in the fight against malnutrition.
- Given the regional imbalances in improvements, there is a need for differentiated strategies to address the problem of child malnutrition in India. The interventions should be relevant to the region’s challenges. There is a need to understand the risk factors that contribute the most to malnutrition. This would ensure more effective interventions.
- Given the fact that there now exist both the problems of undernutrition and overnutrition, India will need a more nuanced approach to address malnutrition.
Addressing the problem of over nutrition:
- Need to incentivize the cultivation and consumption of a range of food commodities and not just cereals.
- Need to ensure supply of nutritive food like pulses in programmes such as the PDS, ICDS and school meals.
- Need to restrict the marketing of unhealthy foods and drinks.
- Should work towards improving nutrition literacy.
- Given the diversity and complexity of the challenge of malnutrition, there is the need for an evidence-based and data-driven approach to diagnosing the challenge of malnutrition in India’s states, districts and communities. There is a need to commit to evidence-informed policies and programmes.
- There is a need for increased use of data and science to inform India’s efforts, to track progress and to learn from both successes and failures.
- Silos in data systems should be broken and community health-workers and Anganwadi workers should be provided feedback on areas of good performance and where improvement is needed.
- The data from the comprehensive National Nutrition Survey must be made available to the scientific community.
- The World Health Organization’s updated Essential Nutrition Actions across the Life Course, offering evidence-informed options, is a critical guide that must be adapted to India’s needs.
- Given the interlink between malnutrition and social determinants, there is the need for a more integrated approach towards addressing malnutrition in India. Coherence is needed in areas of public policy across multiple ministries.
- It is imperative that policy efforts come together under a common umbrella and an overarching body is needed to ensure convergence.
The U.S. decisions making the World Trade Organization’s Appellate Body dysfunctional.
- In December 2019, the U.S. cut short its share of the funding to the WTO. This move has resulted in a shortage of funds for the Appellate Body of WTO to function.
- The U.S. has also stalled the selection process for filling six vacancies at the Appellate Body by virtue of the veto power it enjoys in the appointment process. Consequently, the Appellate Body is left with only one member, who will not be able to deliver any rulings on pending trade disputes since a quorum of three members is required to adjudicate any dispute.
- The U.S. has paralysed the World Trade Organization’s Appellate Body, which acts as the adjudicating body for any disputes in international trade.
Dispute settlement at WTO:
- Given the increasing global trade and an increasing number of disputes in such trade, a binding, two-stage dispute settlement system was established at the World Trade Organization in the 1990s.
- The Appellate Body consisting of seven standing members forms an important part of the dispute settlement system of the WTO.
Process of appeal:
- In the first stage for adjudicating trade disputes, a panel would decide cases brought before it by the members of the WTO.
- Rulings issued by the panels can be appealed at the Appellate Body. As part of the second-stage of adjudication, the Appellate Body can uphold, modify or reverse the legal findings and conclusions of the panel.
- The Appellate Body’s decisions are final and adopted within 30 days by the dispute settlement body.
- Since Sanctions can be imposed on a member in case of its failure to comply with the Appellate Body’s rulings, the establishment of the Appellate Body has given teeth and credibility to the rules-based multilateral trading system.
- The appellate body has provided security and predictability in the multilateral trading system.
- The panels and the Appellate Body have issued rulings in many disputes. It has addressed major issues in the domain of trade remedies such as countervailing and anti-dumping measures.
Reasons for U.S. actions:
- The U.S. has of late taken an isolationist approach with respect to its trade policy. The U.S. China trade war is an example. It seems to favour more bilateral trade deals which would be more favourable to the U.S. than the multilateral framework approach of the WTO.
- Several U.S. provisions for imposing countervailing and anti-dumping measures were found to be inconsistent with core provisions of the WTO agreements. The functioning of the Appellate Body has posed hurdles to the U.S. for adopting unilateral measures in global trading.
- The independent and impartial functioning of the Appellate Body in complex trade disputes had become a problem for Washington over the past many years. The U.S. has raised concerns about adverse decisions that struck down the U.S.’s trade measures.
- Washington has repeatedly accused the Appellate Body of being partisan in procedures and rulings.
- The U.S. has repeatedly alleged that the appellate body was crossing the limits of its powers and growing more powerful than the WTO itself of which it is a part. The U.S. has argued that such a role of the Appellate Body is not reflected in the Dispute Settlement Understanding (DSU) framework agreed to by all the members of the WTO.
Efforts to revive the Appellate body:
- Many WTO members do not agree with the U.S.’s criticism of the functioning of the Appellate Body. Despite this, efforts were made to address the specific concerns raised by the U.S. about the Appellate Body.
- After hectic consultations, a draft decision was finalized. The draft decision included a package of reforms to improve the functioning of the Appellate Body.
- Despite an overwhelming acceptance for the package of reforms at the WTO General Council meeting in December 2019, the U.S. decided to reject the draft decision.
- The failure to break the deadlock on the functioning of the Appellate body, an important component of effective WTO dispute settlement mechanism, will act as a blow to the multilateral trading system. At the core of a functioning multilateral trading system is an effective dispute resolution mechanism.
- The dispute settlement system had led to reductions in unfair trade practices and had helped to strengthen the rules-based international trading system. The absence of it will hamper the global trade system.
- Given the fact that the majority of WTO members are developing and poor countries who mostly lack the political and economic power to enforce their rights and protect their interests in a system governed by power, this would severely impede their ability to benefit from global trade.
- The strangulation of the Appellate Body is a reflection of unilateralism and protectionism that are on a sharp rise. The absence of the Appellate Body paves the way for the return of the General Agreement on Tariffs and Trade, 1947 rules which many countries consider as a step back in global trade.