Corporates and the business of nutrition - National seminar on business ethics – Issues and

Challenges

Dr. Sylvia Karpagam, Public Health doctor,23rd September 2016

The sickening state of nutrition in India According to UNICEF(2013) India has a huge burden of malnourished under-five

year children.  43% of Indian children under five years are

underweight and 48 per cent (i.e. 61 million children) are stunted due to chronic undernutrition

India accounts for more than 3 out of every 10 stunted children in the world. That means 1/3 of the global total of stunted children under the age of five are Indian children.

What are the effects of stunting?Stunting is associated with an under developed brain diminished mental ability and learning capacity poor school performance in childhood reduced earnings and increased risks of nutrition

related chronic diseases, such as diabetes, hypertension, and obesity in future

What does this mean in terms of the future productivity and well-being of the country??

Integrated Child Development Services (ICDS) Scheme Launched on 2nd October, 1975 One of the flagship programs of the Government of India One of the world’s largest and unique programs for early childhood care and

development. The objectives of the ICDS

to improve the health and nutritional status of children 0–6 years to lay the foundation for proper physical, psychological and emotional

development of the child to reduce the incidence of mortality, morbidity, malnutrition and school

dropout to achieve effective co-ordination of policy and implementation among

various departments to promote child development to enhance the capability of the mother to look after the normal health and

nutritional needs of the child, through proper health and nutrition education.

Nutrition supplements under the ICDSSupplementary nutrition is to be provided to the beneficiaries under the ICDS programme as a supplement to their normal intake with revised feeding norms of 500 calories of energy and 12-15 gms of protein to 0-6

years children 800 calories of energy and 20-25 gms of protein to

severely malnourished children. Supplementary nutrition is to be given for 300 days in a

year at a cost of Rs. 6.00 per beneficiary per day for normal children

Rs. 9.00 to severely malnourished children.

Brief history of malnutrition in IndiaIn 2000 – 2001 there were a spate of starvation deaths in the country following which a Public Interest Litigation was filed by the People’s Union for Civil rights where the Supreme court intervened into child feeding with orders to universalize the ICDS Anganwadis on demand (where there are at least 40 children) Provision of hot cooked meals and Very importantly, to do away with middle men or

contractors and no role for packaged food like biscuits, “ready to eat’ foods, Kurkure etc.

Self help groups in the local area to be supported Appointing cooks/helpers preferably from the poor SC/ST

communities.

Status of malnutrition in KarnatakaAccording to RTI information (2012) more than 21 lakh children in the state are mildly

malnourished 12 lakh are moderately malnourished Karnataka ranks11th in the India State Hunger Index

Field experience leaves no room for doubt that these numbers would account for only the tip of the iceberg.

Status of malnutrition in Karnataka On the 5th of May 2011, a local news channel in

Karnataka brought to light the starvation deaths in the state, implicating both the health department and the Women and Child Department.

This was converted to a Public Interest Litigation (Writ Petition No.38 1571201 1 (PIL))

A nine member committee was constituted under the Chairmanship of Hon'ble Mr. Justice N.K. Patil, Judge, High Court of Karnataka, to document the factors contributing to the unacceptable levels of malnutrition in Karnataka and submit a report.

The Comprehensive action plan report on prevention of malnutrition of children in Karnataka Submitted to High Court of Karnataka on 23-8-2012 Acknowledged that malnutrition is widespread among

the disadvantaged in Karnataka, with severe and long lasting consequences.

The causes of malnutrition were stated to be numerous, intertwined with each other and hierarchically related

With the most immediate determinants being poor diet and illness, which are themselves caused by a set of underlying factors influenced by basic socioeconomic and political conditions within which poor families are attempting to raise children.

The Comprehensive action plan report An accurate understanding of the relationships

among these various causes of malnutrition and the relative contribution of each is essential for the design of efficient and effective programmes to reduce malnutrition and its consequences.

The Central and State Governments cannot neglect or fail to provide basic healthcare needs such as shelter, clothing, nutritious food, pure drinking water and timely medical treatment as a Constitutional duty.

At the same time another story was unfolding……………..

Mahila Supplementary Nutrition Production & Training Center’s (MSPTC) In Karnataka, 137 MSPTC were to be promoted by

the Department of Women and Child development (DWCD) for manufacture and supply of Supplementary Nutrition Production (SNP) food items to ICDS beneficiaries.

Each MSPTC would consist of women members from the most vulnerable sections of the society (widows, destitutes, physically challenged, mothers of the beneficiary children, poorest of the poor and the members of the Stree-shakti groups)

The menu would be selected by the committee constituted under the chairmanship of Deputy Commissioner of the district.

Between April 2009 and May 2012……….. A private company called Christy Friedgram

Industries (CFI) was “given” the contract to supply raw material to ICDS

at a cost of Rs 600 crore annually

In April 2012…….. Christy Friedgram Industries (CFI) was investigated

by the Lokayukta police for fraudulent practice in the supply of supplementary nutritional foods to anganwadis under the ICDS

Found to have an elaborative system of deception in place.

Former employees of CFI disclosed that the company had violated several norms.

Their contract was to capacity build 137 MSPTCs at the taluk level in the state of Karnataka, and not as a contractor for food supply.

Agreement of CFI with governmentThe company would be paid for

raw material supplied to MSPTC and also paid a profit of Rs. 1 /kg of food supplied.

The rest of the profit was to be shared among the members of the MSPTC.

Instead……… CFI had ordered its employees to hire women who

were uneducated and semi-literate. The women mentioned as the President, Vice

president and Treasurer on paper, in reality, had no idea about what was happening and were only paid a salary for loading and unloading the food, mixing different items and packing the food.

These centres were also deliberately located at remote areas so that ‘it was not accessible for inspection by government officials’.

Collateral beneficiaries

The Director of Women and Child department Shyamala Iqbal received Rs. 20 lakh per month as a bribe

The Deputy director Usha Patwari and Assistant director Muniraju received Rs. 15 lakh per month from CFI for their tacit involvement.

When Shyamala Iqbal’s house was raided, they found 900 grams of gold, diamonds worth Rs. 4 lakh, bank deposits worth Rs. 65 lakh, documents of ownership of three flats and a Toyota Innova.

A faction of the pro-Kannada outfit, Karnataka Rakshana Vedike had been roped in for proper distribution of the bribe money, with officers coming in the first week of every month to collect there share.

Investigations into CFI showed

CFI was supplying roasted and powdered cereal mixes with salt or sugar, which were stale and rancid.

Most children refused to eat these cereal mixes. Parents too complained and wrote detailed

letters to authorities about their children falling sick after consuming the food provided by CFI.

The Government Order (GO) of May 31 admits that…….. there had been serious flaws in the execution of the agreement by

the company Ranging from deviously retaining control over Mahila

Supplementary Nutrition Production and Training Centres to flouting stipulated standards in maintaining quality of food supplied to anganwadis under the Integrated Child Development Scheme.

The food supplied by the company “did not have stipulated amount of protein and calories and used colours that were not permitted”.

An earlier inspection had found that there was “no hygiene maintained and food contained ‘coliform bacteria'.

Contrary to the terms of the agreement, the food quality and infrastructure was not certified by a competent authority

Karnataka State Agro Corn Products Ltd (KSACPL),A government-owned company which used to manufacture and supply energy foods to anganwadis since 1973 and provided mid-day meals. “The KSACPL started making losses in 2001, after the DWCD handed over 50 percent of the energy food supply contract to CFI,” says H Subbaiah, the last managing director of the company. Due to insurmountable losses, the company was shut down.

This was at the same time that the state was reporting two to three deaths every day due to malnutrition….

‘Malnutrition kills 2,600 kids in Raichur’ – The Sunday Guardian, 30th October 2011‘Gold mine town Raichur tops death chart’- India Today, 3rd October 2011

‘In four months, 358 children died of malnutrition in Raichur district’ – Deccan Herald, December 23rd 2011

‘1.2 million children in Karnataka are malnourished, state tells high court’ – Down to Earth, 21st January 2012

‘Karnataka's shame: 2000 die of malnutrition’ – Indian Express, October 21st 2011

Etc………………….

Soon after the CFI fiasco, the Karnataka government signed a contract with mining company Vedanta to provide mid-day meals to 200,000 schoolchildren in four districts

In 2013……..

In December 2013, the death of a 6-year old child Kum. Meghala in July 2013 in DJ Halli, Bengaluru, was protested by various activists and organisations

In 2013…

A public hearing was held on 12th of December 2013 in D.J. halli in the presence of representatives from many commissions and government officials.

Background At the public hearing, the DWCD officials informed

the Jury that the Spirulina foundation, based in Tumkur, Karnataka has been distributing spirulina to children in the anganwadis. The reason the government gave them permission was because the government offered to give it free of cost !!

The jury issued a strong statement…‘Children are not guinea pigs’ ‘On no account should irrational, unscientific elements such as spirulina or commercial fortified biscuits be introduced into the treatment protocol for children with moderate/ SAM”. Jury was composed of The Karnataka State Minorities Commission State Human Rights Commission Karnataka State Commission for Protection of Child Rights Office of the Commissioner for PWDS the Advisor to the Commissioner of the Hon’ble Supreme Court in the

Right to Food case (W.P. No 196/2001) NGOs and Civil Society Organisations.

In 2016……………News article in the Times of India

“Corporates help govt fight malnutrition using spirulina” the Times of India, May 27th, 2016

Biocon says………. They procure spirulina from Tumakuru from Spirulina Foundation. "Growing spirulina is easy, and it is a very cost effective way of

fighting malnutrition. Till the age of six months the child is dependent on breast milk but after that we have to think of a long term solution to tackle acute malnutrition,"

They use government data to identify children with moderate and severe malnutrition and give them spirulina.

They also “ask the mothers to bring back the sachets or bottles to spirulina after a month to make sure the child is indeed taking the prescribed dietary supplements.

Anganwadi workers have to record the weight of the child and make home visits to sensitize mothers about the importance of the dietary supplements.

They are more than happy to share their model with more corporates and encourage them to come forward to help the cause.

They need to reach the interior pockets of the state that are in acute need of attention.

Biocon continues…….. Biocon has been ‘investing its own funds’ to ‘strengthen the

government initiative’ and has ‘reduced’ the number of severe acute malnourished children in the district.

Spirulina is not a drug and hence does not require clinical trials. It is a food supplement and hence has been certified by the Food Safety and Standards Authority of India (Government of Karnataka) in November 2015.

Spirulina ‘strengthens the fight against malnutrition’ because it is ‘low cost and easy to administer’ as it is in the form of granules and ‘a very small quantity’ has to be given to the child.

It is also ‘easy to transport’ and distribute since it has a ‘good shelf life’.

WHO and other UN bodies recommend this to governments across the world to combat malnutrition.

Kolar Scania malnutrition project – Spirulina foundation facebook page

Launch of the ‘second’ leg of the ‘malnutrition project’ in Kolar by Scania, Spirulina Foundation FB page

The government says…….. According to the department’s data, there are 23,295

“severely malnourished” children It has set aside a budget of Rs 3.6 crore for

administering Spirulina to 25,000 children. The pilot programme carried out by it, in association with JSW

Foundation in Sandur taluk in Ballari, has brought down malnutrition levels from 33 per cent to eight per cent.

Following this, a decision was taken to supply Spirulina to all the districts in Karnataka.

The department will be also adopting the module experimented by the three corporates - JSW Foundation, Scania and Biocon Foundation.

It will be administering two grams of Spirulina per day per child for 180 days, as recommended by JSW Foundation.

So whats the problem??

Some facts………. Fifteen years ago, the National Institute of

Nutrition, conducted a study using spirulina to combat vitamin A deficiency in children.

The study had to be terminated as the levels of beta-carotene – a pigment that the human body converts into the essential vitamin A – dropped to 40% of its value within one month of receipt of the capsules..

Instead, they realised that a seasonal fruit or an egg could help increase vitamin A levels.

Some facts………. “How can a child, who probably needs to gain 4-6 kilos,

going to add weight with just two grams of a capsule given daily (which amounts to 730gms/ year). Two grams is, probably the weight of a small seed. Children need food that is traditional and tasty. Giving hot cooked meals would help them not only to gain weight, but also to help improve their eating habits. How can we take away the satisfaction and joy that these cooked meals give? Hot cooked meals endorse the local foods, provides employment, and helps women appreciate quality foods appropriate for children”. Dr. Veena Shatrugna, Former deputy Director, National Institute of Nutrition, Hyderabad

Some facts……….

Spirulina is not a traditional food in India, and has never been advocated for child feeding, simply because it DOES NOT TRADITIONALLY GROW IN INDIA

Spirulina is not listed in the volume "Nutritive value of Indian foods" brought out by the ICMR since 1937, and updated from time to time. This volume lists over 550 foods eaten anywhere in India, including foods from the tribal areas, foods from the North East, and the desert regions. 

None of the recommendations of the Indian Academy  of Pediatrics, or the recommendations of the  Young Child Feeding Practises reports of the UNICEF recommend Spurilina as a food for children.

Some facts……

Proteins and Calories are derived from cereals, millets, pulses, potatoes, oils etc. and children need 1600-2200 cals daily. They must  consume 250-350gms of cereals, 50-70gms of pulse, and 25-30gms of fats and oils with  eggs, greens, fruits, nuts, milk etc to reach their requirements 

2 gms of  Spirulina does not contain enough proteins or other macronutrients necessary for child needs. Children will have to eat 300-400gms of Spirulina for that. 

Some facts………. In the case of Vitamins and minerals,  an egg, or a carrot

or even greens provide better nutrients when compared to Spirulina. 

 When we compare the B carotenes in different foods as per the Nutritive Value of Indian foods, the requirements for B Carotene are 400-600ug/day

Per (ug/100g) - Eggs (420), Carrot (6460), Mango ripe (1990), Spinach (2740),  SPIRULINA ( 342)   For children in the age group of 8-14 years,

 2gms of Spirulina will provide 6.8ug of B Carotene/day

Condition of anganwadis in Karnataka Children often have not had food at the

anganwadi. The reasons are endless- no supplies, no

budget, no kerosene, no gas, no utensils.

Or is it something else?

Food eaten by astronauts of NASA !!

Look Mum, I’ve become an astronaut

Some questions…….

Biocon is one of India’s biggest pharma majors.” Can firms such as Biocon, Spirulina Foundation and JSW

independently access anganwadis and unilaterally distribute spirulina?

Will they be held liable in the event of adverse drug reactions, death or disability among children who consumed spirulina?

Has there been any cost-benefit analysis of spirulina? Does Biocon have a right to distribute spirulina to children,

particularly to children who are malnourished and already vulnerable to organ damage?

Some facts……..

Spirulina is an algae that grows on lakes and ponds. If the water contains heavy metals such as mercury or lead, the spirulina

algae absorb the metals. When harvested and dried as a supplement, the metals continue to remain inside the supplement.

Studies reveal that improperly processed spirulina contain significant amounts of cyanotoxins, which can accumulate in the body over a period of time

The World Health Organization says cyanotoxins can cause irreversible nerve, bone and tissue damage.

The Chinese State Food and Drug Administration reported that lead, mercury, and arsenic contamination was widespread in spirulina supplements, and recalled all spirulina products in 2012. Over 15 years ago, a study by the National

Some facts……

Biocon Foundation claims to have started giving spirulina to children from “2012 even before the government embarked on the ‘project’. This means that for three years (from 2012 – 2015) Biocon has issued spirulina to children even before the FSSAI approval in 2015.

If Biocon Foundation has indeed chosen to address malnutrition, then there are adequate guidelines for their ready reference which should have encouraged them to feed children local foods and eggs. 

If indeed CSR is the agenda, then why should DWCD set aside 3.6 crores for spirulina?

Some facts………“Pre-school children require between 1,000 and 1,500 calories every day. The food calories must come from a variety of food sources so that children get all the nutrients such as proteins, vitamins and minerals. Most cooked foods consumed by children have an energy density of less than one calorie per gram of food. This means that pre-school children require 1 kg of cooked food from milk, rice, dal, eggs, fruits and vegetables with an extra dose of oil/fat, and even sugar every day to meet their nutritional needs. It is, therefore, laughable that two grams of spirulina daily can provide enough macro or micronutrients necessary for a child’s needs, as claimed by the companies” Dr. Veena Shatrugna, former Deputy Director, National Institute of Nutrition, Hyderabad

Some facts The nature of the ‘study’ mentioned by Biocon is

highly problematic and questionable. Nutritional studies are notoriously difficult to plan and implement. If indeed spirulina is being given to children and efficacy studies are being conducted by IHMR, this in effect becomes a clinical trial and the nature of it is extremely problematic.

There has not even been any pretension of consent in these ‘study trial’ areas and mothers have given evidence to state that they were made to believe that the granules were being given as part of the ICDS program. There has been no verbal or written consent for these clinical trials.

Some facts………

The statement that spirulina is approved and recommended by WHO to governments across the world to combat malnutrition is a fraudulent claim and not backed by any WHO statement. In fact, this has also been prominently displayed on all the boxes of spirulina issued to children and has the Government of Karnataka logo on it to give it official sanction. This claim along with the statement that 2 gms of spirulina equals 1 kg of fruits and vegetables directly violates the FSSAI standards that states than no nutraceutical product  should make claims in excess of actual benefit.

Influx of corporates into nutrition

In 2008, the Biscuits Manufacturers Association lobbied the government to replace hot meals in the ICDS programme with their products. The offer was shot down by the Supreme Court appointed commissioners.

The Uttar Pradesh government gave a contract to slain liquor baron Ponty Chadha’s company to make a wheat flour mixture called panjeeri for the ICDS.

Later in 2012, when the activists of the Right to Food Campaign sent samples for analysis, it was found that 25%-30% of the cereal sugar mixture was actually sawdust.

Vinita Bali - “Independent” Director and Chair, Global Alliance for Improved Nutrition says She says that the ICDS offers excellent platforms for public private

partnership and should be considered for collaboration in CSR projects Standardise the nutritional component of supplementary food Enhance productivity and effectiveness of anganwadi workers The mid-day meal is an excellent structure to reach 120 million children

with continuity and regularity. A single intervention in that scheme to focus on nutrition in addition to

food will make a critical difference. This can easily be accomplished by the addition of micronutrients to

cooked food or by adding universally liked and accepted products such as milk, biscuits, etc. fortified with micronutrients as a mid-morning or afternoon snack.

Vinita Bali – Managing director, Britannia Food Industries

We LOOOVVVEEE Britannia

What about meat and eggs?

Many of the children with severe acute malnutrition who are supposed to receive eggs as part of the High court directive and malnutrition management guidelines have never been given eggs.

ISKCON (The International Society for Krishna Consciousness) says A lot of violence has happened before a non vegetarian

meal is brought to the table All those who are involved in killing, carrying, selling,

cooking and eating of meat of an animal are sinful Non devotees are killing animals and devotees are

vegetarian, Meat falls in the category of ignorance, it is tamasic food. Eating meat creates ignorance and makes spiritual life

different to follow.

ISCKON continues The ignorance is also associated with qualities of

foolishness, anger, violence, laziness, chaos, uncleanness, obsessiveness, hard-heartedness, deceitfulness, cheating etc.

Eating meat is an addiction and will lead to develop animalistic qualities making stomachs into a graveyard of animals.

Onions and garlic are a lower mode of nature but still superior to meat.

They are very categorical that fish and eggs come under the purview of meat.

Mid-day meal –ISKCON’s Akshaya patra, KarnatakaSince the food in ISKCON is packed at a centralized kitchen and transported, the schools that receive food at a distance don’t get it in a fresh form.The childrenalso complain ofhaving to eat sambar everyday.

Some thoughts …… ISCKON is the largest private supplier of food for

government schools. They claim to be non religious and non sectarian, If

we as a country are so much against conversion, isn’t this a form of conversion?

Can you force children to eat foods that they don’t really eat at home, condemn their own eating habits with such derogatory language and insults.

Can communities that traditionally eat a variety of foods – beef, eggs, roots, tubers, and all other kind of animals feel a sense of pride in their traditions and cultures?

Isnt this form of conversion much more dangerous?

More thoughts…… Choices of food are not left to individuals and families

and communities any more. There is an onslaught of control by communities that in

India have traditionally controlled everything – from our thoughts, our food, our work, our sense of self esteem, our religious choices.

When millions of our children are starving, can we further degrade the only few foods that they can actually afford or have access to?

Can we ban beef and eggs and bring in spirulina as an alternative?

Is it really a question of business and ethics? What class and caste and religious group in India have accesss

to education, income, resources and entry into privileged spaces in India?

What class and caste group sit at policy making, at the nutritional boards, at the food and safety standards organisations, at public health institutes?

As Dr. Veena says, given a good chance, most of us would only be eating curd rice.

I say that with the influx of corporates into the food industry, we would only be eating curd rice with spirulina as a side dish.

What can be done?

At the level of the Individual Family Community School College Office Company Policy