Disparity between nutritional status in context of ‘wealth docile’

Sandeep Pawar

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CTARA

IIT Bombay

HEALTH is WEALTH

BUT

Does having WEALTH guarantees HEALTH?

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Economic status

• For a household it is calculated by– Consumer durables

– Land size

– Housing quality

– Water and sanitation facilities

• Households in the highest wealth quintile are not necessarily wealthy in monetary terms, but they are better off socioeconomically than four-fifths of the population in India.

3Source: Nutrition in India – NFHS 3, August 2009

Poverty on malnutrition• Hard to buy enough food

• Poor diet

– Affordability and access to food

– Inadequate feeding practices

– Proper healthcare services (Source: Saha, 2008)

• Less likely to go to the doctor when fall sick

• Inadequate nutrition

• Poor sanitation and clean water availability issues

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Findings from the survey data

• In general, those who are poor are at risk for under-nutrition, while those who have high socio-economic status are relatively more likely to be over-nourished.

(Source: Kenjilal, B; et al (2010))

• Anaemia is negatively correlated with wealth.(Source: NFHS 3 – Nutritional status of adults)

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Vaccination: Effect of poverty and wealth (economic status)

• There is an almost direct relationship between household wealth and vaccination rates.

6Source: Joseph Mathew, Advanced Pediatric Center, India (2012)

47.361.8 66.4 70 76.5

1 2 3 4 5

%

Wealth Quintile

Complete Vaccination

13.7

6.34.2 4.7

2.7

1 2 3 4 5

%

Wealth Quintile

Unvaccinated infants

NFHS-3 data findings

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Children age 6-59 months living in households with adequately iodized salt w.r.t. household wealth

Stunting, wasting and underweight among children <5yrs by household wealth

Source: Nutrition in India – NFHS 3, August 2009

NFHS-3 data findings

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Lowest Second Middle Fourth Highest

76 7469 65

56

Anaemia by household wealth

Among children age 6-59 months

Even in the highest wealth group more than half of the children are aneamic

51 4738

2818

2 37

15 30

1 2 3 4 5

Total malnutrition- wealth wise

Underweight Overweight

Malnutrition of women 15-49 years by household wealth

Source: Nutrition in India – NFHS 3, August 2009

Nutrition awareness Vs. Wealth

• According to NFHS III across all wealth classes, mothers who have discussed nutrition with their health workers, including Anganwadi (child welfare centres) workers, were more likely to follow the Indian government’s guidelines while feeding their children.

• Nutrition information and advice offered by Anganwadi workers and other health professionals significantly improved the feeding practices.

• “Appropriate infant and young child feeding practices even in the highest wealth quintile are extremely poor. This indicates that undernutrition in India is not a poverty or food insecurity issue alone, and that child care and feeding information and awareness play an important role.”

-Onno Ruhl, World Bank Country Director in India, Nov. 2014

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Where is the actual problem?

• Poor feeding practices– Exclusive breastfeeding in first 6 months

• Low nutrition information

• Hidden hunger – irrespective of wealth quintiles

• Opportunities– Nutrition education (Give it a first priority)

– Major interventions on improving children feeding practices and their nutritional needs

10Source: Nisha Malhotra, Child malnutrition in India- The Economist Sept. 2010

Conclusion

• Wealth is definitely an essential condition for eradication malnutrition but it is definitely not a sufficient condition

• More emphasis should be on improving feeding practices for children rather than other interventions especially eradication poverty only for the sake of improving the malnutrition status.

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