The effects of COVID-19 will be felt for generations to come, so systems must act now collaboratively to address all these challenges
The COVID-19 pandemic has hit incomes, social systems and the world economy. The management of this dual burden has put pressure on the Indian healthcare system which has limited resources in terms of equipment, protective gear and essential medical supplies. The pandemic and the subsequent lockdown strategies in many countries around the world, including India, had a crippling impact on jobs, housing, migration and, most importantly, nutrition. The State of Food Security and Nutrition in the World report produced by five UN bodies estimated that almost 690 million people went hungry in 2019, up by 10 million from 2018 and one billion people in the world still do not have access to a healthy food supply. Estimates show that by the end of this year, the figure is likely to go up. Malnutrition increases the chances of individuals becoming susceptible to infections because of a weakened immune system and eventually dying, setting in motion a vicious cycle for future generations. Those experiencing malnutrition and diet-related diseases in particular face the brunt of COVID-19 and malnutrition. When families face grave challenges in the form of food price hikes, unemployment, restricted mobility and disruption to health and social services — regardless of whether they are directly affected by the virus — their nutritional intake and, therefore, health will be harmed if urgent action is not taken to address the barriers they face in accessing healthy food.
As per the Global Nutrition Report 2020, the global prevalence of severe acute malnutrition (SAM), was 7.3 per cent in 2018, compared to 7.9 per cent in 2012, validating negligible progress towards the five per cent target set for 2025 in the 2012 World Health Assembly. India is home to half of the wasted children globally. Even before COVID-19, one of the most impacted groups when it comes to access to nutrition-related schemes has been the marginalised section of women and children everywhere. According to the National Family Health Survey-5 (NFHS-5), malnutrition indicators have worsened, with the proportion of children with stunting rising in 11 out of 18 States, cases of those with wasting going up in 14 and of those with anaemia in 17 States. One study interprets that the contagion may result in health system disruption, collapse and decrease in access to food, which will further increase child and maternal deaths. The least severe scenario over six months would result in 2,53,500 additional child deaths and 12,200 more maternal deaths. A most severe scenario over six months would result in 11,57,000 additional child deaths and 56,700 more maternal deaths. The increase in wasting prevalence would account for 18-23 per cent of additional child deaths.
The Gross Domestic Product (GDP) growth of India has been 6.1 per cent in 2018, 4.2 per cent in 2019 and 1.9 per cent this year. Fitch rating slashed the country’s economic growth prediction to 0.8 per cent for April-March 2020-2021. Part of this probably is the effect of the outbreak and the subsequent lockdown. Consumer spending has fallen to 0.3 per cent from 5.5 per cent a year ago. This is twice the 2009 recession. In 2018, people from the lowest income quintile from India spent 35.1 per cent of their income on food whereas in the highest quintile, food expenditure was 8.2 per cent. So if the food prices increase by 20 per cent, the effect on the lowest quintile will be disproportionately high. New data released by the Ministry of Consumer Affairs on food prices showed that barring cereals, the cost of all other food items has increased three times since April. Prices of pulses are likely to rise due to the unavailability of labour to peel the lentils. This relation between income elasticity and food intake shows that some degree of increase in malnutrition is inevitable during the outbreak. Besides a drop in income during the lockdown, there have been many issues related to a supply chain breakdown and the unavailability of fruits and green vegetables. Transport limitation, closure of shops and markets, too, led to an increase in food prices. Seasonal variation on the availability of food in the summer has compounded the issue further.
Key strategies to combat malnutrition and COVID-19 together involve building a resilient future to also face shocks of future pandemics. These include ensuring continuity to provide critical community-based nutrition services, using innovative and digital delivery systems for basic services such as promotion of breastfeeding, micronutrient supplementation and basic primary healthcare, including immunisation. In India, the need for pushing Community-Based Management of Acute Malnutrition guidelines by the Centre is the need of the hour. Emergency supply of fortified food, scaling up of public distribution systems and health promotional outreach activities on COVID-19, reiterating the need for social distancing while continuing to safely breastfeed infants and emphasising the need for healthy diets, basic nutrition services such as vitamin A supplementation and immunisation, should be intensified. The effects of COVID-19 on malnutrition will be felt for generations to come, so systems must act now collaboratively to address all these challenges for healthier outcomes.
(The writer is a Food Technologist and a Public Policy Consultant. The views expressed are personal)