The contemporary fight against Covid-19 is one that has involved the efforts of many stakeholders. It is a testament to our commitment to protect ourselves and those who are more vulnerable amidst our communities. In terms of Covid-19, people like migrant labourers, people with comorbidities, elderly people and those employed in the informal sector were recognized as the most vulnerable. The prioritization of this fight against Covid-19 while other healthcare issues take a backseat, has opened a Pandora’s box with the imminent issues being – is it possible to find a perfect solution for social or economic problems? Multiple socio-economic issues can be characterised as ‘wicked problems’ due to their numerous, complicated dimensions. Policymakers have struggled to formulate responses to issues like climate change, persistent poverty and food insecurity – but most countries have not successfully reversed these epidemics in their geographies. Wicked problems represent the complex and interrelated nature of challenges to human wellbeing: with globalization, many problems have also become more complex and harder to tackle due to differing interests of multiple stakeholders.
Simply put, to invest resources in solving one problem often means that another goes ignored and unsolved. This raises the question: is it possible to ignore these threatening, wicked problems while dealing with others? This article explores the deprioritization of nutritional health care for children and its ramifications.
Today, one out of every 3 children is growing poorly due to malnutrition.
– The Changing Face of Malnutrition
Efforts to stop the corona virus have come at the cost of running health care and nutrition projects across nations.
Since countries around the world offer various lunch meal programs, the UNICEF estimates that closure of schools has resulted in 39 billion meals missed.
– Nutrition Crisis Looms as More than 39 Billion In-School Meals Missed since Start of Pandemic – UNICEF and WFP
Undernutrition is a systemic health care issue that is less visceral: poorly fed children experience stunted physical and mental growth and are susceptible to other illnesses. However, it is difficult to estimate the number of deaths that occur due to malnutrition alone. This has caused a consistent deprioritization of nutrition services for children as Covid-19, tuberculosis, and other communicable diseases are always seen as more immediate threats.
What do the numbers say?
As per UNICEF, undernutrition is a causal factor behind nearly 50% of all deaths of children under the age of 5.
– Malnutrition in Children – UNICEF DATA
Poor nutrition is the biggest contributor to child mortality in the developing world. Covid-19 will leave 6.7 million more children vulnerable to stunted growth or ‘wasting’. It is a dangerous assumption that a child who survives on poor nutrition intake can easily overcome its effects if their adulthood is nutritionally secure. Malnutrition interferes with cognitive development, bodily growth, reproductive health and the capacity to undertake physical work. What makes this issue so entrenched is that malnourished mothers across the world give birth to infants who are less likely to survive or suffer undernourishment as well. As of 2021, one-third of all children in the developing world are underweight or stunted.
The multiple faces of malnutrition
Another factor that makes malnutrition an enormous challenge is the fact that it is not recognized in all its forms. When people think of malnutrition, it immediately triggers an image of starvation and hunger. But, malnutrition too, has evolved with globalization and capitalistic economic relations. Obesity is a less recognized form of malnutrition, caused by eating a diet which consists of processed foods that are extremely high in sugar, sodium and fats. This leads to ‘hidden hunger’ where meal consumption may appear normal but there is a great lack of micronutrients like vitamin A, zinc, iodine, iron etc.
Hidden hunger has taken root in developed nations like the USA, that have seen the rise of food deserts. A food desert is usually defined as an area where affordable, healthy food like fruits and vegetables is not accessible for people, while processed and unhealthy snacks are cheaper.
As per a 2014 study by Johns Hopkins university, food deserts disproportionately coincide with areas where African-American communities live.
– Research Shows Food Deserts More Abundant in Minority Neighborhoods | Hub
It is important to note that 48% of African American adults are obese
– Adult Obesity Facts | Overweight & Obesity | CDC”; Ogden and Flegal, “Prevalence of Obesity Among Adults and Youth: United States, 2011–2014
– a problem that begins deprivation of access to nutritious food in childhood.
Nutrition and Healthy Futures – Where does our responsibility lie?
Primary health care is essential for the needs of any community, but especially for those that have been left out of social security nets. What drives poor health is often a complete lack of awareness and information – and the absence of people who can provide it. The health care network at present is not wide enough to offer comprehensive care to all geographical regions, marginalized communities or specific population groups like the elderly or infants. This makes nutritional health care an area of social responsibility where corporations can create exceptional impact in the lives of people by investing little.
- Community-Corporate Engagement:
Community health care is one of the most successful ways to bridge the gap between individual needs and systemically available resources. Local stakeholders like community health care providers are better able to understand local dietary practices and food availability. They are able to pinpoint the existent detriments to the health of the community they are themselves a part of. What we eat is also socially determined – culture, gender, geography are important determinants to nutritional access. Policies and strategies that recognize these social factors and create a bottom to top approach to tackle nutritional crises like childhood obesity and undernutrition have greater potential in harnessing local engagement and participation.
- Awareness and Incentivization:
There is low awareness on child immunization and antenatal-postnatal care across the developing world. In many communities, women have time contractions, weak financial positions, very poor means of transportation and low access to health services. Programs that focus on promotion of infant immunization, breastfeeding counseling and awareness of child and maternal health have a great benefit-cost ratio (BCR). Promotion of breastfeeding and hygiene practices using informative advertising campaigns, counselling of mothers via staff volunteers and sharing printed information in easy to understand, vernacular languages are some strategies that can have a transformative impact.
Promotion of child nutrition requires an overarching focus on maternal health and nutrition as higher breastfeeding rates have the potential to improve childhood nutrition, with associated impacts on infectious and noninfectious disease prevention.
– Scherbaum and Srour, “The Role of Breastfeeding in the Prevention of Childhood Malnutrition
Intergenerational malnutrition can only be slowed by promoting nutrition for mothers.
Another strategy of promotion of child nutritive care and immunization is by combining awareness with incentivization. As implied earlier, strategies are most effective when communities become integrated with the healthcare system at large. Strategies like in-kind transfers of foodstuffs or iron supplements to encourage mothers to bring children to PHCs for immunization or other check ups requires low cost and yields great benefits.
Sustainable Development Goal 3 on good health and well being can only be met when children receive appropriate nutrition that enables their healthy growth. Public health care involves a commitment to social justice, equity, solidarity and participation, which OneBarrow is passionate about. Good intervention strategies that highlight education, behavioral change and trust building can allow primary health care services to rebalance the current challenge to equitable health. This is done by heightening the access to nutrition and other resources for vulnerable individuals and communities. We play our part by enabling purpose, based on the recognition that each person deserves dignity and fundamental access to good quality healthcare, without any discrimination. The pursuit of economic growth or reactive healthcare investments should not involve the opportunity cost of providing preventative health measures like access to nutrition.
– Riya Shankar Sharma
Content Writer, OneBarrow
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References:
- “Adult Obesity Facts | Overweight & Obesity | CDC.” Accessible at: https://www.cdc.gov/obesity/data/adult.html.
- “Malnutrition in Children – UNICEF DATA.” Accessible at: https://data.unicef.org/topic/nutrition/malnutrition/.
- “Nutrition Crisis Looms as More than 39 Billion In-School Meals Missed since Start of Pandemic – UNICEF and WFP.” Accessible at:. https://www.unicef.org/press-releases/nutrition-crisis-looms-more-39-billion-school-meals-missed-start-pandemic-unicef-and.
- “Research Shows Food Deserts More Abundant in Minority Neighborhoods | Hub.” Accessible at: https://hub.jhu.edu/magazine/2014/spring/racial-food-deserts/.
