Why South Asian Governments Should Prioritize Tackling Malnutrition

Remarks by Kul Chandra Gautam
At a Panel Discussion at the World Bank
Washington, DC, 23 September 2011

Distinguished participants,

I wish to commend the World Bank, and its South Asia department for giving nutrition the priority it deserves, both in terms of overall policy and practical support it provides, e.g. through the South Asia Food and Nutrition Security Initiative (SAFANSI).

Previous speakers have already made an eloquent and compelling case on the importance of investing in combating malnutrition, and why this ought to be a particularly high priority in South Asia.

I completely associate myself with these statements and sentiments.

But putting myself in the shoes of Ministers and Secretaries of Finance or Planning of our countries, I empathize with their dilemma and predicament.

Today, we have emphasized the importance of nutrition in this panel discussion with senior officials from finance and planning.

But I know Ministers and Secretaries receive delegations every day who make similar case for building roads, airports, schools, hospitals, opening new industries, helping the unemployed, setting aside special budget for pension for the elderly or scholarships for children from deprived communities, expanding the network of telecommunications and electricity, combating climate change, and the list goes on.

Faced with limited budget and unlimited demands and political pressure to satisfy many constituencies, Ministers and Secretaries of Finance or Planning have among the toughest jobs in any government.

They are bound to have to disappoint many who knock on their doors with many legitimate demands and proposals.

So we appreciate the polite hearing we get from senior officials from South Asia as we press them to give higher priority to nutrition.

Where should nutrition fit in the balancing act that Ministers and Secretaries have to perform faced with many legitimate and competing demands from various sectors?

We would all hope that nutrition would command a high priority, but I suspect that those of us who advocate for greater investment in nutrition are probably among the least influential constituency.

We are a bunch of policy specialists and development professionals from academia, some donors, UN agencies, and now the World Bank.

It can be costly and dangerous for Ministries of Finance and Planning to disappoint powerful politicians, well-organized trade unions or other pressure groups.

But such influential personalities and groups are hardly likely to lobby for increased investment in nutrition.

And advocates of nutrition generally do not have much political clout and they can be safely ignored.

Indeed, nutrition is like an orphan issue. Many people recognize its importance, but nobody considers it as their top priority.

In governments, nutrition is often handled by the Ministry of Health. But it is much lower in the order of priority than hospital administration, medical education, the drug purchase agency and other departments.

Sometimes, nutrition is handled by the Ministry of Agriculture. But there too it is much lower in the pecking order than the departments of irrigation or forestry, fishery or cooperatives, food safety or procurement of agricultural inputs.

Some governments wisely recognize nutrition as a multi-sectoral issue, which it is.

But making it multi-sectoral often has the disadvantage of nobody taking it as their prime responsibility and passing the buck to other sectors.

Yet, as we have heard, nutrition ought to be considered central to human development.

Let us recall that some 80 percent of human brain is formed in the first 1000 days, or from conception to two years of age of a child’s life.

Whether a child will be a genius, mediocre mentally retarded is largely determined during those first 1000 days.

If we miss the opportunity to invest in proper care, stimulation and nutrition of the child in those first 1000 days, we often doom the infant to a life of sickly childhood, lethargic adolescence, mediocre student, and unproductive adult.

And such fate can rarely be reversed through later interventions.

As some previous speakers have said, conventional wisdom is that malnutrition is a product of poverty, and that if we focus on poverty eradication, malnutrition will simply go away.

But evidence suggests that malnutrition is both a cause and a consequence of poverty.

We have seen in South Asia relatively high rates of child malnutrition even in well to do families and affluent communities.

So it would be foolish to say: take care of poverty and that will automatically take care of malnutrition.

Specific, well-targeted nutrition interventions are necessary along with general poverty reduction schemes if we are to break the back of malnutrition.

As pilots of the national economy, I would hope that enlightened senior officials from ministries of finance and planning from South Asia would give high priority to investing heavily in combating maternal and child malnutrition.

Healthy and well-educated citizens are the greatest asset for our national development. High levels of malnutrition in early childhood, dooms our future generation from being healthy, well-educated and productive citizens.

Even mild levels of micronutrient deficiencies such as vitamin A, iodine, iron and zinc expose our children to becoming sick, lethargic, brain-damaged, and unproductive.

Yet such deficiencies can be overcome with many extremely low-cost and effective interventions.

As recent studies such as the “Scaling up Nutrition” show, there are many other cost-effective nutrition interventions.

Just like the ministries of finance, planning commissions and central banks regularly and rigorously monitor GDP growth rate, inflation, balance of payments, etc. I would hope that they would not only provide adequate funding but insist on regular monitoring of progress in the growth and development of our children.

We need to lift up nutrition from being an orphan issue to becoming a key indicator of our progress in human capital, so essential for our economic development.

Nothing would elevate nutrition from being an orphan to a favoured child, as its adoption by the ministries of finance and planning as a critical indicator of a nation’s long-term economic health.

If this is going to be an Asian century, as is often said in the halls of this great institution, and beyond, South Asia will have to overcome its shameful record of being the region with the highest levels of malnutrition in the world – even higher than sub-Saharan Africa and all other sub-regions.

The leadership of our most powerful ministries – those of Finance, Planning, the Prime Minister’s or President’s office – will be needed to put nutrition at the centre of our development and political agenda.

As pilots and guardians of South Asia’s economies, I urge you, Ministers, Secretaries, and Governors, to adopt combating malnutrition as a central part of your mission.

Please do not consider this just as an appeal of bleeding-heart child advocates or some humanitarian activists.

As we have heard, hard-nosed economic institutions like the World Bank, the Inter-American Bank, donors like DFID, and others have come to the conclusion that investing in nutrition is very central to achieving the Millennium Development Goals and building strong foundations for national development.

So even if there are no powerful constituencies knocking on your doors to allocate more funds for nutrition, I would hope that Ministers and Secretaries of Finance and Planning would themselves see the wisdom of investing heavily, and investing early in nutrition.

After all, the mark of good leaders is not just to respond to pressures of political and other interest groups, but to take enlightened leadership and initiative to do what is right for long-term, sustainable development.

Investment in nutrition is precisely one of those vital issues crying out for your leadership.

Thank you.