India endeavours to nourish and nurture a productive population with many years of ‘healthy life expectancy’ to propel the country to the aspirational goal of being Viksit Bharat by 2047. That’s why adequate nutrition must be a major engine of this journey.
On the other hand, poor nutrition sets the nation back along the development path. It predisposes us to a host of diseases across the life course, while stealing health and sapping productivity. Thus, sagacious public policy must be geared towards protecting health and wellbeing across the life-course of the population. It must be guided by sound scientific research that generates evidence-informed, context-relevant, resource-optimising, culturally-adaptive and equity-promoting recommendations.
Nutrition is a key to good health across life cycles. Nutrition of the girl child, adolescent girl and newlywed woman will shape her health prior to pregnancy and the health of the child to be conceived. Nutrition during pregnancy will critically influence the physical growth of the child, while epigenetically programming metabolic processes that will determine risk of diabetes, cardiovascular diseases and even some cancers later in adult life.
For these reasons, Indian public policies and scientific research in the first six decades of independent India focused almost exclusively on the problems of undernutrition and anaemia in women and children. Micronutrient dietary deficiencies of iodine, iron and zinc also started attracting policy response.
However, overweight and obesity did not, alongside the associated problems of non-communicable diseases (NCDs). Principal among these were cardiovascular disease, diabetes and cancer—all of which were clearly linked to faulty nutrition through unhealthy diets. While excess body fat contributes to a high risk of these diseases, accumulation of fat in the abdomen—visceral adiposity—is especially dangerous in stoking widespread inflammation and vascular damage.
Overweight and obesity was for long dismissed as a problem of excess calorie consumption. The term ‘over-nutrition’, coined by nutritionists to differentiate it from ‘undernutrition’, was misleading. It ignored the fact that diets which resulted in obesity were often deficient in fibre and anti-oxidant rich fruit and vegetables, healthy fats (from sources like nuts, seeds and fish), while healthy edible oils were an overpriced, unaffordable option for the poor. It unfairly placed the odium for obesity on an individual’s gluttony, rather than the quality of his diet and nutrition. This simplistic understanding of nutritional science led to economists and planners focusing on ‘energy security’ instead of ‘nutrition security’.
The rapid rise of NCDs threatens to extract a high toll of early deaths, prolonged disability, prohibitive healthcare costs, strained health system capacity and lost productivity—all of which can become potholes on the road to Viksit Bharat. Since most NCDs are nutrition-related, caused by diets which disturb many inter-related regulatory systems in the human body, greater attention now needs to be paid to this public health emergency approaching in slow motion.
Diet is what we eat and drink. Nutrition is what we get from it in a mix of chemicals. Our diet also feeds the trillions of bacteria which reside in our gut and constitute an individual’s signature microbiome. These bacteria feed on dietary fibre that we cannot digest. In turn, they help us manufacture vitamins and boost our immunity. They also use the enteric nerve plexus and use the ladder of the long vagus nerve to influence brain function. When modern food systems which strip grains of fibre deprive the microbiome of their food, humans suffer adverse health effects.
Recently-unveiled scientific knowledge has brought home valuable lessons: nutrition has to be balanced through composite diets that can prevent both undernutrition and obesity; dietary diversity is essential, as is crop diversity which can enable dietary diversity; nutrient quality of crops depends on soil health, water quality and water security; seed quality; nutrients that enable plant growth and environmental conditions such as ambient temperature and atmospheric carbon dioxide levels.
While several of these requirements continue to be addressed through multi-sector policies, agricultural research in India has recently focused on ensuring scaled up production of nutrient rich, climate resilient crops. Bio-fortification has emerged as an important intervention to boost the nutrient content of crops.
Unlike food fortification, bio-fortification does not add nutrients to food items like salt, flour or milk. It aims to produce plants which can yield the right mix of nutrients at desired levels to support growth, good health and wellbeing. It is not subject to the market vagaries of production processes and pricing which impact the consumption of fortified foods. It also enables the plant to provide a right balance of multiple phytonutrients instead of a skewed supply that comes from selective food fortification.
Indian Agricultural Research Institute has undertaken innovative research in recent years to employ a variety of bio-fortification techniques to improve the zinc, iron and vitamin A content in commonly-consumed crops. Innovations include high-nutrient maize, wheat and vegetable varieties such as vitamin A-enriched carrots and iron-rich pearl millet, zinc-enriched wheat and protein-packed maize with higher yields.
While these innovations are exciting, science-led public policy demands evidence of the intended benefits. For that, IARI recently linked arms with the Indian Council of Medical Research to launch a purpose-driven partnership, SEHAT or Science Excellence for Health through Agricultural Transformation. Its key action areas include bio-fortification of crops; integrated farming systems (combining crops, livestock, fisheries and horticulture); agri-nutrition for NCDs; a ‘One Health’ approach and protection of farmers’ health.
Even as these two scientific agencies work on estimating the health benefits of crops like pearl millets, pearls of wisdom from Union ministers linked ancient wisdom to contemporary challenges at the launch of SEHAT. Health Minister J P Nadda called for an effective response to the challenge of NCDs by coupling multi-sectoral interventions to integrated health systems which prioritise prevention, early detection and continuity of care. Agriculture Minister Shivraj Singh Chouhan invoked the Ayurvedic canon of healthy nutrition: “Hith bhojan, mith bhojan, rithu bhojan.” We await SEHAT to make this possible through validated dietary advice.
K Srinath Reddy | Chancellor, PHFI University of Public Health Sciences; and Chair, Centre for Universal Health Assurance, Indian School of Public Policy
(Views are personal)
(ksrinath.reddy@phfi.org)
