Society owes its children better healthcare
Recently, my car stopped behind a school bus in the middle of a traffic jam in Delhi. The children were returning home from school in the afternoon. A street vendor was selling packets of junk food to eager hands reaching out from the bus windows. It appeared that this was a usual occurrence.
The vendor cannot be faulted as he is working and earning a meagre income which he hopes will support him and his family. The trader who has employed the street vendor, too, is not at fault because that is part of his daily commerce. The children are not to blame either because they have become addicted to the taste of these calorie-packed, nutrient-poor snacks. Parents may be partly to blame if they have not educated their children about the adverse health effects of such foods and discouraged consumption. Some of them may not even be aware of how the children are spending their pocket money.
So, who is to blame as childhood obesity rates rise and ultra-processed foods (UPFs) erode immunity, injure blood vessels and inflame tissues and organs across the body? Even if obesity is not visually apparent, body fat levels increase—especially in the abdomen. This happens at the expense of muscle mass, which growing children need to build instead. Such ‘adiposity’ sets the scene for the advent of hypertension and diabetes in early adulthood and heart attacks in the early midlife years. While this is well-established scientific knowledge, the addictive assault of UPFs on children’s bodies continues without much resistance from most of society.
Industries that produce these foods and aggressively market them to reap huge revenues are to blame. They are aware of the science, but deny, dispute or ignore the evidence of harm as they pursue profits. Governments are also to blame because regulatory measures are inadequately framed or ineffectively implemented.
The Food Safety and Standards Authority of India (FSSAI) banned the sale of junk foods—products that are high in salt, sugar or fat—within schools or up to 50 metres around the school. The FSSAI also launched the Eat Right India movement to promote awareness and adoption of healthy diets. However, the forces of commerce are far more powerful in promoting their products than governmental agencies are in cautioning against them. What is needed is a slew of strong fiscal and regulatory measures: higher taxes on unhealthy food products will discourage people with limited disposable income, like children, from purchasing UPFs; powerful health warnings on UPF product packages, with clear communication of their being high in salt, sugar and fat; crackdown on advertising, promotion and sponsorship, including celebrity endorsements; and enforced reduction of the salt, sugar and unhealthy fat levels in manufactured food products. These must be coupled with effective programmes that promote nutrition and health literacy among parents, teachers and students.
The day after I witnessed the school bus episode, I attended a multi-stakeholder workshop on providing health and social services to children with disabilities. These disabilities were due to developmental delays, defects at birth, diseases and deficiencies. The Rashtriya Bal Swasthya Karyakram (RBSK) was launched to enable their early identification and corrective intervention. While RBSK has salutary objectives, the intensity and quality of implementation are different across states. Low-income urban communities suffer because primary healthcare services don’t reach them. Often, parents are left to fend for themselves as they struggle to find competent care providers and sustain this care over many years.
Here, too, society at large expresses concern but does not show sustained commitment to care, extending sympathy rather than support. Other than a few government programmes and a little compassionate philanthropy, there is no collective societal will to ensure that such children receive the care they need to achieve their full potential in areas where their disabilities do not impede them. Several disabilities can be corrected if they are detected early and the right kind of care is provided. Community-based rehabilitation services enable children to overcome the limitations of their disabilities.
Often, the responsibility of providing care and support to such children falls wholly on their families which have limited finance, knowledge, and access to healthcare or social support services. Children are thereby deprived of the quantity and quality of their lives. The nation, too, loses out on talents that might have otherwise blossomed. There has to be a common societal commitment to the multi-sectoral implementation of policies and programmes which recognise and readily respond to the physical, mental, emotional, nutritional, educational, and socialisation needs of these children. This is both a moral imperative and economic investment to reap the benefits of our demographic dividend.
Yet, society does not see the health of children as its collective responsibility. This is a strange paradox. Society, represented by governmental agencies, exercises its ‘custodial responsibility’ when there is real or perceived child abuse or severe neglect. Children are then taken away from parents and placed in childcare agencies or foster homes. However, when children’s physical or mental health needs corrective or rehabilitative care, society shrugs off its responsibility and places the burden on parents. The children played no role in creating those disabilities for themselves and parents, too, are often unaware of how those birth defects, deficiencies or diseases came to affect their offspring. Shouldn’t society accept that it has a collective custodial responsibility for care and support of such children? It can do so by framing enlightened policies, creating efficient systems, delivering programmes effectively and creating a collective empathetic response to the special needs of children. Not as a momentary gesture of charity but as a continued commitment to sustained social solidarity.
Be it preventing UPFs from harming child health or providing supportive care to children with disabilities, society has a collective custodial responsibility which it cannot shrug off. If we neglect the health and well-being of children despite the knowledge of what needs to be done, it will be a civilisational failure.
(Views are personal)
Prof K Srinath Reddy
Cardiologist and epidemiologist at PHFI. His book Pulse to the Planet: The Long Lifeline of Human Health has been published in September 2023