A child, more than all other gifts
That earth can offer to declining
man, Brings hope with it, and
These beautiful words by Wordsworth ring hollow in Pakistan where according to the government’s own statistics, over one‐third of children are underweight, 46% of children suffer from malnutrition (stunted) and over 10% are acutely affected (wasting), half of them are anemic, and almost one‐third of the children have iron deficiency anemia. This leads to significant percentages suffering from mortality and morbidity below the age of five. Over 177,000 children die each year, because they or their mother suffered from malnutrition. For a country, whose leaders eulogize over its youth potential and upcoming youth dividend its malnutrition statistics are worse than most sub- Saharan countries.
“The Economic Consequences of Undernutrition in Pakistan: An Assessment of Losses” report published last year by the Ministry of Planning Development & Reform calculated the overall cost to society from malnutrition and its consequences, to be $7.6bn or annual loss of 3% of GDP. This would be equivalent to setting up the Diamer Basha dam – which the government has delayed for over 20 years as no donor agency has been willing to give Pakistan the money to set it up.
The report issued by the Pakistan Scaling Up Nutrition (SUN) Secretariat at the Ministry of Planning Development & Reform, in collaboration with the United Nations World Food Programme (WFP), revealed that more than two-thirds of Pakistan’s children suffering from stunting or iodine deficiencies will suffer deficits in mental and physical development, leading to lower school performance and lower productivity as adults, depressing GDP by US$3.7 billion annually. A Lancelot study published in 2013 showed that these percentages have not changed in the past twenty years.
Unfortunately, public health issues are of least interest to leaders who are not voted for their efficiency or work on public interest and but on the basis of tribal loyalties and what they can deliver on ‘thana’ politics. Punjab, Pakistan’s largest province with over 100m residents, has shown an overall decline in stunting, yet, has seen a rise in wasting in over two-thirds of its districts. On the other hand, the province has launched an Orange Metro project with an estimated cost of Rs162bn. Dr Farrough Saleem in a recent article, has stated this is the most expensive metro line in the world at Rs6bn per km; by comparison the Punjab government’s health budget is only Rs54bn and in a province in which 3 out of 4 people do not have access to clean drinking water, only Rs12bn is allocated to water supply for the over 100m residents of Punjab.
The first 1000 days of a child’s life and neuro development sets them up for the rest of their lives. If they do not get the basic food nutrition it decreases their capacity to learn, increases their susceptibility to infection and disease and can lead to a lifetime of lost earnings through poorer performance at school and lower productivity as adults. A UN report published in February 2018 as part of its SDG 2030 Agenda, showed that over 48% of Pakistani women have no say in their health. They also eat less nutritious foods than other members of the family as they give them priority over their own needs.
Malnutrition is preventable and needs to be a focus for the political leadership in order to ensure greater national development. Its existence is a sign that not only that it lacks priority; but also, it does so since it affects the poor and those with the least say in society. According to a budget analysis done by a government research institute only 10% of the health budget is spent on nutrition, and of that, only 10 percent is spent by the government and 90 percent is actually disbursed by development agencies or related NGO’s.
UKAID is supporting a $48m food fortification program, seen as a very cost-effective way to reduce malnutrition. It will see nutrients added directly into staple food consumed in Pakistan into wheat flour, edible oils and ghee at source in mills and factories. They are working with over 1000 mills and over 100 oil producers directly. Fortification at source usually in cereals in does in many countries through-out the world.
One suggested method used worldwide is governments providing young children in schools with fortified food. I remember growing up in the UK getting milk in school during the 11am break-time, which to be honest, I didn’t appreciate as much as I do now with hindsight. The sustainable development goals have a zero hunger agenda, however, in Pakistan with the 18th amendment health has been devolved down to the provinces creating stakeholder coordination issues which combined with a general lack of importance given to nutrition from policy makers, don’t suggest that it will be realized any time soon.
The writer is managing editor for Global Village Space magazine. A graduate of Columbia University.