Maharashtra, 2010. In a village 130 km (80 miles) from Mumbai, the head of a nursery is weighing a child. Four years old, she is just 10 kg (22lb), two-thirds of what she should be. More than half the nursery’s charges are below their proper weight (“wasted” in the jargon) or short for their age (“stunted”, a result of years of undernourishment). The children out in the fields are even worse off, the teacher says. And most of their mothers are anaemic. Yet this Indian state is not especially poor.
India has done a miserable job of improving nutrition of its people — but so has most of the world. In 1974, Henry Kissinger, America’s secretary of state, told the first world food summit that within ten years no child would go to bed hungry. He was miles off. Figures calculated for a follow-up conference, held on November 19 in Rome, show that 162 million children under five worldwide are stunted. The rate of child wasting has not budged in the past couple of years. The number of undernourished people in the world has fallen since 1990, but only by a fifth, and now stands at about 800 million. That is despite real global GDP growth of 3.6 percent per year over the same period and a fall by half in the share of the population of developing countries living on $1.25 a day or less.
As the world’s economy has grown, the prevalence of undernourishment — eating too few calories to sustain an active life — has fallen only half as fast as poverty. But at least it has fallen. Micronutrient deficiency is not falling at all. To be healthy, people need not just calories but nutrients such as vitamins and minerals. Lack of vitamin A can cause blindness; lack of iron causes anaemia. Two billion people are thought to suffer from some micronutrient deficiency.
Obesity, meanwhile, is getting worse — and not only in the rich world. Between 2000-2013, the number of overweight children rose from 32 million to 42 million, more than two-thirds of them in low and middle-income countries. It used to be thought that when poor countries cut hunger, they would have some respite before obesity took off. Not so. As undernourishment has fallen, the number of people eating too many calories has risen correspondingly, meaning that many developing countries suffer all three manifestations of malnutrition — undernourishment, micronutrient deficiency and obesity — simultaneously.
According to the first Global Nutrition Report, published in early November by the International Food Policy Research Institute, a Washington think-tank, every country except China and South Korea has at least one of three public-health problems — child stunting, anaemia among women of reproductive age, or excessive weight among adults.
More fundamentally, better nutrition is a byproduct of half a dozen policies, many of which are not about diet at all, but each of which is essential. Dirty drinking water and poor sanitation cause gastrointestinal illnesses which prevent the body from absorbing nutrients. In most of sub-Saharan Africa, more than 30 percent of the population has no access to treated water or sanitation. The widespread lack of toilets goes some way to explaining India’s dire nutritional performance.
Few countries think about nutrition when crafting education or welfare policies. When they do, the results can be striking. In Maharashtra, the prevalence of stunting among under-fives fell from 37 percent in 2005-06 to 24 percent in 2012. Many small improvements explained the change: economic growth and poverty reduction were slightly above the Indian average; spending on nutrition programmes doubled from a low level; female education rates rose to a high level; and implementation of some policies improved (staff vacancies in nurseries, for example, were cut from 50 percent to 15 percent).
Global rankings boom
Education ministers across the globe quake in the run-up to the publication, every three years, of the OECD’s Programme for International Student Assessment (PISA), which rates 15-year-olds’ academic performance in dozens of countries, except in India which has opted out.
Those that do well can expect glory; the first PISA ranking, published in 2001, surprised the world by putting unshowy Finland near the top in every subject and made it a mandatory stop-off for any self-respecting education policymaker. Germany’s poor showing, by contrast, led to national hand-wringing, school reforms and creation of a €4 billion (Rs.31,000 crore) federal education support programme.
Similarly influential is the yearly Ease of Doing Business Index of the World Bank. Government presentations to investors will always show the highlights (provided, that is, there are numbers worth boasting about). The Trafficking in Persons (TIP) report compiled by America’s state department each year ranks governments on their perceived willingness to combat trafficking. A bad showing blackens a country’s name and can mean losing aid and investment.
Such performance indices, which rank social issues or policy outcomes in different countries by combining related measures into a single score for each, are enjoying a boom. Their number has soared over the past two decades. “Numbers, rating and ranking catch people’s attention and make information easy to process,” says Judith Kelley of Duke University.
The best indices are meticulous (PISA, for instance, combines dozens of carefully standardised sub-measures and raises statistical caveats). But others are based on shaky figures calculated differently in different countries. And choosing what to include often means pinning down slippery concepts and making subjective judgements. An index of democracy, freedom or happiness means putting hard numbers to the fairness of elections, weighing civil liberties against economic rights, or deciding how much to rely on surveys.
However an index is calculated, voters tend to conclude that their country’s position is at least partly due to government policies — and governments agree, at least when they do well. Increasingly, though, the causality flows the other way. “Ratings and rankings can be powerful tools of both branding and influence,” says Kelley. Together with Beth Simmons of Harvard University, she has found that a big reason for the boom in indices is their growing use by governments, NGOs and campaigners to shape new laws and get them passed.
(Excerpted and adatped from The Economist & Times Higher Education)