Undernutrition is a major public health problem leading to adverse health consequences and also affecting the economy. Undernutrition leads to 3.1 million child deaths annually, which accounts for 45 percent of all child deaths.
Increased investment in human capital brings about economic growth by improved knowledge and skills in people. Healthy women and children are pillars of a flourishing society. Evidence suggests investing in the well-being of women and children as an effective strategy for improved outcomes for children.
The human capital is the wealth of nations and is dependent on the health, nutrition, skills and knowledge of people. India ranks 116 out of 174 countries as per the Human Capital Index, with a score of 0.49 that indicates a child born in India will be 49 percent productive if provided with complete education and good health.
Evidence suggests that every additional dollar invested in quality early childhood programmes yields a return of between US$6 and US$17. Early stimulation in infants is known to increase their future earnings by 25 percent. Stunting in childhood leads to impaired brain development, lower cognitive skills and education, leading to lower incomes in the future. It is often associated with adverse outcomes for life in terms of non-communicable diseases, leading to increased health care costs.
According to the Global Burden of Disease study, out of ten risk factors for disability adjusted life years in India, six were linked to nutrition. According to the National Family Health Survey (NFHS)-5, India has unacceptably high levels of stunting (35.5 percent), despite marginal improvement over the years. According to the World Bank, “A 1 percent loss in adult height due to childhood stunting is associated with a 1.4 percent loss in economic productivity”, having a lasting effect on future generations. According to estimates, children who are stunted earn 20 percent less as adults than children who are not stunted.
Another compounding factor is anaemia among young women, at 57 percent, which has lasting effects on their future pregnancies and childbirth. The situation further worsens when infants are fed inadequate diets, and there is inadequate sanitation and hygiene.
Evidence suggest that two-third of India’s current workforce is stunted which has enormous economic costs in terms of decrease in the per capita income. The average reduction in per capita income for developing countries is at 7 percent with a high of 13 percent for India due to the high rates of stunting. The economic losses incurred by India due to wasting is estimated at more than US $48 billion in terms of lifetime lost productivity.
According to the Global Nutrition Report, preventing malnutrition delivers $16 in returns on investment for every $1 spent, making clear the need for investing in nutrition. India’s Economic Survey 2016 acknowledged that while there are intrinsic reasons to invest in maternal and early-life nutrition, nutrition related programmes also offer very high returns on investment.
Nutrition-sensitive interventions like water, sanitation and hygiene (WASH) focus on the underlying determinants as poor sanitation can lead to stunting. Evidence suggest both short term and long term reductions in diarrhoea episodes (3-50 percent) through an integrated water and sanitation improvement program in rural India. WASH can bring significant gains in tackling childhood undernutrition and are important determinants of stunting (Cumming et al, 2016).
Education to children plays a pivotal role in amassing of human capital, improving productivity, and economic development. It has been advocated to target on the 1000 days’ period from conception to two years of age for improving birth and nutrition outcomes. Children learn faster as maximum brain development happens during this period and investing in this critical phase has far more advantages in economic terms.
Studies suggest long term benefits on adult human capital and health by improving the nutrition of pregnant women and young children. The first 1000 days of life is the time for rapid growth and development and lack of good nutrition can lead to lifelong adverse consequences. This period is a critical window of opportunity as stunting sets in during this period and aggravates by age of two years.
Data (NFHS 5) reveals that India has more stunted children in rural areas as compared to urban areas, possibly due to socio-economic variance. Stunting prevalence varies depending on mother’s education and household income. There is wide variation among regions, with high rates of stunting in states of Meghalaya (46.5 percent) and Bihar (42.9 percent) while states like Sikkim and Puducherry have lowest at 22.3 percent and 20 percent respectively. There are notable inter-state and inter-district variation in terms of stunting prevalence.
The need for investing more and more in the human capital including good education, nutrition and healthcare to India’s children is more real now than ever. There is a need to couple nutrition-specific interventions with nutrition-sensitive programmes that tackle undernutrition.
In order to produce and maintain a healthy, highly skilled workforce, India must make cost-effective investments to improve child health, nutrition, and education. Investing in healthcare facilities helps create a human capital pool that is both physically and psychologically healthy, which is crucial for enhancing productivity, economic growth, and security.
According to the World Bank report on the Investment Framework for Nutrition, in order to achieve the global targets for stunting, anaemia in women, exclusive breastfeeding for infants, and to scale up the treatment of severe wasting among young children, $70 billion over 10 years must be invested in high-impact nutrition-specific interventions. Thus, India needs to invest in young children, especially in the first 1000 days, in cost-effective nutrition specific interventions if it aims to achieve the Sustainable Development Goal (SDG) 2 on ‘ending all forms of malnutrition’ to reap the benefit of investing in human capital development.
The author is Senior Fellow, Health Initiative, Observer Research Foundation. Views expressed are personal.
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