FeaturedNationalVolume 13 Issue # 11

The economic cost of malnutrition

According to a new official report, Pakistan loses $7.6 billion or three percent of its GDP each year due to malnutrition. The Economic Consequences of Undernutrition in Pakistan: An Assessment of Losses report prepared by the Pakistan Scaling Up Nutrition (SUN) Secretariat in collaboration with the United Nations World Food Programme (WFP) has used economic modeling to review 15 nutrition indicators from the 2011 National Nutrition Survey and the 2013 Pakistan Demographic Graphic Survey.

The report says that “malnutrition is a heavy burden – both for the mother of a weak baby, but also for the economy of Pakistan. And each time a malnourished child is born to a malnourished mother, the burden grows. It is possible to reduce these inequalities and to overcome the consequences of under-nutrition, but we need to work together, we need to work at a local level, and we need to scale up our interventions for maximum impact”.

According to the report, more than 177,000 children die annually in Pakistan before their fifth birthday due to their, or their mothers’, malnutrition. Because this constitutes as future lost workforce, it costs the country estimated US$2.24 billion per year. It is an alarming sign that more than two-thirds of Pakistan’s children suffering from anaemia, iodine deficiencies or stunting will suffer deficits in mental and physical health, which results in lower school performance and lower productivity as adults. This depresses the GDP by $3.7 billion annually.

Also, more than 90 million cases of diarrhoea and respiratory infection among children are linked to to poor breastfeeding practices and zinc deficiencies per year, which costs the healthcare systems and families greater than US$1 billion annually. Lastly, there is an annual reduction in economic output, agriculture and other manual jobs by more than $657 million largely due to more than 10 million working adults with anaemia, suffering from chronic weakness and fatigue.

Nutritional problems in Pakistan are multifarious. They range from issues pertaining to governance, institutional mismanagement and distribution to low productivity, lack of awareness and the inflow of low-quality and adulterated food items. The most debilitating impact of malnutrition is faced by infants, lactating mothers and children. These issues are mostly triggered by poverty, unconducive hygiene conditions, poor maternal nutrition and the lack of understanding among mothers about the weaning process.

Pakistan faces a severe nutrition crisis. The Global Nutrition Report 2015 said that only a small minority of children are growing healthily in Pakistan, which is estimated to have more than half the children under the age of five as stunted or wasted. The report claims that many countries, including Pakistan, Bangladesh, the Democratic Republic of Con­go, Ethiopia and Nigeria, had only a minority of children who were growing healthily. It also presents a dismal picture of the global nutrition status and says that no country is on track to achieve the global nutrition targets set by the World Health Assembly.

Pakistan’s 2011 National Nutrition Survey (NNS) showed high levels of stunting (43.7%) and wasting (10.5%) in children under five years of age. Half of women of reproductive age are anaemic and the population suffers from a significant lack of vitamins and minerals. The developmental, social and health impacts of this burden are serious and often long lasting. During his recent visit to Pakistan, the World Bank president said that Pakistan should address the high prevalence of stunting among its children on a priority basis. According to WB data, Pakistan has one of the highest prevalence of stunting in the world: as many as 45% of its kids under the age of five face stunted growth. He pointed out that if the problem of stunting is not tackled immediately, almost half of the workforce may not be able to participate in the digital economy in about 15 years.

Malnutrition in Pakistan is not only about the physical state of an individual. Instead, it is also about the lack of education, awareness, faulty distribution, bad governance, primitive agriculture and low-quality agricultural inputs. A balanced intake of carbohydrates, fats, proteins, water, vitamins and minerals may require technical advice. But for this it is important to educate the people to maintain a healthy life. In a deeper sense, nutrition is not only about the availability of food. It is also about the suitability of food for human growth and health. This requires education, behavioural changes, lifestyle adjustments and a health-seeking social environment in addition to food supply.

The malnutrition threat in urban and rural areas is different in nature. The lifestyle that we have been accustomed to in the urban areas is one of the major impediments towards creating a nutrition-conscious society. In the rural areas that are plagued by extreme poverty, people face acute malnourishment owing to poor distribution mechanisms and a macroeconomic policy that does not consider agriculture as a sector of priority for investment. When production is driven by an economic proposition of profitability rather than the social and nutritional needs of the people, the issue of malnourishment will continue to exist in a country where 42 percent of children suffer owing to stunted growth and acute malnourishment.

The indiscriminate use of chemicals and pesticides are poisoning food supply and the environment. Around 80 percent of the antibiotics that are used on farms give origin to the danger of antibiotic-resistant superbugs. This has devastating effects on public health and the local economy whereby people have become vulnerable to fatal diseases.

According to local research sources, the prevalence of lifestyle-related diseases like diabetes, hypertension, cancer and cardiovascular complications have increased by 80 percent during the last 20 years in relatively healthy societies like Hunza. Dietary patterns have seen a significant shift from the consumption of locally-produced organic food to the low-quality and unhygienic products that are available in the market. According to a senior agriculturalist of the GB government, the staggering challenge posed by health issues is linked with the increasing reliance on low-quality and adulterated food items that are sold in the local markets in collusion with corrupt government officials.

The waste of food is another important dimension that causes malnutrition and food insecurity. More than 50 percent of food items produced for the market is wasted due to systemic inefficiencies and the primitive means of food production, processing, packaging and distribution in Pakistan. Crops such as sugarcane and cotton, which have high prospects of return on investment, are grown on vast expanses of land while Pakistan is not self-sufficient in wheat and corn cultivation despite being a predominantly agricultural economy.

It is good news that the Ministry of Planning Development and Reform (MPDR) and the Health Services Regulation and Coordination are planning to review the current malnutrition programmes to figure out existing gaps and actions to take. The government of Pakistan is taking many steps towards improving the situation. Various networks have been formed and are working under the leadership of the MPDR/ SUN Secretariat, linking government, donors, UN agencies, civil society, the business community and academia, in an attempt to combat malnutrition in the country. But much work remains to be done to achieve food security and also improved nutrition indicators.