A number of research reports published recently paint a sorry picture of public health in Pakistan.The Global Burden of Disease the first global assessment of the United Nations’ health-related Sustainable Development Goals (SDGs) in 188 countries, was launched recently at a special event at the UN General Assembly. The report assesses countries by creating an overall index score on a scale of zero to 100. The analysis shows that despite expanded health coverage, greater access to family planning and fewer deaths of newborns, much remains to be done to move toward achieving the SDGs. On the other hand, hepatitis B, childhood obesity, violence and alcohol consumption have worsened. Pakistan, ranked at 149, shares the score of 38 with Bangladesh and Mauritania — six places behind India and way behind neighbouring countries like Iran. According to the report, Pakistan is especially vulnerable in the area of child health. Child mortality rate remains abnormally high and childhood diseases take a heavy toll of life. Malnutrition is rampant among large sections of the population and retards normal physical and mental growth among a majority of children belonging to the deprived classes.

A major issue of childhood health in Pakistan is the widespread menace of stunting which is a result of malnutrition and leads to retarded and defective physical and mental growth. Technically, it is defined as the height for a child’s age below the fifth percentile on a reference growth curve. Stunting also affects a child’s educational attainment and job earning prospects. According to a survey, stunting affects nearly half of all children in Pakistan. In absolute terms, over 10 million children in Pakistan are stunted. According to United Nations Children’s Fund (UNICEF)/ World Health Organization (WHO) data, prevalence of stunting below the age of five in India was 62 percent in 1990, but it has now declined to 48 percent; in China it has declined from 22 percent to 9.0 percent, while in Pakistan it has increased from 43 percent in 1992 to 45 percent 2012. In Bangladesh, prevalence of stunting below the age of five was 51 percent in 2004 and has now declined to 41 percent. Sri Lanka has even a better record where stunting has declined from 28 percent in 1995 to 15 percent now.

Stunting basically results from under-nutrition during the most critical periods of growth and development in early life. It starts from pre-conception when an adolescent girl, who later becomes a mother, is undernourished and anaemic; it worsens when the diet of the infant is inadequate or poor. It is only in the last decade that research has shown that a well-known link between a physical marker such as height and a lifetime of chronic undernutrition was also related to weakened immunity, impaired brain development and developmental delays. In later life, this leads to increased risks of obesity and non-communicable diseases, such as diabetes and heart diseases in adulthood. It may be recalled here that during his recent visit to Pakistan, World Bank President Dr. Jim Yong Kim pointed out 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 work force may not be able to participate in the digital economy in about 15 years.

Nutritional stunting means short height for an age, or a reduced growth rate in human development. Stunted children cannot be expected to grow up as productive adults compared with those who are fed adequate food in the first five years of life. Malnutrition is a widespread problem in Pakistan and affects a large section of the population. At a recent conference organized by the Planning Commission,the Country Director World Food Programme said that two out of every five (44 per cent) children under the age of five are stunted, 32 per cent are underweight and 15 per cent children are suffering from acute malnutrition in Pakistan. Another confirmation of the disturbing phenomenon comes from the Global Nutrition Report 2015 which says that only a minority of children are growing healthily in Pakistan. 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. One in three people in the world is malnourished and the problem exists in every country on the planet — yet strategies and interventions available to resolve it are not being implemented due to lack of money, skills or political pressure.

Research shows that it is not just a lack of calories, or vitamins and minerals that cause stunting. In fact, causes of stunting can be attributed to repeated cases of diarrhoea, drinking unclean water, lack of proper early stimulation, inability to buy nutritious food, anaemia in mothers, early marriage leading to early pregnancies, decreased nutrient value of crops and a whole host of non-nutritional factors. In terms of magnitude, Pakistan has a serious problem with stunting since it has been fighting the other critical nutrition issue, starvation — technically called wasting. Limited nutrition funds are naturally focused on saving the lives of those children most at risk of dying. However, a decade of efforts has not prevented the problem and this has created chronic malnutrition. According to the annual report of the National Economic Council, which was recently placed before the National Assembly, one out of three Pakistanis “does not have regular and assured access to sufficient nutritious food”. The report suggests that the poor performance of the agriculture sector in recent years is responsible for this situation, and that the remedy must, therefore, be in making agriculture growth more pro-poor, that is by diversifying the base of incomes and creating more linkages between the farm and non-farm sectors.

Successive governments in Pakistan have miserably failed to address the issue of malnutrition and stunting that results from it. Experts say that Pakistan can add 2-3 per cent to its GDP by tackling the issue of malnutrition. The paradox is that despite Pakistan being one of the major food producing countries in the world, 50% of its population is food insecure. Pakistan is the eight largest food producing country, the sixth largest producer of apricot, fifth largest producer of milk and grows about 25 million metric tonnes of wheat. Yet, food insecurity is on the rise, and a growing majority of its children are malnourished and underweight due to lack of access to adequate food.