Every child fortunate enough to grow up in financial comfort has been scolded, “There are poor and starving children in the streets, now finish your dinner!” In this narrative, poverty and hunger go hand in hand, which explains the significant money spent globally on food aid. In 2012 alone, the U.S spent $1.45 billion on food aid in the developing world; a large part of which was delivered as food on the ground to developing countries. This type of food aid is based on what development economists call the Nutrition Based Poverty Trap, which refers to the idea that hunger and poverty are intrinsically linked; that if you are poor you are hungry; if you are hungry you are unproductive; if you are unproductive you are trapped in poverty.
Although this argument seems convincing, Abhijit Banerjee and Esther Duflo, MIT development economists and authors of Poor Economics, explain that the relationship between nutrition and poverty is a bit more complex. Based on their extensive 18-country data set, Banerjee and Duflo found that most people living below the poverty line are not, in fact, hungry. The real challenge seems to be what the Micronutrient Initiative calls hidden hunger, which is caused by micronutrient deficiencies rather than a lack of food. Hidden hunger is especially problematic for pregnant and breast-feeding women and young children, and effects of micronutrient deficiencies during these critical developmental stages can be seen years down the line in stunted growth, compromised immune systems, and debilitating, life-long health problems. As we saw in one of our previous posts, healthcare costs trap the poor in poverty, and compromised immunity from malnutrition, and the resultant recurring health problems it causes, are bigger contributors to poverty than simply hunger.
Maybe because it faces some of the worst malnutrition rates globally, home to one-third of the world’s undernourished children, India has become an epicenter of nutrition innovation. Successful nutrition innovations being employed in India take into account the complex nutrition ecosystem including agriculture and food security, food access, education, fortification and micronutrients, maternal and pre-natal care and education, as well as health and hygiene interventions like hand-washing, clean water, and sanitation initiatives. Over the next few posts I will explore nutrition innovation in India through each of these lenses. Today’s post sets a context for Indian nutrition innovation and explores micronutrient fortification and food treatment initiatives that are helping to reduce the burden of hidden hunger on India’s poorest populations.
Fortification and Food Treatment: India’s Answer to Hidden Hunger
Unlike macronutrients (carbohydrates, protein, and fat), which are required in large quantities to satiate hunger and provide energy, micronutrients are essential vitamins and minerals, required in trace amounts by the body for normal cellular function. Micronutrients include dietary minerals like iodine, fluoride, sodium, and zinc as well as vitamins like vitamin C, A, D, E, K, and B-complex vitamins. Although getting enough micronutrients from food isn’t difficult for most, for an Indian living below the poverty line, whose diet consists mostly of rice, micronutrient deficiencies are a real threat. Common micronutrient deficiencies include Iodine deficiency (which causes brain damage), Vitamin A deficiency (which causes blindness), and Iron deficiency and anemia.
A Holistic View of Fortification and Food Treatment
In an attempt to take on the nutrition ecosystem and support comprehensive solutions, The Bill and Melinda Gates Foundation is addressing nutrition in India through their Grand Challenge in Global Health: Achieving Healthy Growth through Agriculture and Nutrition. This challenge represents some of the best in nutrition innovation as it takes a particularly holistic view of the problem. The program focuses on solutions that “empower women to prevent [malnutrition] through a virtuous cycle where increasing agricultural productivity improves rural families’ nutrition and healthier smallholder farmers have increased productivity, contributing to economic growth.” Two of the challenge winners were featured for their programs in micronutrient fortification: Annamalai University & The International Rice Research Institute for their work with micronutrient fortification of rice and Amity University for its work with agronomic bio-fortification of food crops.
A third challenge winner, Science for Society, is worth highlighting here at some length for their innovative food treatment process that ensures year-round access to the essential vitamins and minerals in fruit and vegetables. Unlike fortification, which requires external inputs and extensive education, Science for Society’s Domestic Solar Conduction Dryer, takes advantage of the inherent nutritional value of fruits and vegetables to supplement the diet of low-income communities. Dehydration of fruits and vegetables drastically extends their shelf life, reducing wastage from agricultural harvest and providing year-round access to vitamin rich food. The Solar Conduction Dryer runs without electricity and uses conduction to transfer heat for increased efficiency, reducing processing time by 40%. Despite being at a pilot stage, this initiative demonstrates the potential of technology to exploit locally grown and easily accessible micronutrient sources to supplement local diets without the need for large-scale fortification efforts.
Bringing Fortification Down to the Community Level
Micronutrient fortification of foods like salt and flour have been employed by countries around the world to supplement the nutritional value of commonly consumed foods. India has long understood the importance of fortification, particularly iodine fortification, and India’s Salt Iodization Programme dates back to the 1950s. It wasn’t until the mid 1980s, though, that commercial entrants introduced branded, iodized salt, with Tata as the pioneer. Other players like Hindustan Unilever Limited were quick to follow and even extended their fortified product range to include iron fortified Atta. The success of commercially fortified products did much to extend the uptake of micronutrients among the general population, but there remained a considerable, mostly rural, population that was not impacted by these nutritious additions to commercially branded products.
To combat iron deficiency and Anemia throughout rural Rajasthan, an NGO called Seva Mandir attempted to translate the success of large-scale, corporate fortification efforts to rural communities through a local grain fortification initiative. Recognizing that many rural families consume their own grain, and are thus excluded from the benefits of commercial fortification, Seva Mandir taught local chakkis (millers) to enrich grain and provided them with a “micronutrient premix…diluted with flour” to add to wheat during grinding.
Although innovative in concept, Seva Mandir’s local iron fortification initiative didn’t prove as successful as hoped. Initial uptake of fortified flour was 60% in targeted villages, but this number dropped to about 30% after one year. This dramatic decrease in consumption has been attributed largely to the millers, who without proper education, may not have consistently fortified grain. Seva Mandir’s experiment demonstrated that though local, community-level fortification initiatives may offer an opportunity to reach those outside of the mainstream commodities market, without proper education and support, such initiatives will not consistently impact nutrition in India.
Innovation and a New Definition of Hunger
So what does this all mean for traditional food aid? It means that just because people are poor, doesn’t necessarily mean they are hungry, BUT just because they aren’t hungry doesn’t mean they are properly nourished. It means that nutrition is a complex issue—closely tied to “poverty, nutritional deficiencies, inadequate feeding practices, and women’s fragile socioeconomic positions”—and requires an equally complex solution addressing hidden hunger and micronutrient deficiencies. It means that dropping rice from planes might not be the best way to end world hunger.
About the Author: Research & Project Manager at Innovation Alchemy, Hannah Rosenfeld explores the intersection of design and social impact & supports entrepreneurs in thoughtfully crafting products and services to transform under served communities.