REPORTS

India slips in Global Hunger Index ranking

Print edition : November 19, 2021

India falls to 101 from 94 among 116 countries in the Global Hunger Index. In this photograph, needy people eat lunch distributed by volunteers near Kashmiri Gate area in New Delhi on October 15. Photo: SUSHIL KUMAR VERMA

A volunteer of Shramjeevi Sanghatana performing the weight check test of a malnourished child at Bhospada, a remote village in Maharashtra’s Palghar district, in September 2016. A total of 208 deaths were reported in Palghar between April and August that year. The government swung into action only in September, rushing severely malnourished children to hospitals in Jowhar and Mokhada towns. Photo: Prashant Nakwe

At a slum in Hyderabad, a file photograph. The absence of proper sanitation and child care practices often complicates problems caused by inadequate nourishment. Photo: NOAH SEELAM/AFP

Malnourished children with no access to clean drinking water and proper food in Lakhimpur Kheri in Uttar Pradesh, a file photograph. Photo: V.V. KRISHNAN

Although the government has reacted angrily to the GHI report of 2021, which has ranked India lower than its South Asian neighbours, the report has in all probability erred on the side of underestimation of the levels of hunger and deprivation in India.

THE Narendra Modi government has rubbished a global report on hunger that describes India’s level of hunger as “serious” and rates the country, at 101, below its South Asian neighbours in the global rankings. The scores are categorised as low, moderate, serious, alarming and extremely alarming. From 38.8 in 2000, 37.4 in 2006, and 28.8 in 2012, India’s score has declined to 27.5 in 2021.

The Global Hunger Index report, published by two humanitarian and private aid organisations, Concern Worldwide and Welt Hunger Hilfe, came into existence in 2000. There are four parameters for the rankings and scores—prevalence of undernourishment in the general population, child mortality, child wasting (low weight for height among children under five denoting acute malnutrition) and child stunting, which includes children under five with a low height for their age denoting chronic undernutrition. The 2021 report says 15.3 per cent of the Indian population is undernourished, 34.7 per cent of children under five are stunted and 3.4 per cent die before their fifth birthday. The report accessed data for 135 countries but could find sufficient data for only 116 of them. For 19 countries, individual scores could not be calculated and ranks could not be determined because of lack of data.

India’s rank of 101 places it behind Pakistan (92), Sri Lanka (65), and Bangladesh and Nepal (76 each). War-torn Iraq has fared better at 86. China and Cuba are among the first 18 countries, among whom the differences in score are minimal. At 17.3 per cent (up from 17.1 per cent in 1998-99), India has the highest rate of wasting. The report states that the ranking is based on the Prevalence of Undernourishment (PoU) data between 2018 and 2020 and not anything that has happened in 2021. Data were drawn from the United Nations and other multilateral agencies to compute scores and a uniform standard was applied to ensure comparability.

In order to track a country’s performance over time, the report carries the data for three reference years for each country. India’s score in 2021, therefore, can be directly compared with its GHI scores for 2000, 2006 and 2012.

Faulty methodology: India

The Indian government has claimed that the report uses faulty methodology and inaccurate rankings based on inaccurate data. (No other country, incidentally, has found fault with the GHI methodology and rankings). India says the rankings are based on a Gallup survey, a claim that the report’s authors have refuted. The government also complains that its efforts to mitigate hunger levels have not been acknowledged. The GHI report, however, makes it clear that acknowledging the efforts of individual governments is not its mandate.

Also read: No data, little relief: Panel report exposes government inadequacies

A day after the GHI findings were published in the media, a statement from the Women and Child Development Ministry said that it was shocked to find that “the Global Hunger Report 2021 has lowered the rank of India on the basis of FAO [Food and Agriculture Organisation of the United Nations] estimate on proportion of undernourished population, which is found to be devoid of ground reality and facts and suffers from serious methodological issues”. It accused the Concern Worldwide and Welt Hunger Hilfe of not doing due diligence before releasing the report. It said the methodology used by the FAO was unscientific as it based its assessment on the results of a “four question” opinion poll that was conducted telephonically by Gallup and that the “scientific measurement of undernourishment would require measurement of weight and height, whereas the methodology involved here is based on Gallup poll based on pure telephonic estimate of the population”. The Ministry also said that the GHI report “completely disregards government’s massive effort to ensure food security of the entire population during the COVID period, verifiable data on which are available. The opinion poll does not have a single question on whether the respondent received any food support from the government or other sources. The representativeness of even this opinion poll is doubtful for India and other countries.”

It expressed surprise that going by the FAO report “The State of Food Security and Nutrition in the World 2021”, Afghanistan, Bangladesh, Nepal and Sri Lanka did not appear to have been affected at all by the “COVID-19 pandemic induced loss of job/business and reduction in income levels, rather they were found to have improved their position on the indicator ‘proportion of undernourished population’ by 4.3, 3.3, 1.3 and 0.8 percentage points respectively during the period 2018-20 over 2017-19”. (The PoU data on the FAO website did show that hunger had risen in all South Asian countries, though it was highest in India and lowest in Nepal and Bangladesh.)

The Ministry’s statement asserted that the GHI 2021 and the FAO’s report on food security had “completely ignored” facts available in the public domain pertaining to the various schemes of foodgrain distribution in 2020 and 2021. The government highlighted the allocation of 5kg of foodgrain per person per month and pulses at 1 kg per household under the National Food Security Act (NFSA) for targeted beneficiaries. (This, incidentally, is what the government is mandated to do under the NFSA anyway.) The statement also highlighted how under the Atma Nirbhar Bharat Scheme, 5kg of foodgrain per person per month, and also chana (gram), for two months (May and June 2020) was allocated to migrants not covered under the NFSA or State Public Distribution System. It detailed the various ameliorative measures in 2020—the increase in wages by Rs.20 under the Mahatma Gandhi National Rural Employment Guarantee scheme; release of the first instalment of Rs.2000 under the PM Kisan Yojana; grant of Rs.500 to women account holders under the Jan Dhan Yojana for three months from April to June 2020; and the grant of a one-time support of Rs.1,000 to 3 crore widows and differently abled persons to tide over the crisis.

But these ameliorative measures were limited to a specific period and gave only foodgrain to targeted populations. They did not measure up to anything substantial in the prolonged crisis faced by unorganised sector workers, migrant workers and other vulnerable sections in 2020 and also 2021. The disbursement of 5 kg of foodgrain alone for a limited period was not enough to address the deficiencies caused by undernourishment. Inadequate intake of food is known to cause undernutrition, which can also lead to poor utilisation of available nutrients. The situation becomes complicated in the absence of health care and sanitation. Inadequate maternal health and child care practices can cause further complications.

GHI response

In an e-mail response to Frontline, Miriam Wiemers, Advisor to the GHI (Policy and External Relations), explained that “the concerns of the Indian government on the working of the Global Hunger Index have been considered very carefully and we strive to ensure that the GHI continues to improve and remains a useful reference tool in collective efforts to end hunger. We highly appreciate the engagement of the WCD and we value the quality of data and analysis available to us. We welcome the recent debate and are at disposal to jointly seek further clarity on the parameters of the GHI.”

Also read: How the poor live in the time of pandemic and lockdown

She clarified that the GHI report was peer-reviewed by external experts and that the methodology used was long established and tested. It uses four indicators to reflect the complex and multidimensional nature of hunger, drawing on data from the U.N. and other multilateral agencies. Together, the indicators reflect deficiencies in calories and micronutrients. She wrote that the international community, including India, had agreed upon Sustainable Development Goals (SDG) and the GHI used indicators that were part of the internationally recognised indicator set to measure progress in meeting these goals.

She also emphasised that that the GHI report did not use the FAO’s telephone-based indicator that includes information from a poll taken by Gallup—the Food Insecurity Experience Scale (FIES). “Of the suite of indicators produced by FAO, GHI uses only PoU, which is a measure of proportion of population facing chronic deficiency of dietary energy intake. Prevalence of Undernourishment takes into account average per capita availability of food supply as obtained through carefully constructed food balance sheets. Food balance sheets are primarily based on data officially reported by member countries including India. PoU also takes into account distribution of calorie intake in the population (as estimated through official consumption surveys conducted by governments including India), as well as calorie requirement of the population (based on data on age distribution for men and women, distribution of heights and other key determinants of dietary energy requirements). All data compiled by FAO—including data officially reported by the member countries, data available from other public sources, and estimates made by FAO—are made public by FAO with detailed documentation of how these are obtained,” Wiemers wrote.

She clarified that GHI was best suited to compare hunger levels over time (reported within each report) and between countries and regions. But, she said, it was not designed to assess and reflect individual measures taken by governments. “It is important to differentiate between policy interventions and their outcomes, so that effectiveness of government programmes and other interventions in improving outcomes can be evaluated. We welcome a scholarly debate to improve the Index and strive to ensure that the GHI remains a useful reference tool and is permanently enhanced to serve the collective efforts to end hunger. Not only India, but the world as a whole is facing tremendous challenges posed by COVID-19, conflicts, and climate change. And this is reflected in worrying GHI trends in many countries across the world. Multiple crises exacerbate existing inequalities and other challenges that are underlying causes for hunger and undernutrition,” Wiemers wrote. She added that “the questions and concerns of the government have been considered very carefully” and GHI was in contact with the government to jointly seek further clarity on the parameters of the GHI.

How PoU works

The GHI is a measure of development of outcomes in the domain of hunger. It is a tool to measure and track hunger comparatively at the global, regional and national levels. The idea behind it is to raise awareness and compare inter-regional and international hunger levels in order to draw attention to areas that need additional resources to eliminate hunger. The report includes a section on the progress that India has made. It says that the proportion of the undernourished in the population and the “under 5” mortality levels are relatively low. It also says, however, that the incidence of child stunting remains high in spite of a significant decrease from 54.2 per cent in 1998-99 to 34.7 per cent in 2016-18.

Also read: How the pandemic has led to a shrinking of the middle class in South Asia

For computing India’s 2021 GHI score, the report relied on undernourishment data from the FAO’s Food Security Indicators (published in July 2021). It used the FAO’s PoU indicator, which is based on the FAO’s assessment of each country’s Food Balance Sheet, which measures the proportion of the population with adequate access to calories on the basis of food supply data. The FAO has been using the PoU as an indicator of food security since the 1960s; the PoU is said to have been developed by P.V. Sukhatme, an award-winning Indian statistician, during his stint with the FAO in Rome.

The PoU is an estimate of that proportion of the population whose habitual dietary intake is less than the minimum dietary requirement for normal, active, healthy living. It factors in the average per capita availability of food supply obtained through food balance sheets which are themselves based on data officially reported by member countries. The PoU also takes into account the distribution of calorie intake (based on official consumption surveys conducted by governments) as well as the calorie requirement of the population.

The child stunting and wasting data are from the 2021 edition of the United Nations Children’s Fund (Unicef); the World Health Organisation and the World Bank Joint Child Malnutrition Estimates (published in April 2021); and India’s own Comprehensive National Nutrition Survey (CNNS) of 2016-2018, published in 2019. The under-five mortality rates were taken from the United Nations IGME (Inter Agency Group for Child Mortality Estimation) Child Mortality Estimates.

Proof galore of hunger

There is enough evidence of hunger and deprivation independent of the GHI report. It is reflected in indices of malnutrition, undernutrition, stunting, wasting and under-five mortality in the National Family Health Surveys and the Comprehensive National Nutrition Survey (2016-18) measuring the nutritional status of children of the 10-19 age group. The CNNS report stated that only 6 per cent of children in the “6 to 23 months” age group received a minimum acceptable diet, 21 per cent ate an adequately diverse diet and only 57 per cent of children were breastfed within one hour of birth. Timely complementary feeding was initiated for only 53 per cent infants in the six-to-eight-month age cohort.

Also read: Latest NFHS data reveal high levels of anaemia across nation

Other studies have also shown that there might be significant underestimations of hunger and nutrition levels. In an article in Economic and Political Weekly (April 13, 2019) titled “Prevalence of Under nourishment in Indian states—Explorations based on NSS’ 68th Round Data”, the authors Vikas Rawal, Vaishali Bansal and Prachi Bansal argued that it was difficult to estimate the proportion of people who were undernourished as energy requirements varied according to age, sex, physical activity and body size. It is therefore incorrect to compare the dietary intake of an individual with an average dietary requirement. This means that the PoU may may well provide an underestimation and the problem of undernourishment was is perhaps more severe than what the GHI report suggests.

Arun Gupta, the central co-ordinator of the Breastfeeding Promotion Network in India, feels that in 2024 the success of the Narendra Modi government will be judged against numbers of the India’s darkest distended underbelly—its millions of malnourished children. He said the government had responded to the GHI to counter the ‘shame’ induced by it but the reaction also betrayed an illusion that it was doing enough for feeding infants and young children.

He said that for the first time in the 30 years early breastfeeding rates had shown a decline, while underweight, stunting, wasting prevalence had shown an increasing trend. “This is worrying and calls for re-framing of nutrition programs in India,” he said. Both NFHS 4 (2025) and 5 (2020) were stark reminders of the support that women and children need for their nutrition, growth and development. The NFHS-5-phase-1 (Data from 22 States/UTs) revealed that while 88 per cent women delivered in hospitals, 51 per cent were able to begin breastfeeding within an hour of birth, 61.9 per cent breastfed exclusively during 0-6 months, 56 per cent received timely complementary feeds at 6-8 months and only 16.1 per cent received adequate diet during 6-23 months. “Obviously 26.9 per cent children were underweight, 31.9 stunted, 18.1 wasted and 5.5 obese. This means India is suffering both from undernourishment and over-nourishment,” he said.

Case of underestimation

The economist Jomo Kwame Sundaram, who has worked at senior positions at the FAO, convened the second International Conference on Nutrition in 2014. Talking to Frontline in the context of the controversy stirred up by the GHI report, he said that there might have been underestimates of dietary energy from the outset. With uneven development in the world and variations like less or more mechanisation and sedentary lifestyles, it was difficult to arrive at a uniform calorie intake for the world over. He pointed out that it was a given that “whether one was well nourished or not made a world of a difference to life expectancy, cognitive development and physical development”.

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The basic methodology, the former U.N. official said, had been problematic to begin with but it improved over time. The major assumption was that incidence of undernourishment was understood as calorific undernourishment and little else. Factors like a sedentary lifestyle that required fewer energy requirements and urban eating habits was not factored in while calculating PoU. “We know that most poor people do a lot of manual labour. I was concerned that we were underestimating their undernourishment by using that methodology. A single yardstick could not be applied for the whole world,” he said.

“The main defence one can make of the FAO numbers is that they purport to be something which continues to be relevant over time. I would be among the first to qualify my support, but it reminds one that our poverty numbers also might not be what we think them to be. All governments want to look good and they want to think that growth is being equally distributed. To find fault with the measure is not difficult. Yet to do any kind of international comparison is very difficult. Some countries have serious data reporting issues. The PoU tells one whether people have enough dietary energy to live; it doesn’t say whether one is living healthy or well. The underestimation has been happening since the outset as everyone was looking at calories and calories of people with a sedentary lifestyle. Life has changed and measures need to change. I think there are greater underestimates today. One is generalising across 200 countries, with many having patchy data. The numbers are based on what the Indian statistical office gives Rome. Unless there is a conspiracy by the Indian Statistical office to underestimate something,” he said, referring to the Indian government’s objections to the GHI methodology to calculate PoU based on FAO data.

Boost for pharma?

There is an opinion that the GHI scores might be used to push interventions driven by pharma and big business in nutrition and food security. H.P.S. Sachdev, a leading paediatrician who has been very critical of the government’s latest approved policy to fortify rice with iron to prevent anaemia, said that the PoU based on FAO data on food balance sheets had a cut off of 1,830 calories as a minimum energy requirement for everyone in the world. It was not based, he said, on what people were actually consuming. He said that the CNNS survey had also showed that half of the children aged between five and 19, irrespective of whether they were thin or short, had evidence of high sugar or hyper lipidemia.

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“Half of our children have more robust bio markers showing over nutrition. Hunger is a very small component of what causes wasting, stunting and deaths among children. There are other determinants which also vary from place to place,” he said adding it could not be denied that hunger was a major issue in impoverished pockets. “But there are contradictions. There is over-nutrition in biochemical markers, probably because a lot of cereal is being pushed. India is supposed to be the global capital of non-communicable diseases. I am not denying there is a lot of poverty and inequitable development. But dietary diversity is the best way to go about it and overall development. How is it possible that both hunger and over nutrition exist? I think the GHI could give an opportunity for lobbies to push nutrient dense supplements and pre-mixes,” he said.

Whichever way the scores and rankings are interpreted, there should be little doubt that the pandemic worsened hunger and nutritional outcomes. If fact the GHI report has a cautionary word on that as well. There is so far no government data on the number of people who have lost jobs or were driven to penury because of the pandemic. Likewise, there has been no assessment of deprivation levels among the population. In such a scenario, the hunger and undernourishment estimates of the GHI report can be safely viewed as an underestimation of the real problem rather than an exaggeration.

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