Video Description: Dr. Lawrence Haddad, economist and executive director of the Global Alliance for Improved Nutrition (GAIN) discusses linkages between nutrition and sustainable development with Ravi Bhatnagar, Director External affairs and partnerships AMESA of Reckitt Benckiser and Ramananda Sengupta, Consulting editor – Outlook.
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00:00 (upbeat music)
00:02 - Hello and welcome to this edition
00:05 of Outlook Portions first 1000 day campaign.
00:08 Our special guests today, Dr. Laurence Sadad,
00:13 economist and executive director of the Global Alliance
00:16 for Improved Nutrition
00:17 and the winner of the World Food Prize in 2018.
00:21 We also have with us Mr. Ravi Bhatnagar,
00:24 director of External Affairs and Partnerships,
00:26 Africa, Middle East and South Asia of Recruitment Kaiser.
00:29 Thank you so much both of you for joining us.
00:31 Let me just kick off this thing with a question
00:34 to Dr. Sadad, after which I'd like Ravi
00:37 to sort of take over the rest of the questions.
00:40 Dr. Sadad, this pandemic has impacted nutrition programs
00:45 across the world I suspect,
00:46 but particularly in the developing nations.
00:50 What kind of impact do you see it having,
00:53 particularly in nations like India
00:56 and on the programs for women and children?
00:59 - Thank you, thank you for the question.
01:03 Yeah, the COVID crisis has impacts
01:06 on nutrition in three ways.
01:08 First of all, it disrupts the rollout of programs,
01:13 vitamin A supplementation, diarrhea prevention and treatment,
01:17 severe acute malnutrition,
01:19 those kinds of programs that have highly targeted
01:22 to nutrition, it disrupts those
01:24 because health clinics get disrupted
01:26 through closures and lockdowns.
01:28 Second way it affects nutrition is through food prices.
01:31 Food is absolutely, it's crucial.
01:33 It's not the only thing that's important for nutrition,
01:35 but it's absolutely crucial for good nutrition,
01:37 especially early in life, post breastfeeding
01:41 and food supply chains have been disrupted,
01:44 food markets have been disrupted
01:45 and so you get wild price fluctuations
01:48 in foods that are very perishable,
01:51 such as vegetables, fruits, eggs, dairy, meat, fish.
01:55 These are the kinds of foods that are very high
01:58 in micronutrients, so that's a problem too.
02:01 And then of course, income collapses for lots of people.
02:04 Lots of people can't work anymore,
02:06 their livelihoods are decimated.
02:08 And so for these three things coming together,
02:11 the estimates are that the number of kids
02:14 that are wasted worldwide,
02:16 so the wasted means they're too thin for their height,
02:19 they're skin and bone.
02:21 It's a very worrying form of malnutrition.
02:26 The numbers globally pre-pandemic were about 47 million
02:31 and some estimates that I and a whole group of researchers
02:35 have been involved in show that this is going to increase
02:38 to 55 million in a six month period.
02:42 And many, the majority of those cases
02:44 are to be found in India.
02:47 So we're projecting a 14% increase
02:51 in the number of stunted kids.
02:53 And I think that number will apply to India too.
02:56 So it's, and that's just the first six months.
02:59 This is gonna go on for years.
03:03 So we need to mitigate those numbers very quickly.
03:07 - Great, I think Ravi has a bunch of questions for you.
03:11 Over to you, Ravi.
03:15 - Thank you, Ramananda, thank you, Mr. Lawrence.
03:18 It's great to be here on this show today.
03:20 And it's great to learn about your all the achievements
03:22 on the nutrition space and all the awards you have won.
03:25 I myself, I'm a public health practitioner
03:29 and public policy specialist.
03:31 And I happen to work with a company
03:36 which has very strong purpose definitions
03:39 and our approach is very, very strong
03:42 on the work that we do for the nutrition.
03:45 One of our recent social return on investment study
03:48 what we have conducted on our nutrition program
03:50 has given one rupee invested, giving return of 39 rupees.
03:55 So we'll be happy to share that on a later note.
03:57 But before I discuss it more,
03:59 I have two small questions for you.
04:02 We will start one by one.
04:04 And the first question is pandemic has substantially eroded
04:08 the gains made in the last few decades
04:11 due to the loss of livelihood.
04:12 What strategy do you suggest for our government
04:15 to prevent marginalization of the vulnerable section
04:18 while maintaining and regaining the momentum
04:21 in the portion of the arm?
04:22 This is my first question, sir.
04:23 - That's not a small question.
04:27 But I'm not going to make recommendations
04:32 to what the Indian government should do.
04:34 But governments in general,
04:36 I think there are two things they need to do.
04:39 Well, three things really.
04:40 The first is to make sure that public procurement of food
04:44 and public distribution of food,
04:47 any kind of safety net or subsidized program
04:50 that involves food,
04:51 make sure that the quality of that food does not diminish.
04:55 And if you can, improve it.
04:58 So instead of just focusing on grains,
05:01 add some pulses,
05:03 'cause pulses are really rich in good proteins.
05:07 Add, if you can, add some dried fruits
05:10 and vegetables, if you can.
05:13 So that's the first thing.
05:14 Keep the social protection programs going
05:17 'cause they reach the poorest, keep them going.
05:20 And if you can, improve the quality,
05:24 not diminish the quality.
05:26 Second thing is keep programs like food fortification going.
05:30 Food fortification is where you add vitamins and minerals
05:33 to staple crops, to cereals.
05:36 And this is a very cheap and effective way
05:38 of getting essential nutrients to everyone,
05:43 especially the poorest.
05:44 And this is really important to prevent infection,
05:46 not necessarily from COVID-19.
05:49 We don't know if there's any correlation or relationship
05:51 between a higher quality nutrition diet
05:56 and COVID-19 infection,
05:58 but we do know that good nutrition
06:00 prevents all sorts of other kinds of infections.
06:03 And we know that COVID-19 thrives on comorbidities.
06:07 So that's what I would do.
06:09 Keep those social protection programs going.
06:13 It's really important for livelihoods.
06:15 And then, double down on investing in farmers.
06:18 If the harvests this year, I don't think worldwide,
06:24 weren't quite as affected by COVID-19
06:27 because of the timing of COVID-19,
06:29 but they could very well affect next year's harvest,
06:33 which could lead to a really massive food crisis
06:36 in a year's time.
06:38 So really protect farmers,
06:40 especially the small holder farmers,
06:42 through finance, get, you know, not grants,
06:46 but through lending programs,
06:48 get good lending, low cost lending programs to farmers
06:52 and smaller medium enterprises in the food system.
06:55 Those are the two things I would really be focusing on.
06:58 - Thank you.
06:59 - On your comment about the social returns
07:02 to nutrition programs,
07:05 that 39 to one is very similar to numbers
07:08 that the academic literature has generated
07:11 for scaling up nutrition programs.
07:13 So it's a very credible estimate.
07:16 And 39 to one, what a fantastic benefit cost ratio,
07:20 higher than the stock exchange
07:21 over the last a hundred years, that ratio.
07:25 Higher than many road and port and bridge projects
07:29 in terms of benefit cost ratios.
07:30 Investing in nutrition is a fantastic economic investment
07:34 as well as a fantastic health and human rights investment.
07:37 - Thank you so much, Angus.
07:40 My small second question to you is,
07:43 it said that one of the silver lining of the pandemic
07:46 is that where people are increasingly turning
07:48 to the healthier habits, like washing hands with soap,
07:51 using mask or avoiding outside food
07:54 in order to build immunity or protection from infections.
07:58 Do you see this as a situational compulsion
08:01 or is a substantial behavior change
08:03 towards a leading healthier and hygienic life?
08:06 - I think we do see substantial behavior change,
08:11 whether it's temporary or permanent is an open question.
08:16 I don't think anyone really knows that yet.
08:19 I have seen big behavior change in people.
08:23 I think where they can afford it,
08:27 and that's not everywhere,
08:29 people are looking a bit more
08:30 about where their food comes from,
08:33 is it locally sourced, can I trust this food?
08:37 There's a bit more distrust of food that comes from far away
08:41 versus food that's more local.
08:42 That might be good for local economies.
08:47 The thing I have noticed,
08:48 the biggest behavior change I've noticed is in politicians,
08:52 because politicians, and I'm based in the UK right now,
08:57 and in the UK, the government has made the connection
09:02 between obesity, diabetes, hypertension, and heart disease,
09:08 and the fact that people with those conditions
09:11 experience COVID-19 symptoms more severely.
09:16 And so they've been using that as a way
09:19 to reinforce anti-obesity messages to say,
09:23 look, if we reduce obesity levels,
09:27 it also reduces the severity of COVID-19.
09:30 And that's been interesting,
09:32 and I think that is potentially a big impact.
09:35 And of course, in India,
09:37 diabetes is a big and growing problem.
09:39 - One of the biggest NCDs actually in India,
09:42 which is a non-communicable disease.
09:44 - Yeah.
09:45 - Third question actually comes from a very interesting book
09:48 which I was reading called "The Spillover."
09:51 So "Spillover" is written by David Kerman.
09:54 So in the book, it talks about the animal infections
09:56 and the next human pandemics.
09:59 It's a very, very highly rated book,
10:01 and the New York Times has written about,
10:03 it's a book of the year, et cetera, et cetera.
10:05 So my question is in that light, actually.
10:07 What steps we can take to ensure that the next pandemic
10:11 or epidemic or crisis does not derail these programs again,
10:15 especially on nutrition?
10:16 What should be done?
10:18 - I'm really a big fan of the idea of one health,
10:21 which is human health, planetary health, and animal health.
10:25 Those three things coming together.
10:27 It's a good way of thinking about the trade-offs.
10:30 So I think you're absolutely right.
10:32 One of the reasons we're seeing more of these
10:35 transmission of infection from animal to humans,
10:38 which is called zoonosis, as you know,
10:41 we're seeing more of these because the space
10:44 that humans occupy is encroaching more and more
10:48 on the space that wild animals occupy.
10:52 So we have to be really careful about encroachment
10:56 into wildlife spaces.
10:59 We have to be really careful about the conditions
11:02 within our open food markets, our fresh food markets,
11:05 our wet food markets.
11:07 We have to be really careful how we handle food,
11:10 about food safety protocols,
11:14 especially when it comes to animal-sourced foods.
11:16 And animal-sourced foods are very important
11:19 for populations that are undernourished.
11:22 It's a really good source of protein
11:24 and vitamins and minerals.
11:26 It's highly digestible, highly bioavailable to the body.
11:30 But if you consume too much animal-sourced food,
11:34 you're susceptible to coronary heart disease,
11:37 diabetes, other forms of non-communicable disease,
11:41 and you're generating big greenhouse gases emissions,
11:46 and you may be encroaching into wildlife spaces,
11:51 and you may be using production techniques
11:57 that are very, that are not good for the animals
12:02 while they're alive.
12:03 So I think the production and consumption
12:06 of animal-sourced foods is going to be a hotspot
12:10 for many years to come.
12:12 It has multiple dimensions,
12:13 and it needs to be carefully monitored and carefully managed.
12:16 - Thank you so much for your wonderful response on this.
12:20 My next question takes me to something
12:23 which is very much related to education space and nutrition.
12:26 Like in many countries across the globe,
12:29 there is adolescent sexual reproductive health,
12:31 which is taught in the schools.
12:33 Then there is hygiene curriculums,
12:35 which is taught in the schools,
12:36 especially in the countries like India, Bangladesh,
12:38 Sri Lanka, and many more.
12:40 What about, you know,
12:41 teaching similar kind of nutrition curriculums in the school
12:44 and making the, you know, the generation,
12:46 the school children prepared,
12:47 and they know about, you know,
12:49 they can distinguish between the right nutrition,
12:52 the proper nutrition, and between the junk and others.
12:55 So that's a very important point,
12:59 which I would like to, you know, get your opinion on.
13:02 - That's a super important point.
13:04 I mean, the earlier you can get kids
13:06 to reframe the way they think about food,
13:11 it's not just fuel, it's actually nourishing your body.
13:15 So it's not just reducing hunger.
13:17 It's, we call it, again, where I work,
13:21 we call it nourishing dreams.
13:22 Adolescents, especially, they think about dreams a lot.
13:26 They, what are they going to become when they're an adult?
13:30 Are they going to become a politician, a business person,
13:33 a doctor, you know, a sports person,
13:38 an artist, a business person, you name it.
13:40 They've got dreams,
13:43 and the key is to link those dreams to what they eat.
13:47 I think that's very important.
13:48 So there's that, and they need to learn about what's good
13:50 and what's not good to eat.
13:52 They need to learn that tasty is not always good for you,
13:56 and they need to learn how to prepare food
13:58 and buy food and store food.
14:01 So these are all really important things.
14:03 And, you know, it's important to get kids
14:05 when they're young, because these are lifelong habits
14:07 that they then teach their own kids.
14:10 So it's absolutely vital.
14:12 I don't quite know why schools,
14:14 and this is the case in the UK as much as it is in India,
14:17 schools don't see this as an essential part
14:19 of the curriculum, and I don't really understand why.
14:22 Because-
14:23 - Like why the color of the plate,
14:28 what does your tiffin looks like?
14:31 - You know that if you're a health professional,
14:36 you know that food is the number one driver
14:39 of disease and mortality.
14:40 Higher than unsafe sex, higher than bad water,
14:45 bad health, higher than air pollution,
14:47 higher than road accidents.
14:51 This is the number one driver of mortality
14:53 and morbidity above everything.
14:56 So why we're not teaching our kids about this in the school,
14:59 I don't know.
15:00 We could be involving chefs very, very well.
15:05 You know, there are lots of TV shows with chefs.
15:07 We could, and they'd be delighted
15:10 to be involved in these kinds of things.
15:13 - My next question focuses about, you know,
15:17 your own organization and its strategy
15:19 on the large scale food fortification.
15:23 So what's the vision behind that?
15:25 And how you're using technology like artificial intelligence
15:28 or something else so that the benefits
15:31 reaches to the last quintile?
15:32 - Yeah, I mean, GAIN is an NGO,
15:37 non-government organizations, nonprofit.
15:40 And we try to connect food systems,
15:44 everything from farm to fork, to improve nutrition.
15:48 So when you think about all the different actors
15:50 in the food system, all the different choices they make,
15:53 they very rarely make choices guided by
15:56 what's the impact on nutrition or on diet.
15:59 So we try to connect those two things
16:01 and we do it by connecting the public sector
16:04 with the private sector.
16:06 The private sector is the main actor in food systems.
16:08 Most people buy their food.
16:11 They don't grow their own food that they eat.
16:12 They buy their food, even low income populations.
16:15 If you look at the data from India,
16:17 90% of food that is acquired is purchased.
16:22 So you have to engage with businesses.
16:25 It's not a question.
16:26 We, at GAIN, we think that businesses are part
16:28 of the problem, but they also must be part of the solution.
16:31 We can't sort of ignore them.
16:33 And about 20% of our work is on large scale
16:36 food fortification.
16:38 The other 80% is working with small and medium enterprises
16:42 to help them expand their businesses
16:45 in the nutritious food space,
16:47 helping them getting ready for investment,
16:50 helping them get access to investment and loans,
16:53 and helping them basically develop their business case
16:56 so that more healthy food can be available
16:59 at a lower price to more consumers.
17:02 Fortification is about 20% of our work
17:05 and it's an important part
17:07 because it relies on adding nutrients to foods
17:11 that low income people already consume.
17:14 So you don't have to convince people
17:15 to switch from this food to this food.
17:17 You don't have to rely on SMEs and small businesses growing.
17:22 You can rely on some of the larger processors
17:25 and manufacturers to deliver these kinds of staple foods.
17:29 And it's a very low cost, very highly effective way
17:33 of improving micronutrient consumption.
17:37 So we think it's very important.
17:38 We are using AI more and more to connect
17:42 food consumption patterns with the consequences
17:48 of food consumption patterns,
17:50 but also to connect with the actions that are needed.
17:53 So if you're in a food,
17:55 if your food system in a state in India shows,
17:58 and we've constructed a food system dashboard,
18:03 which has data on India.
18:06 One of the things we want to do
18:07 is to make that a state level dashboard.
18:10 It's not state level yet.
18:11 That's in the works.
18:14 But if you're a state in India and you've got,
18:16 your food system is described by 150 different indicators,
18:20 everything from production through to consumption.
18:23 The question then is, well, how do you make sense of that?
18:26 How do you say, well, given I've taken the temperature
18:29 of these 150 indicators of my food system,
18:32 what does that mean for action?
18:34 Does that mean I should start in the production side,
18:38 in the consumption side, in the processing side,
18:40 in the storage side, in the distribution side?
18:43 Where do I start?
18:45 And AI is a really helpful way of connecting
18:47 all of that data with a menu of outcomes.
18:52 - My last question to you, what my public health degree,
18:57 makes me ask you this question.
19:01 The question is, in India,
19:03 world over the nutrition sensitive investments
19:06 are leading the global donor portfolios.
19:09 And same is reflected in India also.
19:11 The CAGR is around 11.2% at this moment,
19:15 and it's continuously growing.
19:17 So people are not able to understand,
19:19 like should we invest more
19:21 on the nutrition specific interventions
19:24 or the nutrition sensitive interventions
19:26 and how to balance between the two?
19:28 - That's a really good question.
19:30 And I don't think anyone really knows the answer to that.
19:34 I think it's part,
19:38 that the answer is partly based on technical evidence.
19:42 We know that scaling up nutrition specific interventions,
19:47 and for your listeners and readers,
19:49 nutrition specific interventions are interventions
19:51 that their primary goal is to improve nutrition.
19:55 Nutrition sensitive programs tend to be much bigger
19:59 in terms of budget,
20:00 but nutrition improvement is only one of several goals,
20:04 and it may not be the primary goal.
20:06 So an example of a nutrition sensitive intervention
20:09 might be the PDS or MREGA
20:13 or some other kind of social protection program
20:19 or an education program.
20:20 So how to get that balance right?
20:23 The evidence tells us that
20:25 if you scale up nutrition specific interventions
20:29 all the way up to 90% of coverage rates,
20:31 you'll deal with about 20% of stunting.
20:34 So that's a big chunk, but it's only 20%.
20:37 So the other 80% has to be found from elsewhere.
20:41 So I think that's probably,
20:43 probably the first strategy is to scale up
20:47 your nutrition specific as much as you can,
20:50 and then make sure there's a really good set
20:52 of nutrition sensitive programs that are supporting that.
20:56 Nutrition sensitive programs
20:58 don't usually require a lot of extra money
21:00 to make them nutrition sensitive.
21:01 It's more of a design issue.
21:03 The budget is already there.
21:04 It's a design issue.
21:06 Nutrition specific require extra money
21:09 to scale interventions up.
21:11 So it's that combination of technical, political,
21:15 what's the political appetite,
21:17 and also capacity.
21:18 What capacity do you have to scale nutrition specific
21:22 and redesign nutrition sensitive?
21:24 So it's more of an art than a science, I'm afraid.
21:28 - Very interesting.
21:29 Thank you so much.
21:30 So over to Mr. Ramananda.
21:34 - Hey, thank you so much.
21:36 You know, I really appreciate the conversation,
21:40 the twist that this conversation took,
21:41 because some of these questions were, you know,
21:44 answers to which I was looking forward to.
21:47 I really appreciate the fact that the two of you
21:50 took time for this.
21:52 That was Dr. Lawrence Salaar of GAIN
21:56 and Mr. Ravi Bhatnagar from Rekitmen Kaiser
22:00 in a fascinating conversation on nutrition
22:03 in the time of the pandemic.
22:05 I look forward to having both of you again
22:07 with us sometime soon,
22:08 because this is a long time campaign
22:09 and I hope to have both of you again.
22:11 Thank you so very much, gentlemen, for joining us.
22:14 Thank you.
22:15 - My pleasure.
22:16 Thank you for having us.
22:17 (upbeat music)
22:20 (upbeat music)
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