Patralekha Chatterjee | Why is India so prickly as it faces global gaze?

Is the world conspiring to make India look bad? Or are we too sensitive about the global gaze?

The latest trigger is our ranking on a global index on hunger. The Narendra Modi government has trashed the latest Global Hunger Index in which India ranks 101 among 116 countries. It has called the GHI 2021 assessment of India as “shocking” and “devoid of ground reality and facts and suffers from serious methodological issues”.

India’s rank slipped to 101 from 94 (in 2020) and is now among the 31 countries where hunger has been identified as a “serious” problem. Pakistan, Bangladesh and Nepal are doing somewhat better. There are countries that are even worse, and in the “alarming” and “extremely alarming” categories. Like Somalia and Afghanistan.

The ongoing furore over the latest GHI reminds me of the annual launch of the UN Human Development Report and the Human Development Index ranking. Year after year, sections of India’s mainstream media typically focused on whether India was ahead of Pakistan or the other way around. Never mind that both had low ranks.

In the latest UN Human Development Index, India is placed 131 out of 189 countries (down by two ranks). This doesn’t mean there has been no progress on any front in India but as UNDP resident representative Shoko Nada put it, the drop in India’s ranking doesn’t mean “India didn’t do well, but other countries did better”.

India is a huge country, with huge diversity. Global ranks don’t always capture the big variations between states, districts or city/village. But undoubtedly, there are serious problems on the ground. The latest Global Hunger Index doesn’t tell us anything that is really new.

That India’s economic growth story in recent decades has co-existed with alarming levels of chronic hunger and stunting is no secret. Recent official data from the first phase of the fifth National Family Health Survey (2019-20, NFHS-5), released in December last year, shows that child malnutrition may be worsening in many states. The available official data tells us that child mortality is going down in large swathes of the country but those who live are more malnourished and anaemic in many states.

This should ring alarm bells, whichever way you look at it.

The Accountability Initiative of the Centre for Policy Research, a leading Indian think tank, points out that “many states show slow progress on reducing malnutrition. The fifth round of the National Family Health Survey (NFHS-5) in 2019-20 found that, compared to the earlier round in 2015-16, stunting among children under five years of age increased in 13 out of 22 states and UTs for which data is available. Similarly, wasting increased in 12 states and UTs”.

“The Global Hunger Index is not a new survey. It looks at countries across the globe. It is not focused on just the Indian situation. The same methodology used to assess India is used for every other country,” says Dr Amir Maroof Khan, professor of community medicine at University College of Medical Sciences, Delhi.  

Dr Khan also notes its data sources relate to earlier years -- till 2019.
The GHI portal points out that “for the calculation of the 2021 GHI scores, undernourishment data are from 2018-2020; child stunting and child wasting data are from 2016-2020, with the most current data from that range used for each country; and the child mortality data is from 2019. In 2021, owing to the Covid-19 pandemic, the values of some of the GHI component indicators, and in turn GHI scores, are likely to worsen, but any changes that occur in 2021 are not yet reflected in the data and scores in this year’s report”.

GHI scores are comparable within each year’s report, but not between different years’ reports. Since 2000, India has made substantial progress, but there are still areas of concern, particularly regarding child nutrition, the GHI acknowledges.

This is what Indian health experts are saying as well.

There are two important ways which can help us understand India’s hunger problem -- macro-economic factors that have an impact and the micro picture.
“There is widening inequality which is making large swathes of the population poorer. Just giving subsidised food, mostly cereals, is not going to address the malnutrition problem if people have very little money overall to buy nutritionally-adequate food for their families. We can’t ignore macro-economic factors while talking about hunger or any other human development indicator,” says Dr Khan.

India is a hugely diverse country; the reasons for malnutrition are often contextual and cultural. “In one case that I came across, a migrant worker’s child in Delhi suffered from under-nourishment because the mother, who was from a upper caste, and from another state, was of the view that going to an anganwadi centre was like begging for food for her child. She could not do it. The family did not have enough money to buy nutritious food. After a lot of counselling, she was persuaded to change her mind about anganwadis. It is vital to look at the micro picture. More needs to be done to develop linkages between undernourished children and nutrition related schemes,” he adds.

Dr Anant Bhan, a global health expert, also argues that while one can always debate methodologies, one does not really need a global survey to know that India has a serious hunger problem and many other serious health challenges.
“Our own data tell us this. The latest NFHS (Phase 1) has a trove of data and many indicators which says pretty much the same thing. This is data collated by Indians and has been a benchmark for years.”

Another well-known public health expert, Dr Bobby John, puts it bluntly.
“I don’t care about global rankings. We have some of the best scientists and health experts. What is NFHS and other official data saying? Do we have a serious hunger problem or not? We must learn to accept pain spots in the health/nutrition landscape and deal with them. The prickliness to critique is something that needs root cause redressal -- from encouraging and accepting critical enquiry to questioning of received wisdom. It will take time, and will be fiercely opposed.”

If you want to be part of the global discourse on health, nutrition and related issues, you can’t be totally dismissive towards global surveys and rankings because the methodology is the same for every country, as Dr Bhan puts it.
In a globalised world, should we be so prickly to the global gaze? We need to look within.