Diets, Nutrition, and Poverty - The Oxford Topic of Food, Politics, and Society - page 350

One important insight is that dietary diversification reduces calorie intake. Downward
shifts in the calorie and protein intakes over the period 1993-2004 in India were asso-
ciated with both food prices and near stagnant expenditure/income in rural India and
simultaneous changes in diets. There is then room for compatibility between a view
of caloric intake exclusively focused on demand, and one allowing for lower calorie
“requirements” due to less strenuous activity patterns, life-style changes and improve-
ments in the epidemiological environment. Dietary changes are associated with food
prices, their time-varying effects, income/expenditure changes, rural-urban location,
household characteristics, and environmental changes reflected in life-style and activ-
ity patterns. Although some of these changes (for example, urbanization and growing
prosperity) in both rural and urban areas are irreversible , a policy insight from the anal-
ysis in this chapter is that prices and income also shape dietary patterns in important
ways. Recent evidence on eating out, for example, shows it to be more pervasive than a
middle-class urban phenomenon. More people in metropolitan areas eat out and spend
larger amounts, as do the relatively affluent. But others—especially the socially disad-
vantaged—are also prone to eating out and spending moderate amounts.
The most important food questions concerns those at greatest risk of insufficiency.
Undernutrition has serious welfare implications, not just in the present but also in the
longer-term. The poverty-nutrition trap (PNT), for example, is a vicious circle in which at
low levels of nutrition, productivity is low, wages are low, purchasing power is low and, con-
sequently, there is low nutrition. This chapter introduced a new measure of child under-
nutrition, more comprehensive than conventional ones, that indicated much higher levels
of undernutrition (6 out of 10 are undernourished) and higher risks of infectious diseases.
The double burden of undernutrition and obesity exacerbates the gravity of malnutrition.
Aging is a key factor in the growing burden of NCDs. Affluence also has a significant role
through life-style changes and dietary composition. Because the share of NCDs in the dis-
ease burden is likely to rise and will increase demand on the health-care system and highly
scarce resources of those least likely to afford the costs of health care, cost-effective inter-
ventions that address tobacco use, alcohol abuse, consumption of unhealthful fats, and
excessive salt intake are well understood but need careful implementation.
Though noncommunicable diseases represent a major societal problem induced
by malnutrition, policy imperatives are more readily recognized in cases in which
individuals face deprivation from structural pressures rather than choice. A range of
interventions to lessen the vulnerability of those who cannot easily choose their diets
for want of resources is on the global agenda. This chapter has analyzed two poles
of intervention: public works in the form of an employment guarantee (NREGA)
and Targeted Public Distribution System (TDPS) of food. A choice between these
mechanisms is difficult because their effects varied across states and by nutrient in
our analysis. Any general inference about the greater effectiveness of TPDS or NREG
is ruled out. More importantly, the question is not really one of larger allocations to
the TPDS and NREG, but how to make sure that the transfers intended for the poor
reach them. Because current debates on food security have veered toward a right
to food as a major policy initiative, this chapter offers a new perspective: The food