Most of us have heard about the under-nutrition problem in Pakistan, where the prevalence of undernourishment still affects 20% of the population, and about 38 million people. We think particularly about our young children, and the hardships faced in the rural areas, where poverty and food insecurity strike hard. In fact, Pakistan lags well behind other South Asian countries in improving its figures on stunting (low height for age) and wasting (low weight for height). It seems we are still a long way off from the dream of having an energetic and well-nourished population that can work hard and achieve its collective goals.
But there is also an emerging problem of overweightness and obesity. Even in young children, overweightness has reached about five per cent nationally, doubling in just seven years. It is higher in school-aged children and adults. Persistent hidden hunger for micronutrients including iron, vitamin A and zinc also remains. Perhaps the most disturbing trend of all is the poor nutritional status of women of childbearing age in Pakistan. It puts the potential health of unborn children at risk, undermining not only their individual future, but also national productivity and wellbeing.
The combination of undernutrition, overnutrition and micronutrient deficiencies is called the triple burden of malnutrition. It is a global phenomenon, including in lower middle income countries like ours, cutting across all social and economic levels of society. Bad diets are mostly to blame. An unhealthy diet is the now leading risk factor across the world for non-communicable diseases like heart disease, diabetes and cancer. But how can we improve our eating habits?
World Food Day is marked every year in October. For World Food Day 2019, the Food and Agriculture Organization of the United Nations (FAO) is encouraging us to reflect that healthy diets can help achieve “zero hunger”. For this, we need to not only end hunger and malnutrition, but maintain a sustainable agricultural economy that nourishes both people and planet. Healthy diets start with a “food system” approach that fully integrates farmers and rural women and men in a diversified and resilient agriculture production that meets the needs for both local or self-consumption and export. The chain of diversified, safe, fresh and nutritious food needs to be continued all the way to packaging, labelling, storage, advertising and sale of foods to the consumer.
Unfortunately, humanity as a whole has moved away from eating seasonal, mainly plant-based and fibre-rich dishes. Diets have become high in refined starches, sugar, fats and salt, containing too many processed and convenient foods, while breastfeeding rates are disappointingly low. These changes are said to be mainly due to urbanisation, globalisation and income growth. Less time is spent preparing meals at home and eating them with our families. Our time gets eaten up by working longer hours. Conscious consumption of a healthy and diverse diet, with a balance between vegetables, fruit, pulses, nuts, seeds, whole grains, milk, eggs and meat, has fallen away.
We see this in Pakistan particularly in major cities like Karachi. The urban poor have insufficient access to safe and affordable fresh food, and cannot grow it or raise it themselves due to lack of space and water. Unhealthy snacks like chips, biscuits or sugary drinks often cost less than healthy snacks like dates, yoghurt or fresh fruit. Water quality and sanitation — the important partners to a healthy diet — have become perilously unreliable, and compound the effects of a bad diet by introducing infections that interfere with nutrient absorption. People who work and live itinerantly in cities to support their rural families often end up taking their meals at roadside hotels, where the food is oily and unhygienic. The urban rich have got into a habit of eating too many fast foods and special-occasion foods with high oil and sugar content, too often, while neglecting more healthful, home-cooked meals.
Across the world, nations are turning to country-specific dietary guidelines to educate their populations to eat better. This in turn, can stimulate the agriculture and livestock sectors to produce more diversified food choices at fair prices. In Pakistan, the 2018 Pakistan Dietary Guidelines for Better Nutrition (PDGN) are our guide. These were jointly developed by the federal government and FAO based on the latest scientific evidence. In essence, the PDGN provide updated, culturally appropriate recommendations to the general population on how to eat for good health by using locally available ingredients. The diet recommended is within reach of the poor, especially if self-produced in rural localities.
With good partnerships between the government, private sector and local communities, dietary guidelines can help tackle malnutrition by raising awareness of how to make better food choices. Healthy food needs to once again become more attractive to consume than unhealthy food. The PDGN should be widely promoted and explained in local languages, especially to schools, women and the poor. In the long run, making a healthy diet accessible is less costly to the nation than the health-related costs of a poor diet. We must all pay attention to striving for a healthy diet for ourselves, our communities, and everyone in our care. We must make it a priority in the household and national budgets.
Published in The Express Tribune, October 31st, 2019.