The numerous instances where Prime Minister Imran Khan emphasises on growing poverty and poor health outcomes remind me of how a poor family is caught in an unending poverty trap.
Every time I hear the PM talk about stunting or infant mortality, I’m reminded of the obvious factors contributing to these worsening health indicators. Milk (with all its nutrients), a necessity for an expectant mother, is difficult to be acquired by the poor stratum. There is a great number of maternal and infant deaths due to malnutrition in Pakistan that keeps increasing compared to other neighbouring countries. Rates of malnutrition, stunting and wasting remain alarming and impact the lives of many children. Nearly half of all deaths among children under five are attributable to undernutrition. Poor nutrition in the first 1,000 days of life can lead to stunted growth, impaired cognitive ability and reduced school and work performance.
Despite being among the largest milk-producing countries and having the largest number of milk-producing animals, Pakistan faces severe malnutrition and milk shortage. It is estimated that only 45% of the milk produced is available for sale in the country. Of the milk sold by farmers, 15-19% is wasted due to improper cooling, storage and transport systems.
A unique obstacle to access safe and hygienic milk products in Pakistan is raw milk adulteration. In a country where more than 90% of the dairy market is informal and unregulated, adulteration is an alarming practice and poses serious health risks for consumers and for expectant mothers and children, particularly. Studies associate unsafe milk consumption with undernutrition among women and sub-optimal growth among children. The interaction between undernutrition and infection due to unsafe milk can create a potentially lethal cycle of worsening illness and deteriorating nutritional status. Knowing this, loose milk consumption should be out of the question. There are effective control measures that can minimise the risk of milk-borne diseases, of which minimum pasteurisation is key.
However, on a broader public health spectrum, consuming safe/processed milk is also not an affordable option for families living below poverty line. It is pertinent to understand here that the price hike is an expression of the problems the packaged industry faces in terms of quantity, quality and cost involved in milk processing.
As we mention about quantity, demand for milk is growing faster than its supply, creating a substantial deficit. The small herd size, lack of selective breeding and nutritional deficiencies further reduce animal productivity. With this disequilibrium, the law of demand plays its role leading to an increase in price until the demand for milk comes at par with its supply. Quality has its own set of problems; unhygienic animal environment, feeding practices and low mechanisation in dairy farming augmented by poor infrastructure, contaminated water and power outages. It poses a cost to the dairy industry for ensuring that the milk coming from small or medium-size farmers is in line with set quality parameters. Furthermore, the ever-increasing input cost and the abolition of zero-rated tax policy lead to a hike in milk prices, making it unaffordable and resulting in overall decline in the sales of packaged milk.
Eventually the packaged milk turns out to be an unlikely choice for consumers generally and the poor particularly. Access to safe milk, like safe water, is everyone’s priority and it should be made available easily.
It is time to eradicate the root cause of the problem and do something beyond just mentioning the poor in our talks. Such rhetoric does earn us popularity, but we need to do better on our health indicators. The UN Sustainable Development Goals (SDG), that Pakistan is a signatory to, also talks about ending hunger (SDG-2 on zero hunger). Ensuring the availability of safe milk can improve our health and poverty indicators significantly. Not all poverty comes from wealth, some come from deteriorated health conditions too.
Being poor in terms of health is the most threatening type of poverty.
Published in The Express Tribune, May 24th, 2021.