A nation underfed
It was an ordinary evening with the usual humdrum of life. In the backdrop, headlines scrolled across the TV screen. One particular news item caught my eye: the government had set the national monthly poverty line at Rs 8,483 per adult. According to this benchmark, anyone earning more than that amount is officially not considered poor. I paused.
Not because poverty lines are unusual; they are an important tool for measuring deprivation—but because I couldn't stop thinking about what that number actually meant in everyday life.
Rs 8,483 a month. That works out to roughly Rs 283 a day.
I reached for my phone and began doing simple arithmetic on its calculator app. Could Rs 283 buy breakfast, lunch, and dinner? Could it provide a glass of milk, an egg, fresh vegetables, fruit, lentils, or meat—the basic ingredients of a healthy diet? More importantly, if a family has a young child, how far would that amount go in meeting the nutritional needs of a growing body and developing brain?
The questions became more difficult with every calculation.
A child does not need food merely to stop feeling hungry. A child needs protein to build muscles, calcium for bones, iron to prevent anaemia, vitamins to strengthen immunity, and a balanced diet to support cognitive development. Nutrition is not a luxury; it is the foundation of a healthy future.
Yet the same Rs 283 is expected to coexist with other unavoidable realities of life—rent, electricity, gas, transportation, healthcare, education, and clean drinking water. After paying for those necessities, what remains in the wallet for nutritious food?
The more I explored the numbers, the clearer one distinction became: there is a difference between filling a stomach and nourishing a body. Bread and tea may quiet hunger. Rice may provide calories. But neither can replace the nutrients required for healthy growth, especially during childhood.
That single news headline led to a much larger question: Does crossing the official poverty line really mean a person can afford to live a healthy life?
The answer, according to global nutrition experts, is increasingly no. More than 2.6 billion people worldwide cannot afford a healthy diet, and Pakistan is among the countries where this global crisis collides with rising food prices, child malnutrition, climate shocks, and persistent poverty. For millions of families, the struggle is no longer simply to put food on the table—it is to put the right food on the table.
According to recent global estimates, over 2.6 billion people cannot afford a healthy diet—nearly one in three worldwide. This lack of access to nutritious food undermines growth, learning, immunity, and productivity, and is reflected in rising child malnutrition, maternal health issues, micronutrient deficiencies, and obesity.
The 2025 nutrition data shows a serious global challenge. Around 150.2 million children under five are stunted, 42.8 million suffer from wasting, and 35.5 million are overweight. These figures highlight the double burden of malnutrition, where some children lack enough nutritious food while others consume too many unhealthy, nutrient-poor foods.
When people hear the word "malnutrition," they often imagine starving children in famine-stricken regions. While severe hunger remains a devastating reality for millions, modern malnutrition is far more complex.
Nutrition experts describe three major forms of malnutrition.
First, undernutrition, which includes stunting, wasting, and underweight, results from inadequate nutrition during the first 1,000 days of life and can cause permanent physical and mental damage.
Second, micronutrient deficiency or "hidden hunger" occurs when people get enough calories but lack essential vitamins and minerals, weakening immunity, impairing learning, and increasing disease risk.
Third, overweight and obesity are rising due to increased consumption of cheap, processed, nutrient-poor foods, causing obesity and undernutrition to coexist in many countries and communities.
Pakistan’s nutrition crisis
Pakistan reflects the global nutrition crisis. Although it produces enough food, millions of people—especially women and children—still suffer from malnutrition. The main challenges are not food production but the affordability, accessibility, and availability of nutritious food, along with weak policies and limited awareness.
The most comprehensive picture of Pakistan's nutritional health emerged through the National Nutrition Survey (NNS) 2018, a landmark exercise conducted by the Ministry of National Health Services in collaboration with Aga Khan University and Unicef. Surveying more than 115,000 households across the country, it remains one of the largest and most detailed public health assessments in Pakistan's history.
The findings were alarming. Nearly four in 10 Pakistani children under five were stunted—around 12 million—suffering from chronic malnutrition that impairs brain development, weakens immunity, and limits future potential.
The survey also found 17.7 percent wasting among children under five, the highest ever recorded in Pakistan and above the World Health Organisation (WHO) emergency threshold of 15 percent, indicating severe acute malnutrition and increased risk of child mortality.
The crisis extends beyond children.
More than half of children aged six–59 months were anaemic. Among women of reproductive age, 42.6 percent suffered from anaemia, while nearly half of pregnant women were iron deficient. Over 81 percent of pregnant women were also deficient in vitamin D, showing that malnutrition begins before birth and continues through life.
At the same time, Pakistan faces a growing burden of overweight and obesity. Overweight prevalence among women has nearly doubled in seven years, while about 14 percent of women of reproductive age are obese.
Moreover, according to international estimates, more than two-thirds of Pakistan's population cannot afford a nutritionally adequate diet on a daily basis. For millions of families already struggling with inflation, stagnant incomes, and economic uncertainty, purchasing fruits, vegetables, meat, eggs, dairy products, and other nutrient-rich foods has become increasingly difficult.
Despite contributing less than one percent of global emissions, the country is highly vulnerable to floods, droughts, heatwaves, and erratic rainfall that disrupt food systems.
The 2022 and 2025 floods destroyed crops, displaced communities, and damaged supply chains, while also disrupting nutrition services. Rising food prices, loss of livelihoods, and unsafe water further worsened malnutrition, especially among women and children.
Furthermore, the National Nutrition Survey found that about 58 percent of household water is contaminated with coliform bacteria. This leads to repeated diarrheal and intestinal infections in children, preventing proper nutrient absorption even when food is available.
For instance, malnutrition carries a heavy economic cost for Pakistan, with an estimated loss of around $17 billion annually due to reduced productivity, higher healthcare costs, lower education outcomes, and premature deaths.
Yet much of it is preventable. Proven nutrition interventions—such as improving maternal nutrition, breastfeeding, food fortification, and tackling micronutrient deficiencies—can deliver high economic returns, but remain underprioritised.
Pakistan’s nutrition spending remains fragmented and difficult to track, with no clear or dedicated budget line. Instead, funds are scattered across health, agriculture, education, and social protection, weakening accountability and impact.
In effect, Pakistan continues to underinvest in nutrition despite its central role in shaping health, education, and economic productivity.
“It is not the result of a lack of interventions alone but of multiple interconnected factors,” says Farah Syed, a nutritionist at the nutrition and food services department at Aga Khan University Hospital, Karachi, as she explained why child malnutrition remains high despite decades of nutrition programmes in our country. “Persistent poverty and food insecurity force many families to rely on staple foods that provide calories but lack essential nutrients”.
“Poor maternal nutrition is a major underlying cause, as undernourished or anaemic mothers often give birth to low-birth-weight babies, affecting growth from the very beginning,” she highlighted. “The first 1,000 days—from conception to a child’s second birthday—remain the most critical period for lifelong physical and cognitive development.”
Syed further noted that inappropriate feeding practices, including low rates of exclusive breastfeeding and the early introduction of non-nutritious complementary foods, continue to worsen child nutrition outcomes. A high burden of infectious diseases, driven by unsafe water and poor hygiene, also prevents proper nutrient absorption. Even when food is available, repeated illness reduces its effectiveness. She emphasised that weak implementation and poor coordination mean many nutrition programmes exist on paper but fail to reach vulnerable populations.
Explaining how rising inflation reduces both the quality and quantity of food families can afford, Syed said that as prices rise, households shift toward cheaper, carbohydrate-heavy diets, reducing dietary diversity. “This results in widespread micronutrient deficiencies, particularly iron, zinc, Vitamin A, calcium, and protein deficiencies, while in many households, limited purchasing power leads to smaller food portions for women and children, deepening nutritional inequality within families.”
She agreed that climate-related disasters, especially the 2022 floods, severely affected all dimensions of nutrition, including food security, healthcare, sanitation, and livelihoods. Crop destruction and income losses increased food insecurity and food prices, while displacement and damaged health systems limited access to care. “Contaminated water triggered outbreaks of diarrhea, cholera, malaria, and respiratory infections, further worsening nutritional outcomes by increasing nutrient needs and reducing absorption,” Syed warns, adding that long-term consequences include stunting, poor cognitive development, reduced educational attainment, and higher risk of chronic diseases.
“The impact of chronic malnutrition is most severe during early childhood as it leads to stunting, reduced physical strength, and increased risk of non-communicable diseases such as diabetes and cardiovascular conditions later in life,” says Syed. “Brain development is particularly affected in the first two years, when deficiencies in protein, iron, iodine, zinc, folate, and essential fatty acids disrupt cognitive growth. This results in poor memory, weak attention span, delayed language development, and reduced problem-solving ability, affecting lifelong learning and productivity.”
“Complete reversal of stunting after the age of two is extremely difficult,” she adds. “The most critical window remains from pregnancy to two years of age. After this period, only limited catch-up growth is possible, so early detection and intervention are essential, including improved diet diversity, infection control, and supplementation. School feeding and micronutrient programmes can help but cannot fully reverse early damage.”
Food insecurity directly weakens the immune system by limiting access to protein, energy, and essential micronutrients. Deficiencies in vitamins and minerals such as vitamin A, zinc, iron, vitamin C, and vitamin D impair immune function, leading to frequent and severe infections. Children recover more slowly and suffer more complications. “This creates a vicious cycle where malnutrition weakens immunity, infections reduce nutrient absorption, and poor nutrition further deepens vulnerability,” says Syed.
Nutrition remains politically invisible because its effects are slow, indirect, and less visible than other crises, even though its long-term impact is severe.
Unlike sudden disasters or economic shocks, malnutrition develops gradually—damaging a child’s learning, productivity, and future opportunities over years, and even affecting the next generation. Because of this delay, it rarely creates immediate political urgency.
However, it erodes human capital, which is essential for national development. While governments invest heavily in infrastructure and visible projects, nutrition—despite shaping the workforce behind all growth—receives far less attention.
At the same time, global pressures are making healthy diets increasingly unaffordable. Rising food prices, conflict, climate change, and economic inequality are pushing families toward cheaper, less nutritious foods, deepening malnutrition, especially among children.
If we see the world there are many success stories. Brazil reduced hunger through social protection and food security programmes. Thailand improved child nutrition through community-based action, while Rwanda linked health, agriculture, and social services.
China also made major gains through large-scale rural development and targeted nutrition programmes.
In the end, malnutrition is not just a health issue—it is a quiet crisis shaping the future before it even begins. It does not make headlines like disasters or economic shocks, yet it slowly weakens children, mothers, and entire societies from within.
Behind every stunted child is a story of lost potential; behind every anaemic mother, a cycle that continues into the next generation. And behind every policy on paper, there is a reality waiting to be changed.
If nutrition is about life itself, then ignoring it means accepting a future that is less healthy, less productive, and less fair. Real progress will only begin when nourishment is treated not as charity, but as a basic foundation of national development.
The writer is a teacher and a freelance contributor
All facts and information are the sole responsibility of the writer