- Introduction of speaker
- Lecture transcript
- Nutrition during the pandemic
- From food security to nutrition security
- Not merely adequacy but also sustainability
- Responsible food processing sector
- Importance of healthier food choices
- Role of civil society and the government
- Role of consumers
- Role of international agreements and the private sector
- Need for collaborative and unified action
Introduction of the speaker by Dr. Rajan Sankar
It's my proud privilege and I'm really delighted and honoured that Professor K Srinath would deliver the first foundation day lecture. Dr Srinath Reddy is the President of Public Health Foundation of India (PHFI). Earlier he headed the Department of Cardiology at All India Institute of Medical Sciences. Professor Reddy is the first Indian to be elected as a foreign associate member of the National Academy of Medicine (formerly the Institute of Medicine of the National Academy of Sciences) of United States of America. He served as the first Bernard Lown Visiting Professor of Cardiovascular Health at Harvard School of Public Health for five years.
He is presently an adjunct Professor at Harvard, Emory and Sydney Universities. He has served on many government panels. Most importantly, he chaired the high level expert group on Universal Health coverage for Planning Commission of India. He is also a member of the leadership council of UN Sustainable Development Solutions Network (SDSN) and chairs the thematic group on health in SDSN.
Professor Reddy is a member of the global panel on agriculture and food system for nutrition. He has published more than 500 scientific papers. He has received several honours, most notably the President of India conferred on him the Padma Bhushan in 2005.
Greetings to all the dignitaries who have graced this event and also the various participants from different institutions who are adding strength to this foundation day event through their time and talent. Well, the raison d’etre of the foundation has been very clearly explained and its relevance for our future has also been very well outlined. Therefore, whatever I say, I would be in a sense be embellishing what has already been stated in a very clear manner by all the preceding speakers. Nevertheless, I shall attempt my task with some degree of humility and greatly humbled by the honour that's been conferred on me.
It is the malnourishment of many forms which actually erodes our defence and makes us easy prey for viruses and bacteria.
Nutrition during the pandemic
People may wonder why during this Covid phase, we are really focusing our attention on nutrition where it appears to be a battle for survival against a virus. But this is a very appropriate time to re-emphasize the importance of nutrition for human health. It is very clear that food and nutrition in a balanced manner are the main contributors to innate immunity which is the first and foremost defence against any microbial invader. It is the malnourishment of many forms which actually erodes our defence and makes us easy prey for viruses and bacteria.
This has been very clearly outlined in this particular pandemic too, when we recognize that the most vulnerable are those who have nutritional disorders of any kind.
But we also recognize that we harbour within us hundreds of trillions of microbes who also constitute our micro-biome. They not only help us both in building up our immunity but also in fostering our nutrition.
Some of the food we consume and the nature of the food we consume is also good for the bacteria who reside in our gut and we recognize that their nutritional needs are also conditioned in a way by the food we consume. If we have a disordered micro-biome we are likely to have a disordered immunity and we can fall prey to a variety of diseases.
Therefore, we are not eating just for ourselves but for our co-habiting microbes which are beneficial for us and which help us to fight the not-so-beneficial or harmful microbes and help ward off a variety of autoimmune diseases. So in that context too, it has been noted by some Australian researchers, that perhaps one of the contributors for the lower level of mortality and the less severity of the manifestation of the Covid19 virus in the South Asian population could have something to do (particularly among the poor not so much among the middle class and the rich) with the high fibre content of the food which may actually foster a healthier micro-biome. This therefore makes them less susceptible to and cope with COVID-19’s ravages.
So, we are seeing even in the context of Covid19 how clearly important nutrition is and how food is the foundation for our battle against any challenges visited upon us by external world of microbes. But then we ought to look at nutrition across the life course not merely in a segmented manner but right from preconception to the very end of life.
We have transitioned from essentially looking at calories to nutrition and from food security to nutrition security. So not merely energy but the nutrient sufficiency and balance
From food security to nutrition security
We need to transition from food security which is absolutely critical to nutrition security and this has already happened in the basic parlance of nutritional dialogues. We have transitioned from essentially looking at calories to nutrition and from food security to nutrition security. So not merely energy but the nutrient sufficiency and balance. We've also moved on from our scientific quest in a very reductionist manner, as needed sometimes for advancing science, from individual nutrients to composite balanced diets. We have recognized through our research that there are several individual nutrients which are very important, several food items which are very important. But none of them really predict the health outcomes as much as composite diets which are balanced and nutritionally well represented in terms of their composition.
The future of food is not merely for the present generation but for generations to come.
Therefore, food becomes a very important element of our sustainable development and even as we do try and refine our knowledge through elegant science, we must recognize that the spectrum of science is reductionist in content but holistic in context. Therefore, we need to bring together all of that knowledge to create not only wholesome balanced diets but also a food system which is capable of providing it to everybody who needs it on earth. Therefore, equity becomes a very important element here. I am happy that the foundation has emphasized equity as one of the important goals.
Therefore, we need nutrition security for all and when I say ‘all’, we are also talking about present as well as future generations. The future of food is not merely for the present generation but for generations to come.
Not merely adequacy but also sustainability
Therefore, sustainability is a very important element, particularly when we are living in an era where we are substantially environmentally challenged by conditions that we have helped to create unfortunately. Then, how do we fashion the future of food so that we can actually ensure not merely adequacy but also sustainability?
As we move along from 2005 to 2050, it is believed that the world would require 60% more food.
We recognize that the demand for food is likely to increase. As we move along from 2005 to 2050, it is believed that the world would require 60% more food. That is because of an increasing population, increasing urbanization and increasing incomes as poverty levels decrease. Though we are right now seeing an economic setback, that will not be the set pattern for the future. But we also recognize that we will have less availability of food if we do not take action.
There will be less agricultural land available as the population expands and seeks new habitats. We will have increased climate stress both in the form of heat stress and water stress and all of them are likely to be reducing our agricultural output unless we take action to balance our overall production processes with climate change mitigation processes. Now we also recognize that some of the technological changes that we are relying upon so far, for advancing our ability to produce more food, will not have the same level of returns as we move along.
Therefore, we have to adapt to the future. While we (do) invest in technology, we cannot believe it to be our sole saviour because we may be on the law of diminishing returns in terms of the technological returns for agriculture.
We must recognize that there are places on earth which are especially vulnerable. Sub-Saharan Africa and South Asia which are already operating at temperatures very close to the highest level tolerated by staples. For every degree further rise in temperature, we will be seeing a 10% decrease in yield. (Loss in the yield, loss for staples)… so 10 degrees in the yield for staples but non-staples too will suffer. Fruits and vegetables will ripen early and rot early and in the staples too, the nutrients would be lost. There would be lesser amount of protein, lesser amount of zinc, lesser amount of iron.
As the heat rises by 2050, it has been forecast that India that would experience
- 2.9% increase in zinc deficiency which would translate into 49.6 million new zinc-deficient persons in India.
- It would have a 2.2% increase in protein deficiency which would mean 38.2 million new cases of protein deficiency.
- And we will see 106 million children and 396 million women iron-deficient by 2050 if we do not take preventive action, in order to stall climate change and also improve our nutritional programmes.
Diversifying crop production in India particularly by increasing the production of millets and sorghum to partially replace rice, would enable us to have more nutritious food supply reducing the irrigation demand, reducing the energy use and also reducing the greenhouse gas emissions.
Accompanying heat stress is water stress. 50% of India will experience extreme or high water stress which will (again) further impact upon our agricultural productivity and nutritional sufficiency. The rising sea levels will pose a threat to our coastlines and our availability of fish as a source of nutrition. In fact (rising) sea levels are increasing by 3.4 millimetres per year and they substantially impact upon the yield of our fish. Therefore, we do require to diversify crop production in India. It has been forecast, by modelling, by the Data Science Institute of the Columbia University, that diversifying crop production in India particularly by increasing the production of millets and sorghum to partially replace rice, would enable us to have more nutritious food supply reducing the irrigation demand, reducing the energy use and also reducing the greenhouse gas emissions. A much more balanced ecological and nutritionally appropriate response to climate change. So what we need to do is to try and aim for methods of production which are going to yield much more per unit investment in land, water and energy.
Responsible food processing sector
We recognize that the food systems are complex adaptive systems. Agriculture is only the beginning of the supply chain and is only a part of that adaptive system; harvesting, storage, and transport are important elements. Post-harvest losses are an important source of food waste not merely food waste on the table. Post-harvest losses are also an important element and how do we actually tackle that? In the whole area of processing what are the nutrient losses that happen to beneficial nutrients and what are the harmful elements that are added in the course of processing, particularly of ultra-processed foods. Whether it's trans fats or increased salt or increased sugar, all of these are going to be very critical. We recognize that when we talk about trans-fats the original intent was to increase the shelf life, as indeed in olden times, the idea of adding a lot of sugar or a lot of salt to foods, was essentially to increase the shelf life as preservatives. But all these things that we add to prolong or lengthen shelf life shorten human life. And, therefore, we do need to take adequate action to ensure that the foods that we prepare and process are far safer then comes in food safety as well. But pricing is an important element to make appropriate diets available and affordable to everybody.
Importance of healthier food choices
Consumer demand and practices are very critical in shaping the nature of food production. If there is a responsive industry and responsive agriculture, and policies are set to meet not merely the health and nutrition knowledge from science but also the aspirational demands of consumers, which of course must be steered in the right direction.
Quite often it has become the practice to say that it is a matter of individual choice - that what you eat is essentially a matter of individual choice and it should not be interfered with. But choice is determined by multiple factors. It can be conscious, it can be conditioned or it can be constrained. Conscious can based on the right information or the wrong information. Therefore, health and nutrition literacy become very important elements. I am sure that the book that you have published is going to contribute substantially there. It can be conditioned by aggressive marketing by peer pressure, by cultural traditions. So all of those need to be contended with if we are trying to promote healthier consumer practices, with reference to food choices. But very importantly, choice can also be constrained. You may have all the knowledge in the world about what type of fruits and vegetables and how many times to consume but you may be greatly constrained by your financial conditions which limit your affordability in terms of purchase. (And) therefore, it is not enough to say that somebody knows that fruits and vegetables have to be consumed in this quantity per day. But does the family budget permit that can they buy healthier edible oils in preference to unhealthy edible oils. Now, that actually depends upon policy instruments which can make the healthier products more easily available and affordable.
So, we have to definitely influence the nutrition related knowledge of people but also create conditions through our policy instruments which will make it easier for them, which will enable them to make those right choices by creating conditions which are conducive for making and maintaining healthy choices across the life course.
Equity becomes absolutely important not only in terms of quantity being provided, in terms of certain degree of caloric security, it is also in terms of quality. It will not do if the manufacturers of food adopt different quality standards in the west and different quality standards in the rest of the countries and push products which are not of equal quality, which are likely to be more harmful, to populations elsewhere.
Role of civil society and the government
Equity becomes absolutely important and I am glad again as I said that equity remains a foundational piece of the agenda of the foundation. Equity is not only in terms of quantity being provided, in terms of certain degree of caloric security, it is also in terms of quality. It will not do if the manufacturers of food adopt different quality standards in the west and different quality standards in the rest of the countries and push products which are not of equal quality, which are likely to be more harmful, to populations elsewhere. Therefore, even as the consumer knowledge increases it behoves a number of organizations particularly the civil society as well as the government, to join hands to make sure that not only adequate quantities are being produced for easier distribution and uptake, but also that the quality remains unimpeachable and promotes nutrition and health.
Now, that brings us to the role of the government. The role of the government is absolutely critical. (As Mr. Agarwal and many others have stated).
The government can actually use a lot of fiscal instruments as well as regulatory instruments to condition the market.
I call policy of frozen carrot which can be both a carrot and a stick at the same time.
The government can actually use a lot of fiscal instruments as well as regulatory instruments to condition the market, and move us towards a food future which is a much better future than we have right now, in terms of our nutritional experience and affordability. These instruments are very important. I would say that the government policy instruments can promote healthier foods, not merely curb unhealthy practices through taxation, for example, of sugar sweetened beverages or high salt high fat foods or put warning labels on it or put regulatory limits on it. All those are going to be important. But if we can also subsidize or promote healthier foods that will be very good. Policy has to have both the carrot and stick.
I call policy of frozen carrot which can be both a carrot and a stick at the same time. So we do need also consumer choices to be influenced but who shapes consumer choices? Who enables advocacy for policy change? Who articulates the demands for appropriate food and nutrition policies in the country?
And there we bring in the civil society, very strongly. It cannot be job of the government alone but the civil society is a fairly heterogeneous entity. Civil society can be defined in very many ways. Some include the private sector, some exclude the private sector. But certainly, anything other than the government, has to be included as a part of the broader platform. And within the private sector, and I lead with the private sector further on, we have the agriculture, industry and trade represented. Then we have the academia, in the civil society, producing and translating knowledge for policy and programs and for monitoring their impact.
Consumers have a tremendous amount of power that they can wield, provided they're adequately informed and organized.
Role of consumers
Then you have consumers who are either in groups organized or even as individuals. We know that even an individual adopting a preferential practice for buying fair trade products, (they) have changed how the industry behaves and makes its products or prioritizes the nature of its agricultural investments. So we know that consumers have a tremendous amount of power that they can wield, provided they're adequately informed and organized. Then we have the media, then we have the citizenry at large.
So, all of these will have to be mobilized if there has to be an ‘all of society’ response as has been stated. Therefore, when we are dealing with the market we recognize that the market has unfortunately become the reigning deity of the day.
But, the market cannot remain impervious and unresponsive to the priorities of public health, nutrition and therefore, we, have to model the market to become much more sensitive and responsive to public health priorities.
Therefore, we have to use fiscal and regulatory measures. We have to set the consumer demand. We have to also appeal to responsible sections of the industry that there is a health dividend - a healthier population which is well nourished and well protected is likely to be more economically productive is more likely to have greater consumer spending which will benefit the industry in general. Therefore, there is a dividend which health and nutrition will pay off and therefore unite the industry to move towards food security, nutrition security and health security and environmental security! Because we have to do whatever we do in an environmentally and ecologically sustainable manner.
Role of international agreements and the private sector
Then, of course, there is a scope for international agreements like we have seen in the case of the tobacco agreement. There can be international agreements to make sure that the practices are followed which are favourable to health. But at the same time not differentiating and discriminating between part of the world and another part of the world. That for example, if industry commits to reduce some harmful ingredients in its products, it will do so uniformly everywhere in the world and not try and dump its products in Africa or India or somewhere else. So these are all important elements that we need to bring together. As far as the private sector is concerned it plays a very-very critical role, there's no doubt about it.
Unlike the tobacco industry, the private sector in the food industry is absolutely important at various levels - from the farmer to the miller to the producer to the trader. But when the industry tries to reposition itself saying that we'll promote healthier products, there is both a credibility gap and an edibility gap. The credibility gap comes in when people question whether this is just a tactical repositioning to avoid litigation or regulation. Is the industry earnest? And, we'll have to try and ensure that the industry not only is posturing, but is actually delivering on its promises. Collectively we can do that.
Then comes the edibility gap which we recognize that it also has to be a tasty product because, otherwise, the consumer will reject it. Therefore, we depend upon the industry's ingenuity to try and address the consumer test preferences as well but without sacrificing nutrition. And we have to also reposition some of the cultivated, conditioned tastes of the consumer, because we know that if you start consuming salt in lesser amounts over a period of time the taste does get reconditioned.
I would like to redefine it as Partnership for a Public Purpose. First, we identify the public purpose and then have a unified action agenda around that public purpose with clearly defined deliverables and accountability mechanisms. So it is the public purpose that must drive the collective action.
Need for collaborative and unified action
But all of this requires unified action and frequent consultation and collaboration. The academia is very important in that area, both as knowledge creators and as knowledge translators. How do we actually ensure that we provide the right kind of knowledge and we also ensure that it's translated into practical solutions? Consumer groups are very critical absolutely and farmers’ organizations and traders all of them are important, as are the media. Now media, both in terms of educating the people, enhancing nutrition and health literacy but also questioning policies and programs and practices. All of these will require partnerships at multiple levels and the foundation actually now provides an excellent platform for those kind of partnerships to be formed. We have frequently heard the word PPP employed, as partnership as a Public-Private Partnership. I would like to redefine it as Partnership for a Public Purpose. First, we identify the public purpose and then have a unified action agenda around that public purpose with clearly defined deliverables and accountability mechanisms.
So it is the public purpose that must drive the collective action. Therefore, there has to be an ‘all of society’ effort as is already being stated. But for that we need an ‘all of society’ consensus, a consensus that is built periodically and commitments that are renewed regularly.
This platform that you have created, in the form of the foundation (Food Future Foundation), can be excellent platform for India and set a great model there. So we need this platform for convening different actors, followed by consultation among them, building up of consensus, adoption a common agenda, and then collective action.
(Such) collective action must amplify advocacy, accelerate action and assert accountability from all stakeholders. And we must measure progress objectively. Therefore, we also need good indicators of progress in each of these elements and that is where research comes in. Implementation research, policy research - all of them will come in. And we must keep on emphasizing equity. Because the availability of a balanced and adequate nutrition through a food system which is responsive to population needs, is not a matter of charity. It is true that we see in the pandemic a lot of organizations feeding those who require it. That's a wonderful thing. But nutrition security should not be merely left to acts of charity which are undependable. It should be a matter of right and therefore that is where the foundation must assemble all the actors so that this value is actually translated into a right which everybody can benefit from.
We cannot afford a passive response, we have to have an active and alert response because the present will not merely extend itself, if we do not act the future will actually get worse than the present and we cannot afford that.
So I believe, knowledge must be translated to action, action to impact and impact to equity. And then, we can create the kind of future for food, for health for human welfare, for ecological sustainability and thereby bring in, a much healthier, a better balanced nutrition and much healthier world, with more balanced nutrition and bring in intergenerational equity also. So that the future is not going to be compromised by our present mistakes. Nobel laureate Tony Morrison who won the Nobel Prize for literature said if we do not create the future, the present extends itself. We cannot afford a passive response, we have to have an active and alert response because the present will not merely extend itself, if we do not act the future will actually get worse than the present and we cannot afford that.
I am sure the Food Future Foundation will ensure that India at least will move in the right direction and will set the pace for the rest of the world also to move towards a healthier future with appropriate and affordable nutrition assured for all.