Even as the top economists in the government concern themselves with 8 percent growth, they seem to be missing the urgent concerns. Health and human rights activist Dr Binayak Sen talks of India's nutritional failure and the ramifications it could have in an interview with Governance Now.

Dr Sen says that large parts of the country are under the grip of a stable famine situation since the last several years. As a member of steering committee of health in the planning commission, he has been vociferously laying India’s health woes in front of the policy makers.

Edited excerpts:

Looking at the health of the country, what would be your immediate area of concern?

I want to talk of the malnutrition problem which is rather shocking. The extent of malnutrition in India is a part of general discussion but it is not exactly known in the country. We generally discuss malnutrition in children and also anemia in women, an extremely important part. But over large parts of population in India, there is stable famine, which is caused by high prevalence of malnutrition and starvation and its has been continuing since years. This has not been in the common knowledge.

Can you elaborate more on stable famine conditions in India? How do you measure it?

Considering  body mass index (BMI)* as a measure of nutritional status, people with BMI below 18.5 are regarded as undernourished. At the population level, more than 40 percent of the pouplation with a BMI less than 18.5 level indicates famine in the community, according to the World Health Organisation (WHO). At least 37 percent of the total adult population of India have BMI less than 18.5. It is very close to the forty percent mark. If you look more microscopically, then more than 50 percent of scheduled tribes (STs) population has a BMI of less than 18.5 percent. For the schedule castes (SCs), the undernourished population is as high as 60 percent. So, in several pockets with a high population of SC and ST, the body mass index has been below WHO norms for years, which means that these communities are in a state of famine.

In addition to this, 47 percent of the children below five years are malnourished by weight for age criteria. About 23 percent of the new born children weigh less then 2.5 kg which indicates that they have low birth weight and will suffer from related complications later in life. The malnutrition rate amongst children in the minority community is almost at 50 percent.  

Which are the states affected most by stable famine?

All the states, across India -- except for Kerala where the condition is better than other states. Look at Maharashtra, which has the second highest per capita GDP in India. A large number of children in the state are malnourished by the weight-for-age criterion.

In fact, the entire food economy is vitiated in a way in which a huge chunk of the people who are consuming the food are in extreme conditions which can be called a famine. The people who are producing the food are also in an extremely difficult situation. The only people who are profiting are the ones who are trading in this food economy.

Have you made the planning commission aware of this?

I am not saying anything new even though this does not form a part of general knowledge or debate. Large parts of India are suffering from stable famine. It should concern everybody, especially the policy makers. It is absolutely shocking but not to our policy makers. It is a major governance issue.
I am just a member of steering committee on health in the planning commission. I have raised issue of health in such meetings. But the issues related to nutrition have been also raised under the right to food campaign. As a member of this campaign, I have been raising the issue.

How do you see healthcare facilities in states like Maoist-affected areas?

Health care facilities in the Maoist-affected area is very dismal. We can say that it is simply not available. Everybody should be worried about it. That is quite separate from the nutrition issue. Well-meaning schemes are defeated by the lack of facilities, for example, the Janani Suraksha Yojana (JSY) where pregnant women are encouraged to opt for institutionalised delivery instead of delivering at home. In such areas, there are no facilities to ensure safe delivery despite the talk. So, my question is that why do you ask pregnant women to come to such places? You do not have equipment for emergency situations. There are capability issues as well also because all the hardware and the software needed to deal with this emergency are simply not present in the government hospitals. So, how will it benefit to the women coming to the government institutions?

There are reports of large scale corruption in health schemes like the national rural health mission in Uttar Pradesh. Your comment?

It is shameful. As it is, people do not have access to health care and on the top of that money that is disbursed is being swallowed up.

*“Body Mass Index (BMI) is a number calculated from a person's weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems,” according to the centres for disease control and prevention.