Thu03232017

Last updateTue, 20 Dec 2016 7am

Font Size

Profile

Menu Style

Cpanel
You are here: Home | Poverty | Agenda | Hunger & food security | Consumed by calories

Consumed by calories

By Alpana Sagar

A realistic measure of poverty would recognise that mere intake of calories does not indicate nutritional status. It would move away from an emphasis on minimal energy requirements and consumption expenditures and recognise that the balance of nutrients in a diet, absorptive capacity of the body, quality of living environment, nature of a person's work, and gender, among other factors, determine the body's food and energy requirements. A poverty line that ignores such complexities is missing a large part of the picture of deprivation

It should be a matter of great concern, for economic as well as ethical reasons, that a large proportion of the population remains poor in India. Despite the Five Year Plans, policies for development and poverty alleviation programs, millions of people continue to live in poverty. The per capita expenditure in rural areas is still only Rs 10 a day for 30.2% of Indians, Rs 20 a day for 41%, Rs 30 a day for about 15% percent, and only 5% spend more than this amount. 1

Poverty can be relative or absolute. The absolute viewpoint defines poverty as the inability of an individual's income to meet subsistence needs. Relative poverty is defined as a situation in which the individual's income is low relative to some social standard2. The poverty line in India attempts to measure levels of absolute poverty. People below the poverty line are defined as those with a per capita daily energy intake of less than 2,400 kilocalories in rural areas and 2,100 kilocalories in urban areas.

Does use of this prescribed energy intake as a marker reflect the real impoverishment in our country? Can we get an accurate picture of poverty and of poor people's lives by talking only in terms of energy intake? Does talking about 'poverty lines' sideline the fact that absolute poverty threatens the very survival of families?

Delving into data

The National Sample Survey Organisation's (NSSO) data on consumption expenditure and food intake is used to calculate the poverty line. First, the per capita daily total expenditure is grouped. The food items utilised in each group are noted and the caloric value of this food is calculated. An already specified standard daily calorie intake is taken. The total daily expenditure per person and daily caloric intake are correlated. People whose expenditure is not sufficient for them to obtain the standard daily intake of calories are said to be below the poverty line. The poverty line is updated by accounting for changes in price levels over time.

Examining consumption expenditure is useful because individuals may generate income, but consumption would be shared among members of the household. However, it is implicitly assumed that this distribution would be equal - which may not be the case. Consumption may also not be met out of current income, but can come from assets, debt and savings. As a result, expenditure may not always indicate the real economic status of the family.

The methodology of the NSSO's latest survey (1999-2000) for obtaining data on expenditure has been strongly critiqued. The critiques indicate that the survey under-represents poverty levels. Despite the debates about the methodology, the current estimate of people living below the poverty line is high at 27-33%.

The methodology used to collect data to calculate the poverty line is important, but the prescribed caloric value that determines the official level of the poverty line plays an equally important role. What is the basis of this value? Does it give us a true picture of chronic hunger? Does this poverty line help in remedying the situation?

Energy intake: Inaccurate lines

In 1971, Dandekar and Rath described the first assessment of poverty 3. They used National Sample Survey data for 1960-61 and 1961-62. There was a basic difference between the methodology they used and later calculations for determining the number of poor people. Dandekar and Rath began by estimating expenditure a little below average and then calculating the per capita kcalories available at this level. They found that the per capita daily intake of calories was 2,194 in rural areas and 2,159 in urban areas.

This was close to the value of 2,250 kcals suggested by nutritional experts, so they took the persons below this-about one-third of the rural and almost half the urban population-as living on diets inadequate even in terms of calories. However, they pointed out that when they used the expenditure standard for the minimum level of living as calculated by a distinguished group 4 set up by the government, about 40% of the rural and 50% of the urban population was below the desirable minimum.

The concept of a poverty line was introduced later, on the recommendation of the Task Force on 'Minimum Needs and Effective Consumption Demands'. Using the recommendations of the Nutrition Expert Group, 1968, the daily per capita calorie requirement was derived separately for rural and urban areas as 2,435 kcals and 2,095 kcals respectively 5 . This is close to the present level of 2,400/2,100 kcals that is used to estimate the population below the poverty line.

The Indian Council of Medical Research (ICMR) Expert Group (1990) has concluded that the poverty line should be at a weighted average standard for the whole population at 2,200 kcals per capita per day 6 . This, according to ICMR documents on nutrient requirements, is said to represent the actual requirements of individuals of the two sexes in a population averaged over their entire range of activity and body weights. That is, the weighted average (ICMR 1990). It is not clear whether studies were carried out to reach this figure or whether it is a theoretical calculation.

Although 2,200 kcals is the latest suggested intake for calculating the poverty line, the document notes an alternative physiological approach. This approach uses the lowest level of energy intake possible for "habitually active adults". Two studies in apparently healthy and active adult males engaged in sedentary and moderate activity have been used to fix this caloric level. The weight of a sedentary adult male is taken to be on average 54 kilos. He thus needs only 2,221 kcals/day at the requirement of 41.5 kcals per kilo. A moderate working male is said to need 2,180 kcals/day at the requirement of 47.3 kcals/kilo (ICMR 1990). This indicates a body weight of only 46.1 kg for the latter. It is noteworthy that this body weight of 46.1 kg for a person doing moderate levels of work is 25% less than the ideal weight of 60 kilos.

These "actual required" caloric values are interesting because the "recommended allowances" for a sedentary person or a person doing moderate work, but of ideal weight are very different (Table I). The Recommended Dietary Allowances (RDAs), if used wisely, would allow people to attain their potential.

Table I: Recommended Dietary Allowance in calories for adults

 

Sedentary work

Moderate work

Heavy work

Male: 60 kg

2425

2875

3800

Female: 55 kg

1875

2225

2925

Source: ICMR Nutrient Requirements and Recommended Dietary Allowances for Indians

It is significant that when we talk of ideal "recommended" calculations (RDAs), we consider the well-nourished Indian male/female, but when calculating "necessary" energy requirement we take the malnourished worker to see what minimum energy keeps him running! It does not seem to matter that he has just enough energy intake to function, and is just above starvation7. The RDAs talk of requirements of different levels of energy for different levels of work (Table I) but the latest ICMR proposal of 2,200 kcals does not consider this. Using the logic of "actual required" 2,200 kcals, we find that a male doing heavy work -- thus utilising 63.3 kcals per kg -- should weigh only 34.8 kilos!

If we calculate 54 kilos for a sedentary worker but only 46.1 kilos for a moderate worker we have accepted the "small but healthy" hypothesis. "Small but healthy" was a theory put forward in 1982 8. It said that individuals can "adapt" over time to inadequate intakes by not only becoming more efficient metabolisers and reducing losses and requirements, but also by becoming "smaller" over time and further reducing requirements. According to this theory, this is at no "functional cost". The experts at the ICMR have obviously accepted this theory.

The complexity of the issue of adaptation as discussed later by Rand 9 and Gopalan 10 has been completely bypassed. Gopalan pointed out that adaptation represents a state of strategic metabolic and functional retreat in response to stress, which may help the victim to ward off death, but will unfortunately not help him to "live" life 11 Rand has pointed out that not only did data indicate that capacity to work could be affected among "adapted" individuals, the reduced intake also meant they had no margin of safety above minimal needs to meet environmental insults like illness. He also pointed out that low intakes could decrease longevity. Such individuals could stave off death for some time but they would have higher levels of morbidity and shorter life spans than the average.

When the present lower energy requirements are taken in tandem with the Tenth Plan's views that energy requirements of Indians are likely to be substantially lower than current ICMR recommendations 12 it seems likely that under-nutrition may be accepted as the norm. We must not consider a state of chronic energy deficiency as "normal" merely because it is so common. In such a situation the number of people below the poverty line would decrease and the nation's food problems would be solved 13 .

Adequate calories, inadequate nutrition

If calorie intake is used to decide the poverty line, is it a sufficient indicator of the adequacy of a diet? Energy intake may well be a poor measurement of nutritional status. When calorie levels are used to set the poverty line, it implicitly assumes that a diet with sufficient calories will contain adequate quantities of all nutrients. Such a diet should ideally have sufficient proteins and other micronutrients to meet a person's nutritional needs. But dietary patterns have changed over the decades and a diet with adequate calories may not automatically be a balanced diet. Measuring only calories may not tell us if the person has a "nutritious" diet.

The inadequacy of measuring only energy requirement is illustrated in a well-known early-19th century experiment done by Magendie. He took a single food that was accepted as being nutritious and fed it to dogs. Sugar (very high in energy content) was the first food that he tested. The dog ate well for the first two weeks but then began to lose weight, developed a corneal ulcer and died after a month. Magendie repeated the experiment using various other substitutes as sole foods in each case and every time the animals eventually died 14 . Similarly studies on scurvy, beri beri and pellagra revealed that while foods could contain enough energy and maybe protein, they could still be deficient in other compounds. This reveals the importance of a nutritionally balanced diet 15,16 .

To be adequate, a diet must not just have sufficient calories but an adequate amount of other nutrients such as proteins, vitamins and iron. An analysis done by Qadeer and Priyadarshi 17 reveals that for the poor the energy intake as well as protein, iron and vitamins are all inadequate, and the energy intakes of the middle class are adequate but micronutrient deficiencies remain concentrated in this group.

Studies of people with mal-absorption reveal that intakes may be adequate, but if the absorptive capacity of the gut is affected, the actual amount of nutrient reaching the system is inadequate and the person will lose weight over time. Similarly, while intake may be sufficient, poor quality of water and sanitation can lead to recurrent gastrointestinal disorders that could affect absorption. A crowded physical environment can increase susceptibility to communicable diseases and fevers, which could affect the body's energy requirements. Intakes that may be adequate in ideal conditions may therefore be inadequate in a poor environment. Those who live in such conditions are usually the poor, who also have inadequate intakes.

This means that diets must be balanced and the person's health, environment, activity, climate and method of cooking must also be considered when looking at "energy intake". But our policymakers unhesitatingly accept caloric standards and consider health for the poor only as their capacity to produce a sufficient amount of work regardless of the quality of their lives. The poor are considered merely as transducers for converting energy to manual work

Many strands of poverty

What does it mean when we say that about 30% of the population (NSSO: about 27%; UNDP: about 33%) lives below the poverty line? It means that about 70% of India's citizens are food insecure to various degrees, but those below the poverty line are always food insecure. The lowest 20% get just about 1,500 calories of energy per capita per day, much lower than the average recommendation of 2,400 kcal 18 -that is, even by this conservative standard, they lack about 900 kcals per day. In other words, they are subsisting at starvation levels. Starvation deaths of adivasi children in Maharashtra and other states are the outcome of the children being unable to "adapt" to low levels of caloric intake.

Caloric requirements are met mainly by cereals, and cereal food security in India is important. India increased its food production from 50.8 million tonnes in 1950-51 to 213.5 million tonnes in 2003-04, but production has declined to 204.6 million tonnes in 2004-05. The per capita availability of foodgrain increased from 395 grams per day in 1951 to 510 grams per day in 2000 and then decreased to 417 grams per day in 2001 19,20 . This year we have had to import items of food. The problem is related not only to supply but also to purchasing power and distribution. The targeted Public Distribution System (PDS) has been criticised by many. Any attempt to increase food intake would have to act at multiple levels.

Aggregate statistics that mask the grim reality are often used to obfuscate the issue. From 1976 till the 1980s, nutrition as assessed by anthropometry for children, improved to some extent. However from the 1980s to the '90s, there has been a fall in nutrition with only a marginal improvement over time (Figure 1). The 2002 National Nutrition Monitoring Bureau (NNMB)21 data indicates a marginal shift from moderate to mild malnutrition but the picture is still abysmal. Even today about 37% of males and 39% of females have chronic energy deficiency (NNMB 2002)-more than the number below the poverty line.

Figure I: Distribution of 1-5-year-old children by weight for age 1979-2002

              

Source: NNMB data 1976 to 2002 rural survey

An examination by income shows that the prevalence of severe malnutrition is more than twice in the poorest households as compared to the economically better-off households (NNMB 2002). That is, the poorest children are carrying the burden of under-nutrition. The links of poor nutrition to a poor quality of life are well-known. The children are more susceptible to diseases partly due to the association between nutrition and immunity, but also because the more undernourished children also come from more deprived families. This link between poverty, malnutrition, a degraded environment, infection and mortality (Table II) is extremely significant.

Table II: Infant and under-5 mortality rate(22)

Social groups

Rural

Urban

Infant mortality rate

Under-5 mortality rate

Infant mortality
rate

Under-5 mortality rate

M

F

M

F

M

F

M

F

Scheduled caste

89

90

112

134

71

58

87

86

Scheduled tribe

89

86

125

121

48

67

61

89

Others

70

75

88

103

41

43

52

58

Total

76

79

97

111

45

46

57

63

Source: Government of India 2005

Poverty is not just a calorie line but is related to chronic food insecurity, hunger, under-nutrition, a high burden of ill health, high mortality and enormous suffering (Banerji D [1982] Poverty Class and Health Culture, Volume I, Lok Paksh, New Delhi India).The poverty line should measure this complex reality. A poverty line that measures only calorie intake is missing a large part of the picture of deprivation. Caloric intake must be studied according to gender, age and occupation. Besides studies that examine the interconnections between nutrition, energy intake and expenditure, we also need studies that show what it means to be poor.

Policies for nutrition intake must add to the present requirements of calories, the amount of food necessary for the poor to have the best possible diets (and not only energy) if they are to attain their potential over time. It’s time we stopped dismissing poverty as a line and stopped viewing the poor as mere statistics.

(Alpana Sagar is a medical doctor trained in public health. She is on the faculty of the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi.)

Acknowledgement

Thanks to Oommen Kurien for his invaluable assistance in tracing many of the references.

Endnotes

  1. Government of India (2000): National Sample Survey Organization Household Consumer Expenditure in India 1999-2000. Key Results Report No 454. NSS 55th round Ministry of statistics and Program Implementation.
  2. Joshi PD (1997): Conceptualisation, Measurement and Dimensional Aspects of Poverty in India, paper presented at Seminar on Poverty Statistics, Santiago.
  3. Dandekar VM and Rath N (1971): Poverty in India-1: Dimensions and Trends, in Economic and Political Weekly, Jan 2, pp 25- 146.
  4. These monetary norms were set in 1962 taking into account the ICMR’s Nutrition Advisory Committee’s recommendations of a balanced diet in 1958. As P.D. Joshi points out, this monetary norm excluded expenditure on health and education which were expected to be provided by the state
  5. Joshi PD (1997): Conceptualisation, Measurement and Dimensional Aspects of Poverty in India, paper presented at Seminar on Poverty Statistics, Santiago.
  6. Nawani NP (1994): Indian Experience On Household Food And Nutrition Security, Regional Expert Consultation, FAO-UN Bangkok, Thailand, accessed on 24 august 2006 http://www.fao.org/DOCREP/x0172e/x0172e.htm
  7. It is worth remembering that to shift from a ‘reference’ person to an ‘actual’ individual requires full knowledge of the levels of energy expenditure, activity levels and consumption for each group—which, as pointed out by Qadeer, are parameters we do not have.
  8. Messer E (1986): The ‘Small but Healthy Hypothesis’: Historical, Political, and Ecological Influences on Nutritional Standards, in Human Ecology, Vol 14, Plenum.
  9. Rand WM (1984): Protein and Energy Requirements – Insights from Long Term Studies, www.nutritionfoundationofindia.org/archives.asp?archievid6
  10. Gopalan C, Swaminathan, MC, Krishna Kumari VK, Hanumantha Rao, D and Vijayaraghavan, K (1973): Effect of Calorie Supplementation on Growth of Undernourished Children, in The American Journal of Clinical Nutrition, 26, pp 563-565.
  11. Cited in Qadeer I and Priyadarshi A (2005): Nutrition Policy: Shifts and Logical Fallacies, in Economic and Political Weekly, Jan 29.
  12. Government of India (2002): Tenth Five Year Plan, Ministry of Health and Family Welfare, Delhi
  13. Messer E (1986): The ‘Small but Healthy Hypothesis’: Historical, Political, ad Ecological Influences on Nutritional Standards, in Human Ecology, Vol 14, Plenum
  14. Carpenter KJ (2003a): A Short History of Nutritional Science Part I (1785-1885) in American Society for Nutritional Sciences, J Nutr. 133: 638-645
  15. Carpenter KJ (2003b): A Short History of Nutritional Science Part II (1885-1912) in American Society for Nutritional Sciences, J Nutr. 133: 975-984, 638-645 and
  16. Carpenter KJ (2003c): A Short History of Nutritional Science Part III (1912-1944) in American Society for Nutritional Sciences, J Nutr. 133: 3023-3032
  17. Qadeer I and Priyadarshi A (2005): Nutrition Policy: Shifts and Logical Fallacies, in Economic and Political Weekly, Jan 29.
  18. Sharif, Abusaleh: (2004): Poverty and Equity in India With a Special Emphasis on Health, http://www.globalforumhealth.org last accessed on 29th August 2006.
  19. Suryanarayana MH (1997): Food Security in India: Measures, Norms and Issues, in Development and Change, Vol 28, pp 771-789 Blackwell Publishers, Oxford, UK
  20. Vepa SS (2004): Policy Implications of Food Insecurity’ in Swaminathan MS and Medrano P (eds) Towards a Hunger Free India – From Vision to Action, pp 124-125, East West Books, New Delhi
  21. National Nutrition Monitoring Bureau (1976- 2002) Diet and Nutritional Status of Rural Population NIN, ICMR, Hyderabad
  22. The Infant Mortality Rate is the ‘ratio of infant deaths registered in a given year to the total number of live births registered in the same year’. It is expressed per 1000 live births.

InfoChange News & Features, October 2006

OPENSPACE

 OpenSpace Talk Think Act for change
Our youth forum

KIDSFORCHANGE

Food diaries of poor children
Stories for children

VIDEOS

In Search of My Home
Infochange documentaries

AUDIO FILES

The visible scares of Kashmir
Infochange audio stories

FILM FORUM

REVIEWS OF FILMS
Reviews of documentary films