The Changing Health, Food and Nutrition Scenario in India

1
The Changing Health, Food and Nutrition Scenario
in India
Prof. Indira Chakravarty Dean and Director
Professor,Head, Dept. of Bio-chemistry
NutritionAll India Institute of Hygiene Public
Health, 110, Chittaranjan Avenue, Kolkata
Indira Chakravarty 23 - 24 Jaunary, 2006
2
CHANGES IN THE DEMOGRAPHIC PROFILE
Indira Chakravarty 23 - 24 Jaunary, 2006
3
Growth of Indias Population (in Millions)
Health Information of India, 1999 Health on the
March, West Bengal 2001-02 (Registrar General of
India)
Indira Chakravarty 23 - 24 Jaunary, 2006
4
Decadal Variation of Population (Percent increase)
Source Health Information of India 1999.
Health on the March, Govt. of West
Bengal, 2001-02 (Registrar General of India )
Indira Chakravarty 23 - 24 Jaunary, 2006
5
Population Profile
Source Health Information of India 1999.
Health on the March, Govt. of West
Bengal, 2001-02 (Registrar General of India )
Indira Chakravarty 23 - 24 Jaunary, 2006
6
Density Per Square Kilometer
Source Health Information of India 1999.
Health on the March, Govt. of West
Bengal, 2001-02 (Registrar General of India )
Indira Chakravarty 23 - 24 Jaunary, 2006
7
Rate of Increase in density over decades
Years Rate of increase 1941 14.4 1951 11.9
7 1961 21.37 1971 24.65 1981 48.92 1991
26.39 2001 18.68 Source Compiled from
the data of Health Information of India,
1999 and Health on the March, West Bengal,
2001-02
Indira Chakravarty 23 - 24 Jaunary, 2006
8
Sex Ratio
Source Health Information of India 1999.
Health on the March, Govt. of West
Bengal, 2001-02 (Registrar General of India )
Indira Chakravarty 23 - 24 Jaunary, 2006
9
Percentage of Urban Population to Total Population
Source Health Information of India 1999.
Health on the March, Govt. of West
Bengal, 2001-02 (Registrar General of India )
Indira Chakravarty 23 - 24 Jaunary, 2006
10
Total Literacy Rate in India
Source Statistical Abstract, India 1997
(V-I) Health on the March, Govt. of West Bengal,
2001-02. ( Census of India 2001, Provisional
Population Totals )
Indira Chakravarty 23 - 24 Jaunary, 2006
11
Literacy among Male and Female
Source Statistical Abstract, India 1997
(V-I) Health on the March, Govt. of West Bengal,
2001-02. ( Census of India 2001, Provisional
Population Totals )
Indira Chakravarty 23 - 24 Jaunary, 2006
12
Total Percentage of Population below poverty line
Source Selected Socio - economic Statictics ,
India - 2001 Planning Commission
Indira Chakravarty 23 - 24 Jaunary, 2006
13
Percentage of Population below Poverty Line in
Rural and Urban Areas
Source Selected Socio - economic Statictics ,
India - 2001 Planning
Commission. Note The 1999-2000 estimates may
not be strictly comparable to the estimates of
earlier years because of some changes in the
methodology of data collection with reference to
reference period.
Indira Chakravarty 23 - 24 Jaunary, 2006
14
Summary
1. Population Increasing rapidly. (11 in 1931 to
21.34 in 2001). 2. Resulting in Density / sq.
km. Increasing rapidly (90 in 1931 to 324 in
2001). 3. F/M sex ratio coming down showing a
discrimination against females. (950 in 1931 to
933 in 2001). 4. Migration to urban areas is
increasing (11.9 in 1931 to 27.78 in 2001) 5.
Literacy rate is increasing but not too
satisfactorily. 6. Positive trend is that while
Male literacy has gone up 3.04 fold between 1951
and 2001, Female literacy has gone up more viz.
6.86 fold. 7. Number of people BPL has decreased.
But is still more than 25. Need better planning.
Indira Chakravarty 23 - 24 Jaunary, 2006
15
CHANGES IN HEALTH INDICATORS
Indira Chakravarty 23 - 24 Jaunary, 2006
16
Crude Birth Rate (CBR) Number of live births
per 1000 population in a given year. Crude Death
Rate (CDR) Number of deaths per 1000 population
in a given year. Infant Mortality Rate (IMR)
Number of infants dying under one year of age
in a year per 1000 live births of the same
year. Expectation of life at birth Average
number of years a new borne child is expected to
live under current mortality conditions. Maternal
Mortality Rate Number of deaths of women while
pregnant or within 42 days of termination of
pregnancy from any cause related to pregnancy and
child birth per 1000 live births in a given
year.
Indira Chakravarty 23 - 24 Jaunary, 2006
17
Crude Birth Rate
Source 1. Health Information India 1990,
Ministry of Health and Family Welfare, New
Delhi 2. Family Welfare Statistics at a Glance,
1995. 3. SRS Bulletin, Volume 37 (No. 1)
Indira Chakravarty 23 - 24 Jaunary, 2006
18
Percent decrease over the decades in Crude Birth
Rate
Years Percent Decrease 1951-61 4.51 1961-71
1.20 1971-81 9.71 1981-87 13.98 1987-96
14.38 1996-2001 7.30
Source Compiled from - 1. Health Information
India 1990, Ministry of Health and Family
Welfare, New Delhi 2. Family Welfare Statistics
at a Glance, 1995. 3. SRS Bulletin, Volume 37
(No. 1)
Indira Chakravarty 23 - 24 Jaunary, 2006
19
Crude Death Rate
Source 1. Health Information India 1990,
Ministry of Health and Family Welfare, New
Delhi 2. Family Welfare Statistics at a Glance,
1995. 3. SRS Bulletin, Volume 37 (No. 1)
Indira Chakravarty 23 - 24 Jaunary, 2006
20
Percent decrease over the decades in Crude Death
Rate
Years Percent Decrease 1951-61 16.79 1961-71
16.67 1971-81 21.05 1981-87 28.0 1987-96
17.59 1996-2001 5.62
Source Compiled from - 1. Health Information
India 1990, Ministry of Health and Family
Welfare, New Delhi 2. Family Welfare Statistics
at a Glance, 1995. 3. SRS Bulletin, Volume 37
(No. 1)
Indira Chakravarty 23 - 24 Jaunary, 2006
21
Natural Growth Rate
Source 1. Health Information India 1990,
Ministry of Health and Family Welfare, New
Delhi 2. Family Welfare Statistics at a Glance,
1995. 3. SRS Bulletin, Volume 37 (No. 1)
Indira Chakravarty 23 - 24 Jaunary, 2006
22
Infant Mortality Rate
Source 1. Health Information India 1990,
Ministry of Health and Family Welfare, New
Delhi 2. Family Welfare Statistics at a Glance,
1995. 3. SRS Bulletin, Volume 37 (No. 1)
Indira Chakravarty 23 - 24 Jaunary, 2006
23
Percent decrease over the decades in Infant
Mortality Rate
Years Percent Decrease 1951-61 8.96 196
1-71 11.64 1971-81 14.73 1981-87 13.64 19
87-96 24.21 1996-2001 8.33
Increased from 1941 -134 1951(156)
Source Compiled from - 1. Health
Information India 1990, Ministry of Health and
Family Welfare, New Delhi 2. Family Welfare
Statistics at a Glance, 1995. 3. SRS Bulletin,
Volume 37 (No. 1)
Indira Chakravarty 23 - 24 Jaunary, 2006
24
Changing Trends in Expectation of Life at Birth
Years
Selected Socio-Economic Statistics for India,
1991. Census of India, 1981. Projected
Figures. Source 1. Health on the March, Govt.
of West Bengal 2001-02 2. Report of the
Technical Group on Population Projections 1996,
R. G. India 3. Statistical Abstract, 1997.
Indira Chakravarty 23 - 24 Jaunary, 2006
25
Maternal Mortality Rate
1 2 2 3 4
1. Govt. of India 1962 Report of Health Report
of Health Survey and Planning Committee. 2.
WHO/UNICEF Revised 1590 estimates of maternal
mortality April 1996. 3. NFHS-1- India (1992-93)
. 4. NFHS-2 - India (1998-99) Estimation done two
years preceding the Report. 5. Health on the
March, West Bengal 2001-02. SRS Bulletin April
2000
Indira Chakravarty 23 - 24 Jaunary, 2006
26
Maternal Mortality Rate
Rural MMR is much higher than Urban MMR
Source NFHS-2 -India (1998-99) Estimation done
two years preceding the Report.
Indira Chakravarty 23 - 24 Jaunary, 2006
27
India during Independence and India Today

• The great Bengal famine of 1943 during the latter
  part of 1943.
• Conditions during newly Independent India
• - Average life span - around 30 years.
• - IMR - 140
• - Death Rate - 27.4
• - Birth Rate - nearly 40.
• India Today - 2001
• - Average life span - 60.8 years.
• - IMR - 66
• - Death Rate - 8.4
• - Birth Rate - 25.4
• Year 1996
• - SRS Bulletin Vol. 37 (No. 1)

Indira Chakravarty 23 - 24 Jaunary, 2006
28
CHANGES IN FOOD SECURITY AND NUTRITIONAL PROFILE
Indira Chakravarty 23 - 24 Jaunary, 2006
29
Trends in Food grain Production (Million tonnes)
Statistical Abstract India, 2001 Economic
Survey 2002-03. Economic Abstract India, 1997
(1st Part) Statistical Abstract India, 1949
(Vol. II)
Indira Chakravarty 23 - 24 Jaunary, 2006
30
Production and Import of Food Grains
_at_ Net availability Net production Net
Imports - Changes in Govt. Stock. Source
Directorate of Economic Statistics, Dept. of
Agriculture and Co-operation. Economic Survey,
2002-03
Indira Chakravarty 23 - 24 Jaunary, 2006
31
Surgarcane Production over the years
Source Economic Survey, 1991-92 Statistical
Abstract, India 1984 Economic Survey
2002-03 Ministry of Agriculture.
Indira Chakravarty 23 - 24 Jaunary, 2006
32
Oilseeds Production over the years
Source Economic Survey, 1991-92 Statistical
Abstract, India 1984 Economic Survey
2002-03 Ministry of Agriculture.
Indira Chakravarty 23 - 24 Jaunary, 2006
33
Vegetable Production over the years
Source Economic Survey, 1991-92 Statistical
Abstract, India 1984 Economic Survey
2002-03 Ministry of Agriculture.
Indira Chakravarty 23 - 24 Jaunary, 2006
34
Milk Production over the years
Source Economic Survey, 1991-92 Statistical
Abstract, India 1984 Economic Survey
2002-03 Ministry of Agriculture.
Indira Chakravarty 23 - 24 Jaunary, 2006
35
Fish Production over the years
Source Economic Survey, 1991-92 Statistical
Abstract, India 1984 Economic Survey
2002-03 Ministry of Agriculture.
Indira Chakravarty 23 - 24 Jaunary, 2006
36

• Summary
• Food Production and availability
• Total food grains production increased from
  47.28 MT in 1951 to 195.92 MT in 2001 which is
  about 310 increase.
• Hence per capita food grain availability has
  maintained despite huge population growth.
• Production of sugarcane, oilseeds, milk and fish
  production has increased from 1971 onwards. Only
  in case of oil seeds production it has gone down
  during 2000-01
• Production of vegetables has increased from 1985
  onwards

Indira Chakravarty 23 - 24 Jaunary, 2006
37
Poor Indian Dietaries (1937 - 1942)
In OZ per consumption unit (1OZ25 gm approx)
Source Nutrition in India, V. A. Patwardhan
The Indian Journal of Medical Sciences., 1952
Indira Chakravarty 23 - 24 Jaunary, 2006
38
Middle Class Dietaries (1937-1942)
In OZ per consumption unit (1OZ25 gm approx)
Source Nutrition in India, V. A. Patwardhan
The Indian Journal of Medical Sciences.
Indira Chakravarty 23 - 24 Jaunary, 2006
39
Comparison between average intake of foodstuff
during the years of 1937-42(poor dietaries) with
that of 1995 -96 (RuralUrban)
Foodstuff (in gms) 1937-42 1995-96
Total Rural Urban Cereals 575
474.1 488.1 419.5 Pulses 41.5 37.1 32.5 54.
9 Leafy Vegetables 32.5 29.4 31.8 23.4 Other
Vegetables 80.5 71.2 70.2 75.1 Fats and
Oils 10 15.7 14.3 21.2 Milk and Milk
products 44.25 131.3 125.9 142.5 Fleshy
Foods 8.75 22 22 19 Sugar Jaggery
2.75 20.5 20.2 21.9
Source Nutrition in India, V. A. Patwardhan
The Indian Journal of Medical Sciences,
1952 India Nutrition Profile, Dept. of Women and
Child Development, 1995-96.
Indira Chakravarty 23 - 24 Jaunary, 2006
40
Comparison between average intake of foodstuff
during the years of 1937-42 (middle class diets)
with that of 1995-96 (Rural Urban)
Foodstuff (in gms) 1937-42 1995-96
Total Rural Urban Cereals 378.75
474.1 488.1 419.5 Pulses 53.33 37.1 32.5 54.
9 Leafy Vegetables 38.5 29.4 31.8 23.4 Other
Vegetables 160.5 71.2 70.2 75.1 Fats and
Oils 56.25 15.7 14.3 21.2 Milk and Milk
products 256.25 131.3 125.9 142.5 Flesh
Foods 67.5 22 22 19 Sugar Jaggery 40 20.5
20.2 21.9
Source Nutrition in India, V. A. Patwardhan
The Indian Journal of Medical Sciences,
1952 India Nutrition Profile, Dept. of Women and
Child Development, 1995-96.
Indira Chakravarty 23 - 24 Jaunary, 2006
41
Differences between Poor Middle level
Pre-Independence diets in Comparison with Present
day diet
1. In Pre Independence era the middle class
community took less of cereals and more of
Pulses, Leafy vegetables, other vegetables, fats
and oils, milk and milk products, fleshy foods
and sugar and jaggery as compared to the poor
community. 2. Same trend is true now. 3. Compared
to the present rural dietary intake pattern, the
poor community of pre-independence era took more
cereals but less of protective foods. 4.
Conversely middle income group of
pre-independence era took less of cereals more of
protective foods as compared today.
Source Compilation from - Nutrition in India,
V. A. Patwardhan The Indian Journal of Medical
Sciences, 1952 India Nutrition Profile, Dept. of
Women and Child Development, 1995-96.
Indira Chakravarty 23 - 24 Jaunary, 2006
42
1995-1996 Study conducted in the following
States Haryana, Himachal Pradesh, Punjab,
Rajasthan, Chandigarh, Delhi, Bihar, Sikkin,
Orissa, Arunachal Pradesh, Assam, Manipur,
Meghalaya, Mizoram, Nagaland, Tripura, Dadra
Nagar Haveli, Daman Diu, Goa, Gujarat,
Maharastra, Andhra Pradesh, Karanataka, Kerala,
Tamil Nadu, Madhya Pradesh. 1937-42 (Poor
Diets) Study Conducted in the following States
Madras, Mysore, Baroda, Madhya Pradesh, Bengal,
Orissa, Bihar, Uttar Pradesh, Punjab, Assam,
Kashmir, Hyderabad. 1937-42 (Middle Class Diets)
Study Conducted in the following States
Bengal, Bihar, Bombay, Gurajat, Madras, Punjab
(Hindu, Muslims)
Indira Chakravarty 23 - 24 Jaunary, 2006
43
Changing Trends in Food consumption (g/cu/day)
over decades in Rural Areas(Cereals and millets,
pulses, fats and oils, sugar and jaggery)
NNMB Report of Repeat Survey (1988-90) NNMB Rural
Survey Report 2002 Visible Fats.
Indira Chakravarty 23 - 24 Jaunary, 2006
44
Changing Trends in Food consumption (g/cu/day)
over decades in Rural Areas (Contd..)(Roots and
Tubers, Green Leafy Vegetables, Other Vegetables,
Milk and Milk products)
NNMB Report of Repeat Survey (1988-90) NNMB Rural
Survey Report 2002
Indira Chakravarty 23 - 24 Jaunary, 2006
45
Changing Trend in Nutrient Intake in Rural Areas
(Per cu/day) over Decades in Rural Areas
NNMB Report of Repeat Survey (1988-90) NNMB
Report of Rural Survey 2001
Indira Chakravarty 23 - 24 Jaunary, 2006
46
Changing Trend in Nutrient Intake (Per cu/day)
over Decades in Rural Areas (Contd..)
NNMB Report of Repeat Survey (1988-90) aNNMB
Report of Rural Survey 2001
Indira Chakravarty 23 - 24 Jaunary, 2006
47
Consumption Pattern(Over the decades)

• Cereals, Roots and Tubers - Adequate in most
  states.
• Green leafy vegetables - Inadequate in most
  states.
• Milk Milk Products - Inadequate in most
  states.
• Fats Oils - Inadequate in most states.
• Dietary Protein - Inadequate in most states
• Energy intake - Lower than RDI in most states.
• Iron Intake - Inadequate.
• Calcium, Thiamine, - Adequate in most states.
• and Vitamin C

Indira Chakravarty 23 - 24 Jaunary, 2006
48
Changing Trends in Prevalence of Malnutrition
among Children (1 to 5 years) over Decades (using
Weight/Age Gomez Classification) in Rural Areas
NCHS Standard. NNMB Report of Repeat Survey
(1988-90). NNMB Report of Rural Survey 2000-01
Indira Chakravarty 23 - 24 Jaunary, 2006
49
Prevalence of Malnutrition among children in (1-5
years) (height for age) in Rural Areas
NCHS Standard. Source NNMB Report of Repeat
Survey 1988-90. India Nutrition Profile, Dept.
of Women and Child Development 1995-97 NNMB
Report of Rural Survey 2000-01
Indira Chakravarty 23 - 24 Jaunary, 2006
50
Nutritional deficiency signs in children (1 to 5
years) using Selective Indicators in Rural Areas
NNMB Report of Repeat Survey (1988-90) NNMB
Report of Rural Survey 2000-01
Indira Chakravarty 23 - 24 Jaunary, 2006
51
Changing Trends in Chronic energy deficiency of
adult males over Decades in Rural Areas
Nutritional Status of Indian Adults (Assessed by
BMI) 1991 NNMB Report of Rural Survey 2001
Indira Chakravarty 23 - 24 Jaunary, 2006
52
Changing Trends in Chronic Energy Deficiency of
Adult Females over Decades in Rural Areas
Nutritional Status of Indian Adults (Assessed by
BMI) 1991 NNMB Report of Rural Survey 2000-01
Indira Chakravarty 23 - 24 Jaunary, 2006
53
Iron Deficiency Anaemia among children (age 6-35
months) (Trend in 50 years)
Source Preliminary analysis based on published
work (1950-2001). Micronutrient Profile in
Indian Population (Part - I). G.S.
Toteja and Padam singh, ICMR, New Delhi
Indira Chakravarty 23 - 24 Jaunary, 2006
54
Iron Deficiency Anaemia among Children (age 6-35
months) by State (1998-99) (States better
than Indian average)
Source NFHS- 2, India 1998-99
Indira Chakravarty 23 - 24 Jaunary, 2006
55
Iron Deficiency Anaemia among Children (age 6-35
months) by State (1998-99) (States
inferior than Indian average)
Source NFHS- 2, India 1998-99
Indira Chakravarty 23 - 24 Jaunary, 2006
56
Iron Deficiency Anaemia among Pregnant Women
(Trend in 30 years)
Average of Southern, Northern, Western and
Eastern Region of India.
Source Preliminary analysis based on published
work (1950-2001). Micronutrient Profile in India
Population (Part - I). G.S. Toteja
and Padam singh, ICMR, New Delhi
Indira Chakravarty 23 - 24 Jaunary, 2006
57
Percentage prevalence of Different grades of
Anaemia in Pregnant Women
Source Evaluation of National Anaemia
Prophylaxis Programme 1989
Source NFHS -2 India 1998-99
Indira Chakravarty 23 - 24 Jaunary, 2006
58
Iron Deficiency Anaemia among ever married women
by State (1998-99) (States better than Indian
Average)
Source NFHS 2 India 1998-99
Indira Chakravarty 23 - 24 Jaunary, 2006
59
Iron Deficiency Anaemia among ever married women
by State (1998-99) (States inferior than Indian
Average)
Source NFHS 2 India 1998-99
Indira Chakravarty 23 - 24 Jaunary, 2006
60
Iron Deficiency Anaemia in Women

• Age Group ANAEMIA IN DIFFERENT AGE GROUPS OF
  WOMEN
• Mild and Moderate Severe
  Anaemia Anaemia
• Range () (Mean of five
  states) Range () (Mean of five states)
• 6 - 12 years 61.9 -
  87.1 73.5 0.6 - 11.0 3.7
• 12 - 18 years 71.1 - 89.3
  81.3 3.2 - 9.1 6.0
• 19 - 45 years 70.8 -
  90.4 82.7 3.6 - 9.3 6.4
• 45 - 60 years 68.0 -
  88.0 79.1 3.0 - 9.4 5.9
• 60 years and above 64.8 - 88.2
  78.0 2.2 - 4.5 3.3
• Pregnant Women 68.0 - 89.0
  79.7 6.3 - 15.0 11.2

States covered are Assam, Bihar, Orissa, West
Bengal and Tripura.
Source National Pilot Programme on Control of
Micronutrient Malnutrition, All India Institute
of Hygiene and Public Health, Kolkata
Indira Chakravarty 23 - 24 Jaunary, 2006
61
Bitots Spot in Pre-school Children over the years
Source Benefit and Safety of Administration of
Vitamin A to pre-school children and pregnant and
lactating women, Dr. Umesh Kapil, Dr. V. K.
Srivastava, All India Institute of Medical
Sciences, New Delhi. NNMB Report of Rural Survey
2000-01
Indira Chakravarty 23 - 24 Jaunary, 2006
62
Keratomalacia in Pre-school Children over the
years - Hospital based data
Hospital Year Cases of Keratomalacia
CALCUTTA, 1964-1972 8.5 (average) WEST
BENGAL 1974-1985 1.3 (average) 1987
0 1988 0 VELLORE, 1960 5
(0.37) TAMIL NADU 1970 6 (0.28)
1981 5 (.017) 1984 3 (.009)
1987 0 1989 3 (.008)
Source Benefit and Safety of Administration of
Vitamin A to pre-school children and pregnant and
lactating women, Dr. Umesh Kapil, Dr. V. K.
Srivastava, All India Institute of Medical
Sciences, New Delhi.
STM, Calcutta. CMC, Vellore
Indira Chakravarty 23 - 24 Jaunary, 2006
63
SummaryNutritional Deficiency Diseases

• Marasmus (Protein Energy Malnutrition) has
  reduced gradually over the years from 1.3 to 0.2
• Change in Prevalence of malnutrition (weight for
  age) indicate increase in mild malnutrition with
  simultaneous decrease in moderate and severe
  malnutrition
• Chronic energy deficiency (BMI indicators of
  nutritional status of adults) has reduced over
  the years both in case of males as well as
  females.
• Iron deficiency anaemia(IDA) in children has
  reduced from over 85 in sixties to 70 in
  eighties and still remains around the same level.
• IDA in pregnant women has slowly reduced over
  the years i.e. 75 in 70s to 50 in 1998-99.

Indira Chakravarty 23 - 24 Jaunary, 2006
64

• Summary Contd..
• Bitots spot (Vitamin A deficiency) in preschool
  children has reduced from 1.8 in 1975 to 0.7 in
  2000.
• Keratomalacia (Vitamin A Deficiency) has been
  nearly irradiated except in special pockets of
  intense hunger, scarcity and deprivation.
• IDD in children was 20 in 1980 which has come
  down to 8 in 1990.

Indira Chakravarty 23 - 24 Jaunary, 2006