This blog is based on an article in the Journal of Social Policy. Click here to access the article.
As countries around the globe struggle to feed their populations in the midst of record unemployment, food system disruptions, and physical distancing associated with the covid-19 pandemic, careful consideration of the long-term consequences of social protection measures to safeguard food security and nutrition is vital.
Even before the pandemic, child malnutrition was a pressing social and public health problem in India. Nearly one-third of undernourished children in the world live in India, and the country ranks in the bottom 20 countries according to the Global Hunger Index score. At the same time, overweight and obesity are on the rise in India. Both undernutrition and overweight and obesity are associated with a range of negative health and well-being outcomes–not only in childhood, but also often with long-term consequences throughout the lifecourse and at a societal level.
One potential means through which malnutrition can be addressed is through social protection programmes. India’s Public Distribution System (PDS), which provides subsidised staple foods to households, is India’s main governmental programme to combat malnutrition since the country’s independence. The programme was revamped in 1992, and was explicitly re-focused to target poor households in 1997.
In our study, we used survey responses for 2,944 Indian children aged 5-16 years old, taken from the longitudinal Young Lives data, which takes a pro-poor sampling approach. We examined the association between children’s nutritional outcomes and two food items subsidised through the PDS: rice and sugar. Subsidy programs such as the PDS can offer important caloric and nutrient supplementation, and may also free up income for households to spend on other vital items. However, it is also possible that subsidizing items of limited nutritional value can promote unhealthy dietary patterns.
Compared to other cereals, rice has a limited content of iron, protein and fibre, much of which is lost during processing and preparation. Sugar, meanwhile, offers no nutritional value and is associated with overweight, diabetes and cardiovascular disease. Because of the limited nutritional value of these food items, we investigated whether receipt of subsidised rice and sugar through the PDS was associated with increased consumption of these food items. We also examined whether consumption of subsidised rice and sugar was associated with improved nutritional outcomes for children.
We found that receipt of PDS subsidies was associated with an increase in the consumption of subsidised sugar. This was particularly the case for wealthier households in the sample, where the subsidies encouraged the consumption of less nutritious foods, with children in households receiving sugar subsidies snacking on sugary treats.
Figure 1 shows the pattern of sugar consumption we observed in the data. The top graph shows the mean daily intake of sugar in grams, and the bottom shows sugar intake as a proportion of the overall diet. Bars in each graph are grouped by household wealth (poorest, middle and richest wealth tertile). Within each wealth category, the bar on the left shows consumption in households not receiving sugar through the PDS, and the bar on the right shows sugar consumption with PDS subsidised sugar. Across categories, whether considering consumption in grams or as a proportion of the overall diet, receipt of subsidised sugar was associated with higher levels of consumption.
We also found that, overall, children in households receiving subsidised rice also consumed more rice compared to children in households not accessing the PDS subsidies. However, the pattern of consumption for rice was somewhat more complex; children in middle- and low-wealth households consumed 30g and 20g more rice respectively per day when accessing subsidised rice, as compared to children in households of similar wealth not accessing the rice subsidies. In the wealthiest households however, accessing rice through the PDS was associated with a 50g per day increase in rice consumption compared to children in households not accessing the subsidies. Children in wealthier households consume less rice overall compared to those in poorer households, but across wealth tertiles access to rice through the PDS was associated with an increased consumption of rice.
Next, we wanted to know whether consumption of PDS-subsidised rice and sugar was linked to improved nutritional outcomes for children. We considered several indicators of child nutrition: dietary diversity, which is essential for helping children to get an adequate array of macro- and micronutrients in their diet; height-for-age and stunting (low height-for-age), with stunting indicating sustained undernutrition; and body mass index (BMI) for age and low BMI, which can indicate sustained malnutrition.
Overall, we found no evidence that consumption of PDS-subsidised rice improved nutritional outcomes for children. Subsidised sugar had a very small association with improved dietary diversity, but was not associated with improvements in any other nutritional outcomes. This is consistent with the idea that greater food and nutrition security may facilitate snacking on sugary items once basic needs have been met.
Importantly, our data came from a pro-poor sample in a single southern Indian state, and should not be generalized to the entire population. There are also many factors impacting nutritional content of food which we were not able to test with our data, including considerations like food preparation. Nonetheless, our findings suggest food subsidies need to be considered over time rather than as a snapshot. This is essential for understanding not just the short-term effects of subsidies, but also the association with long-term nutritional outcomes. Subsidised foods available through the PDS may very well prevent severe malnutrition in the short-term by addressing caloric deficits, but rice and sugar subsidies appear not to improve longer-term outcomes.
Social protection policies, especially those providing food subsidies, should be carefully reviewed to ensure long-term nutritional benefits. One potential way forward would be to enlarge the scope of the PDS from the current package of rice, wheat, and sugar to include more nutritious food (e.g. pulses, eggs, vegetables). It may be possible to utilize the vast distributional network of the PDS across the country, along with respective state governments’ institutional setup, including fair price shops and local food acquisition facilities, so that high-quality, nutritious food can be distributed in a more timely and efficient manner.
About the authors
Jasmine Fledderjohann is Lecturer in Sociology and Social Work at Lancaster University.
Janita Bartell is Hygiene Specialist at UNICEF.
Sukumar Vellakkal is Assistant Professor in Economics at the Birla Institute of Technology and Science