Drawing up a diet plan
The welfare challenge lies in providing assistance to needy households
to ensure adequate diets without creating conditions in which they opt
for inferior diets that are too heavy on cereals
With the Kerala government’s decision to implement the National Food
Security Act (NFSA) from April, the whole country will be covered by the
legislation. However, if we expect the NFSA to improve India’s
malnutrition statistics, we may well be disappointed. According to a
study by Himanshu and Abhijit Sen, even before the NFSA is fully
implemented, use of the public distribution system (PDS) expanded
sharply with proportion of households getting PDS subsidy rising from
about 25% in 2004-05 to 50% in 2011-12. However, decline in child
malnutrition has been far more modest.
A patchy record
While
we still do not have nationwide data on malnutrition, State-wise data
from Annual Health Survey/District Level Health Surveys of 2012-14 as
well as National Family Health Survey IV of 2015-16 suggest only modest
improvement in child malnutrition since the National Family Health
Survey III of 2005-06. Proportion of households receiving PDS subsidies
in Rajasthan increased by about 15 percentage points, underweight
declined by 3 percentage points; neighbouring Madhya Pradesh experienced
similar increase in the PDS but a sharper decline underweight (17 percentage points); another neighbour
Gujarat shows a drop in PDS use but records a modest improvement in
underweight statistics (5 percentage points). The strangest case is that
of Andhra Pradesh where 59% of the population received PDS subsidy in
2004-05 rising to 76 % in 2011-12 but underweight rate seems to be stuck
around 32% with hardly any improvement. Why do we see this
disconnect? Critiques of the PDS may point to leakages and suggest that
perhaps these subsidies are not reaching the target beneficiaries.
However, a large number of studies have recorded improving performance
of the PDS and suggest this may be an overly cynical assumption. Other
critiques may argue that with rising incomes, poverty has fallen in
India and regardless of the PDS, individuals may get sufficient
calories, making changes in PDS use irrelevant to caloric intake. This
also seems somewhat of an overreach, given the entrenched poverty in
some sections of the country and society.
A recently released
report based on India Human Development Survey of 2004-05 and 2011-12
suggests that the relationship between the PDS and nutrition may be more
complex. Jointly organised by researchers from National Council of
Applied Economic Research and University of Maryland, this is the first
nationwide survey to interview the same households at two points in
time. By matching households with similar income, family size, land
ownership and place of residence, but one group with Below Poverty Line
(BPL) or Antyodaya Anna Yojana (AAY) card and the other without these
cards, this study is able to compare apples to apples and examine the
role of the PDS in a quasi-experimental design.
The results suggest that access to PDS subsidies changes the way
people allocate their household resources. When rice, wheat and other
cereals are available cheaply, households try to get more of their
required calories from cereals and less from milk, fruits and
vegetables. Results show that households with BPL/AAY cards consume a
monthly per capita average of 11.87 kg of cereals, but only 2.77 litres
of milk. In contrast, households without BPL/AAY cards but at the same
income level, consume somewhat less cereals (11.22 kg) but more milk
(3.21 litres). One would normally expect that the savings from cereal
purchase due to price subsidies would be used to buy milk, fruit and
nuts, but in an era where school and medical costs are rising and
households face many other demands on their purse, these savings seem to
be spent on non-food items. Food consumption forms 56% of household
budget in BPL/AAY households compared to a slightly higher level (58%)
in matched households without access to PDS subsidies.
A prior study using the same data and a similar matching procedure, published in a joint NCAER/Brookings journal, India Policy Forum,
found that households with a BPL/AAY card were no better than
households without PDS subsidies when it came to child nutrition. This
may well be because access to cheap calories reduces consumption of
different foods and dietary diversity is very important for balanced
nutrition.
This does not mean that we should do away with food
subsidies. The NCAER report mentioned earlier also found that for very
poor households or householdsthat experience income declines of 20% or more between the two
surveys, access to the PDS is very important for preserving food intake
and dietary diversity. When faced with a sharp income decline,
households with BPL/AAY cards reduce their cereal intake by 770 g per
capita per month, and maintain their milk intake. In contrast,
households who can’t avail of food subsidies reduced their monthly per
capita cereal intake by 930 g and milk intake by 280 milliliters.
Nudged towards better choices
The
challenge lies in providing assistance to needy households to ensure
adequate diets without creating conditions in which they opt for
inferior diets that are heavy on cereals. This is a particular challenge
for modern India where rates of diabetes, high blood pressure and heart
conditions are on the rise. Indian immigrants in the U.S. and U.K. also
suffer from higher prevalence of these conditions than the native-born.
So it may be that Indians have greater genetic predisposition for these
so-called “lifestyle” diseases, but it is also well recognised that
these diseases are exacerbated by excessive consumption of
carbohydrates, amply available in cereals.
Cash
transfers may be one way of dealing with this challenge. They would
allow households to invest in better diets without circumscribing what
they consume. However, their success would depend on the ability to
effectively administer transfers and reduce leakages. Moreover, how this
may affect grain markets remains unknown. International research on cash
versus in-kind food subsidies presents mixed results, with the
effectiveness of cash transfers depending on the institutional
framework. Current debates on Universal Basic Income tend to see it as
an additional component of social safety nets. But if the mechanisms for
effective administration of the UBI are in place, it is possible to
make a case for replacing PDS by cash transfers on nutritional grounds
and this is well within the framework laid down by the NFSA.
Sonalde
Desai is Professor of Sociology at University of Maryland and Senior
Fellow at National Council of Applied Economic Research. Views are
personal.
Source: The Hindu, 1-02-2017