Malnutrition In Three Acts

(Editor’s Note: The author would like to particularly thank the good folks at Word Made Flesh for their assistance with this article. You can read about their work here.)

Mention India in polite conversation these days in America, and your listeners will quickly draw one of two mental pictures. The first is the classic: Indian as poster-child, hairless with stomach distended, flies buzzing about forlorn eyes, near-death, suffering for our sins of neglect and self-absorption. The second is more recent, more politically charged: Indian as pariah, leeching jobs from the noble working-class American, living off the largesse of soulless multinational corporations. This Indian is fat and happy, with bright white teeth.

These images occur to us by instinct, based primarily on two conflicting American values: if we are bent toward a sense of responsibility for the world, a progressivism that can’t rest while another human being suffers unnecessarily, we picture the poster child and are moved to tears and action. If we are compelled by a sense that our economic reach has exceeded our grasp, then India has come to represent the bogeyman of international commerce, the land of our replacements.

Happy or forlorn, fat or distended - what’s your mental image of India? Either way, you’re not far off.

India is suffering from at least two epidemics simultaneously: a culture of undernourishment, and a crisis of overnourishment. Economist Jean Dreze estimates that 42 percent of the population nationwide are not receiving adequate nutrients; meanwhile increasing numbers of Indian children in large population centers are overweight—nearly twenty percent of Delhi’s adolescents (“India Prosperity Creates Paradox,” New York Times) and over fifty percent of women and forty percent of men over 35 (” ‘Waist’ Food,” The South Asian).

For a country accustomed to the traditional definition of malnutrition—lacking adequate access to a healthy mix of nutrients—the rise of bad dietary habits and a more sedentary lifestyle has led to an awkward parsing of language among health-care professionals: “We will come to people who have tropical diseases and are undernourished. But … we are becoming malnourished - that is, bad-nourished” (“India Sounds Alarm on Rise in Obesity Cases,” National Public Radio). That can’t be good for India’s public health systems - nor, for that matter, for its burgeoning English-language telemarketing industry.

The growth in prosperity has been one of the harbingers of the obesity crisis. India has become a world-class economy, with lucrative jobs imported from the West, along with all the fixin’s - India’s fast-food industry has grown at a rate of roughly forty percent a year, becoming a billion-dollar concern in 2005 (“The Global Spread of Food Uniformity,” Worldwatch Institute). More money with more available junk food, and a Western clock-watching business culture tapping its foot throughout every lunch break - better loosen your belt.

Added to these habits is the closeness of everyone and everything. Population density for the country increased by 21.3 percent between 1991 and 2001 - from 6,352 people per square kilometer in Delhi to an astounding 9,294 (Census of India 2001). “People are living much more sedentary lives,” reports Dr. Sanjay Borude. “If you are rich, you can pick up a phone and order a pizza. You have a car, so you don’t need to walk anywhere” (“India’s Newly Rich Battle with Obesity” India Resource Center).

It’s this ubiquitous closeness- of everything and everyone - that continues to propel both epidemics. In a culture organized by caste, in a rapidly growing economy, the extremities of health are caught up in issues of economics, culture and politics. The wealthy have the greatest discretionary income, and have embraced the fatty foods imported from the West:

“The risk of obesity in India is highest in the 20% of the population that consumes 80% of visible dietary fat,” said Dr Umesh Kapil, professor of human nutrition at the All India Institute of Medical Sciences, New Delhi.

[S]chool surveys in Indian cities show that 30% of adolescents from India’s higher economic groups are overweight. (“Asia grapples with obesity epidemics,” BMJ Online)

Meanwhile, indifference serves as a defense mechanism in the cities. The poor are ignored, avoided as the wealthy go about their business. Chris Heuertz, executive director of the justice mission Word Made Flesh, wrote of his encounter with a man dying of bad nutrition (the “nothing to eat” kind). The man was lying near death on at the edge of a train station, at the gate of a church; the church bore a sign that read “All Are Welcome Here.” The church was gated shut.

Sarah Lance, working with Word Made Flesh in India, sees culture as a contributing factor:

If you take a look at the gods and goddesses in the Hindu faith you will find some very full-bodied women and some chubby, potbellied men. There is also the cultural ideal, especially among the middle and upper class, that you do not tell your children “no” so they will take good care of you when you get older.

Outside the cities, members of higher castes are fed first from the reserves made available through government programs such as Integrated Child Development Services (ICDS): “Low-caste children or those from Muslim families were not served” (“India Prosperity Creates Paradox,” New York Times).

Lance sees the problem of undernourishment as “not a food crisis” but “a mis-management of resources.”

The value of human life is little in a country of one billion people crowded together in small spaces. Everyone has to think about themselves because it is survival of the fittest, for real! So there is little or no response to someone dying on the street, or a little boy emaciated left alone waiting to die on the sidewalk.

She speaks from experience; two weeks before our e-mail exchange, Lance delivered just such a little boy to Mother Teresa’s Sisters of Mercy, to be tended to at the House of the Dying.

In its defense, the government faces an overwhelming hunger crisis; any solution is complex and perplexing. But so far government agencies have seemed to lack the will and endurance to adequately address the needs of lower-caste folks outside the major population centers:

States with the highest levels of malnutrition have the lowest levels of ICDS program funding and a smaller percentage of their villages covered by ICDS centers than states with less malnutrition - The five states with the highest underweight prevalence … all rank in the bottom ten in terms of ICDS coverage. (“Urgent Action Needed to Overcome Persistent Malnutrition in India,” World Bank)

So India is in a double-bind: the influx of new monies from the West has led to a fatter upper-class; meanwhile, the lower classes still suffer from neglect and inadequate resources. India is, paradoxically, ironically, getting simultaneously morbidly obese and dangerously thin. It’s enough to trigger the American sense of irony. Newsweek offered the following imagined rationalization of the American economy relocating itself to Mumbai:

In a speech to the U.S. Chamber of Commerce in Milwaukee, the President said that since most of the millions of jobs outsourced since he was elected President were extremely sedentary, “Those jobs are now making the people of India fat instead of us.” “In the long run, the weight loss more than makes up for the job loss,” the President added. (“The Borowitz Report: U.S. Outsources Obesity to India,” Newsweek)

The solution is, of course, complex and perplexing. India needs a different understanding of the good life: a bucket of KFC chicken is not tantamount to a pot of gold at the end of the rainbow of America’s economic engine, and a car - as New York has learned - is more a liability than a status symbol in a densely populated city.

At the same time, India needs to overcome its internal cultural isolationism and take a hint from the apostle Paul: the days of class and ethnic division have long since passed. The band Caedmon’s Call confronts the injustice of India’s caste system in their song supporting the untouchables, “Dalit Hymn”:

God made every man forward and free Rich man, poor man, every man free Politically, socially, everybody free … Caste is a lie, caste is a lie, Prime Minister, caste is a lie Emancipate, emancipate, Prime Minister, emancipate Free the Dalit, free the Dalit, Prime Minister, free the Dalit.

The solution to chronic undernourishment is to share resources more judiciously, and to do that in India requires moral leadership at the highest levels of political and religious government.

It also requires conviction in the hearts of those whose lives are comfortable at the expense of the poor - and that includes us. It’s not just American jobs that have been exported to India; American values have been sent there as well, via the corporations founded in the States but taking root in the Majority World, and via the media empire that sends images of our consumerist idea of the good life to the four corners of the earth. So we might look at India in a third way: not as poster child or pariah, but as prophet.

Irony is an instinct of American culture, perhaps a defense mechanism against the moral dilemma raised when the American impulse toward compassionate justice is confronted by the American spirit of isolationism. India’s embrace of these values mirrors the American experience and shows that they are irreconcilable and unsustainable; our indulgences are killing us; our indifference is killing others, our irony is making a joke of the whole thing.

So it’s time for new values. Americans need to stop modeling to the world that fat equals happy, that wealth is revealed in girth. We need to eat less and walk more, and become known across the world as fit, not fat. We also need to resist the temptation to retreat from the world’s troubles and instead commit to turning toward our global neighbors. Caedmon’s Call didn’t just protest the Indian government; they reflected on and responded to the prophetic existence of the Indian underclass in their song “Share the Well”:

I’ve heard good people say There’s nothing I can do That’s half a world away …

Some kindred keepers of this earth
On their way to join the flow
Are cast aside and left to thirst
Tell me now it is not so …

Share the well, my friend
It takes a deeper well
To love one another
Share the well, my friend

The ironic state of Indian malnourishment ought to evoke in us an expression of solidarity with those who suffer: we ought to act on our American impulse toward compassionate justice and change our behavior so that we draw less from the earth’s finite well,* and we ought to resist our American instinct of isolationism, and look for ways to place ourselves among those in need. Both responses feed each other, and so before we know it we’ll be living in such a way that the world ceases to understand us as aloof cynics or malevolent imperialists, and starts to understand us as good neighbors.

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* As of 2003 The Population Reference Bureau estimates that the average American consumes about 23 times more goods and services than the average world citizen. Americans also burn 10,000 liters (2600 gallons) of oil-equivalents per year —seven times the world average.

Posted on January 14, 2008 12:00 AM