Malnutrition

1. Malnutrition Economic Impact and Proposed Solutions Ali Khizar Contact: alikhizar@gmail.com

2. Many poor don’t get basic food & nutrition There is a myth that nobody sleeps without food in Pakistan There are ample statistics and studies to support that malnutrition is one of the biggest enemies of the nation Pakistan is amongst the worst in terms of child malnutrition, with 40 percent of children suffering from stunting and 30 percent being underweight These are scary statistics and partially explain why labor productivity is too low in the country; and it may fall further in the next generation

3. Is Pakistan doing better on poverty? • On the face of it, poverty has declined between 1999-2014 • 58% to 30% on old poverty line (FEI) • 29% to 9 % on new poverty line (CBN) • 55% to 38.8% on multidimensional poverty

4. Comparatively, poverty is low in Pakistan Population living under 1.90 dollars a day is much lower in Pakistan (6.1%), compared to India (21.2%) and Bangladesh (18.5%)

5. Nutrition indicators are slow to respond The improvement in nourishment and reduction in stunting isn’t proportionate to the decline in poverty. Meanwhile, India and Bangladesh have reduced their undernourished population significantly since 1991.

6. Comparatively, nutrition indicators are falling Even as poverty in Pakistan has declined, prevalence of stunting in children under 5 has remained stagnant since 1998 and actually increased from 2006 to date. In Bangladesh and India however, there is a significant decline in the prevalence of stunting in children pointing towards an improvement in nutrition and quality of life as poverty reduced.

7. Why are nutrition indicators not improving in Pakistan:the dichotomy Nutrition indicators are not improving in Pakistan due to misaligned priority of using limited fiscal resources In 2008, the wheat price increased from PKR625/40Kg to PKR950/40kg in one go in order to support against increasing global prices The international prices came down thereafter but the support prices kept increasing in Pakistan The three-fold increase in staple food items’ price since 2006 has cascaded to virtually all the food items; and that explains the falling affordability of the marginalized

8. Pakistan versus India: wheat price comparison The wheat support price in India was higher than in Pakistan in FY08; but since the introduction of support price in Pakistan, the prices at home remained 26%-38% higher than our neighbor

9. Food prices soared in Pakistan since 2008 CPI food index increased by 125% between 2008-16 making it difficult to afford basic food, and probably nutrition intake declined since then.

10. Impact of malnutrition Malnutrition inhibits the mental growth of infants and children The damage in the first two years of life is irreversible Malnourished children have reduced learning abilities and have lower productivity in adulthood The damage is already visible from declining labour productivity, which is falling relative to India and Bangladesh (see graph on next slide) The growing stunting and slow reduction in malnutrition would further adversely impact the productivity of the fastest growing nation in the region

11. Impact of malnutrition Lethargic Labour productivity in Pakistanhas a broad-based impact on the economy

12. Need for solutions Affordable food for the poorest and lower middle classes to improve their social and economic outcomes and the overall landscape of the country One way is to reintroduce food subsidies Another way is to provide food stamps A third way is to enhance the portfolio of the Benazir Income support programme They all have fiscal implications so we have to evaluate the choices More research is needed on the impact of support prices and on nutrition and productivity indicators