Commodifying malnutrition

Government is abdicating its responsibility to guarantee the food and health rights of its people by entering into partnerships with the commercial sector. Corporations are only too happy to capitalise on malnutrition by supplying pre-mixed food packets to anganwadis instead of hot cooked meals, trumpeting their social responsibility even as they create markets for their fortified foods and use nutrition education to build brand loyalty for the future.

When the Draft Approach Paper for the Twelfth Five-Year Plan 2012-17 was released, Sachin Jain, a journalist-activist with the Right to Food Campaign, pointed out that the document contained the words dignity, hunger, equality, human rights, and exclusion zero times: in contrast to this, the word PPP(public private partnership) was used 45 times, market 67 times and growth 279 times. While the Draft Approach Paper did not mention PPP or market in the section related to children’s nutrition and development, these have become keywords in commodifying malnutrition.

Today malnutrition in India, especially among children, has reached unprecedented levels. Studies and reports from across the country link this to inadequate feeding practices, brought about by ignorance about nutrition, lack of access to potable water and sanitation, destruction of livelihoods, increase in poverty which in turn leads to lack of access to adequate amounts of food, changing cropping patterns leading to reduced diversity of food, astronomical increases in the price of food, and aggressive promotion of unhealthy foods. However, rather than investing in structural changes that improve people’s access to diverse foods, the primary response of the government appears to be to view malnutrition as an opportunity for the private sector to make profits.

The Supreme Court, in the public interest litigation PUCL vs Union of India and Others, Writ Petition (Civil) 196 of 2001 (1), and in the context of meals for children under the Integrated Child Development Services (ICDS) scheme, passed orders that contractors should not be used to provide supplementary nutrition to the ICDS; village communities, mahila mandals and self-help groups should be given preference for preparing food to be served under the ICDS. As regards midday meals for schools, the Supreme Court ordered that women from marginalised communities be hired to cook the meals. These orders were primarily based on the fact that malnutrition is rarely recognised as a serious health condition by people and communities; that people and communities where malnutrition occurs have the biggest stake in the health of their children; that participating in the reduction of child malnutrition through cooking meals will help people understand the nutritional requirements of their children as well as give children a balanced meal based on local food diversity; and, in the case of midday meals, cooking and eating meals together will help school children and communities not just improve their nutrition but also help to eradicate social discrimination based on caste, ethnicity and religion.

The Supreme Court orders are being ignored by government ministries and departments. The Ministry of Women and Child Development sought to bypass the order related to the ICDS by contracting out the processing of take-home rations (THR) for children under three years of age; it laid down conditionalities that could not be met by these bodies, which among others included requirements such as using the extrusion process for soya bean (the specific protein source laid down), and that processors have a turnover of at least Rs 1 crore annually. As a result, Andhra Pradesh, Karnataka and Maharashtra have outsourced production of THR to companies, sometimes even outside the state, which also manufacture pre-mixes that only need to be mixed with water and cooked to serve as hot cooked meals in anganwadis. In the case of hot cooked meals, contracts are being given to large non-governmental organisations like Naandi Foundation and ISKCON’s Akshaya Patra, to supply schools with such meals, thereby ignoring the spirit of the order that relates to providing livelihoods for women from marginalised communities, and removing social discrimination.

The commodification of malnutrition can be done in several ways. Firstly, malnutrition can create markets for specific products – products that reduce iron deficiency (caused mainly by reduced consumption of iron-rich foods), products that provide high levels of energy and/or protein to reduce undernutrition (caused mainly by lack of food), and so on. Secondly, malnutrition can be used to greenwash corporations that are being targeted for abusing people’s right to health, environment, livelihood, shelter, etc. Thirdly, corporations use ‘nutrition education’ to build brand loyalty for tomorrow.

The Global Alliance for Improved Nutrition (GAIN) has been a leader in using malnutrition to create markets for the food industry. The GAIN-Naandi Foundation-Britannia collaboration in 2007 that helped Britannia promote its fortified Tiger biscuits by distributing them to 150,000 school children in Hyderabad (2), has today resulted in the company fortifying 50% of the total volume of biscuits manufactured, and selling 3.5 billion packs of them annually (3). Besides iron-fortified Tiger biscuits, according to the company, there is a biscuit brand that contains five vitamins and two minerals, another biscuit brand with 10 vitamins, minerals and proteins, a milk-based health drink with seven nutrients that are supposedly good for the brain, and bread with 10 vitamins and minerals added (4). Incidentally, when the project was launched, GAIN’s chairman was the chief of Danone, then a partner of Britannia and a baby food company that is a major violator of the International Code of Marketing of Breastmilk Substitutes.

GAIN, along with its partners Unicef, Micronutrient Initiative, and others, has also been instrumental in getting several states to shift from using paediatric drops for iron supplementation, to Sprinkles, with technical assistance from H J Heinz; while the supplement is currently being produced on a ‘cost recovery’ basis, when commercial production is introduced, Heinz will be offered the ‘right of first refusal’ to develop, manufacture and market the product commercially.

The most vivid example of the commodification of malnutrition for greenwash is the case of Vedanta Resources plc. The giant mining corporation has taken over the running of over 3,000 anganwadi centres in Orissa and Rajasthan, of which approximately half are in the Kalahandi and Rayagada districts of Orissa, catering to over 75,000 children below five years of age (5). Vedanta has been the target of national and international protests for attempting to take over the natural resources of the tribal people of these districts, as well as in Chhattisgarh (6). The London-based owner of Vedanta, Anil Agarwal, is worth 4.1 billion pounds and is currently the tenth richest person in Britain. His personal wealth has grown even in the recession, by 583%. Vedanta and Agarwal have been accused of “corruption, fraud, forgery, manipulation of share prices, and insider trading,” according to Norway’s Council of Ethics. More recently, massive publicity of Vedanta’s crimes forced the British government to criticise it for not having a human rights policy (7). Vedanta is running the anganwadis in Orissa and Rajasthan as a PPP.

In yet another clear instance of greenwash, Nestle, the leading violator of the International Code of Marketing of Breastmilk Substitutes (8) globally, has initiated a programme called Creating Shared Value,which it describes as “a fundamental part of Nestle’s way of doing business that focuses on specific areas of the company’s core business activities -– namely water, nutrition and rural development – where value can best be created both for society and shareholders” (9). An example of its work in this area is its partnership with the Fair Labour Association to investigate whether children are working on cocoa farms supplying to their factories. Nestle’s Healthy Kids Programme, implemented in every country where the company operates directly, is designed to raise nutrition, health and wellness awareness among primary school children. It includes nutrition education.

For corporations like Nestle, ‘raising nutrition awareness’ is a means of using the public education system to create brand loyalty for the future. The company entered into PPPs with four agricultural universities in India to take up nutrition education programmes for adolescent girls in government schools. This is in keeping with the company’s global policy articulated in London at the Creating Shared Value Forum on May 27, 2010, to reach about 5 million children with a programme “to educate teenage girls on good nutrition before they get married and become pregnant, because that’s where we think we have to start, really – before the woman even becomes pregnant” (10).

The Alliance Against Conflict of Interest, an informal network of food rights and health activists, medical professionals and lawyers, protested the MoUs between Nestle and Indian public sector universities, calling it particularly reprehensible as “Nestle is facing a criminal case in India for violation of the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 as amended in 2003 (IMS Act)”. (11)

PPPs in nutrition with the commercial, for-profit sector highlight the government’s abdication of responsibility to ensure the food and health rights of its people. As Urban Jonsson, a former chief of nutrition at Unicef, speaking about Nestle’s PPPs in Africa, puts it: “The business of Nestle is to make money selling processed foods, notably infant formula, weaning products, and products for young children. It is absurd that they should now be acting as if they are in the business of saving Africa. Public health is the responsibility of the public sector, including the UN system.” (12)

Policymaking in health and nutrition is today heavily influenced by the private for-profit sector. Ex-bureaucrats join the corporate sector or their lobbying bodies immediately after retirement on the one hand, and on the other hand, representatives of the private sector sit on government regulatory bodies. Examples include:

• Naresh Dayal, ex-secretary, Ministry of Health and Family Welfare, who retired on September 30, 2009, and soon after joined GlaxoSmithKline Consumer Healthcare as a non-official director (13).

• Dr Veena Rao, former secretary to the government, and Dr Kamala Krishnaswamy, former director, National Institute of Nutrition, are on the board of Britannia (14).

• Dr B Sesikaran (Director, National Institute of Nutrition) and Dr V Prakash (Director, Central Food Technological Research Institute) are on the board of trustees of the International Life Sciences Institute, an industry lobbying body whose members include corporations like Nestle, Pepsico, Coca-Cola, Monsanto, Britannia and others (15).

• Vinita Bali, CEO of Britannia, is on the board of GAIN, whose Business Alliance serves as a platform where companies can network and share market-based solutions to tackling malnutrition worldwide (16).

• Nestle’s tie-up with agriculture universities to provide nutrition education to adolescent girls, Pepsico’s tie-up with schools to impart education on healthy living and nutrition to students.

• Food manufacturing companies on scientific panels to evaluate research and to set food standards (for example, Nestle, Hindustan Lever, Coca-Cola, Pepsico, ITC on scientific panels of FSSAI (17); food manufacturers, pesticide manufacturers included as members of the national delegation at international bodies such as CODEX ALIMENTARIUS that set standards for foods.

When the state does not carry out its duty, it can be called to account through tools such as PILs and RTIs. The Supreme Court orders in the Right to Food Campaign’s PIL are examples of how these tools can be used. However, in the case of PPPs, this is not easy. The answer to an RTI application to Punjab Agriculture University on its MoU with Nestle to provide nutrition education to school children said that the MoU could not be disclosed as it contained information of a commercial nature. This is also the view of the deputy chairperson of the Planning Commission who, reacting to Chief Information Commissioner Satyananda Mishra’s letter asking for PPP documents to be made public, said: “Right to information is not right to information of private companies. It is right to information on public authorities.” (18) This view blatantly ignores the fact that public money is being transferred to a private corporation to create markets and earn profits through PPPs which, in the case of the Nestle-PAU PPP, allows Nestle to use the public education system to strengthen its brand image, and be paid public money to do this.

The right to life, enshrined in Article 21 as a fundamental right, has been extended to cover the right to live with human dignity. In Bandhua Mukti Morcha v Union of India, Justice Bhagwati, referring to Francis Coralie Mullin v Administrator, Union Territory of Delhi, stated:

It is the fundamental right of everyone in this country, assured under the interpretation given to Article 21 by this court in Francis Mullin’s case, to live with human dignity, free from exploitation. This right to live with human dignity […] must include protection of the health and strength of workers, men and women, and of the tender age of children against abuse, opportunities and facilities for children to develop in a healthy manner and in conditions of freedom and dignity, educational facilities, just and humane conditions of work, etc. These are the minimum requirements which must exist in order to enable a person to live with human dignity, and no state neither the central government nor any state government has the right to take any action which will deprive a person of the enjoyment of these basic essentials.

The existence of malnutrition is an indication of the violation of the right to life, the most basic of all human rights. The state has a responsibility to ensure that no man, woman or child in India suffers from malnutrition. It cannot abdicate this responsibility to the for-profit sector.