Over the past week, I’ve chronicled my investigative research on starvation in India – a project I’ve been working on with a colleague from the Centre for Equity Studies, a New Delhi think tank.
We’ve told stories of people who were forced to eat poisoned roots to stay alive; a family that suffered the deaths of members from three different generations in a span of 24 hours; a woman faced with the choice of getting urgent medical treatment for herself or caring for her hungry and sick husband.
What our research revealed to us, clearly, is that India needs a new legal framework for dealing with chronic hunger and starvation. The Supreme Court has issued a series of orders over the past decade in a public interest litigation known as the “right to food” case, directing the government to take measures ranging from giving schoolchildren mid-day meals to setting up centers to provide young children, adolescent girls, and pregnant mothers supplementary health care and nutrition.
Those moves by the Court have been a forceful jolt to the system, but, in my view, legislation is now needed to ensure the right to adequate nutrition is enshrined in law. The draft version of the National Food Security Bill that is being considered by India’s Parliament would guarantee discounted food-grains to 50% of the urban population and 75% of the rural population – greatly expanding existing food entitlements, which are guaranteed for about one-third of the overall population.
Much of the debate on the measure has been over its cost and scope. Budget hawks say India, already struggling to reduce a large fiscal deficit, can’t afford a costly expansion of subsidies. K.V. Thomas, Indian minister of state for food, estimates the draft food bill would increase current subsidies by 54% to $22 billion per year.
Many food security activists, meanwhile, say the bill doesn’t go far enough. Discounted food, they say, should be a universal entitlement. I personally agree with that position. Consider that India’s defense budget this year is $38 billion. Surely, the nation can muster the resources to ensure its people are adequately nourished and can reach their full potential.
But my biggest problem with the bill is the way it deals with starvation. There are two starvation-related provisions. One of them says state governments would be responsible for identifying starving people and communities. The second says that all those people who are identified would be guaranteed two free meals per day for six months.
This approach, as we see it based on our research into the issue, is flawed on many levels. First, it doesn’t lay out a clear method for how to assess what constitutes starvation and identify people who are starving. It is left to the discretion of the states to decide their own methods. There are no guidelines or recommendations on which specific officials should be responsible for doing these assessments.
The second issue is that the legislation employs a narrow, short-term solution to starvation. The Supreme Court has ruled in the right-to-food case that states have a duty to investigate systemic failures that lead to starvation deaths and to ensure that people who are starving have access to food entitlement programs over the long term. The provision of two free meals per day for six months doesn’t come anywhere close to satisfying that mandate.
One way to go about fixing these issues would be to employ the “Starvation Protocol,” a set of guidelines recommended by the National Advisory Council, a group of experts and academics who advise the government on policy. (Disclosure: my boss at the Centre for Equity Studies, Harsh Mander, is a member of the NAC.)
The Protocol was an idea promoted by the “Hunger Watch Group,” a consortium of physicians, medical and public health experts, economists, and activists that work on hunger and malnutrition issues in India. It says that chronic hunger is a public health problem, rather than simply an issue of people not ingesting enough food. As our series showed, government officials often become concerned only when a person dies of starvation, but fail to notice the warning signs that lead up to those deaths, when sick people can’t get vital nutrition or medical treatment.
We believe the Protocol, now formalized in a document, provides a very specific and useful way of assessing whether a person is starving. It defines starvation as a condition resulting from “levels of food intake that are unsustainable for the continuance of life itself.” This definition is important, because it addresses the challenge of drawing a line between malnutrition, hunger and starvation.
But the guidelines get even more specific. Based on empirical studies, the Protocol identifies starvation on two grounds: minimum kilocalorie intake and Body Mass Index, which refers to an individual’s weight relative to height. “An adult who eats 850 kilocalories of food daily or less” is deemed starving, according to the Protocol document. And based on a normal BMI range of 20 to 25, a person with a BMI of less than 16 is also considered to be starving.
The Protocol suggests that the use of these indicators will enable the government to address problems starving people face rather than waiting to react when starvation deaths happen. This approach, if included in the food bill, would make the government’s response to hunger preventative.
The Protocol also instructs officials to carry out a two-part “verbal autopsy.” The first part would be a consultation between public officials and people suffering from starvation, or the families of starvation victims. It would document the status of food supplies in a household and how much income they’re earning. “The idea,” the protocol states, “is not only to probe death and its causes but to understand the poverty and destitution faced by families.”
The second part of the autopsy would be a consultation with “other members of the tribe, caste, class, gender or age group to which the affected people belong,” the protocol states.
The NAC has also recommended that state governments designate specific local officials responsible for preventing starvation deaths and responding to them if they occur. The Starvation Protocol recommends that the head of the District Panchayat (local village council), the District Collector (the senior-most bureaucrat in the region), and the Chief Medical Officer (a senior health official in the region) should undertake investigations.
The current draft of the food security bill would create positions at district, state, and national levels to hear out citizens’ grievances. But the legislation doesn’t specify the roles local officials should play in identifying and providing relief to starving people, as the Starvation Protocol recommends. The role of grievance officers is limited to addressing complaints and violations of food grain disbursals. I believe the bill should require them to coordinate verbal autopsies with other local officials and carry out thorough investigations to find out whether citizens’ rights to food are being violated.
Finally, and perhaps most importantly, the Starvation Protocol calls for the findings from these investigations to provide the basis for relief in the form of food entitlements – and not, as in the case of the current version of the bill, in the form of charity. The Protocol calls for “immediate food availability to the family, free of cost for at least six months” but specifies that this should then be followed up by giving the household access to subsidized grains for the long term.
The Protocol takes into account the complexity of India’s hunger problem, including socio-economic inequalities and matters of public health. Its guidelines are in the spirit that the “right to food” is really just part of every individual’s Constitutional right to life, as the Supreme Court has held.
After assessing government responses to starvation deaths in some the worst affected areas of India, I believe that is the approach we need. It is time to tackle chronic hunger and starvation with vigor, to protect people’s fundamental right to live with dignity instead of accepting that India’s most vulnerable people may be condemned to die.
Starvation is a brutal but little-discussed reality in India. The Wall Street Journal’s India Real Time is publishing a six-part series on starvation, showcasing the findings of an investigation by the Centre for Equity Studies, a New Delhi think tank that is researching hunger and advocating reforms of India’s food policies. The series of essays documents the stories of starvation victims, explores the primary causes of their deaths, and argues fiercely that India must overhaul its broken food security system. We welcome your comments and feedback.