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Hunger: Old torments and new blunders   Amartya Sen
The Little Magazine.   Hunger    Vol II : issue 6	Amartya Sen

It is so old a story,/ Yet somehow always new," so said Heinrich Heine, the German poet, essayist and political activist, in Lyrisches Intermezzo. That early nineteenth century frustration of Heine (Intermezzo was published in 1823 — he went into voluntary exile in revolutionary Paris seven years later) cannot but recur in our thoughts as we observe the continued barbarity of old problems with new and added dimensions, in the distressing world in which we live. Nowhere, perhaps, is this as exasperating as in the terrible continuation of massive hunger and undernourishment in India.

It is not that nothing has been achieved in India over the half-century or more since independence in 1947. Positive things have certainly happened. First, the rapid elimination of famines in India with independence is an achievement of great importance (the last sizeable famine occurred in 1943 — four years before independence), and this is certainly an accomplishment that contrasts with the failure of many other developing countries to prevent famine. And yet this creditable record in famine prevention has not been matched by a similar success in eliminating the pervasive presence of endemic hunger that blights the lives of hundreds of millions of people in this country.

Second, the stagnating agriculture that so characterised — and plagued — pre-independence India has been firmly replaced by a massive expansion of the production possibilities in Indian agriculture, through innovative departures. The technological limits have been widely expanded. What holds up Indian food consumption today is not any operational inability to produce more food, but a far-reaching failure to bring entitlement to food within the reach of the more deprived sections of the population. Indeed, as M.S. Swaminathan has pointed out, "We have reached a stage in our agricultural evolution when our production will increase only if we can improve consumption."[1]

First enemy: Smugness and ignorance

How can things be changed? The first thing to get rid of is the astonishing smugness about India’s food record and the widespread ignorance that supports it. India has not, we must recognise unambiguously, done well in tackling the pervasive presence of persistent hunger. Not only are there persistent recurrences of severe hunger in particular regions (the fact that they don’t grow into full-fledged famines does not arrest their local brutality), but there is also a gigantic prevalence of endemic hunger across much of India. Indeed, India does much worse in this respect than even Sub-Saharan Africa.[2] Calculations of general undernourishment — what is sometimes called "protein-energy malnutrition" — is nearly twice as high in India as in Sub-Saharan Africa. It is astonishing that despite the intermittent occurrence of famine in Africa, it too manages to ensure a much higher level of regular nourishment than does India. About half of all Indian children are, it appears, chronically undernourished, and more than half of all adult women suffer from anaemia. In maternal undernourishment as well as the incidence of underweight babies, and also in the frequency of cardiovascular diseases in later life (to which adults are particularly prone if nutritionally deprived in the womb), India’s record is among the very worst in the world.

A striking feature of the persistence of this dreadful situation is not only that it continues to exist, but that the serious public attention it gets, when it gets any at all, is so badly divided.[3] Indeed, it is amazing to hear persistent repetition of the false belief that India has managed the challenge of hunger very well since independence. This is based on a profound confusion between famine prevention, which is a simple achievement, and the avoidance of endemic undernourishment and hunger, which is a much more complex task. India has done worse than nearly every country in the world in the latter respect. There are, of course, many different ways of shooting oneself in the foot, but smugness based on ignorance is among the most effective.

Poverty, healthcare and education

This takes us to the next question. Once we get rid of the smugness, what should we do? The old barriers to good nutrition do, of course, remain, and we have to recognise that they have not lost their bite. People have to go hungry if they do not have the means to buy enough food. Hunger is primarily a problem of general poverty, and thus overall economic growth and its distributional pattern cannot but be important in solving the hunger problem. It is particularly important to pay attention to employment opportunities, other ways of acquiring economic means, and also food prices, which influence people’s ability to buy food, and thus affect the food entitlements they effectively enjoy.[4]

Further, since undernourishment is not only a cause of ill health but can also result from it, attention has to be paid to healthcare in general and to the prevention of endemic diseases that prevent absorption of nutrients in particular. There is also plenty of evidence to indicate that lack of basic education too contributes to undernourishment, partly because knowledge and communication are important, but also because the ability to secure jobs and incomes is influenced by the level of education.

Maternal undernourishment and its far-reaching penalties

So low incomes, relatively higher prices, bad healthcare and neglect of basic education can all be influential in causing and sustaining the extraordinary level of undernutrition in India. Yet, as Siddiq Osmani has shown, even after taking note of low levels of these variables, "one would have expected a much higher level of nutritional achievement than what actually obtains" in India in particular, and in South Asia in general.[5]

So something else must be brought in. Osmani suggests — plausibly enough — the lasting influence of maternal undernourishment, working its way via underweight babies (India and South Asia lead the world in this field), who grow into children and adults more prone to illnesses of various kinds. This is in line with findings that have been identified by others, such as Ramalingaswami and his colleagues.[6] Recent medical research has brought out the long-run effects of foetal deprivation, reflected in low birth weight, which appear to cause immunological deficiencies and other health vulnerabilities. The health and nutritional adversity related to maternal undernutrition and low birth weight children is almost certainly a significant factor in explaining the terrible nutritional state of India.

Since maternal undernourishment is causally linked with gender bias against women in general in India, it appears that the penalty India pays by being unfair to women hits all Indians, boys as well as girls, and men as well as women. Even though there is ambiguous empirical evidence regarding the relative nutritional backwardness of girls vis-à-vis boys (as Svedberg discusses in his paper in this number), there is no dearth of definitive evidence of the neglect of pregnant women. For example, the proportion of pregnant women who suffer from anaemia — three quarters of all — is astoundingly higher in India than in the rest of the world. The long-run effects of underweight births not only worsen the chances of good health and nutrition of children — both boys and girls — but also immensely increase the incidence of cardiovascular diseases late in life.[7] Interestingly, since men are, in general, more susceptible to cardiovascular diseases, it also turns out that the adverse impact of the neglect of the nutrition of pregnant women is, in this respect, even greater for men than for women. What is sown in the form of unfairness to women is reaped as illfare of men, in addition to the suffering of women themselves.

The analysis so far has identified particular problems that have to be tackled if India is to overcome the massive prevalence of persistent hunger from which it suffers in many different ways. The areas of action include economic opportunities (such as growth of income and its distributional pattern), social facilities (such as basic healthcare and education), and the countering of special deprivations of women (such as maternal undernourishment). These are old problems that have not yet been overcome, unlike other fields in which success has been achieved, such as famine prevention and technological expansion of production opportunities. What, then, are the new problems?

Largest food mountains and worst undernourishment

The barriers to nutritional progress come not only from old dividing lines, but also from brand new ones. Sometimes the very institutions that have been designed to overcome old barriers have tended to act as reactionary influences in adding to inequity and unequal deprivation. The terrible combination that we have in India of immense food mountains on the one hand and the largest conglomeration of undernourished population in the world is one example of this.[8]

In 1998, stocks of food grains in the central government’s reserve were around 18 million tonnes — close to the official "buffer stock" norms needed to take care of possible fluctuations of production and supply. Since then, it has climbed and climbed, firmly surpassing the 50 million mark, and it appears, according to recent reports, that our stocks now amount to 62 million tonnes. To take Jean Drèze’s graphic description, if all the sacks of grain were laid up in a row, this would stretch more than a million kilometres, taking us to the moon and back. Since Jean Drèze wrote this last year (2000), the stocks have risen some more, and the sacks would now take us to the moon and back to the earth, and then back to the moon again.

It is good to hear from the Government of India that a small part of this large stock will be used for various good purposes, including one million tonnes going for relief in Afghanistan (I applaud both as a human being and as the Honorary President of OXFAM, which is much involved in providing relief in Afghanistan), but this would neither make much of a dent in the food mountain, nor stop its relentless enlargement — perhaps to 75 million tonnes soon, or even to a 100 million.[9] The Food Minister has also proposed a different way of paying subsidies to the farmers, which apparently distributes them more equitably among the regions. Instead of the government’s being obliged to buy food grains at the minimum support prices, food would now be sold at market prices and the government will pay the farmers the difference between the market prices and the minimum support prices. Farmers — even very big farmers — would no doubt be relieved to hear that their "interests", as the expression goes, "will be protected". And, of course, the stocks will keep accumulating, even though they are now approaching four times the official "buffer stock" requirements. And the public expense of the programme of subsidies (estimated not long ago at a staggering Rs 21,000 crore a year) is unlikely to spiral down. We are evidently determined to maintain, at heavy cost, India’s unenviable combination of having the worst of undernourishment in the world and the largest unused food stocks on the globe.

Policy delusions

What can be the explanation for this odd insistence on counterproductive policy? The immediate explanation is not hard to get. The accumulation of stocks results from the government’s commitment to unrealistically high minimum support prices of food grains — of wheat and rice in particular. But a regime of high prices in general (despite a gap between procurement prices and consumers’ retail prices) both expands procurement and depresses demand. The bonanza for food producers and sellers is matched by the privation of food consumers. Since the biological need for food is not the same thing as the economic entitlement to food (that is, what people can afford to buy given their economic circumstances and the prevailing prices), the large stocks procured are hard to get rid of, despite rampant undernourishment across the country. The very price system that generates a massive supply keeps the hands — and the mouths — of the poorer consumers away from food.

But does the government not remedy this problem by subsidising food prices according to the level of procurement prices — surely that should keep food prices low to consumers? Not quite. Jean Drèze and I discuss this issue more fully in our forthcoming book, India: Development and Participation, but one big part of the story is simply the fact that much of the subsidy does in fact go to pay for the cost of maintaining a massively large stock of food grains, with a mammoth and unwieldy food administration (including the Food Corporation of India). Also, since the cutting edge of the price subsidy is to pay farmers to produce more and earn more, rather than to sell existing stocks to consumers at lower prices (that too happens, but only to a limited extent and to restricted groups), the overall effect of food subsidy is more spectacular in transferring money to farmers than in transferring food to the undernourished Indian consumers.

Need for a clearer class analysis

If there were ever a case for radical class analysis, in which the Left could take the Right to the cleaners, one would have thought that this would be it. Sure enough, some public interest groups have protested and taken issues of fundamental rights to the Supreme Court. But the systematic criticism of this problem from the perspective of class inequality has been amazingly muffled and silent. The protest we hear is strangely divided, along with repetition of the mantra about keeping food prices high for the benefit of farmers and cultivators. Why is this so?

When the policy of food procurement was introduced and the case for purchasing food from farmers at high prices was established, various benefits were foreseen, and they are not altogether pointless, nor without some claim to equity. First, building up stocks to a certain point is useful for food security — even necessary for the prevention of famines. That would make it a good thing to have a large stock up to some limit — in today’s conditions, perhaps even a stock of 20 million tonnes or so. The idea that since it is good to build up stocks as needed, it must be even better to build up even more stocks, is of course a costly mistake.

It is important in this context to also examine a second line of reasoning in defence of high food prices, which too comes in as a good idea and then turns counterproductive. Those who suffer from low food prices include some that are not affluent — the small farmer or peasant who sells a part of the crop. The interest of this group is mixed up with those of big farmers, and this produces a lethal confounding of food politics. While the powerful lobby of privileged farmers presses for higher procurement prices and for public funds to be spent to keep them high, the interests of poorer farmers, who too benefit from the high prices, are championed by political groups that represent these non-affluent beneficiaries. Stories of the hardships of these people play a powerful part not only in the rhetoric in favour of high food prices, but also in the genuine conviction of many equity-oriented activists that this would help some very badly-off people. And so it would, but of course it would help the rich farmers much more, and cater to their pressure groups, while the interests of the much larger number of people who buy food rather than sell it would be badly sacrificed.

There is need for more explicit analysis of the effects of these policies on the different classes, and in particular on the extreme underdogs of society who, along with their other deprivations (particularly low incomes, bad healthcare, inadequate opportunities of schooling), are also remarkably underfed and undernourished. For casual labourers, slum-dwellers, poor urban employees, migrant workers, rural artisans, rural non-farm workers, even farm workers who are paid cash wages, high food prices bite into what they can eat. The overall effect of the high food prices is to hit many of the worst-off members of society extremely hard. And while it does help some of the farm-based poor, the net effect is quite regressive on distribution. There is, of course, relentless political pressure from farmers’ lobbies in the direction of high food prices, and the slightly muddied picture of some farm-based poor being benefited permits the confusion that high food prices constitute a pro-poor stance, when in overall effect it is very far from that.

It is said that a little knowledge can be a dangerous thing. So, unfortunately, is a little bit of equity when its championing coincides with massive injustice to vast numbers of underprivileged people.

A concluding remark

Not only is the persistence of widespread undernourishment in India — more than in all other regions in the world — quite extraordinary, so is the silence with which it is tolerated, not to mention the smugness with which it is sometimes dismissed. Nutritional deficiencies affect the lives of Indians at different ages but — as has been discussed — they can be closely interrelated. For example, the neglect of women’s nutrition can work through maternal undernourishment, foetal deprivation in the uterus, low birth weights, undernutrition and ill-health of children, and ultimately morbidity of adults as well. Recent research has brought out sharply the impact of early undernourishment on long-run health, and even on the development of cognitive functions and skills. The fact that India has such a massive incidence of childhood undernourishment makes this a particularly alarming consideration. Indeed, the negative effects of early undernourishment can be serious throughout one’s life, including in the propensity to suffer from cardiovascular diseases in later ages (again, higher in India, controlling for other influences, than almost anywhere else).

In battling against "so old a story" of deprivation and hunger, we also have to take note of the fact that the policy problems can take forms that are "somehow always new". In addition to addressing issues of economic growth and distribution, of healthcare and basic education, and the very old problem of gender bias and neglect of women’s health, we must also reassess public policies based on explicit scrutiny of who benefits from the respective policies, and who — most emphatically — do not. Many of the underdogs of society face not only traditional problems that have kept them back, but also new adversities arising from public policies that are meant to help the underprivileged but end up doing something rather different.

Given our democratic system, nothing is as important as a clearer understanding of the causes of deprivation and the exact effects of alleged policy remedies that can be used. Public action includes not only what is done for the public by the state, but also what is done by the public for itself. It includes what people can do by demanding remedial action and through making governments accountable. I have argued in favour of a closer scrutiny of the class-specific implications of public policies that cost the earth and yet neglect — and sometimes worsen — the opportunities and interests of the underdogs of society. The case for protesting against the continuation of old disadvantages has been strong enough for a long time, but to that has to be added the further challenge of resisting new afflictions in the form of policies that are allegedly aimed at equity and do much to undermine just that. The case for relating public policy to a close scrutiny of its actual effects is certainly very strong, but the need to protest — to rage, to holler — is not any weaker.