India is ranked 107/121 on the Global Hunger Index – What does that mean and why should we care?

Around this time each year, the Global Hunger Index (GHI) headline circus comes to town. Hot takes are freely available (usually influenced by political leanings) and concentrated around the ends of the “the government is clueless --> there is a global conspiracy against India” spectrum.

Undeniably, India has a malnutrition crisis. No amount of attention really is enough attention. The hoopla surrounding the GHI is therefore welcome. That said, one does wish the narrative went beyond hot-take headlines to break down the real story. And yes, arguments that are grounded in facts and not wild theories.

So then, how is the GHI rank/score calculated? Why should we care? The GHI score is a composite score consisting of 4 components:

1. Undernourishment prevalence: Inadequate calories i.e., food consumed habitually is insufficient to provide energy for “normal and healthy lives” (% of the population (not just children)
2. Stunting: Low height for age (% of children under the age of 5)
3. Wasting: Low weight for height (% of children under the age of 5)
4. Child mortality: Children dying under the age of 5 (Percentage) (Note: Typically understood as number per 1000 live births)

The standardized value for each component is obtained by dividing the absolute value by a number close to the “highest observed value since 1988”. For instance, India’s current stunting rate is 35.5%. To standardize, this is divided by 70% since the highest observed stunting rate (across countries) since 1988 was 68.2% (local example, think Bangladesh 30 years ago). Therefore, the standardized value would be ~50%.

To calculate the GHI score for each component, the standardized values are first weighted (1/3rd each for undernourishment and mortality; 1/6th for stunting and wasting) and aggregated to obtain the composite GHI country score on a scale of 0-100 (100 being the worst). India’s composite GHI score for 2022 is 29.1. To put this in perspective, 17 countries have brought their GHI scores below 5 (China and Kuwait in Asia) while Yemen with 45.1 is currently the poorest performer.

Should we be especially worried about this year’s scores? The short answer is yes. After a steady improvement from 2000-2014 (GHI score reduced from 38.8 to 28.2), the score has inched back up to 29.1 (See figure below). This is bad news. P.s – I have no ulterior motive for picking 2014 for comparison beyond the fact that GHI only enables direct comparisons for 3 reference years (in this case, 2000, 2007, 2014) given changes in data sources and methodology.

Look closer and the picture becomes clearer – India’s scores on stunting and mortality have continued to improve steadily. However, undernourishment and wasting scenarios have worsened (See figure below). The wasting situation is particularly alarming – wasting in India is among the highest in the world and worryingly, has remained stubbornly around the 19-20% mark. Drilling down to the state level, Maharashtra and Gujarat have the highest prevalence of weighting at over 25%. Will spare you the snark on “economic development”. Undernourishment again has increased year on year. And nope, no “conspiracy” here. The data is sourced from UN organs / World Bank and based on data points reported by countries in addition to official consumption surveys conducted by national governments.

In summary - could the GHI math be better conceived? Certainly. Is the GHI's assessment of 'hunger' in India directionally accurate? Also, yes.

Why should you care? Children are dying. Of every 1000 live births in India, 32 children die before they turn 5. What about wasting though? How significant is that? Malnutrition contributes to 45-50% of child deaths (in India and globally). For anyone who needs an economic case beyond this unspeakable tragedy, malnutrition costs the economy approximately $500 per person per year. Evidence also exists to suggest that investment in reducing malnutrition is money well spent. Investments in reducing stunting and wasting have been found to yield economic benefit-costs of 34-38:1, in India. (That is 2x the global average, by the way)

The good news? Wasting is reversible. There are known solutions and various experts have written extensively about these. See this for a primer on evidence-based interventions for nutrition with associated costs. Moreover, addressing nutrition remains a policy priority, articulated at the highest levels of government. Translation of policy to delivery is unfortunately still far from ideal. However, that is a long story... maybe for another time.

Before we go, what can we do about malnutrition?

1.      Push for more corporate funding of organizations working on malnutrition. “Eradicating Poverty, hunger and malnutrition” received only about ~5% of CSR funds in 2020-21. Key influencing factors such as safe drinking water and sanitation are woefully underfunded (<1% each). Anganwadi workers and centres need all the help they can get – incentives, resources, capacity building, systems. Many organizations large and small are doing some fantastic work in this space. To name one, my old friends at The Antara Foundation are addressing the important questions of inter-departmental convergence of health and nutrition data and capacity building of frontline workers

2.      Demand accountability from elected representatives on nutrition outcomes and the working conditions of service providers

3.      Go beyond the headline, I suppose :) 

 Note: The methodology for computing GHI and the images included in this article are all sourced from GHI's website.