(Child Health, Nutrition and its Governance, Public Policy and Politics)
A Fatal Engagement
Development of India’s food policy is dominated by the food industry and makers of chemical nutrients through their front groups or advisers-thus undermining the health of Indian populations.
On 15th August, during his Independence Day speech, the Prime Minister announced the mandatory fortification of rice. Although the NITI Aayog termed it as a “game changer” it also admitted, “that every second woman is anaemic, every third child is stunted and malnourished and every fifth child is wasted. Further, over 70 per cent of the population consumes less than 50 per cent of the Recommended Dietary Allowance. Disturbingly, we have underperformed on nutrition indicators…”
Why is it that despite recognizing lack of food as the root cause of the problem the GOI is focusing on lack of micronutrients to solve it? What is it that pushes the GOI to opt for fortification with micronutrients rather than investing in increasing the availability of diverse foods?
Apart from undernutrition India is facing another challenge of a rising incidence of non-communicable diseases like obesity, diabetes and heart disease. An important cause of this new epidemic is the aggressive marketing of processed foods by the industry and their resistance to provide information about their unhealthy contents.
Lot has been said about nutrition, science and economics, but there is hardly any discussion on ethics and conflicts of interest among those entrusted with policy development. Data and evidence collected by us reveals that this policy is driven by vested interests in the food industry and that these vested interests infiltrate most of the decision-making bodies. This raises the most crucial issue of conflict of interest. We discuss below the manner in which the food industry influences food fortification and also how they circumvent labelling of content for unhealthy ingredients in processed foods.
India’s Food Safety Authority has set up a Food Fortification Resource Centre. It works with ‘Global Alliance for Improved Nutrition’ (GAIN), Nutrition International, the ‘World Food Programme’ and Tata Trusts and ‘The India Nutrition Initiative’ and ‘Food Fortification Initiative’. We examined information about partners and donors of these organisations and found distinct links of these organisations with the food or nutrients industry as donors or partners. Many multi-stakeholder initiatives act as front groups of food companies.
The BIG influencers
The Wall Street Journal published in 2002 “Gates Fights Malnutrition With Cheese, Ketchup and Other Fortified Food Items” that brought to light how, by the sides of the UN Special Session for Children in New York the Gates Foundation set up the GAIN with a grant of US $ 50 Million. In turn, GAIN signed up with big food companies for them to add nutrients like iron, folic acid, and vitamin A to their food products and offer technical assistance to the governments. GAIN will help them to get a favourable tax policy and regulatory review. The strategy included funding public campaigns for the governments to earn ‘Seal of approval’. This story line continues even today. In 2015, Bill Gates and Ratan Tata penned an opinion piece in the Times of India where they recommended fortification as one of the most cost-effective solutions among others.
The World Food Programme (WFP) in India receives donations from ‘General Mills’ (US company that makes cereals, ice creams pastries), ‘YUM’ (a US fast food company) and ‘Cargill’ (A US company that makes food ingredients, chocolates, ultra-processed foods, corn, edible oils, floor, sweeteners and starches).
‘Nutrition International’ receives funding from Bill and Melinda Gates Foundation (BMGF), and lists DSM and BASF as partners. DSM is based in the Netherlands and makes food ingredients and vitamins; and BASF is a US company that makes food performance ingredients, beverage stabilizers, colorants and interest in fortification) as partners. In 2002 Roche sold its nutrients business to ‘Royal DSM’ making it a big player.
GAIN: Donors include BMGF, Unilever (a global consumer goods company with food and nutrition portfolio), Hershey (US company makes chocolates), Arla Foods (Danish company of dairy foods), Africa Improved Foods (A food producing company in Africa), MARS (it has a food business like snickers, chocolates and expanding in India), and BASF. DSM is the chair of the partnership council of GAIN.
‘Food Fortification Initiative’ has partners belonging to several food companies including Cargill, and BASF. In addition GAIN, Nutrition International are its partners.
Tata Trusts lists funding partners in MARS and BMGF. The India Nutrition Initiative’ is an offshoot of Tata Trusts. They work closely with GAIN
Business interest organizations (BINGOs)
These 3 organisations pose as civil society groups but clearly have business interests.
‘Sight and Life’
It is one such BINGO, an entity that used to work on Vitamin A, was transferred to DSM in 2005 after Roche sold off its nutrient business to DSM in 2002. DSM dominates the Management.
Scaling Up Nutrition (SUN) Business Network: SUN is self- styled movement, not approved by the Member States, but UN supports it. It has an arm called business network with WFP and GAIN as co- conveners. As a principle it advocates for market based solutions and partnerships with nutrition and food companies.
Impact 4 Nutrition
A partnership called ‘impact4Nutrition’ has listed partners as ‘Tata Trusts’ and ‘Sight and Life’ among others.
Food Industry Domination in Policy Development on Food Labeling
FSSAI has a scientific panel to address cut off points for contents to label a food as unhealthy but the food industry has tried every trick to influence the decisions and delay adoption of a regulation. The Stakeholders meeting held on 25th may 2021, to discuss this policy included 22 out of 28 participants from the food industry e.g. Coca Cola, Dabur, Haldiram, Kellogg’s, Mondelez, General Mills, Nestle, DANONE, PepsiCo, Marico and HUL.
We are here to offer a critique on how policies are made and in whose interest. The country is facing a rise in obesity through aggressive marketing of unhealthy processed foods. Growing evidence suggests that consumption of ultra-processed foods is associated with increased non-communicable diseases like diabetes, cancers, heart disease and all-cause mortality. Evidence suggests that businesses influence policy on nutrition through narratives like ‘body needs nutrients’ and ‘manipulation of nutrition science’ through funding of experts.
Experts have indicated that the solution to undernutrition lies in consuming diverse foods in sufficient quantities rather than fortification, which may not be of any use, is wasteful and may be harmful. Facts speak about inadequacy. According to the 2020 data from National Family Health Survey -5 of 22 States and UTs, only one out of 2 babies begin to breastfeed within an hour in the hospitals, 3 out of 5 are adequately breastfed during first six months, and 1 out of 6 children between 6-23 months receive adequate and diverse food. Growth falters around 3 months and between 6-12 months the most.
The government of India while confessing “we have underperformed on nutrition indicators…” should do much more than just offering lip service to the problem. What we need is adequate funding, strengthening human resources in health facilities and making available diverse food for all people, especially the vulnerable – women and children.
Only a strong public health action and active government support can make India free from malnutrition.
At this moment, we urgently ask to cut the influences of vested interests, and keep the policy development process free from conflicts of interests. This can make headway in solving both the problems of persistent undernutrition and now obesity.
Dr Arun Gupta, MD FIAP, Convener Nutrition Advocacy in Public Interest (NAPi)
Dr Navdeep Khaira MD DM (Nephrologist, Fortis Ludhiana, Member Alliance against Conflicts of Interest (AACI)