‘It’s time to find a solution for malnutrition. We can’t ask the children of India to wait any longer’-16/9/11

‘It’s time to find a solution for malnutrition. We can’t ask the children of India to wait any longer’



In this Walk the Talk on NDTV 24X7, Vinita Bali, MD, Britannia, talks to The Indian Express Editor-in-Chief Shekhar Gupta on why malnutrition is a sleeping emergency that needs urgent action.

I am at Delhi’s Lady Sri Ram College for Women. My guest is one of the most famous alumni of this college and one of India’s most powerful CEOs, Vinita Bali. Somehow corporate power and success is not something that you associate with women—anywhere; not just in India.

It’s interesting when we look at new recruits coming into the corporate world—it’s almost 50-50 now. I remember when I passed out, we were 10 per cent women and 90 per cent men. Things are changing.

You were in the most male dominated society in the world—America.

Well, not just North America, but also Latin America and Africa too—in Nigeria and South Africa. In many ways, Africa is so much more emancipated when it comes to women. I was there in 1992 working with Cadbury and 48 out of 50 distributors that we had in Lagos were women. The most successful distributor, not just for Cadbury but for Unilever, Colgate etc., was this woman and interestingly, she employed her husband as an accountant. So in the office, he knocked on the door before he entered.


That was a very trusting wife. To trust her husband with the accounts.

African tribal law is very interesting. It says what the woman earns is for herself and her children. She needn’t share it with her husband. So there was great wisdom in those tribal laws.

Chocolates, soft drinks, biscuits. Do people tell you, ‘Vinita Bali, you spent all your life selling junk’?

They don’t quite use the word ‘junk’. Whenever somebody says that to me now, I say look, I can’t argue with the fact that fruit is more nutritious than biscuit, but I can tell you biscuit is a whole lot more nutritious than a lot of other stuff we eat like puris, papri-chaat, samosas and gulab jamun.

You have been talking a lot about nutrition now. What got you focused on nutrition? And don’t sell biscuits please.

No, this has nothing to do with biscuits. I’d rather say it as a story. Soon after I joined Britannia and I have to use the biscuit analogy because I was walking through one of our factories and I saw cases and cases stacked up in the factory. When I asked what these were for, I was told that these were biscuits that we were making for the United Nations as part of the World Food Program and these are made according to a WFP recipe and largely used in areas where there is either a natural calamity or war.

You have been sending quite a lot of that to Afghanistan, for example.

We have been sending it to Afghanistan, Japan (during the tsunami) and Pakistan. Biscuit is actually a great carrier of both calories and micro-nutrients. The thing is that what you need at times, whether it comes through biscuits or anything else, is not just macro-nutrients but also micro-nutrients. So one of the things that struck me was here we are making calorie-dense and nutrition-dense biscuits for the world...

So these were fortified biscuits?

Yes, these were fortified. These are made according to a UN recipe. My takeaway from that was, we have got a huge issue of under-nutrition and malnutrition sitting right here in India. Seventy per cent of India’s children are anaemic. So even though poverty is the cause, it is not the only reason for anaemia. If you look at the nutrition statistics in India, it is actually a very sad story. I think the issue really is that there are known to be solutions, both food-based as well as involving other sectors. I think we just have to do something about it because it is a serious issue. According to me, it’s a sleeping emergency. It’s a silent epidemic.

So, just stuffing these people’s bellies with rice and rotis is not the answer?

We need food to fill our stomach. But we also need food for nutrition and good health. There are studies done as recently as 2008 by The Lancet, which is a well-respected medical journal. They have published a story for the first time which systematically documents that under-nutrition is the cause of physical impairment, for lack of cognitive and physical development. And it also talks about the fact that there are solutions that other parts of the world have experimented with and succeeded. So it is a severe problem. In fact, I think it is one of the most severe problems the world has and certainly in India. The statistics are terrible. One out of every two children, 47 per cent of children under five in India are either under-nourished or malnourished. That’s about 75 to 80 million children who are under-nourished or malnourished.

So you think the debate over malnourishment has got mixed up with the debate over starvation? Is malnourishment being confused with starvation?

Absolutely. I think if you look at it, nutrition is one of those agendas or priorities that finds its place nowhere. There is food, agriculture, food security, health and education. There were some good programmes that we started in our country in 1975 through ICDS (Integrated Child Development Services), which was aimed at addressing the issue of malnutrition. But here we are, 35 years later, facing this gory statistic which says one out of every three children born in this country is born underweight.

You have now been talking a great deal about malnutrition. When you say this to people, do they assume you want to sell them biscuits? Tiger biscuits with something in it. If they are malnourished, feed them cake and biscuits.

Not at all. I am not here selling biscuits. I am talking as a citizen of this country who got into this area through her work. This talk has nothing to with Britannia. I can leave Britannia and still be as passionate.

Give us some solutions.

I think the solutions are simple and somewhat complex. I think there are two sets of solutions. The first is successfully proven interventions in the field of nutrition—a whole series of good nutrition practices, which includes everything from breast feeding for six months to supplementary nutrition after the age of six months. Then there are nutritional supplements, which the primary health care centres and the National Rural Health Mission is already doing when they give zinc or iron supplements. The third is what a lot of other countries have done which we have to do as well.

Supplements as in tablets?

And through food, nutritionally-dense food that can be locally produced. The third thing is mass fortification of food. An example that has been successful in our own country is the addition of iodine in salt. You remember when we were in school and we used to see those photographs of goitre? Mrs Gandhi decided that iodine fortification in salt is the way to go. She decided, it was implemented and it was effective.

Let me give you another example. I lived in Santiago, Chile, and no children were anaemic there. When I say none, I mean a statistically insignificant proportion. One of the reason for this is that in 1954, Chile decided to fortify its staple flour with iron. Now these are proven to be solutions elsewhere in the world. We ourselves have seen it with iodine.

The Chinese have done the same thing.

The Chinese simply took soya sauce and added iron to it.

Which means all soya sauce sold in China has to have iron in it?

Absolutely. It is a regulation. When we sell any food product, there are certain rules and regulations and this is something that can be mandated. Countries that have done that like Thailand, Mexico and Brazil have seen a lot of success.

What exactly is Thailand doing?

Thailand came up with a very inclusive and comprehensive programme which was going to be my second point. The first thing is food-based intervention. The second, which is more tedious and difficult, is multi-sectoral intervention. Nutrition sits on the cusp of food and food security. If I don’t have enough food, I can’t have enough nutrition. Nutrition sits on the cusp of access to healthcare, no matter what good food you give me, if I, as a kid, have diarrhoea, no amount of food will sustain. Nutrition sits on the cusp of maternal health.

The other thing in India that we have to recognise is that it is not just a medical issue but also a social issue, given the status of women in society. I will tell you a story. I was in a primary healthcare centre in a village not far from Mumbai and there was this little girl sitting there, who was about four years old. She should have weighed anywhere between 13-14 kg. They weighed her and she was 10 kg. Now the fact is that three out of ten children born in India are underweight. There is no way that we are going to create a healthy cycle. So it is about addressing the food needs of adolescent girls, of pregnant and lactating women, because we have to break these inter-generational cycles.

So Thailand began to fortify its food as well.

They did a very comprehensive programme which was managed nationally. There was one body mandated to actually work with all the other bodies like ministry of health and food. They fortified rice. They have also developed certain grains of rice through biotechnology which have a high incidence of micro-nutrients in them.

Is it possible, technically, to fortify rice in India?

I believe so. You can fortify all flour, packaged foods and bread. We are sitting right here in Delhi where bread is called double roti and we even consume it with daal.

I find a lot of labourers in the evening who use it as a snack with an egg or pakora.

Absolutely. When you go abroad, you buy milk, it is fortified with vitamin A and D. We are talking about essential nutrients—iron, zinc, iodine, vitamins A, D and B family. All of which are required in addition to the food in my stomach. I need these micro-nutrients to live a healthy life and to be productive. The other very simple way of thinking about this is, in India we say the productivity of labour is less than other countries. Well, if I am anaemic, I can hardly work with energy for 8 hours or 12 hours. So there is a social cost to under-nutrition and malnutrition and an economic cost.

I will give an anecdotal example. I was asked by a private bank to inaugurate a blood-donation day. While there, I was talking to a doctor and I said, ‘You have got all these people here, you must have collected a lot of blood.’ He said, ‘No, only 60 per cent of the people who come in are actually acceptable because the others are way too anaemic.’ But they were well-paid people. Then it dawned on me that this has to do with their nutritional level and they are eating too much processed food.

In fact, there is 20 per cent incidence of iron deficiency anaemia in India. It tells us something. It is not about people who do not have enough to eat. People like you and I take multi-vitamin pills, iron supplements and calcium tablets. Let me give an example, if I am a child, less than 5 years old, I need something like 28 mg of iron daily. Now to get to 28 mg, I have to eat something like one-and-a-half kilos of spinach or eat a kilo of methi or one-and-a-half pomegranates every day. Now that’s really not feasible. So I think the other insight is it’s about diversity of food that we eat and in India, we have a very diverse palette. We have got to come up with solutions which are both localised not just as in India but localised according to regions in India.

Which five foods would you fortify and how?

I would fortify grains, oil, milk, packaged foods like breads and biscuits, and any drinks, like juice.

But once again, the story will be that it will only reach the consumer classes. Unless you fortify what is there in the PDS shop, it will not work on a larger goal.

When I am talking about biscuits, please don’t think of branded biscuits. PDS shops sell biscuits. There is a large industry, a cottage industry, making these products. The moment you fortify wheat flour or sooji, everybody who is going to use it to make anything will benefit, whether I am making upma or dosa. We have got to fortify staples.

Do you ‘bore’ your Britannia board members with all this?

I really think we are on to something, not just in Britannia. I really think the problem is severe. The solutions are many and simple. We have to work in an inclusive way with the media, government and NGOs and somehow all of us will have to start trusting each other. We are all on the same side of solving the problem and I think the time has come for us to do it because I don’t think we can ask the children of India to wait any longer.

What is the next step you are planning?

There are several things. Two years ago, we created the Britannia Nutrition Foundation. Every year, during the national nutrition week, we organise a seminar and it has nothing to do with biscuits that we sell. It brings together people from diverse sectors such as scientists and nutritionists. So there is a science centre, there is a pragmatic solution behind it. There is a need for large diverse sets of organisations to come together and inclusively address this because it is a humungous problem and I think it is bigger than any one company, any single state or any single NGO can address. It has to be a concerted and comprehensive effort which is inclusive because it is a really big problem. Unless we solve it, the human dividend of India, the productivity and economic development doesn’t really make any sense.

Tell me Vinita, being a CEO at the most cut-throat FMCG business, do people sometimes tell you not to be so woolly-headed, focus on work?

If that’s what they take out of this, I don’t mind being called woolly-headed because I believe that every CEO, every individual, every thinking person, has to get serious about nutrition. We can’t expect economic progress in the absence of social progress, in the absence of human indicators which are actually declining rather than improving. So this is not about a food CEO.

How did polio almost get eradicated from this country? Everybody came together, there was massive awareness. It (malnutrition) requires a concerted effort, it requires a multi-faceted, multi-sectoral and science-based solution. There is also very good evidence-based information that we are getting, which enables us to address this and you know we are not the first country in the world that is going to be doing it.

I do hope you are taken seriously. These are tough times because anything that is laced with a corporate identity is seen with suspicion.

My only hope is that we look at this issue and this problem with greater magnanimity and not get petty over private and government sector.

And not get petty about, ‘Oh Vinita Bali is saying, give

them cake’.

She doesn’t mean give them cake. She doesn’t even care if they don’t have biscuits. But what she cares about is that we have to take this problem seriously because as I said earlier, the children of India can’t wait.

Transcribed by Aashish Saxena