A TIME bomb is ticking and expected to go off in three decades’ time. By spending a few more millions, however, the state can defuse it and reap a demographic dividend instead.
So say experts and officials of the United Nations Children’s Fund (Unicef).
According to the Unicef, the Philippines must invest $1 billion in the next 10 years to avoid the triple burden of malnutrition: stunting and wasting; micronutrient deficiency; and, obesity. The peso equivalent of that amount, about P51.19 billion, is a billion pesos more than the worth of the Philippine National Railways (PNR) Clark Phase 2 Contract Packages 4 (worth P32.7 billion) and 5 (P18.1 billion).
That proposed amount translates to an additional investment of $100 million annually, around P5 billion every year. The level of this investment is not that high considering the alternative: underinvestment or, worse, business as usual.
Filipinos stunted
IF the government continues on its “business as usual” stance, the Unicef said the Philippines stands to lose 3 percent of its GDP annually. This equates to $4.5 billion or P220 billion annually.
Clearly, according to Unicef Philippines Nutrition Specialist Rene Gerard C. Galera Jr., investing $100 million annually is cheaper, especially given that a third of Filipino children are already stunted.
“The cost of that is equivalent to one third of the damages by [Typhoon] Yolanda. So every year, [our] economy is losing that [amount]. So really, we have to consider that nutrition, as much as it’s an economic cost, we have to invest on it, too,” Galera said in a recent forum.
“That’s why it’s actually cheaper to invest in nutrition and you can do so much with [that amount],” he told the BusinessMirror on the sidelines of the forum.
Economic development
IN his recent speech, former Socioeconomic Planning Secretary Cielito F. Habito said stunting, also known as nutritional stunting, is one of the major challenges to the country’s development. Habito said stunting, a reduced growth rate in human development, may make these children “mediocre” when they grow up or become workers with “low productivity.”
While the Philippine population remains young, reaping the full benefits of the demographic dividend from now until 2050 means having a strong and capable labor force. Habito said that if the working population are disadvantaged from a young age, the country’s demographic dividend could become a demographic time bomb instead.
In order to bring down food costs in the country, Habito stressed a need to pursue rice tariffication as well as veer away from rice self-sufficiency strategy. This will bring down commodity prices as well as free up public funds for other cash crops that have the potential to raise farmers’ incomes, according to him.
“If we don’t do something now, it could lead to a demographic time bomb rather than a demographic sweet spot,” Habito, professor at the Department of Economics of the Ateneo de Manila University, said.
Extent of the problem
THE Unicef report titled “State of the World’s Children 2019” showed malnutrition is a global problem. The report stated that over 1 in 3 children are not growing well.
The report said this meant 149 million children under 5 years old are stunted, nearly 50 million are wasted and 40 million are considered overweight.
Unicef added that over 340 million children are suffering from micronutrient deficiencies globally. This indicates that at least 1 in 2 children or half of the children’s population have a hidden hunger.
The report also stated that 42 percent of school-going adolescents drink carbonated soft drinks at least once a day and 46 percent eat fast food at least once a week. From 2000 to 2016, the proportion of overweight children between 5 and 19 years of age doubled from 1 in 10 to almost 1 in 5.
Galera said based on these figures, the world is not on track to meeting the global targets on stunting, wasting and overweight by 2030. Based on Target 2.2 of Goal 2 on “ending hunger, achieving food security and improved nutrition and promotion of sustainable agriculture” of the Sustainable Development Goals (SDGs), the world must end all forms of malnutrition by 2030.
The SDGs, to note, are a collection of 17 global goals set by the UN General Assembly in 2015 for the year 2030. The SDGs are part of Resolution 70/1 of the UN General Assembly, the 2030 Agenda.
Dangers of stunting
TARGET 2.2 stated the world must achieve the internationally agreed targets on stunting and wasting in children under five years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons.
In terms of overweight and wasting, the global target is to bring this down to 3 percent by 2030, but 7.3 percent of children are still overweight and 5.9 percent are wasted. The target for stunting is 12.2 percent by 2030, but the current rate is 21.9 percent.
In the Philippines, the Unicef estimates that 2 percent of Filipino children under 5 years old are severely wasted and 7 percent are moderately and severely wasted. The data also showed 4 percent of under 5 year olds in the country are moderately and severely overweight.
In terms of stunting, the report stated that 33 percent of Filipino children are stunted. The incidence is higher among the poorest 20 percent at 49 percent. However, data showed even among the richest 20 percent, around 15 percent of children are stunted.
According to the Unicef, the dangers can be life-threatening in the case of wasting, and permanent, especially in the case of stunting.
Opportunity window
National Nutrition Council (NNC) Executive Director Azucena M. Dayanghirang said stunting in children is already irreversible after a child reaches 2 years old.
Dayanghirang said stunting does not happen overnight. It is caused by “chronic hunger and malnutrition.” If mothers are also malnourished and stunted themselves, there is a higher tendency for their offspring to also be stunted.
Galera said this is the reason it is also important to remember that good nutrition starts in the first 1,000 days. This refers to the first 1,000 days of a baby’s life which begins in the womb and ends when the baby turns 2 years old. If children lack the nutrition they need at this time, they are likely to be stunted.
“This is why we’re calling the first 1,000 days the first window of opportunity because the brain development in that moment is never outpaced [in a lifetime]. Studies actually show that brain connections during that period are as fast as 1,000 connections per second,” Galera said. “So if we lose that moment, if we don’t support the child in their nutritional needs, the brain doesn’t form correctly. That’s why there is this element of irreversibility because we lose that chance of making those meaningful connections.”
Usually correlated
DAYANGHIRANG said the stunting rate among 1-year-olds in the Philippines is 36.6 percent, which is twice as much as the 15.5-percent stunting rate among infants 6 months to 11 months old. She added that stunting rates remain at the 30-percent level or more among children 3 and 4 years old.
She explained that stunting is not only about height. When children are stunted, they are not only deemed bansot—a local pejorative term for someone physically smaller for their age and underweight, but also have less developed brains. This physical characteristic compromises their ability to absorb lessons while in school and eventually makes them less productive workers.
“We would like to consider stunting as not just a physical impairment but rather as a brain or cognitive impairment,” Dayanghirang said. “There’s lack of nutrients in the development of the brain.”
She explained that the cognitive development is affected because the temporal lobe is usually affected.
“The temporal lobe [has a domain over] memory so, often, if a student is stunted, the child falls asleep in class and would not be able to answer quizzes.”
Dayanghirang said this is one of the reasons street children can be very hostile.
“When they knock on our car windows and when we turn them away, they fight us back. This is because the impact of stunting is in the temporal lobe and that is where hostility lies. It is usually correlated,” she further explained. “The younger stunting occurs, the more risky their lives become.”
Resorting to accessible food
THE NNC said children are malnourished because of bad eating habits and, the Department of Health (DOH) and Unicef said, the absence of a nurturing environment represented by the family.
In terms of food, the NNC and DOH said high consumption of sodium-rich and sugar-rich foods can lead to malnutrition. These kinds of foods are often processed foods with artificial coloring and flavoring as well as those high in trans fat.
Unfortunately, many families are looking for quick-fix solutions when feeding children and adults, DOH’s Anthony P. Calibo said. There is a tendency for families to resort to accessible foods that may not have sufficient nutrition needed by children, especially those aged 0 to 2 years old, according to Calibo, officer in charge of the DOH Disease Prevention and Control Bureau Division.
The Unicef said this is common in cities where “many poor children live in ‘food deserts’ or in ‘food swamps.’ Those in the former face an absence of healthy food options while those in the latter are confronted with an abundance of high-calorie, low-nutrient, processed foods.
Calibo said preparing nutritious food is “not rocket science.” It simply needs some creativity and does not mean cooking separately for adults and children, which can be very expensive.
Common fare
CALIBO said a common fare like tinola (chicken soup) can be good for both children 0 to 2 years old and adults. To make it palatable to children, adults need to mash the green papaya and shred the chicken so that children can eat it. It is also important to make sure the rice is soft enough for children to eat, Calibo said.
Dayanghirang added that when it comes to the consumption of processed foods like instant pancit canton, families can resort to adding vegetables like malunggay (Moringa oleifera) and kalabasa (West Indian pumpkin) to the pancit canton to make it more nutritious. Families also have the option to add a cheap source of protein such as eggs to the dish.
“Globalization is shaping food options and choices: 77 percent of processed food sales worldwide are controlled by just 100 large firms,” the Unicef report stated.
“Poor families tend to select low-quality food that costs less. Because of poverty and exclusion, the most disadvantaged children face the greatest risk of all forms of malnutrition,” it added.
Calibo added that if mothers were stunted children themselves, there is a possibility their own children will also be stunted. This makes achieving the country’s nutrition targets an uphill climb.
Higher stunting rates
THE NNC data showed the prevalence of malnutrition among mothers in the poorest quintile is 12 percent, while for the richest quintile, it’s only 2 percent. Stunting rates of children are higher if mothers are underweight.
Data showed that for the 0-month-old to 6-month-old child, stunting is at 21 percent for those mothers who were underweight during pregnancy, and only 12 percent for those who had normal weight while they were pregnant.
For children 7 to 23 months old, stunting is at 44 percent, which represented those whose mothers who were underweight, while 31 percent of these children were stunted for those whose mothers had normal weight.
Stunting among children 24 months to 59 months old is higher among underweight mothers at 56 percent; it is 42 percent for children whose mothers were of normal weight.
“It’s easy to reverse the wasting,” Calibo said. “Because once you put a child under management of acute malnutrition, that child reaches already the weight for length, or weight for height, similar to the body mass index in adults, they are no longer wasted.”
Intergenerational
HOWEVER, Calibo said it should be understood that stunting is intergenerational.
In the case of “an adolescent female who might probably get pregnant—and this adolescent female was also stunted when she was a child—the offspring may also be [probably] stunted,” Calibo said.
For this reason, families should consider the alternative where children will be used to eating unhealthy food, Calibo said. This will not only undermine their health but also their future. He said this is why monitoring the growth and development of a child is very important.
This includes proper care and providing love and support for children. The Unicef said studies showed orphan children, while able to access nutritious food at the orphanage, have a tendency to also be stunted. This is because of the absence of family dynamics.
Further, the environment should be conducive to nutrition. This means mothers should be able to continue breastfeeding even after six months. Currently, only 54.9 percent of Filipino infants are exclusively breastfed between 0 and 5.9 months.
Local action, global vision
THE Unicef said there is, above all, a need to view nutrition as a basic human right. The report stated that while the Convention on the Rights of the Child was signed 30 years ago, many children are still robbed of their present and their future because of malnutrition.
In the report, the Unicef called on governments to “put children first and combat malnutrition by recommitting to the right of all children—without exception—to food and nutrition as a human right.” This means “stimulating demand for healthy options, strengthening the supply of nutritious foods and improving children’s food environments.”
Further, the Unicef said, governments must place women and children’s well-being at the heart of government policy. Governments, the report stated, must craft policies and regulations that ensure women and children’s needs are addressed.
The Unicef said this includes the imposition of specific taxes on unhealthy foods such as those imposed on sugar-sweetened beverages (SSBs) in countries like the Philippines. The tax on SSBs was part of the Tax Reform for Acceleration and Inclusion (TRAIN) Law, the first of five tax-reform packages to be signed into law. It took effect in January 2018.
Discuss reformulation
IT can be noted that in January 2018, the Philippine government implemented an excise tax on sugary drinks equivalent to P6 per liter for beverages using purely caloric sweeteners and a higher P12 per liter for those using high-fructose corn syrup, as mandated under the Train law.
The Department of Finance (DOF) said this SSB tax helped lower the consumption of sweetened beverages by an average of 6.5 percent, with powdered concentrates registering the highest decline at 25 percent, based on the 2018 data from Euromonitor on the sales of beverage companies in the Philippines.
Moreover, the Unicef said there is a need to provide economic incentives for producers to supply safe and nutritious foods. This could mean lower rent, tariffs and utilities to reward firms that produce and market healthy foods.
“Incentives should also seek to increase the proportion of fresh fruits and vegetables available at markets, supermarkets and other points of sale, especially in low-income communities and food deserts,” the report said.
The NNC said it intends to gather food establishments and manufacturers to discuss the reformulation of their products to ensure their nutritional value. Dayanghirang told reporters there is a need to cut the salt content of certain products, especially those that are regularly consumed by the poor, such as pancit canton.
Required nutrition needs
DAYANGHIRANG said the NNC is also asking food establishments and other fast-food chains frequented by younger Filipinos to get involved in these discussions.
She said that by November and December, or by the first quarter of 2020, the NNC will establish the Scaling Up Nutrition (SUN) Business Network to pool food manufacturers and establishments in producing healthy food for children, especially those 6 months to 2 or 3 years old.
The SUN Business Network aims to create food and labeling standards that food establishments as well as manufacturers will have to comply with to meet the necessary nutritional needs of children.
Apart from this, Dayanghirang said the NNC intends to work with local government units (LGUs) and other line agencies such as the Department of Agriculture (DA) to promote better food options for Filipinos.
She said this will help prevent stunting, which can compromise the education and future employability of children. Stunting can be prevented if Filipinos become more conscious of the nutritional value of the food they consume.
Encouraging gardens
FURTHER, Dayanghirang said a whole-of-government approach is needed to promote good nutrition. She said agencies such as the DA can help by encouraging urban gardens.
She said urban gardens can help increase vegetable consumption, especially among pregnant women and their children. She said it is very easy to cook food such as pancit canton with simple vegetables to make them more nutritious.
Dayanghirang said the NNC also hopes to meet with agencies such as the Department of Public Works and Highways (DPWH) to hire unemployed fathers of malnourished children to give them a means of livelihood through the various infrastructure projects of the government.
“Why do we have stunting, why do we have hunger and malnutrition? There are two ways: one is, they don’t have access to food, why? Because they don’t have money to buy food. [Another reason] is there’s no food available because [households are] geographically isolated and depressed area,” Dayanghirang said.
Dayanghirang said the NNC is also discussing with local government units regarding a “convergence” of programs that would lead them to cooperate more with key government agencies.
She said the NNC would like to “clone” LGUs who already have their own nutrition plans and programs in their areas such as key cities of Mandaluyong, Baguio, Davao, Taguig and Isabela. The list also includes Quezon Province.
Nutrition, health
CALIBO added that monitoring children’s progress is also important. This can be done through the Department of Education, particularly its completion rates and achievement tests. The Department of Labor and Employment can also help through annual data on human productivity.
“It’s difficult to generalize that the human productivity of the Philippines is actually compromised. [But] if this trend will not be reversed, maybe the next 20 years of adult workers would be the not-so-productive adult workers in the future,” Calibo said.
For these experts, nutrition is an important component of economic growth. Ensuring that the children of today are equipped with the best of everything—especially good nutrition—is already one way of ensuring the country’s bright future.
Promoting good health and nutrition, however, is not only about providing sufficient financial resources but also commitment. The commitment of governments and households to improve the present conditions of children will ensure that they have meaningful and fruitful lives.
Image credits: AP/Pat Roque