Malnutrition is killing India's future sports stars

By Vijayetta Sharma

The Paris Olympics was a hard reckoning for India. The nation won just six medals and was 71st in the overall medal tally. None of those medals were gold. Despite being the world's most populous nation, India has won only two gold medals in the last five Olympics.

While obsessing over sporting success may appear trivial, it links back to a far bigger problem. At the heart of this is India's child malnutrition crisis.

In 2022, 69% deaths in Indian children under the age of five (around 3.38 million children) were due to malnutrition and malnourishment. Latest figures show one-third of children under five are stunted and underweight and every fifth child suffers from wasting.

Nutrition is the building block of athletic performance. The provision of proper nutrition for children will provide grounds for the right sports training that can breed athletes of the future. However, this is only possible if the right nutritional health is maintained.

The answer lies in creating robust and accountable healthcare, education, and governance systems.

Ailing healthcare system

As per the Global Hunger Index 2023 report, India ranks 111 out of 125 countries and has a high level of hunger with a score of 28.7.

Almost 58 countries, including India, will not achieve low hunger by 2030 as targeted by Sustainable Development Goals (SDGs) due to undernourishment, child stunting, child wasting, and child mortality.

The quality and availability of medical professionals in health centres have a significant bearing on child malnutrition.

Even after the implementation of Indian Public Health Standard Guidelines 2012 in all states and union territories, the number of healthcare professionals has not improved substantially and stands at nine doctors, 23 nurses and midwives, and 58 community health workers per 1,000 population.

Children who appear malnourished do not get reported to health centres as their parents, who are often daily-wage workers, do not have the income to buy nutritional food.

An accredited social health activist in Punjab's Ropar district told this researcher they do not believe in the health centre's referred care protocols and consider these visits to be a waste of their labour hours.

None of the significant rounds of the National Sample Survey on nutrition and health — the last being in 2017-2018 — dealt with calorie, vitamin, and mineral intake with reference to age groups to understand the nutritional status of children aged 0 to 5 years with geographic distribution across states, which could help the government to devise effective child health policies.

There has been no National Sample Survey round on nutrition intake after 2011-2012 to take stock of the nutrition situation in the country in terms of calorie, vitamin, and mineral undernourishment.

The last detailed survey on nutrition also lacked child diet indicators and child-specific requirements.

Reports by two global NGOs, Concern Worldwide (Ireland) and Welt Hunger Hilfe (Germany), state that India's child wasting rate is the highest globally (18.7%), signalling acute undernutrition.

Income inequality, affordable food, and the poor status of female education are all contributing factors to malnutrition. Income status and female education are linked to child nutrition in terms of food affordability and mothers' knowledge of nutrition and hygiene. Only 27.9% of girls were in higher education in 2020-2021.

Gender discrimination also exacerbates food insecurity, which has a spiralling effect on child nutrition. India ranks 108 out of 193 countries in the gender inequality index 2022.

The country's income inequality index stands very high for India with a Gini index — a measure of income inequality — of 79 out of 163 countries. South Africa has the highest Gini coefficient of 63 in 2023, exhibiting high income inequality. Slovakia has the lowest Gini coefficient at 23.2 as of July.

Sports and nutrition

Developing human resources in sports remains a low priority. Sport isn't considered a good career choice by parents and educators in India due to lack of career prospects and no guarantee of a sustainable income source.

This is a significant cause for both persistently low child nutrition statistics and ignorance in the development of child health for the promotion of sports as the latter draws upon the attitude of parents and educators toward child care.

Scientific studies have found that a diet adequate in iron, zinc, and magnesium can result in an improvement in athletic performance.

If the government ensured nutritional needs were adequately met by households with the help of local healthcare centres through counselling, child diet analysis, provision of supplementary foods, and removal of malnutrition cases, India could gradually improve its sporting outcomes.

There is also a need to develop a culture of sports accountability in schools. Training sports teachers in child nutrition could help.

Despite improvement in sports funding from Rs 2,844 crore ($338 million) in 2010-2011 to Rs 3442.32 crore ($410 million) in 2024-2025, the development of child sportspersons in India remains in a state of flux. 

This money has mostly been used to build on skills of India's National Service Scheme volunteers, youth exchange programmes, assistance to scouting and guiding organisations, and similar activities.

Since 2017, the focus has been on Khelo India which should also include an emphasis on non-Indian audience, the development of elite sports, and grassroot development in sports.

Addressing malnutrition among children could be included in sports promotion schemes through such initiatives for inclusive child development sports policy.

A new approach

India lacks detailed protocols for measuring undernourishment, child stunting, child wasting, and child mortality at health centres, and follows a broader classification by the Global Hunger Index which lacks genetic and geographic specification.

A State Hunger and Nutrition Index could be devised to capture statistics on nutrition, malnutrition, types, reasons, wealth, parental attitudes, geographic distribution, caste prevalence, food behaviour, child illness, and engagement in sports. This could supplement data for the Global Hunger Index.

India also needs to improve health, water, sanitation, and education services, with an emphasis on the removal of inequities and disparities, thereby helping children develop. The Aspirational Blocks Programme launched in 2023 can emphasise malnutrition reduction along with the promotion of popular sports such as hockey and football.

FIFA community projects can be integrated into aspirational districts, which constitute the 112 most underdeveloped districts in the country, to promote sports culture in India through grants and aid for the development of sports.

Until now, India's champion athletes have largely relied on their efforts. The government can draw a plan for the inclusion of children below five years in sports activities with dietary plans, incentives, and family behaviour modification.

At the grassroot level, the training of ASHA and Anganwadi workers on child growth measures and clarity of roles among them needs urgent attention to promote sports and improve child health indicators in the country. 

This can be integrated with the Supplementary Nutrition Programme under Anganwadi Services and POSHAN Abhiyaan initiated by the government in 2023.

A shift in the delivery of nutrition content by health centres is required, taking into account children's dietary requirements for better physical and mental activity. The use of I-T apps to measure child health matrices integrated with sporting activities they undertake can create a database of nutrition and sports activity.

Strengthening of infrastructure and health provisioning at Nutrition Rehabilitation Centres in the districts and promotion of maternal health to check lapses in child health needs to be undertaken on a large scale in the country.

There is also a need to align the activities of Pradhan Mantri Garib Kalyan Anna Yojana and Antyodaya Anna Yojana with the creation of sports awareness among the beneficiaries.

Malnutrition needs to be checked urgently at the local level by providing and maintaining equitable calorie, vitamin and mineral health among children to create future athletes that can take India to new sporting heights.

(Vijayetta Sharma is Associate Professor of Public Policy at Manav Rachna International Institute of Research and Studies. This article was first published under Creative Commons by 360info)

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.