In the 75th year of independence, India has much to look forward to and much to think about. We have overcome two crushes Covid-19 Waves. However, more than four lakhs have died from the disease. Thousands of children have been orphaned and thousands more suffer from a lack of basic facilities. Of all the problems youth face, food insecurity is the worst and can cripple the future of an entire generation. A recent UNICEF report said that nearly 12 lakh children in low-income countries could die in the next six months due to a decline in routine health services and an increase in waste. Almost three lakh of these children would be from India – almost as many as the nationwide death toll from Covid-19. If this challenge needs to be mitigated, India needs to use the pandemic as an opportunity to find long-term, multi-stakeholder solutions to the country’s food problem.

The National Family Health Survey (NFHS 5) shows that acute malnutrition among children under five has worsened since the pandemic began, with one in three children under five suffering from chronic malnutrition. According to the latest data, 37.9 percent of children under the age of five are stunted and 20.8 percent are depleted – a form of malnutrition that makes children too thin for their height. This is much higher than in other developing countries, where an average of 25 percent of children are stunted and 8.9 percent are exploited. Inadequate food intake is the most direct cause of malnutrition. However, this is the most obvious cause of the problem. Several other factors also affect nutritional outcomes, such as contaminated drinking water, poor sanitation and unsanitary living conditions.

According to the World Health Organization, 50 percent of all malnutrition and malnutrition can be traced back to diarrhea and intestinal worm infections, which are a direct result of inadequate water supplies, sanitation and hygiene. Food and water, sanitation and hygiene (WASH) are closely related, and changes in one area have a direct or indirect effect on the other. The global food community has long emphasized this interdependence, suggesting that greater awareness and investment in WASH is a surefire way to improve the country’s nutritional status. Especially in the case of India with its population of more than one billion people, both WASH and nutrition must be approached together in the sense of a holistic, sustainable community commitment in order to achieve a long-term effect.

Realizing that poor diet could not explain most cases of malnutrition prompted researchers to re-examine other possible causes of the problem, including long-held suspicions that unsanitary living environments lead to chronic intestinal damage. One of the earliest instances of the WASH-diet connection was identified in the 1989 Convention on the Rights of the Child, which urged states to provide “adequate nutritious food and clean drinking water” to combat disease and malnutrition. In 2015, Jean H. Humphrey of the Johns Hopkins Bloomberg School of Public Health emphasized that poor hygiene and sanitation in developing countries lead to a subclinical condition called “environmental enteropathy” in children, which causes nutritional malabsorption and is the source of a variety of problems , including diarrhea, retarded growth, and stunted growth.

Put simply, environmental enteropathy is a disorder of the bowel that prevents the proper absorption of nutrients, effectively rendering them useless. Since the disease is closely related to the poor environmental conditions of the victims, it was called “environmental enteropathy”. Diarrheal disease, intestinal parasitic infections, and environmental enteropathy all work together to affect normal growth and cognitive development in children, resulting in anemia, stunted growth, and wasting away. Child diarrhea is a major public health problem in low and middle income countries and results in high under-five mortality rates. According to NFHS 4, around 9 percent of children under the age of five in India have diarrhea.

Safe drinking water, adequate sanitation and hygiene can significantly reduce diarrheal disease and deaths from diet. On the one hand, poor WASH facilities amplify the effects of malnutrition. On the other hand, pre-existing micronutrient deficiencies make children more susceptible to WASH-related infections and diseases. The WHO estimates that access to adequate water, hygiene and sanitation can prevent the death of at least 860,000 children each year from malnutrition. It is evident that there is a direct and irrefutable link between hygiene and nutrition, and the sooner we recognize it, the sooner we can work to fix it.

With the outbreak of Covid-19, adequate hygiene and sanitation measures have become even more important. A simultaneous approach to nutrition and WASH will not only aid India’s fight against malnutrition, strengthen resilience to Covid in the most vulnerable parts of society, but also protect against monsecond health problems. This requires a coordinated, multisectoral approach from health, water, sanitation and hygiene authorities and strong community engagement. An integrated nutrition and WASH approach at the individual, household and community level as well as Covid management will serve to tackle the problem of malnutrition from the ground up, raise awareness and accelerate the implementation of clean and safe living strategies.

At the end of the day, all sides are working towards a common goal: a safe and healthy population and the hope that the 75th year of independence will be a turning point on India’s journey.

This column appeared for the first time in the print edition on September 6, 2021 under the title “The Link Nutrition-Hygiene”. The author is a former director of the ICMR-National Institute of Nutrition