Health activists are divided about the Central Government’s move to discard what it calls the one-size-fit-all international data parameters used to measure the socio-economic progress of the country.
While some activists say that international norms must be seen as aspirational standards others have welcomed the change.
India is now actively discussing redrawing parameters to cater and accommodate its national diversity and local anthropometric measurements and has used — childhood stunting, female labour force participation rate and life expectancy at birth — to highlight the alleged anomalies.
Not new to recalibration, the Union Health Ministry in March this year developed and released its own mechanism for estimating TB burden in the country. Previously the Ministry questioned the World Health Organisation’s mathematical modelling used to estimate COVID deaths calling it “unscientific’’. More recently India has dropped questions on anaemia and disability from the National Family Health Survey-6 (NFHS) which is set to begin next month.
Central Government has cited three widely used data-driven development indicators — childhood stunting (India’s NFHS estimates based on WHO growth standards), female labour force participation rate by International Labour Organization and life expectancy at birth by United Nations in its working paper “Re-examining the estimates of India’s development indicators by international organisations’’ by the Economic Advisory Council to the Prime Minister – stating that global standards often present a misleading picture of important socio-economic development indicators.
Improper adjustments using modelling procedures end up skewing data for India, note experts adding that what is also worrying is the fact that there is a growing use of Environmental Social and Governance (ESG) norms in investment and trade decisions which it said increases the need for accurate data in these areas.
“The examination of well-known development indicators suggest that international agencies systematically underestimate socio-economic progress and this then feeds into wider global indices, but also clouds feedback on policy interventions,’’ says the paper co-authored by Sanjeev Sanyal, member of the Economic Advisory Council.
The paper states that the problem is well-known in the medical field and taking cognisance of the diversity of children’s growth (in this case stunting), Indonesia, U.K., and the US have developed their own growth charts for reference by medical practitioners.
Also for calculating life expectancy at birth for India the estimates were sharply cut by 3.67 years by the United Nations Population Division from 70.19 in 2019 to 67.24 in 2021.
“The globally established standards are something to aim for and every child has the potential to achieve is the message; provided she receives all the health and nutrition services needed for achievement. India should analyse the status of services rather than questioning the standards,” said Dr. Arun Gupta, pediatrician and convenor of Nutrition Advocacy in Public Interest (India), national think tank working in the area of nutrition.
Dr. Santhosh George, director of Cure International India Trust, working in the area of child health, said, “Nothing should seize India’s determination to better its performance and if it requires a paradigm shift in the present biased parameters, so be it. Favoured patterns may look at the half-empty glass, whereas India wants to look at the half-full glass and charge forward.”
Dr. Antaryami Dash, deputy director (Health and Nutrition), Save the Children, India said, ”The WHO 2006 growth standards have provided a valuable framework for comparing the growth of children under five across various races and ethnicities, enabling objective and straightforward assessments, particularly when making cross-country comparisons. However, a growing concern has emerged regarding the universal applicability of these standards, leading some countries, including the United States, to adopt their country-specific growth benchmarks.”
He said, “In developing nations, utilising the WHO 2006 standards has resulted in overestimating stunting and wasting cases. In India, the current practice of using WHO standards would translate to about 10 million and 12 million more children being classified as stunted and wasted, respectively, as opposed to a country and region-specific standard available for the Indian Urban Middle Class (IUMC).”
Dr. Dash said, “Similarly, a significant shift in reported wasting prevalence occurred when transitioning from the previously dominant National Center for Health Statistics (NCHS) growth references to the WHO standard. Pooled data from 21 developing countries demonstrated that the prevalence of severe wasting in infants under six months increased by 3.5 times, while severe child wasting was 1.7 times higher when applying the WHO standard as the new case definition.”
“While the WHO 2006 growth standards prove invaluable for global growth comparisons, exercising caution is crucial when applying them to modify clinical protocols or formulate feeding recommendations. India should engage in an informed and transparent discussion to assess whether sole reliance on the WHO Growth Standards-based prevalence is appropriate or whether an India-specific reference should be considered. This becomes particularly important when setting national targets for addressing stunting and wasting in the country,“ he added.
The paper also noted that international estimates are plagued by conceptual mistakes and inappropriate benchmarks to shoddy methodology.
