The many examples where Prime Minister Imran Khan emphasizes growing poverty and poor health outcomes remind me of how a poor family is caught in an endless poverty trap.
Whenever I hear the PM talk about stunting or infant mortality, I remember the obvious factors that contribute to the deterioration of health indicators. Milk (with all its nutrients), a necessity for a pregnant woman, is difficult to acquire by the poor layer. There is a large number of maternal and child deaths due to malnutrition in Pakistan which is steadily increasing compared to other neighboring countries. The rates of malnutrition, stunting and wasting remain alarming and impact the lives of many children. Almost half of all deaths of children under five are attributable to undernutrition. Poor nutrition in the first 1000 days of life can lead to stunted growth, impaired cognitive abilities, and reduced academic and work performance.
Despite being one of the largest milk producing countries and having the highest number of milk producing animals, Pakistan faces severe malnutrition and milk shortage. It is estimated that only 45% of the milk produced is available for sale in the country. Of the milk sold by farmers, 15-19% is wasted due to inadequate cooling, storage and transportation systems.
Adulteration of raw milk is a unique barrier to accessing safe and hygienic dairy products in Pakistan. In a country where over 90% of the dairy market is informal and unregulated, adulteration is an alarming practice and poses serious health risks to consumers and pregnant women and children, in particular. Studies link unhealthy milk consumption with undernutrition in women and suboptimal growth in children. The interplay between undernutrition and infection from unsafe milk can create a life-threatening cycle of worsening disease and deteriorating nutritional status. Knowing this, consuming bulk milk should be out of the question. There are effective control measures that can minimize the risk of milk-borne diseases, of which minimal pasteurization is essential.
However, on a broader public health spectrum, consuming safe / processed milk is also not an affordable option for families living below the poverty line. It is relevant to understand here that the rise in prices is an expression of the problems facing the packaging industry in terms of quantity, quality and cost related to milk processing.
As we mentioned about quantity, the demand for milk grows faster than its supply, creating a substantial deficit. The small herd size, lack of selective breeding and nutritional deficiencies further reduce animal productivity. With this imbalance, the law of demand plays its role leading to an increase in prices until the demand for milk is at the same level as its supply. Quality has its own set of issues; unsanitary animal environment, feeding practices and poor mechanization of dairy farming, made worse by poor infrastructure, contaminated water and power outages. This represents a cost for the dairy industry to ensure that milk from small and medium-sized farmers meets the set quality parameters. In addition, the ever-increasing cost of inputs and the abolition of the zero-rate tax policy lead to higher milk prices, making it unaffordable and leading to an overall decline in packaged milk sales.
Ultimately, packaged milk turns out to be an unlikely choice for consumers in general and the poor in particular. Access to safe milk, such as clean water, is everyone’s priority and should be made readily available.
It is time to eliminate the root cause of the problem and do something beyond just mentioning the poor in our discussions. Such rhetoric is gaining popularity for us, but we need to do better on our health indicators. The United Nations Sustainable Development Goals (SDGs), to which Pakistan is a signatory, also speak of ending hunger (SDG-2 on zero hunger). Ensuring the availability of safe milk can dramatically improve our health and poverty indicators. Not all poverty comes from wealth, some also comes from deteriorating health conditions.
The most threatening type of poverty is being poor in terms of health.
Posted in The Express Tribune, May 24e, 2021.