Hunger Games: Decoding the Global Hunger Index and the government response it elicited

The 21st edition of the annual Global Hunger Index was released in October. India was ranked at 101 in a list of 116 low- and middle-income countries.

The Modi government promptly rubbished the report and issued a strong rebuttal. This piece attempts to unpack the GHI report, the government’s response, and the larger issue of hunger in India.

So, what is the Global Hunger Index? Its website describes it as a “peer-reviewed annual report, jointly published by Concern Worldwide and Welthungehilfe, designed to comprehensively measure and track hunger at the global, regional and country levels. The aim of the GHI is to trigger action to reduce hunger around the world.”

An obvious question to ask is, how can hunger in a population be quantified? After all, only then can one conduct an exercise of ranking, cross-country comparisons and the like.

The Global Health Index breaks hunger into three dimensions.

1) Undernourishment: This component captures the hunger situation of the population as a whole and is defined as the consumption of too few calories vis-à-vis an individual’s dietary requirements given their age, sex, stature, and physical activity. It measures inadequate food supply, an important indicator of hunger.

2) Child malnutrition: Children are particularly vulnerable to undernutrition. In children under five years of age, chronic undernutrition results in stunting (low height for their age) and acute undernutrition results in wasting (low weight for their height). Both wasting and stunting can be objectively measured and are hence reliable indicators of nutrition availability in a population.

3) Child mortality: An extreme consequence of child malnutrition is death. While it is not the only cause, studies suggest that up to 45 percent of deaths under five can be attributed to inadequate nutrition.

The report says there are several advantages to using this combination of indicators:

“The indicators included in the GHI formula reflect caloric deficiencies as well as poor nutrition. The undernourishment (also referred to as under-nutrition) indicator captures the hunger situation of the population as a whole, while the indicators specific to children reflect the nutrition status within a particularly vulnerable subset of the population for whom a lack of dietary energy, protein, and/or micronutrients (essential vitamins and minerals) leads to a high risk of illness, poor physical and cognitive development, and death. The inclusion of both child wasting and child stunting allows the GHI to document both acute and chronic under-nutrition. By combining multiple indicators, the index minimises the effects of random measurement errors.”

Closely tied to the dimensions of hunger described above, each country gets a GHI score that is calculated using four components.

1) Undernourishment data provided by the Food and Agriculture Organisation of the United Nations. This accounts for one-third of each country’s score. As we shall see later in this piece, the methodology for this component for 2021 GHI scores has drawn sharp criticism from the government of India.

2) Child wasting data drawn from multilateral agencies such as Unicef and the World Health Organisation. This accounts for one-sixth of each country’s score.

3) Child stunting data drawn from multilateral agencies such as Unicef and the WHO. This accounts for one-sixth of each country’s score.

4) Child mortality data sourced from the United Nations Inter-agency Group for Child Mortality Estimation, or UN IGME. This accounts for one-third of each country’s score.

There are some technical things to keep in mind, about how annual GHI scores are computed for each country.

One, the data for the four components listed above is not limited to the preceding year. Instead, numbers for each component are collected over different time windows. For 2021, the undernutrition data is from 2018-2020, the child wasting and stunting data is from 2016-2020, and child mortality data is for 2019.

Two, each of the four component indicators is normalised to thresholds set slightly above the highest country-level values observed worldwide for that indicator since 1988. For example, if the highest value for undernourishment estimated in this period is 76.5 percent, the threshold for standardisations is set a bit higher, at 80 percent. Then, if in a given year, a country has an undernourishment prevalence of 40 percent, its standardised undernourishment score for that year is 50 (40/80 × 100).

In other words, that country is approximately halfway between having no undernourishment and reaching the maximum observed levels. It follows that a lower score indicates higher levels of food security in a country.

Three, the absolute GHI scores for any country cannot be compared with past GHI scores since methodologies have evolved over the years. So, one should not draw any conclusions looking at the trendline of India’s composite GHI score over a period of time. But to allow for tracking a country’s GHI performance over time, each year’s GHI report includes scores for comparing points from the three past. So, the 2021 report has indicator scores for 2000, 2006, and 2012, which can be compared with 2021 GHI scores.

Armed with this understanding of GHI scores, we can now decode what the GHI report of 2021 tells us about hunger in India.

But before that, it may be worth reflecting on the larger point behind this annual ranking exercise. It can be argued that human development metrics like hunger should not be assessed relative to how other countries are doing. After all, what should matter is that less Indians are hungry in 2021 compared to past years. Whether that number is higher or lower than those struggling with food insecurity in other countries is irrelevant.

Therefore, the GHI report’s primary utility is in that it shines a light on an important, existential issue. Instead of getting too wrapped up in rankings, policymakers and advocates should use the GHI report to assess food security in their country and the efficacy of measures in place to address it.

With that caveat, let’s zoom into how India has fared in the GHI rankings in recent years. Table 1 charts India’s GHI score over the last five years.

As the table clearly shows, India’s ranking on this scale has been almost identical in the last four years, when viewed as a percentage of the total countries ranked each year. Thus, starting 2018, India fares worse than roughly 87 percent of the countries ranked each year.

It is surprising that the Indian government took particular offence to this year’s GHI report, when in essence it conveyed the same information that it has been for the last four or five years about India. Perhaps, the optics of “dropping” from 94 in 2020 to 101 in 2021 spurred the rebuttal. But as Table 1 shows, our relative position in the global order was essentially unchanged because the number of countries which were ranked in 2020 also fell, compared to 2021 (and most other years).

Even if unwarranted, the government’s criticism of this year’s GHI report merits scrutiny. The arguments put forth by the women and child development ministry to discredit the report hinge on two points.

1) The report is “unscientific” due to flaws in data on undernourishment (which makes up one-third of the GHI score, as you may recall).

2) The report does not acknowledge the government’s initiative to distribute free grain in 2020 under the PM Garib Kalyan Yojana, or PMGKAY.

The only way to sanity-check the data used for any statistical analysis is to corroborate it with other available sources.

The National Family Health Survey was released recently and reports on many of the same metrics as the GHI. The NFHS is a rich data-set collected by surveys conducted in every state and union territory of India between 2019 and 2021 over a wide range of subjects including health.

This survey was conducted in two phases. Phase I covered 22 states and union territories with data collected between mid-2019 and early 2020, before the pandemic hit. Phase II covered the remaining 14 states and union territories, with data collected between late 2020 and early 2021, after the pandemic-induced lockdowns had ended.

Metrics that overlap between the GHI and NFHS include all three components of child malnutrition: stunting, wasting and mortality. Although the timeframes of data collection do not align perfectly between the GHI and the NFHS (or even between Phase I and Phase II of the NFHS itself), comparing their findings is instructive.

So, let’s see how these two data-sets stack up.

Table 2 compares child stunting, child wasting, and child mortality data between the two reports.

The table above shows that there is considerable agreement between the numbers from both data sources – thereby cross-validating both. It is noteworthy that for all three metrics reported above, the data in the GHI is actually more favourable than in the NFHS, even if only marginally. Thus, for two-thirds of the components that go into the final GHI score, it can be argued that the data used in the GHI shows India in a better light than the government’s own data.

It is easy to get caught up in statistics, but it is worth reflecting on the humanitarian devastation conveyed by this data. More than three out of every 10 children in India are stunted – a condition brought about by chronic undernutrition. Similarly, almost two out of every 10 children suffer from wasting – a condition caused by acute malnutrition.

Worse still, four out of 100 children don’t even make it alive past the age of five. This translated to an estimated 8,24,000 deaths of children aged under five in 2019 – almost twice as many total (reported) deaths due to Covid-19. Surely, the children of this country deserve better.

The one silver lining amidst this grim data is that child nutrition metrics on NFHS-5 have improved since 2014-15, when this exercise was last conducted. Figure 1 below shows the improvements made between 2014-15 and 2019-20 in child stunting, child wasting, child mortality, and underweight children.

This marginal improvement in food security statistics is also reflected in the GHI, where India’s GHI score improved from 28.8 in 2012 to 27.5 in 2021.

While this trend is encouraging, the absolute numbers on child stunting, wasting, and mortality are still alarmingly high, and many states have regressed on these parameters (even though the nationwide statistics are better). The slow and stubborn change in nutritional indicators underlines the enormous challenge of solving food insecurity for a population plagued with extreme and endemic poverty. Governments at all levels must continue to make food security an urgent priority to address this humanitarian crisis.

Coming back to the GHI report, none of the data from the National Family Health Surveys directly address undernutrition. Recall that it was the undernourishment data that the government took particular umbrage to. The ministry’s specific complaint is that the UN’s Food and Agriculture Organisation, which provides undernourishment data to the GHI, resorted to a four-question telephone survey this year to compute undernourishment for 2020.

This is a significant mischaracterisation of the FAO’s methodology. In its The State of Food Security and Nutrition in the World report for 2021, the FAO details the method used to estimate the prevalence of undernourishment in 2020 for each country, which is the figure GHI takes for its scores. While the FAO does mention the use of a four-question survey to assess income loss due to Covid which feeds into the final estimate, there is a lot more that goes into coming with that score. Interested readers should look up Annex 2 of this report.

This is not to say that the undernourishment data for India was definitely accurate, or that it could not have suffered from a downward bias. But the government’s specific methodology critique is misleading, if not inaccurate.

Another heuristic that the Modi administration uses to cast aspersions on this year’s GHI report is the change in numbers for undernutrition from 2020 to 2021 for India vis-à-vis its neighbours. While the FAO (and hence GHI) shows a slight decline for India, the corresponding figure for Afghanistan, Bangladesh, Nepal and Sri Lanka do not show a similar dip. This “anomaly” seems to exacerbate the government’s sense of India being treated unfairly by these foreign multilateral institutions.

Given the government’s finger-pointing at our neighbours, a quick comparative analysis is in order.

The table above reveals a sobering fact. While India may be the economic powerhouse in South Asia, we continue to trail most of our neighbours on many human development indicators. Other than Afghanistan, India’s GHI rank is lower than all our South Asian neighbors.

Finally, let’s examine the Modi administration’s grievance about the GHI report ignoring the government’s foodgrain initiatives during Covid-19.

Since independence, India has had a system of public distribution of foodgrains, or PDS, to combat chronic food shortages and hunger. A detailed analysis of the evolution, expansion and efficacy of the PDS is outside the scope of this article. But some broad points may be relevant to this discussion.

In 2013, the erstwhile United Progressive Alliance regime passed the National Food Security Security Act. This law fundamentally altered the government-citizen dynamics around food security, making food a right. It entitled 81.35 crore Indians to receive at least five kg of wheat or rice at highly subsidised rates (Rs 2 and Rs 3 per kg, respectively). The NFSA and the PDS remain the central policy planks of the central government’s response to address hunger and food security across all age groups.

Last year, during the nationwide lockdown, the NDA government launched the Pradhan Mantri Garib Kalyan Anna Yojana, or PMGKAY, leveraging the PDS-NFSA framework. NFSA beneficiaries were provided an extra five kg grain per month free for April to November 2020. Along with PMGKAY, some state governments announced their own foodgrain distribution measures.

As a result, the total foodgrain offtake from government stocks hit an all-time high. Figure 2 below shows the annual consumption of foodgrains.

As the chart shows, the offtake of rice and wheat crossed an all-time high in 2020-21 and was roughly 50 percent higher than the previous fiscal year.

Thus, the government is not being disingenuous when it points to its efforts to combat food insecurity in 2020. Food rights activists would counter that an administration committed to ending hunger would not use outdated 2011 population census figures to calculate the number of NFSA beneficiaries. According to estimates, almost 10 crore people are being excluded from PDS food entitlements due to this undercoverage. Reports like the GHI and the NFHS could help bring such demands into the public spotlight and spur necessary debate on food policy and its complex entanglements with related domains of agriculture, PDS, and fiscal deficit.

On the topic of food policy, while the government was able to ramp up foodgrain distribution to counter the adverse effects of the pandemic, another important scheme for tackling undernutrition actually suffered. The mid-day meal scheme was adopted nationwide in 2001, following a Supreme Court directive. Under the scheme, a prepared mid-day meal is to be provided to every child enrolled in a government primary school.

Over 10 crore school children benefit from hot, cooked meals under the MDMS. Studies have found that the MDMS has helped tackle malnutrition and stunted growth in children.

In 2020, Covid forced school shutdowns for large portions of the year, jeopardising the MDMS. The union government issued guidelines to states to ensure the continuity of the scheme by providing mid-day meal entitlement to children in kind, cash or both. But reports suggest that the implementation of these guidelines on the ground was uneven and riddled with challenges. Since most kids attending school don’t fall in the age bracket specified in the GHI child nutrition scales, the food insecurity resulting in disruptions of the MDMS would result in increased undernutrition and manifest in the GHI undernourishment scale.

The discussion above clearly shows that both hunger and the policies to address it are multidimensional and complex. Distilling these complexities into scores and rankings will inevitably involve estimates that are vulnerable to inaccuracies. From such a vantage point, exercises such as the GHI have limited utility.

But the GHI is not an attempt to depict a highly granular and accurate food security scenario for every country in the world. It gives a broad overview of the global state of hunger and creates some buzz each year when the rankings are released, bringing public attention to a dire, urgent problem – both net positives. The Modi government’s response to discredit this year’s report comes across as a misleading diversionary tactic. Plus, it seems unnecessary given that India’s global hunger rating this year is really not any more damning than the previous few years.

Maybe the response just follows a pattern of hypersensitivity to foreign criticism, which is always viewed and portrayed as attempts to sabotage India. Maybe it's all Rihanna’s fault. Her songs may be forgotten, but her tweets seem to create lasting memories.