Sri Lanka has achieved excellent health indicators in maternal and infant mortality, life expectancy and immunization. Yet malnutrition remains a major problem.
 
The intergenerational vicious cycle related to malnutrition has four main stages: (i) low birth weight infants; (ii) child growth failure; (iii) malnourished stunted adolescents and (iv) small statured malnourished reproductive age women. Detailed evidence exists on three components of the vicious cycle for Sri Lanka. The DHS 2006/2007 data that links malnutrition (both under and over nutrition) in women aged 15-49 (the reproductive age group), weight at birth and in children under five to the asset index clearly shows that malnutrition is linked to economic inequalities. The very lack of national level information on the third component of this cycle is an issue of importance. Small studies, anecdotal evidence and the continuing intergenerational cycle clearly indicate that adolescent malnutrition is a major problem in the country.
 
Why is malnutrition a problem today but a crisis tomorrow?
Malnourished children are likely to end up as stunted adults with lesser intellectual abilities and hence lower productivity. Given the challenge of demographic transition a countries growth depends on improved productivity. Firstly then from an economic as well as a humanitarian angle focusing on reducing malnutrition is a priority.
Secondly, evidence clearly indicates that malnutrition at all stages of the life cycle is linked with income inequality. Early childhood mortality is negatively linked to wealth levels (DHS 2006/2007). Most deaths in early childhood, in countries with safe delivery and high levels of immunization are linked to foetal growth, with abnormalities in nutrition being a major determinant. Breaking the intergenerational cycle of malnutrition could contribute significantly to breaking the intergenerational cycle of poverty and improving equity.
Thirdly breaking the vicious cycle between maternal malnutrition and low birth weight is particularly important now given the wide spread acceptance of the Barker hypothesis on NCDs (that maternal malnutrition leading to poor gestational growth of the foetus causes the individual’s metabolism to be unfit to cope with higher levels of nutrition and so more prone to NCDs). Non Communicable diseases (NCDs) have major health impacts and impose heavy economic burdens on the individual, household and the national health system, apart from the major psychic costs that result from NCD morbidity and mortality at early ages.

• What then are the policy issues that emerge in this context? What measures should be taken to break the intergenerational cycle? What new measures would you propose?
• Should the health system be focusing on adolescent nutrition and if so what measures would be appropriate?
• While much discussion in policy circles is on the need for inter-sectoral coordination, in practice this component seems dormant. What mechanisms could ensure more systematic and dynamic coordination? 
• Malnutrition while closely related to food security still is still complicated by the fact that on the one hand malnutrition remains a problem even in non-poor settings and on the other that obesity (a non-communicable disease risk factor) is a problem even among the poor. What socio-cultural factors should be addressed in this regard?

Blog synthesis : Malnutrition: Today’s problem – Tomorrow’s crisis