The Circle Game

Poverty and malnutrition feed on each other

By Jin Paul De Guzman

In terms of nutrition, how does our country compare with its Southeast Asian neighbors? "We're in the bottom rank," says Dr. Demetria Bongga, president of the Nutritionist-Dietitians Association of the Philippines and professor of nutrition at the University of the Philippines-College of Home Economics.

    It's been two years and two presidencies into the 20th century, which the Ramos administration had promised to be the start of our country joining the ranks of newly industrialized countries. Despite promising pictures of slow but sure economic growth, the fact remains that we haven't quite left the ranks of the world's poor nations. Still the nation's poor constitute between 60 and 70 percent of the population. This, among many other things, has a genuine impact on the nutritional status of the nation.

Malnutritional Manifestations

    Dr. Bongga says: "Malnutrition is an indicator of economic plight--it really goes up and down with the economic [situation]." Although the results of the 1998 National Nutrition Survey (NNS) may no longer hold true, the slight improvement--if we were to base our observations on latest government data--in the economic situation could also mean a slight improvement in the national nutrition status. Unless the next NNS, which shall be undertaken next year, shows a significant leap, we shall assume the nutritional issues of 1998 still apply today. And two of these issues are protein energy malnutrition and micronutrient deficiency.

    Using weight-for-age, height-for-age, and weight-for-height standards set by the Food and Nutrition Research Institute and the Philippine Pediatric Society, about three out of every five children under five years could be considered normal. Using weight-for-age standards about 40 percent of kids of the same age range are underweight and five percent are overweight; using height-for-age standards a little more than 30 percent of kids are considered stunted and 2.5 percent are of "above average" height; and using weight-for-height rules about 30 percent are considered wasted and five percent overweight. The different shades of underweight being closely related to protein energy malnutrition, this leads to the poor absorption of many necessary nutrients. "You need fat to absorb [micronutrients]…and you need protein because [micronutrients, especially] vitamin A cannot be carried to your tissues without protein," Dr. Bongga explains.

    Thirteen of the country's 16 regions have significant numbers of kids suffering from vitamin A deficiency, while nearly 11 percent of all mothers suffer from night blindness. Dr. Bongga says that vitamin A deficiency takes a heavy toll on visual development, and "if it progresses, there would be stages that are irreversible."

    The highest rates for iron deficiency anemia are in pregnant and lactating women--50.7 and 45.7 percent, respectively. Dr. Bongga says that while the government distributes iron tablets to pregnant women to address this problem, this is hardly enough. Just imagine, she says, having to give 120 iron tablets to each woman who is in her second or third trimester of pregnancy--this, after considering the birth rate and the number of women of child-bearing age. "It's really a drain on our resources," she says.

    And since nutrition does not begin at birth, those children conceived by iron-deficient mothers also suffer from various degrees of iron deficiency. One way iron deficiency manifests in a child is this: "If you make the child go to school, sasabihin ng teacher bobo. Pero hindi bobo e-wala siyang motivation to learn, wala siyang stamina. The child lacks strength."

    Iodine deficiency, while considered mild by the NNS, cannot totally be ruled out as a problem. "Iodine deficiency can cause mental retardation in children," Dr. Bongga says. "Children born of iodine-deficient mothers are 13 IQ points lower [than normal]." These are but a few of the problems.

    Now here are some pieces of information about our neighboring countries in the issue of nutrition. Thailand, Dr. Bongga says, no longer has severely underweight and moderately underweight children. "They have done it in 10 years," she says. The rate of stunting and wasting in the Philippines is significantly higher than in Singapore, Malaysia, and even Indonesia. The Japanese have a life expectancy of about 80 years, while Filipinos are still reaching for 70 years.

    But one major point to consider: Many of our neighbors are now alarmed about the growing incidence of overweight and obesity. The Philippines, meanwhile, has a "small problem of obesity in children, but the bad news is we're still grappling with undernutrition."

Catch-22

    "Malnutrition and poverty [form] a continuous cycle," Dr. Bongga explains. "Because you're malnourished, you're unproductive. Because you're unproductive, you don't earn much. If you don't earn much you don't buy enough food." And if one doesn't--or more appropriately, can't--buy enough food one can't be properly nourished. The situation is like the proverbial dog chasing its tail.

    And this doesn't take into account other variables yet--the loss of agricultural land, the pollution of natural resources, cultural and political constraints, and others. All of these form concentric rings that cover areas ranging from the personal to communal, from the local to the global.

    The question is, where do we start?