The average height of Indians have significantly decreased over the last decade, notes a recent paper published in PLOS medical journal. Using the third and fourth National Family and Health Surveys, the researchers compared the heights of Indian citizens on the basis of age, sex, religion, types of caste or tribe, place of residence, wealth index, geography.
Barring the heights of women between the ages of 26-50, which increased by 0.13 cm, the average height of Indians declined. The height of women between 15-25 decreased by 0.12 cm, and heights of men between 15-25 and 26-50 decreased by 1.10 cm and 0.86 cm respectively.
In the same period, the average heights across the world have been higher than that for Indians, note the authors. BOOM found that during the same period, even though heights across the world were higher than that in India, trends show that heights have marginally decreased, across the world, too.
Height, an important indicator of growth, is not only governed by genetic factors but has several other environmental and socio-economic factors also at play. The results show that the average heights of women belonging to the poorest wealth index category as well as those from the Scheduled Tribes reported a significant decline of 0.57 and 0.42 cm from the NFHS-III estimates. Furthermore, they also mention that economic productivity is linked to average heights.
BOOM spoke to two public health nutrition experts- Dr. Shweta Khandelwal, Head, Nutrition Research, and Dr. Suparna Ghosh Jerath, Professor and Head, Community Nutrition, both linked to the Public Health Foundation of India to understand the role of nutrition in growth indicators.
Along with the past indicators, it also becomes pertinent to understand how COVID-19 and the reduction in the budget for nutritional programs could further impact development of women and adolescents.
Why Do Some Countries Have Taller People Than Others?
Considered to be the tallest people on the planet, even The Netherlands have reported that compared to 1980, males and females born in 2001 are approximately 1 and 1.4 cm shorter than their 1980 counterparts. It is also noteworthy that the Dutch were named the tallest only from 1960 onwards but were considered to be one of the shortest people earlier. An improved quality of life and equitable distribution of wealth assisted in bringing about this change.
During the same time frame as considered by the Indian authors, America's National Center for Health Statistics conducted a survey to measure anthropometric data such as height, weight, and BMI. Average heights in the US for both men and women across time frames was seen to be stagnant with no significant changes but was starting to show a decline, instead.
The US experts questioned the dietary and lifestyle changes in the normal American's life to understand why heights were not improving in the period.
According to the WHO's growth reference standards, the expected average height of a woman should be 163 cm (5 ft 4.3 in) and the average height of a man 176.5 cm (5 ft 9.5 in). However, due to the living conditions of a population along with its genetic potential, the average heights are very different. Indonesia and Bolivia have the shortest people in the world. The average heights are a reflection of the poor economic development and prevailing malnourishment in the country.
How Does Nutrition Affect Height?
Two public health nutrition experts from Public Health Foundation of India BOOM spoke to explained how nutrition besides genetics plays a very important role in height development in children and young adults.
"Proper nutrition is an important environmental and social factor which determines optimal growth which in turns results in ideal height for age in children. The less than optimal gain in height due to lack of proper nutrition is called stunting," said Dr. Suparna Ghosh Jerath, Professor and Head, Community Nutrition.
Dr. Shweta Khandelwal, Head, Nutrition Research explained how the paper reflects on intergenerational impact. "Trends in height take some time to change like we have seen in this paper. Essentially the point the paper is making is to reflect on the intergenerational impact or deprivation of other nutrients in their growing years. The initial stunting in their childhood perhaps or the opportunities they got at that time are reflecting in their heights currently," she said.
The public health nutrition expert said that the height in the first two years of life is governed by the nutrition one gets, and that determines adult height too. But, she said, there have been cases of people who have managed to override childhood stunting due to their economic capability. However, by and large, she said that childhood stunting is irreversible.
Dr. Jerath added, "if the mother is undernourished or is herself growing (adolescent pregnancies) and has not reached her full potential height, her baby is at higher risk of being undernourished and nutritional insult for the baby may start from the womb itself."
The paper points out that women belonging to a certain economic group or caste showed a further decline in average heights.
Dr. Jerath spoke about the inequalities prevalent in provision of nutrition and differences in the nutritional status among different sections of the population. "The population as a whole has inequalities in terms of nutritional intake. Several children are not receiving optimal nutrition and as a result do not grow up to their full potential. This compromise in nutrition shows stunted growth in several children which then adds up to poor adult height reflected in the population."
On the question of how stunting can be controlled, Dr. Khandelwal said, "It is important that we target the modifiable predisposing factors that affect both nutrition and height and work on them so that these children can then go on to become healthier adults. The mother's education also plays a huge role in the nourishment provided to the child. It affects the child's height attained."
Nutrition in the first 1000 days is "extremely crucial" along with enabling policies such as good quality take home ration, the ICDS program, and nutrition education. "All of these come into play for better stunting management," Dr. Khandelwal added.
Genetic factors such as maternal status play a role but such a trend needs further research to explore what are the plausible socio-economic factors that are governing growth in children. The role of the government in boosting public health nutrition is equally important to address this issue.
The Integrated Child Development Scheme, a part of the Women and Child Development Ministry, focuses on providing regular quality nutrition to children and women for their overall growth and health. The mid-day meal program, take home ration, vitamin and folic acid pills for teenage girls are some of the programs run by the ministry. The ministry runs special programs for adolescent girls as it has been widely witnessed across the country that adolescent women do not get enough nutrition to sustain their health. They either drop out of school or are given lesser food than the male child in the family.
Will COVID-19 And Budget Cuts Cause More Problems?
Even though this study only reflects on trends till 2016, the recent pandemic has the potential to worsen the situation for access to nutrition. A July 2021 paper by researchers from the World Bank, and Micronutrient Forum shared that COVID-19 will further exacerbate maternal and child undernutrition in low-and-middle income countries.
The paper estimated that more than 2.6 billion children across the world could face stunting as the pandemic affected the supply of adequate nutrients to the population in need.
Coming to India, while over 35 per cent of kids under 5 are stunted, the budget for nutrition was reduced in the Union Budget of 2021-2022. The budget allocation was reduced to ₹2,700 crore from ₹3,700 crore in 2020-21.
While the government has the POSHAN Abhiyaan, it also scrapped the breakfast scheme which was supposed to be a part of the mid-day meal program.
"Evidence based interventions that have shown to reduce stunting cannot be continued without adequate resources, and for that we need to see proper budgetary allocations," Dr. Khandelwal concluded.