The INDIAN JOURNAL OF SOCIAL WORK Volume II DECEMBER 1941 Number 3 ...
The
INDIAN JOURNAL OF SOCIAL WORK
Volume II DECEMBER 1941 Number 3
ECONOMIC ASPECTS OP THE PROBLEM OP NUTRITION IN INDIA
W. R. AYKROYD
Though India has a very poorly nourished population, it is only recently that the subject
of nutrition has come to receive some attention. A considerable proportion of our popula-
tion reveals malnutritional conditions due largely to qualitative defects in the ordinary diet
of the people. In this article, Dr. Aykroyd analyses the economic aspects of the problem of
nutrition, maintaining that if the resources of science are brought to bear upon the problem,
progress can be made, however formidable the obstacles of poverty and ignorance.
Dr. Aykroyd is the Director of Nutrition Research Laboratories of the Indian Research
Fund Association in Coonoor, South India.
WITHIN the last 30 years science has reached definite conclusions as
to what constitutes a good diet for human beings. The principles of
correct feeding are fairly well understood and "optimum" dietary
standards based on these principles have been drawn up by League of Nations
Commissions and other authoritative organisations. Now generally speaking
a "good" diet—i.e. a diet which approaches or attains the physiological opti-
mum—costs more than a diet which fails at various points to satisfy human
nutritional requirements, and consequently there is a close correlation between
the economic status of a family or population group and the physiological value
of its diet. In a sense this is a platitude, perhaps better expressed in a simple
phrase such as "the poor can't afford to buy enough of the right sort of food
to eat". But a more detailed analysis of the relation between income and diet
than such a phrase provides helps in the understanding of the problem of
nutrition in India.
Dietary Standard's .—The League of Nations "optimum" type of diet is
rich in first class proteins and in all the essential vitamins and mineral salts.
In terms of actual foods, this means a high intake of milk and milk products,
meat, fish, vegetables and fruit, and a relatively low intake of cereals. The
staple grain foods of mankind—rice, wheat, maize, etc.,—are relatively defi-
cient in certain essential food constituents required by human beings and must
be adequately supplemented by other foods—in general more expensive foods—

270 W. R. AYKROYD
which are richer in these necessary constituents. A diet composed exclusively,
or almost exclusively, of cereals will not support proper growth in young
animals.
Let me illustrate the above point by reference to Indian diets. In Table
1, a typical "ill-balanced" Indian diet is compared with a "well-balanced"
diet which more nearly approaches the League of Nations standard and in the
same table the chemical composition of the two diets is given.
The well-balanced diet is much richer in the very important B2 group
of vitamins than the ill-balanced one. Both the diets have the same calorie
content or energy value; 2,600 calories represents approximately the daily
energy requirements of an average Indian male. Both therefore will satisfy
hunger. But the more varied "well-balanced" diet, containing less cereal and
more of everything else, is infinitely more satisfactory in quality, and the
health and development of a population consuming this kind of diet will be
superior to those of a population whose diet resembles the "ill-balanced" diet.

THE PROBLEM OF NUTRITION IN INDIA 271
The "ill-balanced" diet shown in the table will cost from Rs. 2/- to 3/-
per adult per month, depending on the nature of the cereal and of course
on differences and fluctuations in food prices. The cost of the "well-balanced"
diet may be estimated as Rs. 4/- to 6/- per adult monthly. A family
containing four consumption units—i.e. the equivalent of 4 adult males—must
therefore spend Rs. 16/- to 24/- per month on food, or let us say, Rs. 240/-
annually to obtain a diet of this satisfactory standard, and rather more if
allowance is made for an intake of 8 ozs. of milk daily on the part of children.
An ill-balanced diet, sufficient in quantity but defective in quality, will cost,
let us say, Rs. 10/- monthly for a family of the same size.
These figures may be set against actual income levels in India in so far
as these can be determined. The income of urban or industrial groups can be
assessed with fair accuracy; for example, the average monthly wage of an un-
skilled urban worker, such as a peon, is about Rs. 12/-, or Rs. 144/- annually.
But when agricultural families are concerned the assessment of real income on
a monetary basis is a very difficult matter. A number of attempts have been
made to estimate income in terms of cash in village groups, and some of these
may be quoted, though with considerable reserve. Average total annual in-
come per family in Bengal has been estimated as Rs. 150/-1, in a group of very
poor rural families in Madras as Rs. 100/-2, and Rs. 125/-3 in families in the
Kangra Valley, Punjab. The following analysis of net income per family in
a rural area in Mysore, with a population of about 50,000, was made by the
Closepet Health Training Centre4 in 1935. The survey included 11,142 fami-
lies, giving an average family membership of about 5 individuals.
1 Azizul Huque— The Man Behind the Plough. Book Co., 1939, (Calcutta).
2 Aykroyd and Krishnan—Indian Journal of Medical Research, 1937; 24 : 668.
3 Punjab Public Health Dept., "An Inquiry into Diets, State of Nutrition and Factors
Associated Therewith, in Relation to Health in the Kangra Valley, Punjab, 1939."
4 Handbook of the Rural Welfare Centre, 1939, Closepet, Mysore,

272 W. R. AYKROYD
In more than half the families estimated annual income per family was
below Rs. 120/-.
Estimates of national per capita income must also be regarded with a
dubious eye, because the basic statistics necessary for such calculations are not
fully available. One of these may be quoted—that of V. K. R. V. Rao5, who
has worked out a figure of Rs. 65/-, with an error of 6 per cent, for annual per
capita income in British India. His estimate is somewhat higher than those
made by various other investigators.
Such figures, approximate and open to criticism though they may be,
serve at least to indicate the gulf between possible and desirable expenditure on
food. It is clear that a well-balanced diet of the kind shown in Table 1 is far
beyond the means of a large section of the population. Having established this
point, we can proceed to consider the problem in greater detail.
Diet and Economic Status.—The following passage, which refers to Eng-
land in 1933, is illustrative of the subject under discussion.
"Amongst the lowest income groups are still some who suffer from
actual hunger, but these are a declining element which could and should be
lifted out of their present situation without delay. Immediately above is a
much larger group, estimated to cover between 10 and 25% of the population,
who can afford enough food to fill their bellies, but cannot afford a diet of the
type and quality now known to be essential as a safeguard against mal-
nutrition and disease. On the next step upwards, measured by incomes, comes
another large group which commands enough purchasing power to obtain an
adequate diet for the whole family, provided that this purchasing power is com-
pletely spent on the lines suggested by such applications of modern research as
the report of the British Medical Association Committee on Nutrition. Actually
many of the incomes in this group, and especially the lower ones, are often
unwisely spent, at any rate from the strict standpoint of nutrition, and thus a
further large number of families falls, for practical purposes, into the zone of
malnutrition. The higher the income and the more money spent on food,
the smaller this risk becomes, but there is reason to suppose that even among
supertax payers a standard based upon the optimum established by recent
research would disclose the presence of malnutrition due to a faulty diet." 6
The same groups exist in India but the proportion of the population
falling into each is very different. The lowest group includes a much greater
percentage, and the higher groups a much smaller percentage. It is impos-
sible to estimate accurately the percentage of population which "suffers from
actual hunger", but certainly it is a large one. Over 70 diet surveys of groups
5 The National Income of British India—(1931-1932), Macmillan, 1940.
6 Political and Economic Planning, Broadsheet No. 44, 1935.

THE PROBLEM OP NUTRITION IN INDIA 273
of families, both urban and rural, have been made in various parts of the
country within recent years, and in about 30 per cent of the groups average
daily calorie intake per consumption unit was below 2,300—i. e. below any
reasonable standard of requirements. In various surveys in villages and
industrial areas an approximately similar proportion of families was found
to be underfed by the same standard. These observations cannot legitimately
be generalised into a statement about the extent of under-nutrition in India,
because the sample of the population—about 1,500 families—investigated was
small and cannot in a strictly statistical sense be taken as typical of the
country as a whole. But there can be no possible doubt that many millions in
India never get enough food to eat and this fact is of fundamental importance
in connection with agricultural policy. " E n o u g h food" takes precedence
over " t h e right sort of food". The principal aim of agricultural policy must
be to produce more food. India cannot afford to import food in large quanti-
ties. Agricultural departments and research institutes, and other departments
concerned with food supply, should never lose sight of this primary need, or
dissipate the major part of their energies in prosecuting schemes of secondary
importance, however useful and attractive.
One step out of the abyss, and we have the group which "can afford
enough food to fill their bellies, but cannot afford a diet of the type and
quality now known to be essential as a safeguard against malnutrition and
disease". This includes those whose diet resembles the ill-balanced but
quantitatively sufficient diet shown in Table 1, costing Rs. 2/- to 3/- per
consumption unit per month. Certainly a much higher proportion than 10 to
25 per cent of the population falls into this category—it is futile to attempt a
precise estimate. The higher groups, with sufficient "purchasing power to
obtain an adequate diet for the whole family", are correspondingly reduced in
comparison with the English classification. Ignorance as well as poverty
operates strongly in extending the zone of malnutrition. Plenty of people in
India, who could afford to consume an excellent diet and feed their children
on an excellent diet, do not in fact do so because of ignorance of the elementary
principles of nutrition.
Analysis of Expenditure.—Comparison of the cost of various kinds of diet
with estimates of total income are illuminating but crude, because they do not
take into consideration other expenditure items in the family budget. A
number of detailed family budget enquiries have been carried out, mainly by
Labour Departments, among industrial groups in various Indian cities; these
valuable studies, all too little known to the educated Indian public, throw
further light on the subject under discussion. Industrial workers in towns
and cities are a relatively highly paid class; it is the prospect of what appears to

274 W. R. AYKROYD
be a high wage which attracts the villager from the countryside into the squalid
slums of Bombay or Ahmedabad. Family budget enquiries based on field in-
vestigations among rural groups not in receipt of regular wage, and in fact for
the most part not living on a cash basis, are obviously more difficult than
similar enquiries in towns and cities, and few rural studies have been made in
India.
Adyanthaya7 carried out a family budget enquiry on a miscellaneous
group of labourers and coolies in Madras City, using standard International
Labour Office methods. Some of the data obtained in this investigation are
shown in Table 2 on the following page. Various interesting points emerge
from this Table. We may note first of all that monthly expenditure on food,
even in the lowest group, was slightly above that necessary to purchase an
ill-balanced diet sufficient in quantity. Presumably, therefore, the majority
of families were above the starvation level—they had enough to eat. The per-
centage of total income spent on food averaged 52.6 per cent in all families.
As income rises, so does the number of consumption units per family.
A rise in total income per family does not therefore necessarily result in a rise
of similar proportions in income per consumption unit. This means that work-
ers who are in receipt of incomes above the lowest levels gather needy depen-
dents and may themselves lose much of the advantage of superior pay—a
striking illustration of the poverty of India and the strength of family ties
which gives the destitute the right to share in the meagre goods of relations a
little better off than themselves. I do not think that a regular increase in the
number of dependents with increasing income occurs in industrial groups in
England and U.S.A. Apart from other factors, a cold climate and a higher
standard of housing would discourage the crowding in of extra dependents.
Probably, however, a similar trend could be observed in China and Japan.
In any group consisting of poor families at approximately the same economic
level, families including the largest number of dependents naturally tend to
be the worst fed; this is always strikingly apparent in diet surveys in India and
has been observed in similar surveys in other countries. But it is clearly not
the same thing as a steady growth in the number of dependents with rising
income. These facts have a bearing on the population problem, and the
question of family limitation, discussion of which is outside the scope of
this article.
Another point of great importance is that expenditure on food per con-
sumption unit did not rise proportionately to income per consumption unit.
While the incomes per consumption unit of families with incomes of Rs. 40/-
' Report on an Enquiry into the Family Budgets of Industrial Workers in Madras City
Dept. of Industries, Govt, of Madras, Govt. Press, 1940, Madras.


276 W. E. AYKROYD
to 70/- were definitely above those of families with total incomes below this
level, only the highest income group spent enough on food to purchase a well-
balanced diet. There was a rise in expenditure on milk with increasing in-
come but this was small until the highest income group is reached. The prob-
able explanation is that an ill-balanced diet is the normal diet of the poor in
South India, and poor families will not readily make sacrifices in other items of
expenditure to purchase a diet of superior quality. It is only when income
reaches a level which allows needs other than food to be fulfilled with relative
ease that more money is devoted to buying a better diet.
Very similar tendencies were elicited in family budget enquiries carried
out in Ahmedabad8, Sholapur9, Howrah, Bengal10 and Bombay11, on industrial
workers with monthly income ranging from below Rs. 20/- to Rs. 80/- or there-
abouts per family. The percentage of total income devoted to food ranged
from 50 to 60 per cent. Mitra12 has surveyed a group of families in Jharia,
Bihar, with monthly incomes of Rs. 5-2-0 per consumption unit or below, in
which 73 per cent of total income was spent on food. In general the results of
family budget enquiries in India confirm Engel's "law" that percentage ex-
penditure on food falls with increasing income. In all these urban groups rent
was a relatively important item of expenditure. It is of interest to note that
even when poverty is extreme 15 to 25 per cent of the budget is almost invari-
ably devoted to miscellaneous items including recreation and amusements. To
prefer luxuries to necessities is characteristic of the human species.
Improvement in Diet with Increasing Income
A detailed investigation of the relation between diet and income in Great
Britain has been carried out by Sir John Boyd Orr13. The population was
divided into six income groups, and by means of the study of family budgets
and diet surveys average expenditure on food in the various groups was esti-
mated. The various groups were as follows: —
Report on an Enquiry into Working Class Family Budgets in Ahmedabad, 1928,
Labour Office, Bombay, Govt. Press, Bombay.
Report on an Enquiry into Family Budgets of Cotton Mill Workers in Sholapur City
1928, Labour Office, Bombay, Govt. Press, Bombay.
10 Report on an Enquiry into the Standard of Living of Jute Mill Workers in Bengal,
1930, A. C. R. Choudhury. Govt. of Bengal, Commerce Dept., Secretariat Book Depot.
11 Report on an Enquiry into Working Class Family Budgets in Bombay City, 1935.
The Labour Office, Bombay, Govt. Press, Bombay.
12 Mitra, K., Ind. Jour. Med. Res., 1940, SI: 887.
Food, Health and Income, 1936, Macmillan.

THE PROBLEM OP NUTRITION IN INDIA 277
The type of diet consumed by each group was compared with optimum
standards of intake. It was found that the consumption of the more valuable
foods, e.g., milk, butter, cheese, meat, fresh eggs, fruit and vegetables, rose
with increasing income. A steady increase in the intake of protein, fat, vita-
mins, and mineral salts was observed in passing from the lowest to the higher
income groups.
In India interesting investigations of the same type but on a much smaller
scale have been made by Mitra (loc. cit.), Nutrition Officer in the Province of
Bihar. Mitra carried out diet surveys among industrial workers in Bihar by
the method of daily visits and weighing of food which provides more accurate
data about food intake and expenditure than family budget enquiries conduct-
ed by means of questionnaires. He was able to correlate income level and the
amount of each kind of food consumed. Data obtained in an enquiry in Jam-
shedpur, Bihar, in which the works of the Tata Iron and Steel Company are
situated, are given in Table 3 given on the next page.
The proportion of ghee in the item "oils and fats" rose with increasing
income and in group 4 ghee was the chief source of fat. This is one of the
reasons for the relatively high expenditure on food per consumption unit in
this group, which probably paid somewhat more for most articles of food
including rice because articles of better commercial quality were demanded.
Mitra's figures again demonstrate the increase in dependents in the
higher income groups. This is not quite as striking as in the families in
Madras City. Jamshedpur is a relatively isolated town to which labourers
migrate from other districts. In Madras City, families in receipt of regular
wages are more accessible to penurious relatives. Similarly Bhave14 recorded
a considerable difference between the number of consumption units per family
in a group of cotton mill operatives in Nagpur, the capital of the Central Pro-
vinces, and that in another group of workers employed in a manganese mine
in a small town, Tirodi, in the same province. While total income per family
was higher in the Nagpur families, income per consumption unit was con-
siderably lower because of the greater number of dependents, and the diet
2

278 W. R. AYKROYD
TABLE 3
Income and Diet in an Industrial Group
(Jamshedpur, Bihar, 1939)
consumed by these families compared unfavourably, both in quantity and
quality, with that of more poorly paid families in Tirodi.
The main point of interest in Table 3 is that it clearly demonstrates an
improvement of diet in the right direction as income rises above very low levels.
Intake of pulses, non-leafy vegetables, fruits, milk products, meat and sugar
in general rises with income and the same is true of intake of protein, fat,
calcium and certain vitamins. There was a corresponding reduction in the
14 Bhave, P. D, Ind. Jour. Med. Res., 1941, 29 : 99.

THE PROBLEM OP NUTRITION IN INDIA 279
percentage of calories from cereals. The diet of Group 4 resembled the
well-balanced diets recommended by nutrition workers more closely than did
that of Group 1. This does not, of course, mean that the better-paid families
arranged their budgets and food expenditure to the best possible advantage,
but it indicates a general tendency of great importance. In India, as in
England and other countries, an increase in income leads in general to a
change in diet which is to some extent in conformity with the principles of
sound nutrition. It follows that an increase in the material prosperity of the
country—a rise in the national per capita income—will per se tend to improve
standards of nutrition and with them the health of the population.
In Mitra's groups there was a fairly steady rise in the consumption of
most non-cereal foods from Group 1 to Group 4, and the rather sudden rise in
expenditure on food per consumption unit at a certain level of income, appa-
rent in the Madras group, was less evident. Comparison between the two
groups as regards this point is, however, made difficult by the difference in
income classification and possible difference in the real value of wages, depend-
ing on the cost of living and other factors. More detailed investigations
would be required to establish the suggestion previously made that an abrupt
change for the better in diet tends to occur when the income reaches a certain
level. It is, however, probable that the low paid worker will insist on his quota
of so-called non-essentials or luxuries, even at the cost of consuming a cheap
and ill-balanced diet. But once his wages attain a level at which his "non-
essential" needs can be reasonably satisfied, leaving a fair margin for other
requirements, he will improve the quality of his diet.
Table 3 brings out another point of significance. Consumption of one
valuable food—green leafy vegetables—was in inverse relation to income.
Green leafy vegetables are a rich source of certain vitamins, minerals and
salts. The better paid families tended to despise this food, which they could
easily afford, and actually intake of pro-vitamin A, a constituent abundantly
present in leafy vegetables, was lower in Group 4 than in Group 1. This
shows that while a general tendency for diet to improve with increasing income
may exist, prejudice may operate in the opposite direction, and incidentally
provides an illustration of the part which education could play in improving
dietary habits. Although the diet of higher income groups was in many re-
spects superior to that of the lower income groups, it was far removed from
the ideal.
Mitra 15 has demonstrated approximately similar relationship between
income and the proportion of various foods in the diet in another industrial
group in Bihar. Probably these are relatively uniform in urban areas throughout
15 Mitra, K., Ind. Jour, Med, Res., 1941; 29 : 143.

280 W. R. AYKROYD
the country, but further investigations on this point are necessary. Change
in dietary habits would therefore appear to be a useful index of change in
economic status. If in 20 or 30 years time it can be shown that the national
diet has changed in the direction indicated by these figures, it can be assumed
that an improvement in economic condition has taken place.
The Possibility of Progress.—The nutrition research worker in India is
often told, in effect, that he is wasting his time. The cause of malnutrition is
poverty, ignorance, population pressure and so on, and no amount of research
on food values and the causes of deficiency disease, no experiments on rats
and guinea pigs, however pretty and ingenious, will enable the poor to obtain
a proper diet. But in order to solve a problem it is necessary first of all to
define it. Knowledge of the nature and defects of Indian diets, and how the
latter can most easily be corrected, is a necessary basis for effective action.
Even in existing economic circumstances much can be done. Nutrition work
can be included in the programmes of public health departments, school
medical services, rural reconstruction agencies, and so on. The development
of agriculture, animal husbandry, and fisheries can be influenced by know-
ledge of dietary requirements.
Health education, which naturally includes education about diet, can
be extended. Improve health and you increase energy and economic capacity;
the vicious circle, poverty, malnutrition, ill-health, poverty, is broken and
replaced, so to speak, by an ascending spiral. Take, for example, malaria.
Malaria causes a million deaths annually in India and an untold amount of
physical debility; it is a direct cause of malnutrition because victims of the
disease, languid from impoverished blood, cannot cultivate their land
properly and improve their lot. Vigorous anti-malarial measures will thus
tend to improve food supply and the national diet, and the same is true of many
other public health activities. Health education has not yet been developed
to any extent in India. Recently the writer put two questions to a senior
class of boys in a High School. These were: What is the cause of malaria ?
Do you know anything about the nutritive value of different foods 1 Blank
silence greeted both questions; the boys had not heard of these subjects, of
vital importance to their own welfare and that of their country. Every school
child should be taught some elementary facts about health, diet and disease.
A detailed discussion of the various means of improving standards of
nutrition—of the various aspects of public health nutrition work—would be
outside the scope of this article. Numerous reports of the League of Nations
and the International Labour Office have dealt with these questions. But one
interesting and remarkable possibility may be briefly referred to in conclusion.
Normally, when we are considering the improvement of diets, we think in terms

THE PROBLEM OP NUTRITION IN INDIA 281
of ordinary familiar foods—more milk, more vegetables, and so on—a point
illustrated in Table 1. But within recent years, the chemical composition of a
number of the important vitamins has been discovered and some of these can
now be manufactured in large quantities. Vitamins produced in this way are
just as valuable to the body as vitamins contained in foods.
Further developments in research and industry may make it possible to
manufacture vitamins at very low cost. In England pure synthetic vitamin
B1, costing about four shillings per gramme, is being added to refined wheat
flour to bring its nutritive value nearer to that of whole wheat. Human daily
requirements of vitamin B1 are one to two thousandths of a gramme (1-2 mil-
ligrammes). This is a war measure, perhaps unnecessary in normal times
when there is less danger of the diet of the population being deficient in this
particular vitamin. But considerable discussion is at present taking place in
America about the value of "fortifying" foods such as bread with synthetic
vitamins, although the American diet has not been restricted by the war.
Similarly, certain essential mineral elements, such as calcium and iron, could
be given in the form of a pill or capsule, as an addition to the diet. Con-
sumed in this form they produce the same effect in the body as when they are
taken as ingredients in ordinary foods.
In some of the Southern United States there is a great deal of malnutri-
tion among the poor whites and negroes—economically depressed and backward
groups. It has been found that supplying such people with the vitamins they
lack, in the form of daily doses additional to their ordinary diet, may produce
an immediate improvement in their general health and shake them out of the
lethargy engendered by malnutrition. Dispirited and chronically wretched indi-
viduals, it is claimed, may be thus transformed into healthy and active citizens.
The cost of the necessary synthetic vitamins is even now not very great.
The idea of giving malnourished school children in India a daily capsule
containing more than their daily requirements of various essential vitamins
and minerals at present seems rather outlandish. But to any one unfamiliar
with discoveries in bacteriology and immunology, the idea of preventing
various diseases by the systematic inoculation of thousands or even millions of
people would seem equally peculiar. In this instance the state produces the
vaccines—against the small-pox, plague, cholera, enteric, etc.—very cheaply
and the people have learnt, or are learning, to take advantage of them. A
few properly staffed and equipped "vitamin factories" might produce vitamins
by the ton and the cost of per capita requirements might work out at
a low figure.
These speculations are perhaps somewhat out of tune with existing
realities, But they may serve to emphasise the fact that science, so to speak,

282 W. R. AYKROYD
usually has a few aces up her abundant sleeve. Failure to produce results is
not characteristic of the scientific method. An impartial analysis of the
economic aspects of the problem of nutrition in India may leave little ground
for optimism. But it is surely true that if the resources of science are brought
to bear on the problem, progress can be made, however formidable the
obstacles of poverty and ignorance.