Malnutrition: A sickness of government, society

Malnutrition: A sickness of government, society

B. Herry-Priyono, Jakarta

After SARS, there was the avian flu. After the avian flu, it
was dengue fever, then polio, and then the graph descended even
further -- outlining a basic and preventable human malaise --
"malnutrition."

It is the same, sad old story that refuses to go away. With
evidence showing so many children struck down by malnutrition all
bravura about a suave and modern Indonesia vanishes. That
children continue to go hungry in this country is, as it should
be, an embarrassment internally -- an indictment of Indonesian
society with its inefficient and corrupt public service providers
and politicians whose real commitment to eradicating poverty and
hunger must be questioned. It is also a slap in the face to a
nation conscious of international public opinion.

It all started with a report of the widespread incidence of
cases of acute malnutrition in West Nusa Tenggara, east of Bali.
As of May 31,487 children under five in the province were
recorded as suffering from acute malnutrition, with dozens
already dead.

This, of course, is likely to be an understatement of the
seriousness of the problem. The reasons for the cases are also
plain for all to see. In neighboring East Nusa Tenggara, for
example, of the 6,502 health centers in the province, only 40
percent are still functioning -- 60 percent have long been
inactive.

The still-active health centers in the wider Nusa Tenggara
region recorded 66,833 children under five as suffering from
malnutrition in various degrees. Include the likely 50-60 percent
of children with no access to centers and we have a figure at
least 100 percent higher. But is it possible that this province
may simply be an exception, a statistical anomaly?

For the answer we can take Jakarta -- for many Indonesians a
city of glitter, glamor, wealth and power -- as an acid test. The
Jakarta City Health Agency reported that 8,455 children under
five are suffering from malnutrition (June 10). As mentioned,
there is nothing new in this story. Sri Palupi of the Jakarta-
based Institute for Ecosoc Rights, who has long documented
malnutrition cases, noted that as early as 1998 there were 1.2
million children under four in Indonesia suffering from
malnutrition (Kompas, June 9, 2005).

The current uproar about malnutrition should actually be
heartening, it is an old problem that refuses to be swept under
the carpet, but at least the public and politicians are standing
up and taking notice. But for how long? Presumably the cases of
malnutrition did not only surface this year. And if we have
ignored such shocking statistics before, we can ignore them
again.

It is also encouraging to hear President Susilo Bambang
Yudhoyono's avowed personal interest in the cases: "Don't cover
up development problems just to make me happy. I am keen to know
why malnutrition still exists," he said (The Jakarta Post, June
8). Indeed, Mr. President, we are all wondering why some members
of this country lead such a harsh and brutish existence while
your economic minister makes brash claims about the country's
buoyant economic conditions.

Perhaps the widespread incidence of malnutrition has nothing
to do with economic conditions. Or is it that the claims of your
economic minister are laughable and belie the sad reality that
Indonesia remains one of the most inequitable societies in
Southeast Asia. One task of your leadership is to ensure the
claims of your ministers are less extravagant, because these days
Indonesian citizens assume most politicians are lying even when
they are being sincere.

Of course, the widespread incidence of malnutrition cannot be
understood in terms of a single cause, it is a combination of
many causes; structural failures that are economic, political,
managerial and social.

To give Susilo some slack, however, it is also certain that
the present government has inherited a problem not entirely of
its own making. Evidence shows that the Megawati Soekarnoputri
government presided over a period where the provision and quality
of health services sharply decreased for the nation's poor. Even
so, the widespread incidence of malnutrition threatens to poison
the new government's public relations campaign. And the speed
required to address the problem is parallel with the urgent
nature of the cases.

Getting food aid to the people that need it, is indeed a big
but not-impossible task, which calls for the best managerial
talents. We would like to see the President, as the chief manager
of the country, whip his slumbering governors -- the same
governors preoccupied with megalomaniac projects, graft, nepotism
and cronyism and who often ignore dire straits of their
constituents -- into action. Decentralization has no doubt
shifted some important aspects of authority from the central
government to these governors. Autonomy will lose its raison
d'etre, however, unless it leads to a speedy redress of local
problems at the local level.

Second, it is equally important to note that the huge task of
addressing the problem of widespread malnutrition cannot be
undertaken by governments -- central or regional -- alone, if
only because the causes of the problem go beyond the confines of
government offices. I am drawn to this point by Tan Shot Yen, a
medical doctor studying at the Driyarkara School of Philosophy,
who for a long time has been observing the pattern of food
consumption by children in this country.

Her somber observations, for instance, show that many of our
children (and adults) have been seduced by the many deceptive
food advertisements bombarding our television screens. Many foods
being advertised on TV are snacks with almost no nutritional
content. So, even if you have enough money to buy the healthiest
and most nutritious foods, there is no guarantee that your
children will not suffer from a lack of nutrition, if not the
malnutrition suffered by poor families.

Tan argues that we should not be surprised by a strange
phenomenon where the battle between "food for health" and "food
for commerce" is won by the latter.

Add to this the increasing difficulty the poor have accessing
public hospitals and we are certain to create an underclass of
wretches who will live short, difficult lives -- their growth
stunted, their bodies sickly from a simple lack of good food.

It is clear that addressing the problem of widespread
malnutrition needs speedy action by the government. It also needs
a massive publicity campaign that promotes "food for health".

Otherwise, coming generations will continue to be affected by
this preventable scourge.

The writer is a postgraduate lecturer at the Driyarkara School
of Philosophy, Jakarta.