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.