Enough already about stents. As I had predicted in my previous article, some low level employees will eventually be fired or suspended and some senior officers or doctors will be made OSDs for a period of few months and then quietly reinstated when the stent furor dies down. Stents are getting so much press because most people that have stents implanted in their heart arteries are relatively well off. That includes the movers and the shakers of any country including ours.

Interestingly, the latest healthcare issue that is getting some press is making people confused about stents and stunting. Everybody that is anybody is now suddenly talking about stunting. Here I must point out that stunting of children is a serious problem not to be confused with political or social stunts that we in Pakistan are quite used to.

Stunting has recently emerged as an important issue even though it has been around almost forever. In the past stunting just did not have a name. What stunting essentially means is that a significant number of children in a particular environment are not only smaller in size but perhaps also show a lesser intellectual ability than might be normal for their age. Such stunting is generally due to continuously inadequate nutrition among children.

In the past, the most well-recognised form of stunting was what was called ‘cretinism’. This was almost always due to inadequate ‘Iodine’ in the diet of the mother leading to below normal function of her thyroid gland. This then lead to below normal function of the thyroid gland in the newborn child leading to stunted development or cretinism. This problem has essentially been eradicated by the addition of Iodine to dietary salt and medical treatment in young children with cretinism. Perhaps some of my readers might remember that a few months ago ‘micronutrients’ in diet were the healthcare flavour of the month. Iodine is exactly that sort of an essential micronutrient or trace element.

Read also: We need to change how people eat

For most of my adult life as a political liberal, I have believed that the state has a responsibility to provide its citizens with certain basic safeguards and amenities. In a modern world these safeguards include appropriate healthcare and adequate food at all stages in life, and things like decent housing, basic education and job opportunities. But it all starts with proper healthcare for a pregnant woman and then for the newborn child.

Here again every so often the Punjab government makes big press announcements about addressing the problem of ‘maternal and childcare’. Clearly any and all attempts at improving the present dismal death rate among mothers during delivery of a child and that of the child soon after birth (maternal and infant mortality) are laudable goals. But the problem as always is the same. There is just not enough money to make such efforts uniformly successful. Sadly, in spite of all protestations to the contrary, healthcare is not a priority for this government nor has it been for any previous government. As the old saying goes, money talks.

No, I do not wish to put the entire blame for the sad state of affairs on any government irrespective of the political party it represents. Pakistan is a poor country. Almost forty per cent of the population lives at or below the poverty line. Attempts at poverty alleviation have been marginally successful but still enough poverty exists even in a relatively ‘prosperous’ Punjab. And as long as there is poverty, there will be problems that lead to the ‘stunting’ of children.

Stunting in children is due to many reasons but the three most obvious are mothers in poor health that cannot properly breastfeed the infant, general malnutrition, and then certain diseases that prevent children from being able to consume and retain nutrition (food). At the most basic, childhood stunting occurs in children that are not properly breastfed.

A healthy mother that knows how to breastfeed is the first and the best protection against stunting of her offspring. Interestingly, many investigations of stunting in children found that these children were not being properly and adequately breastfed because their mothers just did not know how to and or did not do it for long enough.

The second obvious cause of stunting is ongoing malnutrition in a child. Here poverty plays a vital role. To simplify matters, adequate nutrition includes three basic things. Adequate calories, a balanced diet made up of different food groups like proteins, carbohydrates and fats, and appropriate micronutrients (vitamins and minerals). And to have all these things to eat requires enough money to buy all these things.

The third recognised cause of stunting is water borne diseases like gastro-enteritis (gastro) that makes it difficult, if not impossible, for the child to retain the food that is consumed. Clean drinking water is the obvious way to avoid the spread of such diseases. Almost every day for the last many years, we have heard of a ‘new’ initiative launched by the Punjab government to provide clean drinking water to one and all. Obviously, if previous attempts to provide clean drinking water during the last nine years had been successful, new initiatives would not be needed. I don’t know if this persistent failure to provide clean drinking water throughout the province is due to a lack of adequate financial inputs or due to bad governance.

The interesting question is why has stunting suddenly emerged as an important problem when it has probably existed for almost always. The answer is interesting. Even in relatively advanced countries like the United States there are pockets of population where stunting is emerging as a health as well as an economic problem. Perpetually hungry children grow up to be unhealthy adults and at the same time are incapable of getting properly educated. This creates a class of people that often cannot be gainfully employed and as such instead of becoming contributing economic participants become financial liabilities in a society.

Indeed stunting of children is a problem all over Pakistan and in the Punjab. The primary reason for stunting is malnutrition that is directly related to poverty and lack of education. Unfortunately, poverty alleviation cannot happen in Pakistan as long as the increase in the rate of population in a year is about the same or even greater than simultaneous economic growth. Only population control along with economic development can create an environment where poverty will start to decrease substantially. And only then chronic malnutrition among children will cease to be a widespread problem.

Concerning what to do about stunting of children, first we need better maternal and childcare during and immediately after pregnancy. Second, nutritional supplementation among the poor children is important. Nutritious school lunches supplied though private-public partnerships is an obvious solution. Third, clean drinking water and early medical care of sick children should be made available.

Finally, population control is vital so that expected economic growth can really start improving the financial status of a majority of citizens. In this situation as it is important in so many other problems, an educated mother can make a tremendous difference. So, educate mothers.