Home or the world, no matter where Venkatesh Mannar is, he is never out of his elements. Back in the 1970s and 1980s, he was, like the rest of his family, a salt producer in coastal Tamil Nadu. Today, he is a Canadian citizen who is at home wherever he travels in single-minded pursuit of a mission: using salt as a weapon against the global war on malnutrition.
For over three decades, Dr Mannar has journeyed to different parts of the world, seeking ways and means to reduce micronutrient deficiencies among segments of the world’s population that are most at risk – women and children in the developing nations.
For his contribution in the areas of health and nutrition, he was, in December last year, made an Officer of the Order of Canada. Mr Mannar has worked with several countries helping them deal with public health issues with rational supplementation and strengthening of systems.
The Tuticorin-based family of Dr Mannar, president of the Ottawa-headquartered non-profit Micronutrient Initiative (MI), has been in the salt business for five generations. Today, he is a proud Canadian but has never lost touch with his Indian roots.
Dr Mannar told a Canadian publication after receiving the coveted award: I have lived and worked in Canada for 22 years. It is my adopted home. I am still proud of my Indian roots and still mainstain family connections. My work takes me back there often. I like to be regarded as both Canadian and Indian.”
He added: “It may sound strange, but in fact since moving to Canada I have been able to help India’s undernutrition situation more than I would have had I stayed there. Through MI and Canadian support we’ve been saving and improving the lives of millions of people through our health programmes and interventions. This may not have been possible to initiate through Indian health agencies because of the magnitude of the problem and limited resources and capacity.”
The Micronutrient Initiative is an international organisation that works with state governments to provide vital micronutrients to vulnerable populations in India. In India, MI is leading the Vitamin A supplementation programme across several states, zinc supplmentation for children suffering from diarrhoea, salt iodisation for prevention of iodine deficiency as well as iron deficiency in poor women and children.
Dr Mannar’s transition from entrepreneur to researcher-activist occurred early in life for he was aware of the uses that salt could be put to. He says: “Practically everyone consumes salt, making it the most natural vehicle for fortification.”
Micronutrient enhancement is necessary because under-nourishment is endemic. According to the World Health Organization (WHO), more than two billion people worldwide suffer from anaemia. At least a half of these cases are due to iron deficiency.
India is worse off than sub-Saharan Africa. Nearly 70 per cent of women and 75 per cent of pre-school-age children are estimated to be iron-deficient in this country.
Under-nutrition accounts for 45 per cent of the 1.65 million child deaths in India each year. Between 70,000 and 1.5 lakh Indian women die annually during childbirth on account of anaemia.
Mannar sold his salt business and migrated to Canada in 1990. He took over as executive director of MI in June 1994 after serving for a few years as a retainer-consultant to UNICEF in Toronto.
MI was set up by the Canadian government in the early 1990s as a secretariat within the International Development Research Centre (IDRC). In 2000, it became an independent not-for-profit organization.
“In India, my first port of entry was Delhi, where IDRC has an office in Jor Bagh,” recalls Mannar. “In the initial years, MI’s focus was on building a case for the need to add micronutrients to the diet of those that were most vulnerable. By the end of the 1990s, we had enough evidence to show that we could make a difference by doing micronutrient enhancement in the subcontinent.”
Today, MI’s work reaches women and children in 70-odd countries and the agency has offices with dedicated staff in a dozen capitals in Asia and Africa.
“We do not ever work independently,” he asserts. “We collaborate with governments to help in advocacy for and scaling up of operations in the areas of Vitamin A supplementation and combating iron and iodine deficiencies,” he says.
Mannar’s latest India trip, his fourth this year, was for the New Delhi launch of the 2013 Lancet Series on Maternal and Child Nutrition in late June. The Series underscores the magnitude of the problem of poor nutrition. Almost half of all child deaths in the world today are the result of malnutrition.
Mannar co-authored one of the five papers of the Series, titled ‘The Politics of Reducing Malnutrition: Building Commitment and Accelerating Impact’. The paper calls for “strong leadership at all levels to create and sustain momentum and to convert that momentum into impact”.
The IIT-Madras alumnus says: “India is the single most difficult country to operate in. It is here that we are questioned and opposed the most.” The lack of political will and administrative coordination tend to thwart most attempts to address the problem.
“In Bangladesh,” says Dr Mannar, “once a go-ahead is given at the executive level, we are left alone and allowed to work freely with local NGOs.”
India, he points out, accounts for 40 per cent of the world’s undernourished population. “This country has the highest rates of stunted growth, underweight and anaemia in children,” he says. “India has all the programmes and policies to tackle the problem. What it lacks is implementation,” he adds.
Mannar’s fight against malnutrition began in the 1970s. He went to Northwestern University, Evanston, Illinois, for a Masters in chemical engineering to prepare himself for a role in the family business. He then worked with an American salt company in California.
On his return to India, he and his father started a salt production venture of which he was the managing director from 1973 to 1990. “The concept of additional nutrients in salt was gaining ground at the time. UNICEF would call me to Delhi for consultations on the subject and I got increasingly interested in the process of fortifying salt,” he says.
Mannar’s new salt field was on a 4,000-acre land acquired from the Tamil Nadu government. “Back then in India, salt-making used traditional methods. I brought in modern principles,” he says. The factory did some early work in producing fortified salt.
This successful champion of universal salt iodisation has since created double fortified salt (DFS), which contains both iron and iodine. While the idea might seem simple, adding iron to iodised salt, says Mannar, “poses chemical problems because iron is unstable and interacts with iodine and imparts a brown colour to the salt”.
He developed a solution together with Prof. Levente Diosady of the University of Toronto. The technology was transferred to India about a decade ago. “DFS is now produced in Tamil Nadu, where it is made available to three million schoolchildren in the state’s midday meal programme,” he points out.
It took MI all of five years to secure clearance for DFS in India. “There is too much bureaucracy here,” he says. Mannar now hopes to spread the net wider by getting salt producers across India to adopt the technology and other state governments to follow the Tamil Nadu model. “MI is already active in Uttar Pradesh, Bihar and Gujarat,” he reveals.
“Modern salt refineries have sprung up across the country and the process of iodisation is bound to progress,” he says. Salt iodisation, he adds, has increased from 5 per cent in 1980 to 77 per cent today.
Besides the success stories of Bangladesh and Nepal, Mannar takes pride in having been a small catalyst in how things have panned out in China. In the late 1980s, he was part of a World Bank team that travelled to Beijing to convince the government to adopt universal salt iodisation.
“The then Vice Premier Zhu Rhongji (he later became Premier) seemed completely disinterested as we made our presentation. But when I began to tell him about the deleterious effect that iodine deficiency has on mental development, he was all ears,” he recalls.
Today, China, which implemented universal salt iodisation only in 1993, has gone well beyond 90 per cent. India, which was an early mover, is yet to touch 80 per cent. “In India there are just too many naysayers – medical professionals, commercial lobbies and political sceptics,” says Mannar.
Among these opponents are those that believe that India should focus more on providing food to the hungry rather than worrying about micronutrient deficiencies. Mannar, of course, has no patience for that line of thinking.
He says: “The need for nutritious food is obviously beyond question, but providing micronutrients to the population is a different issue altogether. One is about ensuring that every Indian has enough food to eat; the other is about something that is needed regardless of food intake.”
He adds: “Micronutrient enhancement is an inexpensive and effective way of ensuring that all children of India are able to survive and thrive physically and mentally. To fail to make this a national priority will be to fail India’s people.”
On his part, Dr Mannar loses no opportunity to add his weight to the much-needed project in the land of his birth.