PROJECT STUDIO 3 SEMESTER 4 10 WEEKS
STUDENT AKSHAN ISH S1101106 PGDPD ‘11 GRAPHIC DESIGN
PROJECT DOCUMENTATION
INDIA HEALTH REPORT
GUIDE RUPESH VYAS
INDIA HEALTH REPORT PROJECT DOCUMENTATION
AKSHAN ISH S1101106 PGDPD ‘11 GRAPHIC DESIGN E akshan.i@nid.edu T +91 846 901 7051
Every second child in India under the age of 5, is stunted (lesser height for age)
Every fifth child in India under the age of 5, is wasted (lesser weight for age)
INDEX 02
Chapter 1 INTRODUCTION
42
Chapter 6 VISUAL LANGUAGE
06
Chapter 2 CONTEXTUAL STUDY
58
Chapter 7 PROTOTYPE
14
Chapter 3 PUBLICATION STRUCTURE
62
18
Chapter 4 DATA TO INFORMATION
64
32
Chapter 5 INFORMATION DASHBOARDS
COLOPHON Typeface, ITC Officina Serif Std & Sans Std Document dimensions, 7.5” x 10” Print Version October 8, 2013
CONCLUSION REFERENCES
CHAPTER 1
INTRODUCTION PROJECT CONTEXT
The Public Health Foundation of India (PHFI) has proposed a biennial India Health Report (IHR) aimed at a broad national and international policy and academic audience, as an opportunity to highlight progress made in key health indicators in India as well as shortfalls. IHR will provide periodic assessment of health in India; it will present detailed information on selected measures of India’s morbidity, mortality, health care utilization, health risk factors, prevention, health insurance, and personal health care expenditures. The goal is to use information to better design, implement, and evaluate policies that can improve access, equity and efficiency in health outcomes in India. Each issue of IHR will focus on a specific area of health challenge in India. The inaugural issue will focus on nutrition.
PHFI
The Public Health Foundation of India (PHFI) is a public private initiative that has collaboratively evolved through consultations with multiple constituencies including Indian and international academia, state and central governments, multi & bi-lateral agencies and civil society groups. PHFI is a response to redress the limited institutional capacity in India for strengthening training, research and policy development in the area of Public Health. Structured as an independent foundation, PHFI adopts a broad, integrative approach to public health, tailoring its endeavours to Indian conditions and bearing relevance to countries facing similar challenges and concerns. PHFI focuses on broad dimensions of public health that encompass promotive, preventive and therapeutic services, many of which are frequently lost sight of in policy planning as well as in popular understanding.
INTRODUCTION
Public Policy
MOTIVATION
IHR
Information Design
The decision to take this project up came quite naturally to me. It fell right at the intersection of information design and public-policy advocacy – a domain I’m interested in working with. My initial objective was to pick out some of the human development indicators and visualize the transformation and impact of various public policies on those indicators, but I could not focus on any one indicator as each seem equal or more important than the other. The opportunity to design the India Health Report came as a boon as it eliminated the need to find a design brief and focus on the actual aspects of content generation, information visualization and publication design. Can information be designed in a manner that facilitates effective decision-making? The nature of the project was such that it required me to be extremely objective with the content, and visualize the data for clear understanding and quick identification of problem areas. I have been dabbling in the field of data visualization and infographics, and have often faced a dilemma between creative story telling and analytical clarity. Since the purpose of this publication was to facilitate decision-makers and public health researchers with information regarding malnutrition in India with a view to improve evidence based planning and enhance political will, this was a good opportunity for me to find an aesthetic in the objectivity and austerity of analytical information visualization. There was also the huge incentive of seeing a publication designed by me to have a wide reach across the nation and be used by researchers and policymakers to help in their decision making process to eradicate malnutrition.
3
PROJECT SCOPE
Reimagine the structure and delivery of public interest information. Gain a thorough understanding of the content and design the required information architecture for the report. Design necessary infographics and illustrations to support the content and create narratives from the data. Design a standardized layout template for subsequent issues of the report which would deal with other public health issues.
Understand Content
Gather Narratives
Information Architecture
Visual Language
Visual Content Generation
Data Visualization
Production with Publisher
INTRODUCTION
PROJECT METHODOLOGY & TIMELINE WEEK ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
NINE
TEN
Contextual Study Design Development Design information architecture. Take physical format and production decisions. Set visual language.
Design Execution Guideline Development Documentation Documentation of the entire process.
Content collation and organization. Understand context and target audience. Study publication formats and structures. Study existing work done in the field of information visualization for healthcare and public interest issues.
Visualize data and generate necessary illustrations for the inaugural issue. Bring the content, structure, imagery, infographics, typography together into one cohesive publication. Use the inaugural issue as a model to develop a stylesheet and guidelines for subsequent issues of the India Health Report.
5
CHAPTER 2
CONTEXTUAL STUDY VISION OF THE REPORT
The India Health Report is to be a biennial publication that brings to the forefront various public health issues and recommendations on dealing with them at the state as well as the national level. The initial vision of the report was that it would be data-driven, highly analytical, visually bold and essentially a primer for action. It would have to play a transformational role in broadening the view of nutrition from food intake to a multi-sectorial approach including issues like water & sanitation, mother’s education, and agriculture. There are already a large number of reports that inform the governments on the state of the people, but the India Health Report would have to make sure that the development train actually leaves the platform. The focus of the report would change with each issue, but the core objective would be to highlight health challenges that India is facing and push for multi-sectorial action. Therefore, it was important to understand that some editions might target specific issues like nutrition and take into account various other factors that determine the state of nutrition and other editions might target large scale health systems like Urban Health which would require zooming in to smaller units and sub-parts of the macro issue. A broad structure of the report had also been decided in the initial discussions. The report would be divided in to two sections—section one would have the main content, editorials and chapters written by the authors accompanied with case studies, photographs and information graphics; section two would comprise of state wise tabular information on selected core indicators for demography, health, education, and health-nutrition related socioeconomic indicators. The India Health Report would have a solution-oriented outlook, which is what sets it apart from other reports and publications in this domain. Instead of only presenting the problem areas, the report would enable decision makers to solve complex public health issues by gearing them with appropriate information as well as policy recommendations which are a result of much study and research at PHFI and other partner organizations.
CONTEXTUAL STUDY
TARGET AUDIENCE
The objective of the India Health Report itself is to update information with a view to facilitate policy makers, development programmers, socialscientists, public health specialists and nutritionists to understand the malnutrition issues in correct perspective for enhancing political commitment and for facilitating evidence based planning with adequate investment for accelerating measures for effective implementation for improving nutrition of women and children. National level policy makers are aware of the nutrition scenario (1000 days, etc.) State-level government and planners, however have a lack of clarity about this. States like Madhya Pradesh and Maharashtra that have nutrition missions are ahead in terms of tackling malnutrition issues, but others lag behind. The aim of the report thus became to help these states quickly absorb the global recommendations.
Center for Disease Dynamics, Economics & Policy, Washington, DC
7
ADVOCACY REPORTS
Several organizations produce reports on a yearly basis that pertain to advocacy and contain updated information regarding various development and health indicators. These reports are used mainly to highlight key developments in research and field studies, and to showcase the organization’s activities and annual involvement.
the child development index 2012 progress, challenges and inequality
Child Development Index 2012, Save The Children
CONTEXTUAL STUDY
The world healTh reporT 2007
A sAfer
future Global public healTh SecuriTy in The 21ST cenTury
UNMASKING AND OVERCOMING HEALTH INEQUITIES IN URBAN SETTINGS
Nutrition in the First 1,000 Days State of the World’s Mothers 2012
The World Health Report 2007, World Health Organization
Hidden Cities, World Health Organization
State of the World’s Mothers 2012, Save The Children
food for thought
WITHIN REACH
GLOBAL DEVELOPMENT GOALS
tackling child malnutrition to unlock potential and boost prosperity
2013 HUNGER REPORT
VOLUME 3 ISSUE 1 2013
MEASURING
HUNGER FR O M TH E G R O U N D U P
ETHIOPIA’S PLAN TO TRANSFORM AGRICULTURE
AG R IC U LTU R AL EXTEN SIO N 2.0
WHAT’S THE BEST WAY TO SHARE INFORMATION WITH FARMERS?
2013 Hunger Report, Bread for the World Institute
Food for Thought, Save The Children
Insights 2012, International Food Policy Research Institute
9
CONTENT COLLATION
Most of my first five weeks of the project were spent in helping the researchers gather content for the report from various sources, edit and structure them to fit in the larger scheme of the publication. Large part of the content would mainly come out of commissioned authors who were responsible for writing chapters about developments in nutrition & health, define the various challenges that undernutrition presents to India as a nation, evaluate the various government schemes, and highlight practices that have had a positive impact on eradicating malnutrition. This would make the first section of the report as discussed earlier. Photographs needed to be sourced from partner organizations who had researchers in the field, and their image banks. A thorough process of selection had to be done by sifting through hundreds of photographs. This process was undetermined and difficult as the text which these photographs would accompany was not finalized. Although, having these image banks at my disposal helped me in creating imagery and setting the tone and the visual language for the report.
Discussing the content of the report with PHFI researchers, New Delhi
CONTEXTUAL STUDY
For the second section of the report, a list of data sources was collated. The biggest data sources were the National Family Health Survey (NFHS), Census Sample Registration System (SRS), and the District Level Household & Facility Survey (DLHS). Other data sources included Coverage Evaluation Survey (CES) by WHO & UNICEF, Indiastat, Lancet reports and IFPRI datasets. Depending on our core indicator list, these data sets had to be studied and relevant data had to be scraped. These data would primarily be used to design infographics which would support the main content of the report, and a health & nutrition profile for each state. These indicators and their data sources were tabulated in an excel file for ease of access and sharing. This process also helped me get acquainted with the content and the data more intimately.
Excel file with core indicators and data sources
11
UNDERSTANDING CONTENT
Sketch noting nutrition CONTEXTUAL STUDY
In order to be able to communicate the urgency and the need to focus on nutrition as a nation-wide issue—it was important for me to first get a holistic understanding of the problem, the different factors that have an impact on nutrition of mothers & children, various stakeholders and mechanisms that are already in place to deal with nutrition. While studying the content of the report and background papers that were taken into consideration, I began to understand the multi-fold impact that poor nutrition has on a child’s growth and overall development—poor cognition, low performance at school, reduced employability, reduced economic income, strong anaemia prevalence among teenage girls and pregnant women and eventually a leading cause to pull large populations below the poverty line. It was also important to be able to detach myself from individual case studies and remain objective in order to be able to study the problem from a macro perspective and deliver a design solution that lets the target audience experience the scale of malnourishment and depth of the problem while providing clear information to encourage a problem solving approach.
Photo Credit: Save The Children 13
CHAPTER 3
PUBLICATION STRUCTURE PHYSICAL FORMAT
Since the report was going to be published by the Cambridge University Press (CUP), the physical format had to be discussed with them to make sure that there was no ambiguity in the vision of the report. CUP is essentially an academic publisher, so they had already set constraints on the dimensions and the layout of the publication. It took a few meetings and some prototyping to get them to agree to our vision. The main issue was in deciding whether to handle this report as a magazine or an academic publication. It would be a recurring publication which needed to be easy to consume but one that needs to have a long shelf life. This consideration also influenced the visual language of the report. It was decided that the report would be a four colour printed standard paperback in crown quarto size (7.5 x 10 inches) with roughly 250 pages.
7.5 inches
10 inches
Dimensions scaled to 30% of original size
PUBLICATION STRUCTURE
INCLUSION OF STORIES
The content of the report was extremely straight forward and objective. When I started laying it down on flat-plan to see the flow, I realized that the entire report had deemed people into quantifiable measures that would evoke no emotional response from the readers. If this report was to be a primer for action, it had to connect with the emotions of the policy makers. It was imperative that they realize that it is real people that the dialogue revolved around. In order to do this, I suggested the inclusion of excerpts and interviews of people working in the field and first hand accounts of people who have both benefited from health programmes as well as those who have not been recipients of any help. We would contact local NGOs, government officials, Anganwadi workers to share their experiences and stories with us. This could also be a way to bring to the forefront work being done in remote areas, and establish unorthodox practices that have had a positive impact on maternal and child nutrition.
Boat Clinics in Assam, Center for North East Studies and Policy Research (C-NES) 15
CALL FOR STORIES
A call for stories was made and sent out to all PHFI employees to get in touch with their contacts so that we could have a collection of humaninterest stories that would showcase unnoticed practices, and give an account of the actual situation at the ground level. We received a total of 12 stories that were then edited and a selection of 8 was made to be included in the report.
WE NEED
STORIES FOR THE INDIA HEALTH REPORT nutrition
We are looking for stories, interviews and images relevant to the different aspects of nutrition.
SHARE WITH US (THEMATIC AREAS) Stories on nutrition: its impact on academic / professional performance, ability to work, loss of wages and anything else you might think is relevant
Women’s empowerment & nutrition (for e.g. impact of women’s education, employment/microfinance/social protection schemes, self-help groups, etc.)
Nutrition and its impact on: maternal health, adolescent/youth health, anemia
Agriculture & nutrition (for e.g. impact of type of livelihood/occupation, crop diversification, agricultural techniques, prices, etc.)
WASH & nutrition
Programs/policies on nutrition (for e.g. PDS, ICDS, Food Security Bill, mid-day meals, etc.)
THINGS TO KEEP IN MIND We want to connect readers to the subject matter beyond numbers. Health is about real people, real actions and real consequences. type of story
style
We’re looking for human interest stories. It’s not a research piece, but it should be based on real life, and on the author’s own experience, interactions in the field, or anecdotes and stories of people that the author has personally had a chance to interact with.
We’re looking for short narrative pieces. Short, relevant interviews are also welcome. Stories that focus on an individual or a family, and are personal and emotive in nature, would be great!
images
word limit
Stories should be accompanied with relevant photographs or images in high resolution (250-300 dpi / larger than 1200 x 720 pixels).
The piece must not exceed 300 words. The essence must be communicated within the limit.
The photographs must connect people to any of the aspects of nutrition—impact, causes, programmes, etc. The author can also present their perspective on nutrition through field notes, photographs and photo essays.
DEADLINE FOR SENDING IN STORIES – 24 th JUNE, 2013 we look forward to your contribution. write to: neha.raykar@phfi.org / radhika.arora@phfi.org
PUBLICATION STRUCTURE
STATE-WISE DASHBOARDS
For the second section of the report, it had been earlier decided that an annexure consisting of data in tabular form for various core indicators would be listed for each state. We figured that this data could be converted to an infographic dashboard which visualizes the core indicators instead of just presenting raw numbers. This could provide an easy way to compare indicators of different states and condense the most important information to just a double-sided spread, which can then be detached from the report by state level policy makers who want to focus on only their state. The dashboard would have a solution focus. The indicators and information presented in the dashboard will only present the context to the customized recommendations that are provided for each state. This way, the dashboard provides a public-health profile for each state highlighting key problems and also stating possible solutions and methods to tackle the problems. Upon consultation with experts in the field, it became evident that these state profiles could become the most important knowledge resource that the India Health Report would generate. It could quickly tell decision makers where to look, was extremely accessible, easy to share and become the ideal content to have a discussion over.
FINAL STRUCTURE
Main Chapters
Supporting Infographics
Human-Interest Stories
State-wise Information Dashboard
0 Approximate proportions of pages taken by each kind of content in the report. Colour coded according to the icons above.
250
17
CHAPTER 4
DATA TO INFORMATION SENSE– MAKING
Klein et al. (2006) have presented a theory of sensemaking as a set of processes that is initiated when an individual or organization recognizes the inadequacy of their current understanding of events. Sensemaking is an active two-way cognitive process of fitting data into a frame (mental model) and fitting a frame around the data. Neither data nor frame comes first; data evoke frames and frames select and connect data. When applied to data visualization, it becomes the designer’s role to construct a frame for the data to be presented in so as to make it easy for the viewer to make sense of the data. Raw data is often difficult to comprehend and draw conclusions from, but when visualized and presented in context, the same data has the potential to inform in a compelling manner, instill a spirit of inquiry in the viewer’s mind, or enable thorough understanding and analytical reasoning. In the context of this report which was going to be extremely data heavy, the task of visualizing large number of data sets coherently and clearly was of utmost importance since the target audience that we were dealing with, comprised of social scientists and researchers with large attention spans and an analytical bent of mind, as well as state and national level policy makers with less time on their hands, who needed to know key points at a glance.
Data
Context Visualization
DATA TO INFORMATION
Sense
DATA VIZ. MODELS
Although visualization models cannot be accurately grouped into different models, there seems to be a visual distinction in the visualizations that are common place, which are in turn derived from a difference in intent, in designing the visualization. The purpose of the visualization is what usually defines the aesthetic representation of data, although an underlying principle is that the visualization should make the data comprehensible and fairly easy to make sense out of. A brief summary of different kinds of charts to visualize data is given in the diagram by A.Abela (2006) below, and a poster made by Santiago Ortiz that describes multiple ways of visualizing two quantities is shown on the next page.
19
75, 37 multiple ways to communicate two quantities 75, 37
1
a
b
16
31
17
32
c
2
a
3
18
33 a
4
b
c
b
19
34 a
b
a
5
20 c
b
75 6
35 a
b
a
b
75 75
37
37
37
0 a
21
36
22
37
23
38
24
39
25
40
0
b
c
7 a
b
75
37
a
8 b
75 9
37 37
10
75
a
y = cos(75x)cos(37x)
b
11
26
41 a
12
b
27
42
animation: two pulses with 75 and 37 beats per minute
28
43
animation: two points rotating with 75 and 37 revolutions per minute
14
29
44
two sounds, 75hz and 37hz
15
30
45
a
13 a
b
b
c
Santiago Ortiz 2012, from the post: http://blog.visual.ly/45-ways-to-communicate-two-quantities DATA TO INFORMATION
WHAT SHOULD The authors of the main chapters of the report had provided us with a list WE VISUALIZE of graphs that they would need to support their text. This provided a good starting point to start visualizing, and also get more intimate with the data in the process. Since there was no set visual language yet, these graphs would only be used to understand the content more comprehensively, and help in building narratives. After a few discussions with the editors of the report, we managed to build a list of core messages that needed to go out by means of compelling infographics. These messages were written down in the form of stories, with a typical linear narrative structure of a beginning–middle–end. It was essential to make sure that the infographics and visualizations fit seemlessly within the structure of the report and its visual language.
X number of children in India suffer from stunted growth. Of these, X % live in just N states. Children that are stunted are less able to complete school… Are less productive as working adults…. Are more likely to suffer from chronic disease as adults. Adolescent girls with poor nutrition are more likely to have children that are stunted… Thereby perpetuating the problem across generations. Although India spends Rs X of budget on food intake programs … the lack of water and sanitation, and poor maternal education is a barrier to improving nutrition. If X more families had access to sanitation, Y more mothers were educated and X more villages had effective ICDS programs, Z fewer children would be stunted. Infographic story to explain the causes of stunting and ways to improve it
21
A STUDY OF INFO VIZ.
I had studied Edward Tufte’s books on visualization, and taken an online course with Alberto Cairo to understand and be able to practice data visualization. However, for this project, I browsed through some of the more inspiring work done in recent years to understand the methodology and decisions made by experts while dealing with this kind of content. I found the work of a research lab in Italy called Density Design extremely interesting in terms of the information design and visual appeal. The work of Francesco Franchi, Nicholas Feltron, Moritz Stefaner and Giorgia Lupi also influenced my design process.
Mothers Matter, Density Design DATA TO INFORMATION
Feltron Annual Report, Nicholas Feltron
Sol-itudine, il destino della Terra, Fracesco Franchi 23
SKETCHING STRUCTURES
In order to organize the data, figure out narratives, establish hierarchy of information, and generate visual ideas—I find it helpful to generate basic graphs using Microsoft Excel or Adobe Illustrator to get a sense of the story that the data is telling, and then sketch ideas on paper using the general structure of the generated graphs. It is a back and forth process that often involves quick sketches and rapid iterations on the computer. An initial idea for a visualization was to create a timeline of the 1000 days from pregnancy to two years after child birth, which is often referred to as the Window of Opportunity, and highlight the various systemic problems that hinder a healthy delivery, and the impact of undernutrition on the child’s growth in the early stages. Below are snapshots of the research content used to create the infographic, process sketch and iterations generated in Adobe Illustrator using the charting tools. This graphic was not completed as it was decided not to use it in the report.
DATA TO INFORMATION
25
PROPORTION SYMBOL MAPS
The first visualizations I started with were proportional symbol maps of India marking undernutrition as a proportion of population geographically to get a sense of what is happening where. Proportional symbols were used instead of choropleth maps, which typically use varying colour hues or shading to denote differences in a quantity because the data that I had to visualize had three variables—population that is undernourished below the mean value, population that isStunting undernourished severely (3 happens levels below (or stunted growth) is what to a child’s brain and of body when theystates. don’t get standard deviation), and the relative percentages different
7 STATES WITH MORE THAN 50% STUNTED CHILDREN UNDER-5. the right kind of food or nutrients in their first 1,000 days of life.
The damage is irreversible. That child will never learn, nor earn, as much as he or she could have if properly nourished in early life.
JAMMU & KASHMIR 35 / 14.9
HIMACHAL PRADESH 38.6 / 16
PUNJAB
36.7 / 17.3
UTTARANCHAL
ARUNACHAL PRADESH
44.4 / 23.1
43.3 / 21.7
SIKKIM
HARAYANA
45.7 / 19.4
UTTAR PRADESH 56.8 / 32.4
BIHAR
38.3 / 17.9
MEGHALAYA
55.1 / 29.8
DELHI
42.2 / 20.4
RAJASTHAN
43.7 / 22.7
ASSAM
46.5 / 20.9
55.6 / 29.1
JHARKHAND
NAGALAND
49.8 / 26.8
38.8 / 19.3
MANIPUR
GUJARAT
35.6 / 13.1
51.7 / 25.5
MADHYA PRADESH
WEST BENGAL
50 / 26.3
44.6 / 17.8
CHATTISGARH 52.9 / 24.8
MAHARASTRA
46.3 / 19.1
ANDHRA PRADESH 42.7 / 18.7
GOA
TRIPURA
35.7 / 14.7
MIZORAM
39.8 / 17.7
ORISSA
45 / 19.6
Purple circles represent percentage of under-5 children who are stunted below -2 SD [ values denoted in purple ] 100%
25.6 / 10.2
KARNATAKA
43.7 / 20.5
KERALA
24.5 / 6.5
50%
TAMIL NADU
30.9 / 10.9
25%
Red circles represent percentage of under-5 children who are stutned below -3 SD [ values denoted in red ] States with more than 50% stunted children under-5
DATA TO INFORMATION
JAMMU & KASHMIR 14.8 / 4.4 / 2.3
HIMACHAL PRADESH 19.3 / 5.5 / 1.1
PUNJAB
MEGHALAYA
9.2 / 2.1 / 1.5
30.7 / 19.9 / 2.6
ARUNACHAL PRADESH
UTTARANCHAL
18.8 / 5.3 / 2.3
HARAYANA
UTTAR PRADESH
19.1 / 5 / 1.4
14.8 / 5.1 / 1.2
15.3 / 6.1 / 3.4
SIKKIM
BIHAR
9.7 / 3.3 / 8.3
27.1 / 8.3 / 0.3
ASSAM
13.7 / 4 / 1.2
DELHI
15.4 / 7 / 4
RAJASTHAN
NAGALAND
20.4 / 7.3 / 1.6
13.3 / 5.2 / 4.7
JHARKHAND
MANIPUR
32.3 / 11.8 / 0.6
9 / 2.1 / 2.2
MIZORAM GUJARAT
9 / 3.5 / 4.3
MADHYA PRADESH
18.7 / 5.8 / 1.2
35 / 12.6 / 1
WEST BENGAL
16.9 / 4.5 / 1.9
CHATTISGARH
19.5 / 5.6 / 1.3
TRIPURA
24.6 / 8.6 / 2.2
ORISSA
19.5 / 5.2 / 1.7
MAHARASHTRA
16.5 / 5.2 / 2.8
ANDHRA PRADESH
12.2 / 3.5 / 2.2
GOA
14.1 / 5.6 / 4.3
INDIA
KARNATAKA
19.8 / 6.4 / 1.5
17.6 / 5.9 / 2.6
TAMIL NADU
22.2 / 8.9 / 3.6
KARNATAKA
15.9 / 4.1 / 1.2
Percentage of under-5 children who are wasted, below -2 SD
Percentage of under-5 children who are severly wasted, below -3 SD
Percentage of under-5 children who have high body mass compared to height, above +2 SD
Proportional Symbol Map denoting the proportion of children who are wasted (state-wise)
27
RADIAL GRAPHS
A very interesting part of this study on nutrition was to see how the background characteristics of children like mother’s education, religion, age, caste, place of residence, wealth index, etc. effect their nutritional status. This enables researchers to see what socioeconomic and cultural factors contribute to the health of children. To visualize this phenomenon, I made use of multiple radial graphs laid out on a three column grid. The layout enables the viewer to identify patterns at a glance, and on further examination, one can understand how each socioeconomic factor impacts child nutrition. Radial graphs are also used to keep the visual style coherent, although they are less accurately perceived by the eye than bar graphs, since area is harder to perceive than length. Since the focus here is on comparison rather than accurate comprehension, radial graphs seemed to be the ideal choice. They also present a more compelling emotional visual than bar charts.
12+ YEAR S COMPLETE
12.8 / 4 / 2.6
NO EDUCATION
22.7 / 8.1 / 1.1
10-11 YEAR S COMPLETE
<5 YEARS COMPLE TE
14.3 / 3.9 / 2.2
20.8 / 6.2 / 1.1
8-9 YEAR S COMPLETE
17.5 / 5.2 / 1.9
5-7 YEAR S COMP LETE 18.8 / 5.5 / 1.8
MOTHER’S EDUCATION This radial graph shows the impact of mother’s education on a child’s undernutrition, specifically weight-for-age. The facing page illustrates how these radial graphs present a picture of the impact of socioeconomic backgrounds on child nutrition.
DATA TO INFORMATION
<6
48-59
30.3 / 13.1 / 4.1
15.7 / 4.1 / 1.3
6-8
36-47
MALE
24-35
17.8 / 5.4 / 2
20.4 / 6.9 / 1.7
9-11
16.7 / 5.0 / 0.9
FIRST BIRTH
48+
29.3 / 10.1 / 3.1 20.5 / 6.8 / 1.7
15.5 / 4.7 / 1
FEMALE
28.9 / 10.9 / 1.6
19.1 / 6.1 / 1.4
24-47
<24
21.8 / 7.3 / 1.2
18.9 / 6.1 / 1.4
12-17
18-23
22.2 / 7.6 / 1.1
23.3 / 7.3 / 1.7
SEX
AGE IN MONTHS
6+
1
24.5 / 8.7 / 0.9
17.8 / 5.4 / 1.9
BIRTH INTERVAL
AVERAGE OR LARGER
VERY SMALL
18.2 / 5.9 / 1.6
28.7 / 9.6 / 1
URBAN
16.9 / 57 / 2.5
RURAL
20.7 / 6.7 / 1.2
4-5
2-3
21.8 / 7.6 / 1
SMALL
19.6 / 6.3 / 1.6
25.8 / 8.2 / 1.5
BIRTH ORDER
12+ YEARS COMPLETE
12.8 / 4 / 2.6
RESIDENCE
SIZE AT BIRTH
NO EDUCATION
22.7 / 8.1 / 1.1
OTHER
HINDU
33.6 / 10.5 / 1.3
20.3 / 6.6 / 1.5
JAIN
SCHEDULED CASTE 21 / 6.6 / 1.3
MUSLIM
15.8 / 5.2 / 0.8
10-11 YEARS COMPLETE
DON’T KNOW
14.1 / 3.1 / 1.4
18.4 / 6.1 / 1.6
<5 YEARS COMPLETE
14.3 / 3.9 / 2.2
20.8 / 6.2 / 1.1
OTHER
BUDDHIST / NEO-BUDDHIST 8-9 YEARS COMPLETE
17.5 / 5.2 / 1.9
5-7 YEARS COMPLETE
CHRISTIAN
SCHEDULED TRIBE
16.3 / 5.2 / 2.1
27.6 / 9.3 / 1.5
15.5 / 5.1 / 3.1
21 / 7 / 3.1
18.8 / 5.5 / 1.8
SIKH
OTHER BACKWARD CLASS
RELIGION
CASTE
20 / 6.6 / 1.3
11 / 2.8 / 1.9
MOTHER’S EDUCATION
LOWEST
NOT MEASURED
19.6 / 7.7 / 1.4
UNDERWEIGHT (BMI < 18.5)
25.2 / 7.9 / 1.1
LIVING WITH NEITHER PARENT
15.8 / 4.3 / 1.9
25 / 8.7 / 1
LIVING WITH BOTH PARENTS
19.6 / 6.4 / 1.5
HIGHEST
SECOND
12.7/ 4.2 / 2.7
OVERWEIGHT (BMI > 25)
9.3 / 2.7 / 3
NORMAL (BMI 18.5-24.9)
17.4 / 5.9 / 1.7
MOTHER’S NUTRITIONAL STATUS
LIVING WITH ONLY FATHER
18.8 / 6.8 / 3.8
LIVING WITH ONLY MOTHER
21.2 / 7 / 1.8
CHILD’S LIVING ARRANGEMENTS
22 / 6.7 / 1.1
FOURTH
MIDDLE
16.6 / 5 / 2.1
18.8 / 6.2 / 1.3
WEALTH INDEX 29
61 million children under the age of 5 in India, suffer from stunted growth
LESSER HEIGHT THAN NORMAL FOR THAT AGE
Stunting (or stunted growth) is a reduced growth rate in human development. It is a primary manifestation of malnutrition in early childhood; what happens to a child’s brain and body when they don’t get the right kind of food or nutrients in their first 1,000 days of life. The damage is irreversible. That child will never learn, nor earn, as much as he or she could have if properly nourished in early life.
Of these 50% children live in just 7 states
PUTTING IT TOGETHER
A few lines of body text here. A few lines of body text here. A few lines of body text here. A few lines of body text here. A few lines of body text here. A few lines of body text here. A few lines of body text here.
JAMMU & KASHMIR 35 / 14.9
HIMACHAL PRADESH 38.6 / 16
PUNJAB
36.7 / 17.3
UTTARANCHAL
ARUNACHAL PRADESH
44.4 / 23.1
43.3 / 21.7
SIKKIM
HARAYANA
45.7 / 19.4
UTTAR PRADESH 56.8 / 32.4
38.3 / 17.9 55.6 / 29.1
46.5 / 20.9
MEGHALAYA
55.1 / 29.8
DELHI
RAJASTHAN
ASSAM
BIHAR
42.2 / 20.4
43.7 / 22.7
JHARKHAND
NAGALAND
49.8 / 26.8
38.8 / 19.3
MANIPUR
35.6 / 13.1
GUJARAT
51.7 / 25.5
MADHYA PRADESH
WEST BENGAL
50 / 26.3
44.6 / 17.8
CHATTISGARH 52.9 / 24.8
MAHARASTRA
TRIPURA
35.7 / 14.7
MIZORAM
39.8 / 17.7
ORISSA
45 / 19.6
46.3 / 19.1
ANDHRA PRADESH 42.7 / 18.7
GOA
25.6 / 10.2
KARNATAKA
INDIA
43.7 / 20.5
KERALA
24.5 / 6.5
DATA TO INFORMATION
48 / 23.7
States with more than 50% stunted children under-5
TAMIL NADU
30.9 / 10.9
Purple circles represent percentage of under-5 children who are stunted, below -2 SD [values denoted in purple]
Red circles represent percentage of under-5 children who are severely stunted, below -3 SD [values denoted in red]
Children that are stunted are less able to complete school...
Percentage of under-5 children who are stunted, below -2 SD for a particular background charactericstic. Values are in purple.
Percentage of under-5 children who are stunted, below -3 SD for a particular background charactericstic. Values are in red.
Every concentic circle represents 2% children
<6
48-59
20.4 / 8.4
50.3 / 23.9
MALE
36-47
6-8
48+
48.1 / 23.9
44.7 / 20.9
25.9 / 10.8
54.3 / 27.8
24-35
9-11
55.9 / 28.9
32 / 12.8
18-23
FEMALE
12-17
57.8 / 30.4
48 / 23.4
46.9 / 21.7
AGE IN MONTHS
SEX
6+
1
4-5
2-3
61 / 37.2
47.8 / 22.2
53.4 / 28.2
AVERAGE OR LARGER
21.9 / 7
53.9 / 27.3
SIZE AT BIRTH
NO EDUCATION 57.2 / 31.6
OTHER
RESIDENCE
HINDU
58.5 / 34
48 / 23.4
JAIN
<5 YEARS COMPLETE
10-11 YEARS COMPLETE
33 / 10.9
50.3 / 26.2
OTHER
BUDDHIST / NEO-BUDDHIST 40.7 / 15.6
5-7 YEARS COMPLETE
DON’T KNOW
45.8 / 22.3
MUSLIM
31.2 / 5.9
50.4 / 24.1
8-9 YEARS COMPLETE
URBAN
39.6 / 17.6
SMALL
46.5 / 22.7
BIRTH ORDER
12+ YEARS COMPLETE
BIRTH INTERVAL IN MONTHS
VERY SMALL
41 / 17.9
54.3 / 30.4
24-47
51.2 / 26
CHRISTIAN
40.7 / 17.8
39 / 17.9
56.1 / 23.2
SIKH
OTHER BACKWARD CLASS
29.8 / 13.4
45.6 / 20.3
MOTHER’S EDUCATION
48.8 / 24.5
RELIGION
CASTE LOWEST
46.9 / 21.7
NOT MEASURED
51.7 / 28.9
UNDERWEIGHT (BMI < 18.5) 53.5 / 27.3
LIVING WITH NEITHER PARENT
43.5 / 19.5
LIVING WITH BOTH PARENTS 48.4 / 23.9
HIGHEST
46.9 / 21.7
OVERWEIGHT (BMI > 25) 31.2 / 12
NORMAL (BMI 18.5-24.9) 46.3 / 22.5
MOTHER’S NUTRITIONAL STATUS
LIVING WITH ONLY FATHER
52.4 / 25.5
LIVING WITH ONLY MOTHER
FOURTH
46.9 / 21.7
46.6 / 23
CHILD’S LIVING ARRANGEMENT
WEALTH INDEX
31
CHAPTER 5
INFORMATION DASHBOARDS FIXING INDICATORS
The first step towards conceptualizing the dashboard was to fix on the indicators that needed to be visualized. A long list was already prepared for the annexures earlier, but these were too many to go into the dashboard. The dashboard initially was meant only to give the most important information so it was conceived as a 2 page (front and back) layout. Consequently, the need for the annexure was replaced by a 4 page dashboard that would consist of a demographic profile, issue specific indicators (nutrition in this case), other health and systemic indicators that effect the specific issue, and recommendations and projections to set tangible targets for each state, based on their status and dynamics.
INFORMATION DASHBOARDS
EXPLORING VISUALLY
I started designing the dashboard with a view point to make it extremely exciting visually. Sections were demarcated using icons and a combination of Neurath’s isotypes and graphs were used to visualize the information. This approach made it very heavy on the eye, and there was a lot of visual clutter that made it hard to comprehend the information. Colour variations and typographic styles were explored at this stage. A coding system was devised to use a single accent colour that represented the nutritional status of the state and arrange the states region-wise.
Assam 6%
2340503
TOTAL POPULATION
46%
% LITERATE WOMEN
46%
54%
MALE
FEMALE
46%
46%
URBAN
RURAL
4.6
46%
DEMOGRAPHICS SC / ST
6%
POPULATION BELOW POVERTY LINE
46%
46%
46%
CHILDREN <5 YRS
CHILDREN <2 YRS
CHILDREN <1 YR
stunting / wasting / underweight
stunting / wasting / underweight
40
40
30
30
2340503
6-8
9-11
12-17
18-23
24-35
36-47
48-59
age in months
AGE WISE PREVALENCE OF UNDERNUTRITION
NFHS - 1 (1995)
NFHS - 2 (2000)
40
30
19
23 14
46%
1995
ACCESS TO IMPROVED SANITATION
HUNGER INDEX
2005
2000
TRENDS IN IMR, U5MR, NMR (/1000 DEATHS)
male
urban
scheduled caste
lowest
no education
female
rural
scheduled tribe
second
<5 yrs complete
10
<6
42
ACCESS TO PORTABLE DRINKING WATER
20
10
41 36
46%
4.6
PREGNANT WOMEN
FERTILITY RATE
20
NUTRITIONAL STATUS
46%
% WOMEN WHO HAVE PASSED 8TH GRADE 46%
56
other backward classes
middle
5-7 yrs complete
other
fourth
8-9 yrs complete
don’t know
highest
10-11 yrs complete
NFHS - 3 (2005)
UNDERNUTRITION ACROSS THE YEARS
STUNTING BY BACKGROUND CHARACTERICSTICS
12+ yrs complete
10% CHILDREN
40 30
4.6
4.6
4.6
boys (1-3 yrs)
20 10
initiated to breast exclusively breastfed INFANT FEEDING milkwithin one hour for 6 months PRACTICES BREASTFEEDING FOR UNDER-3’S
girls (1-3 yrs)
4.6
introduced to water within 6 months
breastfed during sickness
<6
6-8
non-pregnant,
adolescent pregnant lactating non-lactating women girls women women
energy protein vitamin a iron calcium
12-17
18-23
24-35
36-47
48-59
age in months
<6
6-8
9-11
12-17
CHILDREN CONSUMING COMPLEMENTARY FOODS
receiving antenatal contacts
ors usage for diarrhea
pregnant women consuming > 100 ifa tablets
vitamin a supplementation in the last six months
36-47
48-59
age in months
breast milk, milk, other products
46% under-5 children
low bmi
46%
46%
high bmi
HEIGHT < 145 cms
ANEMIA PREVALANCE
adoloscent women (15-19)
46%
minimum no. of times
appropriate no. of food groups
INFANT & YOUNG CHILD FEEDING PRACTICES (% FED)
no education
46%
HIGH BMI (>30)
46%
<5 yrs
5-7 yrs
8-9 yrs
10-11 yrs
12+ yrs
age at birth emotional domestic violence
ANEMIA PREVALENCE FOR DIFFERENT GROUPS
HOW THEIR EDUCATION EFFECTS MOTHERS
4.6 4.6 4.6 4.6 4.6
access to institutional delivery
CHILDREN (<5 YRS)
24-35
46%
MOTHERS
full immunization
18-23
LOW BMI (<18.5)
other women (20-49)
DIETARY INTAKE DIETARY INTAKE OF SELECTED NUTRIENTS (% NOT RECEIVING NECESSARY INTAKE)
HEALTH SERVICES
9-11
CHILDREN UNDER 3 WHO ARE EXCLUSIVELY BREASTFED
MOTHERS (15-49 YRS)
PROGRAMME COVERAGE
HEALTH SUB-CENTRES ICDS CENTRES ANM / 1000 WOMEN AWW / 1000 RURAL AGAINST SANCTIONED AGAINST SANCTIONED POPULATION
ASHAs IN POSITION
33
Assam 6%
2340503 54%
FEMALE
46%
46%
URBAN
RURAL
46%
4.6
DEMOGRAPHICS SC / ST
46%
46%
CHILDREN <5 YRS
CHILDREN <1 YR
stunting / wasting / underweight
stunting / wasting / underweight
40
40
30
30
20
20
10
10
6-8
9-11
12-17
18-23
24-35
36-47
48-59
NFHS - 1 (1995)
age in months
AGE WISE PREVALENCE OF UNDERNUTRITION
41
NFHS - 2 (2000)
42
36
40
30
19
46%
4.6
PREGNANT WOMEN
FERTILITY RATE
<6
2340503
POPULATION BELOW POVERTY LINE
% LITERATE WOMEN
46%
MALE 46%
NUTRITIONAL STATUS
6%
46%
TOTAL POPULATION
56
23
ACCESS TO PORTABLE DRINKING WATER
14
46%
1995
ACCESS TO IMPROVED SANITATION
HUNGER INDEX
male
urban
female
rural
2005
2000
TRENDS IN IMR, U5MR, NMR (/1000 DEATHS)
scheduled caste
lowest
no education
scheduled tribe
second
<5 yrs complete
other backward classes
middle
5-7 yrs complete
other
fourth
8-9 yrs complete
don’t know
highest
NFHS - 3 (2005)
UNDERNUTRITION ACROSS THE YEARS
STUNTING BY BACKGROUND CHARACTERICSTICS
10-11 yrs complete 12+ yrs complete
10% CHILDREN
40 30
4.6
20
4.6
10
INFANT FEEDING PRACTICES BREASTFEEDING FOR UNDER-3’S initiated to breast milkwithin one hour
exclusively breastfed for 6 months
girls (1-3 yrs)
boys (1-3 yrs)
<6
6-8
9-11
18-23
24-35
36-47
non-pregnant,
adolescent pregnant lactating non-lactating women girls women women
48-59
<6
age in months
CHILDREN UNDER 3 WHO ARE EXCLUSIVELY BREASTFED
energy protein vitamin a iron calcium
6-8
9-11
12-17
18-23
24-35
48-59
age in months
no education
46%
46%
46%
LOW BMI (<18.5)
HIGH BMI (>30)
under-5 children
low bmi
46%
46%
46%
high bmi
HEIGHT < 145 cms
ANEMIA PREVALANCE
adoloscent women (15-19)
receiving antenatal contacts
ors usage for diarrhea
pregnant women consuming > 100 ifa tablets
5-7 yrs
8-9 yrs
10-11 yrs
12+ yrs
emotional domestic violence
ANEMIA PREVALENCE FOR DIFFERENT GROUPS
full immunization
<5 yrs
age at birth
46%
MOTHERS
vitamin a supplementation in the last six months
36-47
CHILDREN CONSUMING COMPLEMENTARY FOODS
other women (20-49)
DIETARY INTAKE DIETARY INTAKE OF SELECTED NUTRIENTS (% NOT RECEIVING NECESSARY INTAKE)
HEALTH SERVICES
12-17
HOW THEIR EDUCATION EFFECTS MOTHERS
4.6 4.6 4.6 4.6 4.6
access to institutional delivery
CHILDREN (<5 YRS)
PROGRAMME COVERAGE
MOTHERS (15-49 YRS)
HEALTH SUB-CENTRES ICDS CENTRES ANM / 1000 WOMEN AWW / 1000 RURAL AGAINST SANCTIONED AGAINST SANCTIONED POPULATION
ASHAs IN POSITION
Assam 6%
2340503
TOTAL POPULATION 54%
MALE
FEMALE
46%
46%
URBAN
RURAL
DEMOGRAPHICS SC / ST
46%
46%
CHILDREN <5 YRS
CHILDREN <1 YR
stunting / wasting / underweight
stunting / wasting / underweight
40
40
30
30
20
20
10
10
<6
6-8
9-11
12-17
18-23
24-35
36-47
AGE WISE PREVALENCE OF UNDERNUTRITION
48-59
age in months
41
NFHS - 1 (1995)
NFHS - 2 (2000)
42
36
40
30
19
46%
4.6
PREGNANT WOMEN
FERTILITY RATE
2340503
POPULATION BELOW POVERTY LINE 46%
4.6
46%
NUTRITIONAL STATUS
6%
46%
% LITERATE WOMEN
46%
56
23
ACCESS TO PORTABLE DRINKING WATER
14
46%
1995
ACCESS TO IMPROVED SANITATION
HUNGER INDEX
2005
2000
TRENDS IN IMR, U5MR, NMR (/1000 DEATHS)
male
urban
scheduled caste
lowest
no education
female
rural
scheduled tribe
second
<5 yrs complete
other backward classes
middle
5-7 yrs complete
other
fourth
8-9 yrs complete
don’t know
highest
10-11 yrs complete
NFHS - 3 (2005)
UNDERNUTRITION ACROSS THE YEARS
STUNTING BY BACKGROUND CHARACTERICSTICS
12+ yrs complete
10% CHILDREN
40 30
4.6
20
4.6
10
initiated to breast exclusively breastfed INFANT FEEDING milkwithin one hour for 6 months PRACTICES BREASTFEEDING FOR UNDER-3’S
girls (1-3 yrs)
boys (1-3 yrs)
<6
6-8
12-17
18-23
24-35
36-47
non-pregnant,
adolescent pregnant lactating non-lactating women girls women women
48-59
age in months
CHILDREN UNDER 3 WHO ARE EXCLUSIVELY BREASTFED
energy protein vitamin a iron calcium
<6
6-8
9-11
12-17
CHILDREN CONSUMING COMPLEMENTARY FOODS
receiving antenatal contacts
ors usage for diarrhea
pregnant women consuming > 100 ifa tablets
vitamin a supplementation in the last six months
INFORMATION DASHBOARDS
36-47
48-59
age in months
no education
46%
46%
HIGH BMI (>30)
under-5 children
low bmi
46%
46%
46%
high bmi
HEIGHT < 145 cms
ANEMIA PREVALANCE
adoloscent women (15-19)
46%
<5 yrs
age at birth emotional domestic violence
ANEMIA PREVALENCE FOR DIFFERENT GROUPS
HOW THEIR EDUCATION EFFECTS MOTHERS
4.6 4.6 4.6 4.6 4.6
access to institutional delivery
CHILDREN (<5 YRS)
24-35
46%
MOTHERS
full immunization
18-23
LOW BMI (<18.5)
other women (20-49)
DIETARY INTAKE DIETARY INTAKE OF SELECTED NUTRIENTS (% NOT RECEIVING NECESSARY INTAKE)
HEALTH SERVICES
9-11
MOTHERS (15-49 YRS)
PROGRAMME COVERAGE
HEALTH SUB-CENTRES ICDS CENTRES ANM / 1000 WOMEN AWW / 1000 RURAL AGAINST SANCTIONED AGAINST SANCTIONED POPULATION
ASHAs IN POSITION
5-7 yrs
8-9 yrs
10-11 yrs
12+ yrs
It was clear that this approach was not feasible both in terms of clarity and space, so a more compact system was devised that eliminated the icons and concentrated solely on the content. I tried as much to simplify the visualizations so they would convey the messages without any obstruction. NUTRITION
INDIA HEALTH REPORT
Demographics
Nutritional Status
Total Population
234053 24
6% of the total population of India Population below internatinoal poverty line of US $1.25 per day
34053
24
36% of the total population of Arunachal Pradesh 36%
36%
64%
Male
Female
64%
3
36%
64%
36%
Urban
Rural
Pregnant Women
% of population under-five
36%
64%
SC/ST
Others
Fertility Rate
Hunger Index
2
13.4
36%
36%
36%
Anaemia prevalence 24 (non-pregnant)
Antenatal care (at least 4 visits)
13 2
43.3% children under-5 are stunted and 21.7% are severly stunted.
13.4
2
micronutrient deficiency / anaemia prevalence
Age wise prevalence of undernutrition (percentage of children < 5 years old) 24 24 24
24 24 24
25
24
Children under the age of five who are stunted by background charactericstics
Stunted / Wasted / Underweight
Year
Infant & Young Child Feeding
1995
2000
2005
48%
Girls
Boys 36%
48%
Urban
Rural
(in months) <6
36% 6-8
9-11
12-17
18-23
24-35
36-47
48-59
Poorest
Health Services & Programme Coverage
Infant feeding practices Exclusively breastfed / Breastfed and solid/semi-solid foods /
Trends in exclusive breastfeeding (percentage of infants < 6 months old who are exclusively breastfed)
36% 36 36 48%
Richest Spending
Breastfed and other milk/formula / Breastfed and non-milk liquids / Breastfed and plain water only / Weaned (not breastfed)
100%
24
60% 20%
48
48
36%
50% 30% 10%
10
Arunachal Pradesh
13 2
15.3% children under-5 are wasted and 6.1% are severly wasted.
24
40
36%
2
36%
Mothers with low BMI 24 (<18.5)
Have access to improved sanitation
44
Dotted & dashed lines represent national averages
64%
Number / % of births
70%
24
60%
64%
Trends in Infant mortality rate, Under-five mortality rate, Neonatal mortality rate (deaths per 1000 live births)
Have access to portable drinking water
38
40%
36%
Literate Women
(in months) 0-6
6-8
9-11
12-17
18-23
24-35
36-47
48-59
20%
20% 1992-93
1998-99
2000
2005-06
60% 100%
Recommendations
Key & Sources x
national ranking among states All indicators are colourcoded corresponding to the depiction in the graphic
08 state dashboard
09
NUTRITION
INDIA HEALTH REPORT
DEMOGRAPHICS
MATERNAL NUTRITION
Total Population
16.4%
1383727
50.6%
Mothers with low BMI (<18.5) 24
24
0.11% of India's total population Population below internatinoal poverty line of US $1.25 per day
29.9%
Anaemia prevalence (non-pregnant) 24
Antenatal care (at least 4 visits) 24
350000
24 (15.3% / 6.1%)
Wasted
51.6%
48.4%
Female
22.7
77.3%
Urban
24
Underweight
35.8%
Others
40.2%
Piped water
12.4% 24
Tube well
24
Non-improved source
24
14.8%
24
Flush toilet
24
Arunachal Pradesh
52.7% 24
22%
Public tap
(32.5% / 11.1%)
Pit latrine
24
7.1%
No facility
24
Dotted lines represent national averages, -2SD values in black and -3SD in white
WOMEN'S STATUS
State-wise comparison of stunting in children under-5
Arunachal Pradesh Other states
60% 50% 40% 30%
Rural
64.2%
SC/ST
Access to sanitation
85%
48.4%
24
25.9% of the total population of Arunachal Pradesh Male
Access to safe drinking water Improved source
NUTRITIONAL STATUS 24 (43.3% / 21.7%)
Stunted
WATER & SANITATION
20% North
57.7%
Central
North East
East
West
South
Age wise prevalence of undernutrition (percentage of children < 5 years old)
Literate Women
Stunted (-2SD / -3SD) / Wasted (-2SD / -3SD) / Underweight (-2SD / -3SD)
4.9%
HEALTH SERVICES & SPENDING
24 24 24
70%
Pregnant Women 50%
64%
Number of live births
30%
14.7%
10%
Under-five population (in months) <6
Fertility Rate 2
Hunger Index 2
6-11
12-23
24-35
48-59
Children under the age of five who are stunted by background charactericstics
N.A
36%
48%
36%
48%
Boys
Girls
Urban
Rural
Trends in Infant mortality rate, Under-five mortality rate, Neonatal mortality rate (deaths per 1000 live 24 24 24 births) 100
36%
36% 36 36 48%
Poorest
Richest
INFANT & YOUNG CHILD FEEDING
CHILD MORTALITY
87.7
Infant feeding practices Exclusively breastfed / Breastfed and solid/semi-solid foods /
Breastfed and other milk/formula / Breastfed and non-milk liquids / Breastfed and plain water only / Weaned (not breastfed)
100%
60.7 34
20
(in months) 0-6
RECOMMENDATIONS
KEY & SOURCES
x
national ranking among states All indicators are colourcoded corresponding to the depiction in the graphic
60% 20%
60
Year
36-47
2.7
6-8
9-11
12-17
18-23
24-35
36-47
48-59
20% 1992-93
1998-99
2005-06
60% 100%
08 state dashboard
09
35
This version proved to be easier to understand and engaging as it drew the viewer into the visualizations, and they could find their way through each indicator taking in chunks of information. The focus was on clarity of content as there could be no ambiguity in information representation. When the decision was made to make the dashboard a 4 page layout, it gave me a lot more space to accommodate indicators in a clear form, using graphs that did justice to the data. When the readers moved from one information block to another, a narrative for the particular state would appear. A state-wise ranking for most of the indicators was also included. NUTRITION
NUTRITIONAL STATUS
24 (43.3% / 21.7%)
Stunted
Arunachal Pradesh
Solid circles represent this state's nutritional status (-2SD / -3SD). Dotted lines represent national averages, -2SD values in black and -3SD in white
24 (15.3% / 6.1%)
Wasted
Underweight
24
(32.5% / 11.1%)
DEMOGRAPHICS Total Population
1383727 24
0.11% of India's total population Population below internatinoal poverty line of US $1.25 per day
51.6%
48.4%
Male
Female
22.7
77.3%
Urban
Rural
64.2%
35.8%
SC/ST
Others
57.7%
350000
24
14.7%
Under-five population Life Expectancy
?
2
Fertility Rate
2.7
Hunger Index
?
2
Literate Women 4.9%
2
Pregnant Women
25.9% of the total population of Arunachal Pradesh
64%
Number of live births
MORTALITY
BURDEN OF DISEASE
Trends in Infant mortality rate, Under-five mortality rate, Neonatal mortality rate (deaths per 1000 live births) 24 24 24
100
87.7
60
60.7 34
20 Year
1992-93
EXPENDITURE ON HEALTH
1998-99
2005-06
IMMUNIZATION COVERAGE 30% Fully Immunized Children
22%
Drop-Out Rate
Full Immunization Coverage 24 24
INFORMATION DASHBOARDS
INDIA HEALTH REPORT
MATERNAL NUTRITION
CHILD NUTRITION State-wise comparison of stunting in children under-5
16.4%
Mothers with low BMI (<18.5) 24
Arunachal Pradesh Other states
60% 50% 40% 30%
50.6%
Anaemia prevalence (non-pregnant) 24
20% North
Central
North East
East
South
Age wise prevalence of undernutrition (percentage of children < 5 years old) Stunted (-2SD / -3SD) / Wasted (-2SD / -3SD) / Underweight (-2SD / -3SD)
29.9%
West
24 24 24
70% 50%
Antenatal care (at least 4 visits) 24
30%
<6 6-11 12-23 24-35 36-47 48-59
<6 6-11 12-23 24-35 36-47 48-59
(in months)
<6 6-11 12-23 24-35 36-47 48-59
10%
Children under the age of five who are stunted by background charactericstics 36%
48%
36%
48%
36%
Boys
Girls
Urban
Rural
Poorest
36%
36%
SC
ST
36%
36 36 48%
Richest
36
36
OBC
Other
48%
Donâ&#x20AC;&#x2122;t know
INFANT & YOUNG CHILD FEEDING 100% 80% 60% 40% 20% 0 (in months) <6
6-8
Early initiation of breastfeeding Exclusive breastfeeding under 6 months Continued breasfeeding at 1 year Introduction of solid, semi-solid or soft foods
9-11
12-16
17-23
Minimum dietary diversity Minimum meal frequency Minimum acceptable diet Consumption of iron-rich or iron-fortified foods
08 state dashboard
37
This exploration went through a large number of iterations as content was being added and deleted, the layout was restructured numerous times after testing, and the visual style was made simpler with each iteration.
INFORMATION DASHBOARDS
FINAL LAYOUT
This section will change according to the focus are of each report, but state-standing will be done for all the issues
The final layout for the dashboard has bold section dividers, clear annotations, a cohesive colour scheme and a repeatable structure that can be followed for the future editions of the report. The dashboard is still in process of finalization, as a few indicators are yet to be decided on.
Arunachal Pradesh
NUTRITIONAL STANDING State-wise comparison of stunting in children under-5
Arunachal Pradesh Other states
60% 50 40 30 20 North
This section will remain in its place for all issues of the IHR with only the values for indicators changing over time
Central
East
North East
West
South
DEMOGRAPHICS
NUTRITIONAL STATUS
Total Population
Population below state specific poverty line
1383727
350000
0.11% of India’s population
25.9% of Arunachal Pradesh’s population 68.8%
32.2%
Female Urban
48.4%
Rural SC/ST
Others
4.9%
19.8
51.6%
Male
22.7%
57.7%
Literate Women 14.6%
Children under five
77.3%
Pregnant Women
2.7
Stunting (43.3 / 21.7)
Wasting (15.3 / 6.1)
Underweight (32.5 / 11.1)
Solid circles represent this state's nutritional status in percentages (-2SD / -3SD). Dotted lines represent national averages, -2SD values in grey and -3SD in white
Birth Rate (per 1000 population)
?
Fertility Rate
Hunger Index
MORTALITY
WATER & SANITATION
Trends in Infant mortality rate, Under-five mortality rate, Neonatal mortality rate (deaths per 1000 live births)
Access to improved source of water
100%
Time taken to obtain drinking water
98.1% 87.7%
80
92.8%
72% 63.1%
60 40
40%
20
17.5%
60.7%
41.8%
34%
0
40% 31%
66.4% have water on premises
27.1% take less than 30 minutes
5.9% take 30 minutes or longer
48.4% have no access to improved
1990
‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99
sanitation facility and 11.3% of them ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 2000 2010 have no toilet facility
IMMUNIZATION COVERAGE 30%
Fully immunized children
22%
Drop out rate
48%
Not immunized children
39
Section headers and bold lines to demarcate areas
Graph headers with legends under them so referencing becomes easy
MATERNAL NUTRITION
CHILD NUTRITION
16.4%
Age-wise prevalence of undernutrition among children
Mothers with low BMI (<18.5)
Stunting (-2SD / -3SD)
Wasting (-2SD / -3SD)
Underweight (-2SD / -3SD)
60%
Tints and shades of the same hue are used to create a harmonious yet distinct colour palette
Severe (1.6%)
Moderate (12.5%)
Mild (36.6%)
Anaemia prevalence (non-pregnant)
50 40
13.3% 30
Mother’s height less than 145cm
20
0
20
40
-3SD Boy Girl 80 100 (%)
-2SD
-2SD
60
-3SD Urban Rural 80 100 (%)
60
-3SD -2SD Scheduled Caste Scheduled Tribe Other Backward Class Others 80 100 (%)
60
-3SD -2SD Underweight (<18.5) Normal (18.5-24.9) Overweight (>25) 80 100 (%)
60
-3SD Lowest Second Middle Fourth Highest 80 100 (%)
60
Place of Residence
0
20
40
Caste
0
20
40
0
Age in months
<6 6-11 12-23 24-35 36-47 48-59
Sex
<6 6-11 12-23 24-35 36-47 48-59
Graphs for each indicator in this section are vertically aligned so comparison can be made across indicators as well
10
<6 6-11 12-23 24-35 36-47 48-59
NUTRITION (STUNTING) BY BACKGROUND CHARACTERISTICS
Anaemia prevalence among children Mild
80%
Moderate
Severe
60 40 20 0
6-11
Age in months
12-23
24-35
36-47
48-59
INFANT & YOUNG CHILD FEEDING Mother’s BMI
0
20
40
Wealth Index
0
20
40
Mother’s Education
0
20
40
60
INFORMATION DASHBOARDS
-2SD
-3SD -2SD No Education <5 Years Complete 5-9 Years Complete >10 Years Complete 80 100 (%)
Breast feeding initiation
Children ever breasfed (95.5%) Breasfed within 1 hour of birth (58.6%)
Breastfed within one day of birth (87%) Breastfed within half an hour of birth (58.1%)
78.3%
Exclusive breast feeding of infant <6 months of age
16.6%
children <6 months
Introduction of (solid, semi solid or soft) complementary foods
33.8%
63%
Children aged 6-23 months who are breastfed and received food from three or more food groups
Children aged 6-23 months who receive meals at least twice a day
34.3%
Children aged 6-35 months who consumed foods rich in iron in last 24 hours preceding the survey
80.4%
children between 6-9 months
4.1%
Children aged 6-59 months who consumed iron rich supplement in past 7 days preceding the survey
4%
Children given bottle feeding in the last three years preceding survey
WOMENâ&#x20AC;&#x2122;S STATUS
?
EXPENDITURE 8%
Gender gap index
25.3%
Women married below the age of 18 years
Women employed in agriculture
Data for these sections is yet to come, and hence are left blank
Years of education completed by women
Women allowed to make decisions about
Women involved in different types of earning
43%
Married women who have experienced any form of physical/sexual/ emotional violence
The colour identifies the nutritional status range that the state lies in
70.8%
Own health care (27.9%) Major household purchase (19.6%) Daily household purchases (59.4%) Visit friends or relatives (30.9%)
Cash only (24%) Cash and in-kind (13%) In-kind only (24.4%) Not paid (38.5%)
Women who justify hitting/beating of wife
AGRICULTURE 14.6Kg
59.3%
Food crop production to total production
12.6Kg
Urban Rural Monthly average consumption of cereals per person
HEALTH SERVICES 46.3%
51.3%
Women who have taken at least 3 antenatal visits
Women who have taken 2+ TT injections
Women given advice on
Breastfeeding (61.2%) Nutrition (48.2%) Institutional Delivery (42.8%)
18%
Women who have received IFA tablets/syrup for 3 months
1.2%
47.6%
Women whose home delivery was assisted by a skilled person
Women who had an institutional delivery
Similar graphs are used throughout so that the focus is on the content and ease of comprehension rather than decoding the graphs
41
CHAPTER 6
VISUAL LANGUAGE TYPE CHOICE
The India Health Report will be set in Myriad Pro & Minion Pro. A variety of sans-serif and serif pairing was explored, but the typeface choice was restricted by the fact that the future editions of the report would have to be designed, and there is no control over who would be designing it. Myriad Pro & Minion Pro come bundled with the Adobe Creative Suite and the Adobe Reader, so there would be no need to buy a separate license. Both Myriad Pro & Minion Pro are available in OpenType format with close to 40 weights each, which gives the designer a lot of flexibility and wide variety of weights and styles to use. In a publication of this scale, where there are multiple levels of information, section headers, chapter headings, footnotes, references, numbers and raw data, it is useful to have a large palette of type weights and styles.
VISUAL LANGUAGE
PT Serif / 11 / 14 "Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua."
Thesis Serif / 11 / 14
Signika / 11 / 14
"Lorem ipsum dolor sit amet, consectetur "Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua." incididunt ut labore et dolore magna aliqua."
Trade Gothic / 10 / 12
Whitney / 10.5 / 12
"Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua."
"Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua."
Minion Pro / 11 / 13.2
Myriad Pro / 11 / 13.2
"Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat."
"Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat."
43
PAGE LAYOUTS
The layout of the report had to be designed for ease of reading medium length (5000 words) chapters and to accommodate supporting photographs and infographics. I decided to use magazine-style layouts, breaking the text into columns and leaving space for referencing and footnotes as a lot of the facts that were stated had to be backed by supporting reading material. Explorations that lead to the final layout are shown in the following pages.
INTRODUCTION This India Health Report aims to enhance the richness of policy dialogue in India by focusing on data, statistics and objective information, input from the best experts on specific topics from within and outside the country, and lead to more informed policy change in the health and allied sectors.
india is on the move. after many decades of stagnating economic grow th, household incomes are increasingly rapidly. over the past two decades, india has also achieved improvements in agricultur al productivity and reductions in under-five mortality. Between 1990 and 2010, as the average income of Indians doubled, crop yields (kilograms/hectare) of all food grains rose by an average annual growth rate of about 2.4% and 2.9% fewer children died in the first five years of their life on an average annually. The improvements in health indicators have lagged those seen in India’s poorer neighbours including Bangladesh and Nepal. Even among these, child nutrition stands out as the one area of persistently poor performance. Child malnutrition rates in India are among the highest in the world – with nearly one-half of all children under 3 years of age being either underweight or stunted. Further, the incidence of child malnutrition has remained stubbornly high even after nearly two decades of post-reform growth and prosperity in the country. That child malnutrition is weakly correlated with income is additionally borne out by the findings that a quarter of the children of mother with 10 or more years of schooling and an equivalent proportion of children from the top income quintile are underweight. These children are very unlikely to face food insecurity. Even in a relatively prosperous and dynamic state like Gujarat, child malnutrition rates have been stagnant over the past decade.
08 INTRODUCTION
VISUAL LANGUAGE
Between 1992 and 2005, rates of stunting have declined only by 8.3%. Over the same period, stunting rates in Bangadesh declined from
65% to 42% (UNICEF, 2007) while those in Nepal reduced from 57% to 49% (NDHS, 2007). Further, the average per capita per day caloric intake may have actually declined in India. However, the performance of nutrition across states was not uniform. Some states, including Tripura, Arunachal Pradesh and Assam had remarkable rates of reduction in stunting while the situation in states like Nagaland and Gujarat remained virtually unchanged. Even more surprising is the stagnancy of child malnutrition rates in the face of declining infant and child mortality. This incongruence is difficult to understand as most factors that are associated with low rates of infant and child mortality (e.g., delivery and utilization of high-quality health services, high female literacy, and good environmental hygiene) typically also improve child nutrition. This phenomenon is often referred to as the “Indian enigma” – viz., child malnutrition rates are much higher in India than even in Sub-Saharan Africa even though infant and child mortality in India is lower. The Asian enigma throws up many interesting questions – is it culture and dietary habits (e.g., extensive vegetarianism) that account for high child malnutrition in India? Is it the poor nutritional status of mothers and their low weight gain during pregnancy that leads to low birth-weight babies who grow on to become malnourished children?
The problem of undernutrition in India now coexists with the problem of overnutrition and associated noncommunicable diseases for a different segment of the population. Indeed, there is some speculation that the two might be related; children who are underweight and undernourished are more likely to develop chronic illnesses, such as diabetes, later in life. India has the largest number of adults with type 2 diabetes and their number is growing rapidly – having doubled over the past 10 years. Indeed, India has a higher rate of diabetes than many Western countries with much higher levels of economic prosperity. In this first India Health Report: Nutrition we survey the levels of and trends in maternal and child malnutrition in India. It will focus on disparities in these outcomes across geographical regions, socio-economic classes, and demographic groups. It will also review the existing literature on the determinants and consequences of maternal and child malnutrition in the country. The focus will be on understanding the puzzle of why malnutrition rates have remained stagnant despite agricultural productivity growth, economic prosperity, and rising levels of female schooling. We explore why programs like ICDS have not had better success in reducing child malnutrition and how the proposed Right to Food bill can achieve real improvements in child nutrition. We explore the Indian evidence on the productivity impacts of nutrition and more generally on the lifetime economic benefits from early childhood nutritional interventions. And we end by recommending the most costeffective interventions for reducing child malnutrition and hunger in India?
INDIA HEALTH REPORT
INDIA HEALTH REPORT
INTRODUCTION
CHAPTER ZERO
INTRODUCTION india is on the move. after many decades of stagnating economic growth, household incomes are increasingly rapidly. over the past two decades, india has also achieved improvements in agricultural productivity and reductions in under-five mortality. Between 1990 and 2010, as the average income of Indians doubled, crop yields (kilograms/hectare) of all food grains rose by an average annual growth rate of about 2.4% and 2.9% fewer children died in the first five years of their life on an average annually. The improvements in health indicators have lagged those seen in India’s poorer neighbours including Bangladesh and Nepal. Even among these, child nutrition stands out as the one area of persistently poor performance. Child malnutrition rates in India are among the highest in the world – with nearly one-half of all children under 3 years of age being either underweight or stunted. Further, the incidence of child malnutrition has remained stubbornly high even after nearly two decades of post-reform growth and prosperity in the country. That child malnutrition is weakly correlated with income is additionally borne out by the findings that a quarter of the children of mother with 10 or more years of schooling and an equivalent proportion of children from the top income quintile are underweight. These children are very unlikely to face food insecurity. Even in a relatively prosperous and dynamic state like Gujarat, child malnutrition rates have
been stagnant over the past decade.
Between 1992 and 2005, rates of stunting have declined only by 8.3%. Over the same period, stunting rates in Bangadesh declined from 65% to 42% (UNICEF, 2007) while those in Nepal reduced from 57% to 49% (NDHS, 2007). Further, the average per capita per day caloric intake may have actually declined in India. However, the performance of nutrition across states was not uniform. Some states, including Tripura, Arunachal Pradesh and Assam had remarkable rates of reduction in stunting while the situation in states like Nagaland and Gujarat remained virtually unchanged. Even more surprising is the stagnancy of child malnutrition rates in the face of declining infant and child mortality. This incongruence is difficult to understand as most factors that are associated with low rates of infant and child mortality (e.g., delivery and utilization of high-quality health services, high female literacy, and good environmental hygiene) typically also improve child nutrition. This phenomenon is often referred to as the “Indian enigma” – viz., child malnutrition rates are much higher in India than even in Sub-Saharan Africa even though infant and child mortality in India is lower. The Asian enigma throws up many interesting questions – is it culture and dietary habits (e.g., extensive vegetarianism) that account for high child malnutrition in India? Is it the poor nutritional status of mothers and their low weight gain during pregnancy that leads to
08 INTRODUCTION
low birth-weight babies who grow on to become malnourished children?
The problem of undernutrition in India now coexists with the problem of overnutrition and associated noncommunicable diseases for a different segment of the population. Indeed, there is some speculation that the two might be related; children who are underweight and undernourished are more likely to develop chronic illnesses, such as diabetes, later in life. India has the largest number of adults with type 2 diabetes and their number is growing rapidly – having doubled over the past 10 years. Indeed, India has a higher rate of diabetes than many Western countries with much higher levels of economic prosperity. In this first India Health Repor t: Nutrition we survey the levels of and trends in maternal and child malnutrition in India. It will focus on disparities in these outcomes across geographical regions, socio-economic classes, and demographic groups. It will also review the existing literature on the determinants and consequences of maternal and child malnutrition in the country. The focus will be on understanding the puzzle of why malnutrition rates have remained stagnant despite agricultural productivity growth, economic prosperity, and rising levels of female schooling. We explore why programs like ICDS have not had better success in reducing child malnutrition and how the proposed Right to Food bill can achieve real improvements in child nutrition. We explore the Indian evidence on the productivity impacts of nutrition and more generally on the lifetime economic benefits from early childhood nutritional interventions. And we end by recommending the most costeffective interventions for reducing child malnutrition and hunger in India?
india is on the move. after many decades of stagnating economic growth, household incomes are increasingly rapidly. over the past two decades, india has also achieved improvements in agricultural productivity and reductions in under-five mortality. Between 1990 and 2010, as the average income of Indians doubled, crop yields (kilograms/hectare) of all food grains rose by an average annual growth rate of about 2.4% and 2.9% fewer children died in the first five years of their life on an average annually. The improvements in health indicators have lagged those seen in India’s poorer neighbours including Bangladesh and Nepal. Even among these, child nutrition stands out as the one area of persistently poor performance. Child malnutrition rates in India are among the highest in the world – with nearly one-half of all children under 3 years of age being either underweight or stunted. Further, the incidence of child malnutrition has remained stubbornly high even after nearly two decades of post-reform growth and prosperity in the country. That child malnutrition is weakly correlated with income is additionally borne out by the findings that a quarter of the children of mother with 10 or more years of schooling and an equivalent proportion of children from the top income quintile are underweight. These children are very unlikely to face food insecurity. Even in a relatively prosperous and dynamic state like Gujarat, child malnutrition rates have been stagnant over the past decade.
Between 1992 and 2005, rates of stunting have declined only by 8.3%. Over the same period, stunting rates in Bangadesh declined from 65% to 42% (UNICEF, 2007) while those in Nepal reduced from 57% to 49% (NDHS, 2007). Further, the average per capita per day caloric intake may have actually declined in India. However, the performance of nutrition across states was not uniform. Some states, including Tripura, Arunachal Pradesh and Assam had remarkable rates of reduction in stunting while the situation in states like Nagaland and Gujarat remained virtually unchanged. Even more surprising is the stagnancy of child malnutrition rates in the face of declining infant and child mortality. This incongruence is difficult to understand as most factors that are associated with low rates of infant and child mortality (e.g., delivery and utilization of high-quality health services, high female literacy, and good environmental hygiene) typically also improve child nutrition. This phenomenon is often referred to as the “Indian enigma” – viz., child malnutrition rates are much higher in India than even in Sub-Saharan Africa even though infant and child mortality in India is lower. The Asian enigma throws up many interesting questions – is it culture and dietary habits (e.g., extensive vegetarianism) that account for high child malnutrition in India? Is it the poor nutritional
08 INTRODUCTION
INDIA HEALTH REPORT
INTRODUCTION
NUTRITION
CHAPTER ZERO
india is on the move. after many decades of stagnating economic growth, household incomes are increasingly rapidly. over the past two decades, india has also achieved improvements in agricultural productivity and reductions in under-five mortality. Between 1990 and 2010, as the average income of Indians doubled, crop yields (kilograms/ hectare) of all food grains rose by an average annual growth rate of about 2.4% and 2.9% fewer children died in the first five years of their life on an average annually. The improvements in health indicators have lagged those seen in India’s poorer neighbours including Bangladesh and Nepal. Even among these, child nutrition stands out as the one area of persistently poor performance. Child malnutrition rates in India are among the highest in the world – with nearly one-half of all children under 3 years of age being either underweight or stunted. Further, the incidence of child malnutrition has remained stubbornly high even after nearly two decades of post-reform growth and prosperity in the country. That child malnutrition is weakly correlated with income is additionally borne out by the findings that a quarter of the children of mother with 10 or more years of schooling and an equivalent proportion of children from the top income quintile are underweight. These children are very unlikely to face food insecurity. Even
08 INTRODUCTION
this india health report aims to enhance the richness of policy dialogue in india by focusing on data, statistics and objective information, input from the best experts on specific topics from within and outside the country, and lead to more informed policy change in the health and allied sectors.
in a relatively prosperous and dynamic state like Gujarat, child malnutrition rates have been stagnant over the past decade. Between 1992 and 2005, rates of stunting have declined only by 8.3%. Over the same period, stunting rates in Bangadesh declined from 65% to 42% (UNICEF, 2007) while those in Nepal reduced from 57% to 49% (NDHS, 2007). Further, the average per capita per day caloric intake may have actually declined in India. However, the performance of nutrition across states was not uniform. Some states, including Tripura, Arunachal Pradesh and Assam had remarkable rates of reduction in stunting while the situation in states like Nagaland and Gujarat remained virtually unchanged. Even more surprising is the stagnancy of child malnutrition rates in the face of declining infant and child mortality. This incongruence is difficult to understand as most factors that are associated with low rates of infant and child mortality (e.g., delivery and utilization of high-quality health services, high female literacy, and good environmental hygiene) typically also improve child nutrition. This phenomenon is often referred to as the “Indian enigma” – viz., child malnutrition rates are much higher in India than even in Sub-Saharan
Africa even though infant and child mortality in India is lower. The Asian enigma throws up many interesting questions – is it culture and dietary habits (e.g., extensive vegetarianism) that account for high child malnutrition in India? Is it the poor nutritional status of mothers and their low weight gain during pregnancy that leads to low birth-weight babies who grow on to become malnourished children? The problem of undernutrition in India now coexists with the problem of overnutrition and associated non-communicable diseases for a different segment of the population. Indeed, there is some speculation that the two might be related; children who are underweight and undernourished are more likely to develop chronic illnesses, such as diabetes, later in life. India has the largest number of adults with type 2 diabetes and their number is growing rapidly – having doubled over the past 10 years. Indeed, India has a higher rate of diabetes than many Western countries with much higher levels of economic prosperity.
the existing literature on the determinants and consequences of maternal and child malnutrition in the country. The focus will be on understanding the puzzle of why malnutrition rates have remained stagnant despite agricultural productivity growth, economic prosperity, and rising levels of female schooling. We explore why programs like ICDS have not had better success in reducing child malnutrition and how the proposed Right to Food bill can achieve real improvements in child nutrition. We explore the Indian evidence on the productivity impacts of nutrition and more generally on the lifetime economic benefits from early childhood nutritional interventions. And we end by recommending the most costeffective interventions for reducing child malnutrition and hunger in India?
In this first India Health Report: Nutrition we survey the levels of and trends in maternal and child malnutrition in India. It will focus on disparities in these outcomes across geographical regions, socio-economic classes, and demographic groups. It will also review
INTRODUCTION 09
45
VISUAL LANGUAGE
47
Recurring element on all pages to indicate IHR and chapter numbers
Plenty of white space around the chapter headings
Space for footnotes and references
VISUAL LANGUAGE
Identifier for the focus issue and chapter name
Pull out quotes to highlight main points
49
A one/two line summary of the chapter
VISUAL LANGUAGE
Space for photographs or supporting graphs
51
IMAGE CHOICES
The image banks from partner organizations provided a lot of choice in terms of the kind of images we wanted to use for the report. Most photographs though were portraits of mothers and children, in rural settings. We also received a few photographs from health programmes and most of the human interest stories were also accompanied by relevant photographs. Apart from the standard resolution and format specifications of 300 dpi and CMYK image format, we decided to use photographs that were subtle and positive. Since the report needs to have a solution driven approach, we wanted to highlight key areas of improvement and programmes that have been working well and should be replicated. Cut out images were used in the narratives to support analytical infographics. Icons were overlaid on top of images to drive the message across in some places.
VISUAL LANGUAGE
53
COVER IMAGE
The cover of the India Health Report needed to be inviting enough to draw people to pick it up, as is the case with most publicationsâ&#x20AC;&#x201C;but more importantly, it had to communicate the multi-faceted view point that is discussed in the report, or it had to communicate the urgency of the issue at hand and draw people towards thinking about the problem and possible interventions that would improve the nutritional status of children in India. It would also need to have a repeatable element, or a mast-head which would identify the report and bind all the different editions together. I tried two approaches for the coverâ&#x20AC;&#x201C;one was an analytical graphic showcasing the multitude of issues that comprise the core problem of nutrition as I felt that this would be visually striking, and a similar style could be repeated for other issues and it would set the report apart from other similar reports which mostly use a full page photograph. The second approach was to use a photograph overlaid with illustrations to communicate the need to discuss the problem. Explorations are shown on the following pages.
india health report
india health report
NUTRITION
URBAN HEALTH
ISSUE 01 / 2013
ISSUE 02 / 2015
VISUAL LANGUAGE
IND INDIA IND IN NDI NDIA DIAA DIA HEALTH HHE EAALLT LTH TH RREPORT RE EPOR ORT RT NUTRITION
55
INDIA HEALTH REPORT NUTRITION
INDIA HEALTH REPORT a two-yearly publication by the public health foundation of india
space for tag line
nutrition
ISSUE 01 / 2013
space for tag line
ISSUE 01 / 2013
a two-yearly publication by the public health foundation of india
Nutrition
INDIA HEALTH REPORT a two-yearly publication by the public health foundation of india
nutrition space for tag line
INDIA HEALTH REPORT
VISUAL LANGUAGE
ISSUE 01 / 2013
57
CHAPTER 7
PROTOTYPE
PROTOTYPE
59
PROTOTYPE
61
CONCLUSION CURRENT STATUS
The report has not been sent into production yet, but the templates for the chapters, infographics and information dashboards have been designed. A colour coding scheme and information hierarchy has been devised. The content for the report is yet to be finalized, and the data from many states has not come in yet. The report will take its final form once these are received, but the structure and visual language are set, so it would only be a matter of replicating the page templates.
The infographics that are made for the report would also be used widely FURTHER DEVELOPMENT for advocacy purposes so they need to be translated to powerpoint
presentations and possibly motion graphics that could be shared over social media and used in research presentations as well as academic journals with relative ease. Photograph selection also needs to be done in accordance with the content and the vision of the authors.
LAUNCH PLAN
CONCLUSION
The report is scheduled to launch in the end of November in four different states. There would be a consortium before the launch, to finalize the report and send the report into production.
LEARNING EXPERIENCE
Apart from having to design the report and learning information design principles as well as developing my own visualization methodology from experience, I had to play a major role in setting the vision for the report and collate content, and take part in discussions and workshops from the conceivement of the report. It was also a challenge to do justice to the vast content of the report and figure out methods to automate repetitive work. This project required me to think about the system and the report 10 years down the line while setting the template for the layouts and visual language.
ACKNOWLEDGMENTS
This report has been a collaborative effort which would not have been possible without the support of my guide, Rupesh Vyas, the guidance and vision of Prof. Ramanan Laxminarayan (PHFI), the whole Transform Nutrition teamâ&#x20AC;&#x201C;especially Neha Raykar and Moutushi Majumdar, the folks at the CDDEP office, Julia Vivalo and Purnima Menon from IFPRI, the continuos encouragement from my parents and friends at NID.
63
REFERENCES BOOKS
_Alberto Cairo. The Functional Art. New Riders, 2012. _Nathan Yau. Visualize This. Wiley Publishing, Inc., 2011. _Edward Tufte. Visual Display of Quantitative Information. Graphics Press, 2001. _Stephen Few. Information Dashboard Design. O’Reilly Publishers,2006
REPORTS
_Save The Children. The Child Development Index 2012. _Save The Children. Food For Thought. 2013 _The Hunger and Nutrition Commitment Index. Measuring the Political Commitment to Reduce Hunger and Undernutrition in Developing Countries, 2013 _UNICEF. Improving Child Nutrition. 2013. _Save The Children. State of the World’s Mothers. 2013 _National Family Health Survey, 2005. _Sample Registration Survey, 2011.
WEBSITES
_Rhode Island School of Design. Making It Understandable. < http:// makingitunderstandable.tumblr.com/post/16533281030/understandinghealthcare-by-richard-saul-wurman> _CatalogTree. <http://catalogtree.net/projects/information%20design> _The Chronicle of Philanthrophy. Nonprofit data visualization: a Gallery. <http://philanthropy.com/blogs/innovation/nonprofit-data-visualization-agallery/667> _Adobe. InDesign Scripting. <http://help.adobe.com/en_US/indesign/cs/ using/WS0836C26E-79F9-4c8f-8150-C36260164A87a.html> _Scott Murray. D3 Tutorials. <http://alignedleft.com/tutorials/d3/ fundamentals/> _Thousand Days. Mapping nutrition in the 1000 day window. <http://www. thousanddays.org/resources/nutrition-map> _John Grimwade. < http://www.johngrimwade.com/>
REFERENCES
INDIA HEALTH REPORT PROJECT DOCUMENTATION AKSHAN ISH S1101106 PGDPD ‘11 GRAPHIC DESIGN E akshan.i@nid.edu T +91 846 901 7051