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Karnataka perform worse. A closer examination of the past and current investments made by these states in social protection, health and nutrition programs can help inform the debate about policy instruments to protect populations against hunger even in the face of poverty.

The lack of a clear relationship between state level economic growth and hunger is alarming. The implications of this, taken along with the relationship between the ISHI 2008 and poverty, are that first, economic growth is not necessarily associated with poverty reduction. Additionally, even if there is equitable economic growth that improves food availability and access, this might not lead immediately to progress on improving child nutrition and mortality, which need more direct investments to enable rapid reductions. Thus, in addition to wide scale poverty alleviation, direct investments in improving food availability and access for poor households as well as direct targeted nutrition and health interventions to improve nutrition and mortality outcomes for young children will be needed to impact the ISHI scores and rankings of Indian states.

The experiences of states whose rankings on the Nutrition Index deteriorated on the ISHI 2008 scores in spite of consistent positive economic growth is indicative of the need to invest solidly in direct nutrition and poverty alleviation interventions even in the face of continued economic growth. The design and implementation of policies and programs to improve all three underlying dimensions of the ISHI will need to be strengthened and supported to ensure that hunger is reduced rapidly over time. While strides are being made on the public health front to ensure sustained reductions in child mortality, improvements in child nutrition are not satisfactory in India. This is largely because nutrition programs in India are not effectively delivering evidencebased interventions at scale to those vulnerable age groups which need to be reached to ensure rapid reductions in undernutrition.

In conclusion, for Indian states to progress along the ISHI, and to ensure that ISHI scores for Indian states are more closely aligned with GHI scores of countries with comparable economic growth, investments will be needed to strengthen agriculture, improve overall food availability and access to all population segments, and to improve child nutrition and mortality outcomes.

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