A review of the evidence linking child stunting to economic outcomes

Abstract

Background To understand the full impact of stunting in childhood it is important to consider the long-run effects of undernutrition on the outcomes of adults who were affected in early life. Focusing on the costs of stunting provides a means of evaluating the economic case for investing in childhood nutrition. Methods We review the literature on the association between stunting and undernutrition in childhood and economic outcomes in adulthood. At the national level, we also evaluate the evidence linking stunting to economic growth. Throughout, we consider randomized controlled trials (RCTs), quasi-experimental approaches and observational studies. Results Long-run evaluations of two randomized nutrition interventions indicate substantial returns to the programmes (a 25% and 46% increase in wages for those affected as children, respectively). Cost-benefit analyses of nutrition interventions using calibrated return estimates report a median return of 17.9:1 per child. Assessing the wage premium associated with adult height, we find that a 1-cm increase in stature is associated with a 4% increase in wages for men and a 6% increase in wages for women in our preferred set of studies which attempt to address unobserved confounding and measurement error. In contrast, the evidence on the association between economic growth and stunting is mixed. Conclusions Countries with high rates of stunting, such as those in South Asia and sub-Saharan Africa, should scale up policies and programmes aiming to reduce child undernutrition as cost-beneficial investments that expand the economic opportunities of their children, better allowing them and their countries to reach their full potential. However, economic growth as a policy will only be effective at reducing the prevalence of stunting when increases in national income are directed at improving the diets of children, addressing gender inequalities and strengthening the status of women, improving sanitation and reducing poverty and inequities.

How much does birth weight matter for child health in developing countries? Estimates from siblings and twins

“…Given the evidence on intergenerational effects of birth weight (Currie & Moretti, 2007;Lumey, 1992;Victora et al, 2008), any improvements in infant health are likely to have additional benefits that accrue over years and decades. Moreover, the evidence linking health to productivity indicates potentially large economic returns to infant health and nutrition (Caulfield et al, 2006;Haddad & Bouis, 1991;Hoddinott et al, 2008;Maluccio et al, 2009;McGovern, Krishna, Aguayo & Subramanian, 2017;Strauss, 1986;Thomas & Strauss, 1997). For example, anaemia among women in Sierra Leone is estimated to cost $19 million per year (Aguayo, Scott, & Ross, 2003).…”

Trends in inequalities in child stunting in South Asia

“…As well as being important from equity and economic standpoints, from the perspective of achieving reductions in stunting, elimination of socio‐economic inequality in child stunting by bringing prevalence among the worst off to match that among the best off in each country should therefore be a policy priority. It remains an open question as to how best to pursue this goal; however, doing so will likely require ensuring that the proceeds of economic growth are distributed equally among all households through targeting poverty reduction, improvements in diet and sanitation, and gender inequalities (McGovern, Krishna, Aguayo, & Subramanian, ).…”

People Are Taller in Countries With Better Environmental Conditions

“…Milder negative effects on health and growth were found for air pollution, homicide rate, and unemployment. For understanding the mechanism of growth attenuation by stress, we define 'homeostasis' as the steady-state environment of the body that is threatened by stressors, and the "adaptive response" as those mechanisms which are activated to reestablish the steady-state (5). Up to a certain threshold of a stressor's strength and duration, the adaptive response can reestablish homeostasis without any cost to the individual.…”

“…Much attention has been devoted to the contribution of nutrition in height and stunting (4). The long-term outcomes of stunting include a pure stature effect, and the effect of lost growth potential encompassing the cognitive impacts of undernutrition [A review of the evidence linking child stunting to economic outcomes (5)].…”