The economic rationale for investing in stunting reduction

Abstract

This paper outlines the economic rationale for investments that reduce stunting. We present a framework that illustrates the functional consequences of stunting in the 1000 days after conception throughout the life cycle: from childhood through to old age. We summarize the key empirical literature around each of the links in the life cycle, highlighting gaps in knowledge where they exist. We construct credible estimates of benefit-cost ratios for a plausible set of nutritional interventions to reduce stunting. There are considerable challenges in doing so that we document. We assume an uplift in income of 11% due to the prevention of one fifth of stunting and a 5% discount rate of future benefit streams. Our estimates of the country-specific benefit-cost ratios for investments that reduce stunting in 17 high-burden countries range from 3.6 (DRC) to 48 (Indonesia) with a median value of 18 (Bangladesh). Mindful that these results hinge on a number of assumptions, they compare favourably with other investments for which public funds compete.

The politics of reducing malnutrition: building commitment and accelerating progress

“…The large economic returns to nutritionspecifi c interventions (paper two in this Series 5 ), are clear 6 and we recognise the potential of nutritionsensitive interventions (paper three 7 ) and the importance of an enabling environment for reduction of under nutrition-the focus of this report. 8 Most of the concepts and ideas that we develop about enabling environments apply to both undernutrition and the growing problems of overweight and obesity as documented in the fi rst paper in this Series.…”

“…With assumptions about the 11% uplift in income attributable to prevention of a third of stunting by age 3 years, and about the 5% discount rate of future benefi t streams, average cost-benefi t estimates have been generated for 20 countries, 6 with a median ratio of 18 (Bangladesh). These ratios compare extremely favourably with other investments for which public funds compete.…”

Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention

“…Among malnourished children, linear growth (height-for-age) can falter rapidly until age 2 years, then slowly thereafter, whereas weight-for-height, which exhibits more variability, falters until 1 year of age, then tends to recover to international medians [6]. Faltering in either linear growth or weight gain by age 2 predicts shorter adult height and lower educational attainment, and malnutrition in the first year of life predicts low socioeconomic status in adulthood [5,7,8]. …”

Climatic Conditions and Child Height: Sex-Specific Vulnerability and the Protective Effects of Sanitation and Food Markets in Nepal

“…Adverse conditions in utero and during the first two years of life can cause high perinatal mortality and subsequent stunting (Coffey, 2015) as well as low weight and anemia (Kumar et al, 2016), low economic productivity (Paxson and Schady, 2007;Hoddinott et al, 2013), and less academic success (Schultz-Nielsen et al, 2016). Affected children may also have higher odds of developing cardiovascular disease and other conditions (Popkin et al, 1996;Sawaya et al, 2003), as set forth in the fetal origins hypothesis of Barker (1995).…”

“…Gestation and the first two years after birth are the most critical periods for child development, and have clear impacts on physical, cognitive, and other outcomes later in life (Almond, 2006;Black et al, 2013;Hoddinott et al, 2013). Adverse conditions in utero and during the first two years of life can cause high perinatal mortality and subsequent stunting (Coffey, 2015) as well as low weight and anemia (Kumar et al, 2016), low economic productivity (Paxson and Schady, 2007;Hoddinott et al, 2013), and less academic success (Schultz-Nielsen et al, 2016).…”