Minimal association between economic growth and childhood undernutrition for world’s poorest

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1. A very small to null association was seen between national economic growth and improvement in early childhood nutritional status.

2. No association was seen between national economic growth and reduction of undernutrition for the poorest wealth quintile of households.

Evidence Rating Level: 2 (Good)

Study Rundown: Economic growth is often thought to lead to improved nutritional status for populations with low per-head gross domestic product (GDP). The strategy of increased economic growth to improve nutritional status is based on the theory that families will invest in health if they have the additional funds to do so. This study assessed the relationship between national economic growth (per-head GDP) and early childhood undernutrition (stunting, underweight, and wasting). Quantitatively, a very small to null association was found between macroeconomic growth and reductions in early childhood undernutrition. These results emphasize the need to not only rely on trickle-down strategy to improve nutritional status in children, but also to directly invest in health and nutrition. The study is the first multilevel study of its kind with nationally representative data comparable across time and countries, and is adequately powered with over 460,000 samples each for stunting, underweight, and wasting. A limitation of this study is the oversampling of economically successful countries.

Click to read the study, published today in The Lancet

Relevant Reading: Is Economic Growth Associated with Reduction in Child Undernutrition in India?

Study Author, Dr. S.V. Subramanian, PhD, talks to 2 Minute Medicine: Professor of Population Health and Geography, Harvard University:

“The role of economic growth in improving child health is grossly over-stated, and what is required are investments in conditions that DIRECTLY impact child undernutrition including reducing food insecurity (both in terms of calories as well as micronutrients), improving access to clean water and sanitation and ensuring universal immunization.”

In-Depth [retrospective case series study]: This study analyzed data from 121 cross-sectional Demographic and Health Surveys from 36 countries done between 1990 and 2011. Data on nutritional status of children aged 0-35 months was compared with aggregate data on per-head GDP. Total sample size was 462,854 for stunting, 485,152 for underweight, and 459,538 for wasting.

The authors found that 35.6% (95% confidence interval [CI], 35.4–35.9) of children were stunted, 22.7% (95% CI, 22.5–22.9) were underweight, and 12.8% (95% CI, 12.6–12.9) were wasted. After covariate adjustments, a 5% increase of per-head GDP was associated with the odds ratios (ORs) of 0.996 (95% CI, 0.993–1.000) for stunting, 0.989 (95% CI, 0.985–0.992) for underweight, and 0.983 (95% CI, 0.979–0.986) for wasting. Importantly, at the country level there was no association found between average growth of per-head GDP and average changes in prevalence of child undernutrition outcomes. This compares to the ORs for the poorest wealth quintile, which were 0.997 (95% CI, 0.990–1.004) for stunting, 0.999 (95% CI, 0.991–1.008) for underweight, and 0.991 (95% CI, 0.978–1.004) for wasting. Several explanations accounting for this lack of association exists. It could be due to unequal distribution of growth within a country. Additionally, the allocation of this increased income within a family may not enhance childhood nutritional status. Finally, increased average incomes may not be strongly associated with improved public services, such as vaccinations and sanitation measures.

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