Print options

March 26, 2014

Rising Wealth Not Enough to Raise Child Health

by Steve Baragona

Getting wealthier does not automatically make a nation healthier, according to new research.

The study questions whether promoting economic growth is the best way to improve child nutrition in low- and middle-income countries.

The conventional wisdom, according to Harvard School of Public Health professor Subu Subramanian, is “‘Let’s just go after economic growth and then everything else will just follow.’”

Booming India

But Subramanian notes that a booming economy has done little to reduce child undernutrition in India.

The country’s gross domestic product (GDP), the most common measure of the economy, has been growing by more than five percent per year for much of the last two decades. That’s faster than most Western countries.

But more than two-fifths of India’s children are underweight and nearly half are stunted. And that has not changed much since the early 1990s.

In a 2011 study in PLoS Medicine, Subramanian and his colleagues found “zero evidence that increases in economic growth led to any reduction in child undernutrition.”

They wondered if the same was true in other countries. So they looked at health surveys conducted since 1990 in 36 low- and middle-income countries, mostly in sub-Saharan Africa.

"Practically zero"

Writing in the journal The Lancet Global Health, they found that when they compared the impact of GDP growth on indicators of child malnutrition - like stunted growth and being underweight - the effect was “practically zero to very, very small.”

For every five percent gain in GDP, they found a less than one percent decrease in stunting, for example.

Subramanian says that’s because investments that raise GDP are not the ones that will improve child health. He criticized India for building new highways and airports while much of the country lacks basic sanitation.

Without investments in clean water, breastfeeding promotion, food aid programs, and so on, he said, “what we are seeing is [that] economic growth by itself is not making much impact.”

"Wrong"

But critics describe the conclusion that GDP growth has little or no impact on child nutrition as “crazy” and “wrong.”

“Income growth is a necessary condition for increased spending on food, health, education, sanitation and so on,” said Derek Headey at the International Food Policy Research Institute.

Lawrence Haddad, head of the Institute for Development Studies in Brighton, England, says the study looked at too few countries over too short a time period. He points to countries such as Ghana, Brazil and Vietnam, where economic growth gets about half the credit for sharp declines in malnutrition over the past two decades.

“The other half is attributable to strategic investments in water, sanitation, health systems, nutrition programs,” he said.

In other words, it takes both GDP growth and the right investments to improve child nutrition rates.

“Unfortunately, with malnutrition, there is no silver bullet,” he added. “It’s like a series of links in a chain, and if any one of those links is weak, it undermines everything else.”