Consider some of the biggest challenges facing the world — armed conflict, chronic disease, education, infectious disease, population growth, biodiversity, climate change, hunger & malnutrition, natural disasters, water and sanitation.
What would be your response if you were given billions of dollars to invest in one intervention?
In 2004, the Copenhagen Consensus, which is a think tank devoted to finding the most efficient ways to solving the world’s biggest problems, tossed this very compelling question before an expert panel of scientists and economists, which included four Nobel winners.
“If you had $75 billion for worthwhile causes, where should you start?” the panel was asked.
The idea was to find out that one intervention which gives the most bang for the buck — the one that scored the highest in cost-benefit analyses as limited budgets are a global reality.
This exercise was repeated again in 2008 and then 2012 and in each of these three attempts the winning solution turned out to be the same.
The highest-ranking choice, which was informed by a whole host of research papers, was to invest in “Interventions to Reduce Chronic Undernutrition in Preschoolers”.
By preschoolers, we refer to children below the age of 5 years and the standout measure of chronic malnutrition in such children is stunting — that is, having a low height for one’s age.
According to the 2012 results, each dollar spent towards reducing child stunting results in benefits of 30 dollars.
In fact, a research paper — titled “Hunger and Malnutrition” by John Hoddinott et. al. — found benefits of spending a dollar towards this goal in India were far more than most countries.
In India, the benefits ranged from anywhere between $45 to $139 for each dollar spent towards reducing child stunting (see the table below). The benefits would come in the form of higher per capita income in the future for the children who were saved from stunting.
No matter which way one calculates, that is a fantastic rate of return for any investment.
But it is not just a matter of making a quick buck or indeed just about kids growing up a few inches short. There are massive downsides to not arresting high levels of child malnutrition.
According to another paper — “The Economic Rationale for Investing in Stunting Reduction” by John Hoddinott, Lawrence Haddad and others — chronic undernutrition has neurological consequences that lead to cognitive impairments.
Moreover, stunting increases the risk of chronic diseases, which, in turn, have direct resource costs including the costs of medication and the costs associated with accessing and using health-care services. Chronic diseases refer to those which last for more than a year such as cardiovascular disease, chronic respiratory disease, cancer, diabetes etc.
It is hardly surprising then that a number of studies have found malnourished kids to have lower earnings in adulthood.
“Everywhere in the world, schooling and cognitive skills are vital for success in the labor market. A useful rule of thumb is that every additional grade of schooling raises wages by eight to 12 per cent,” wrote Hoddinott in his book — “The economic cost of malnutrition”. “So individuals without such skills and with less schooling earn lower wages, which makes it more likely that they will be poor,” he stated.
Of course, child stunting is just one of the measures of child malnutrition. There are several other measures such as child wasting (having low weight for one’s height) and being underweight as well as child mortality.
Given the high incidence of child stunting, wasting and underweight children in India, it is generally regarded as the country with the maximum number of malnourished children in the world. It is for this reason that India routinely languishes at the bottom of global indices such as the Global Hunger Index.
It is in this background that you should read the multiple stories on the latest round of National Family Health Survey. As the table below alongside shows, on several key metrics not only did many states and Union Territories worsen but also that the number of states worsening was more than the number of states staging an improvement.
Purnima Menon of International Food Policy Research Institute spoke to The Indian Express in a podcast and explained why this is an alarming trend and how things might likely get even worse since this phase of NFHS data was collected before the Covid-19 pandemic. There is an “explained” piece as well on this topic.
In short, the latest data shows that in several parts of India, children born between 2014 and 2019 are more malnourished than the previous generation.
According to the World Health Organisation (see the table below), in 2019 over 8 lakh children under the age of five died in India. In 2020 and the next few years, with the adverse effects of the pandemic in play, this figure could be higher as most of the child mortality is explained by malnutrition.
For a country that already had the most number of malnourished children in the world, this is a scary picture. India cannot be a global superpower unless it first brings down the alarming — and rising — levels of child malnutrition.
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