GDPN: Improving nutrition hub The economic rationale for investing in undernutrition

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Policymakers are confronted on a daily basis with an enormous list of priorities. From improving the status of women, to mitigating climate change and infrastructure development, many worthy activities are competing for limited resources. It is in this context that we argue: investing in the reduction of chronic undernutrition in very young children is not just worthy, it's sound economics.

The economic rationale for investments that reduce undernutrition is simple: weigh the costs against the benefits. The catch in this, of course, is exactly how you calculate each side.

Reducing chronic undernutrition has numerous benefits. There are economic gains because better nourished children are less likely to be sick and adults who were better nourished as children are less likely to suffer from chronic diseases. These gains encompass both reduced direct costs associated with illness and also reduction in time spent looking after sick children.

A second group relates to economic gains that arise because better nourished children are taller in adulthood and have better cognitive skills. For example, undernourished children score poorly on tests of attention, fluency and working memory all of which affect success at school. In turn, taller individuals with better cognitive skills are more economically productive. Some benefits are intergenerational – for example, women who are better nourished as children complete more schooling and are consequently less likely to have undernourished children themselves.

And all these gains could be possible at low cost. Recent research has established a package of interventions, costing around $100, that when implemented together would reduce the prevalence of undernutrition by 20%. The package would include interventions aimed at:

1. Improving the health and nutrition of mothers

Investing in universal salt iodisation, micronutrient supplementation and calcium supplementation can help to ensure mothers are well-nourished. Healthier mothers have healthier children; for example, multiple micronutrient supplementation has been shown to increase birthweights.

2. Improving the quantity and quality of a child's diet

Community-based interventions that manage severe acute malnutrition and the provision of supplementary foods in special circumstances help ensure children's diets are sufficiently nutritious in terms of both energy and micronutrients.

3. Reducing the impact of infections

Infections often contribute to undernutrition. Energy that should be used for growth is instead diverted to fight off infections and the infections themselves often diminish appetite and thus energy intake. Providing each person with therapeutic zinc supplementation can help to mitigate against the effects of infections, including diarrheal disease, and therefore prevent undernutrition.

4. Improving nutritional knowledge

Children are more likely to be well-nourished if their mothers know which foods are nutritious and understand how their offspring benefit from consuming them. In environments characterised by food insecurity, community-based programmes that provide information on nutrition, breastfeeding and complementary feeding work well to ensure this.

There is no denying that some of the benefits we have described above, such as reduced mortality, take us into the ethically difficult terrain of valuing human life. While it is challenging to quantify gains such as those derived from reduced chronic disease in adulthood, we do have some understanding of how undernutrition in early life affects attained height, cognitive skills in adulthood, income and poverty. Using insights from this data, we see that if individuals are given the package of interventions described above, their income would, on average, rise by 11% every year.

Using these methods, we find that the economic benefits far exceed the economic costs of investing in the reduction of undernutrition in the 17 countries which collectively account for much of the global prevalence of stunting. For example, in Bangladesh, every dollar invested in reducing chronic undernutrition generates around $18 in economic returns. Using the standards by which public expenditure is measured, these are enormously high returns. As policymakers grapple with multiple priorities, trying to weigh up the costs and benefits of each, it is clear that investing in reducing undernutrition is in fact really good economics.

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