Abstract
Economic growth is widely perceived as a major policy instrument in reducing childhood undernutrition in India. We assessed the association between changes in state per capita income and the risk of undernutrition among children in India. Data for this analysis came from three cross-sectional waves of the National Family Health Survey (NFHS) conducted in 1992-93, 1998-99, and 2005-06 in India. The sample sizes in the three waves were 33,816, 30,383, and 28,876 children, respectively. After excluding observations missing on the child anthropometric measures and the independent variables included in the study, the analytic sample size was 28,066, 26,121, and 23,139, respectively, with a pooled sample size of 77,326 children. The proportion of missing data was 12%-20%. The outcomes were underweight, stunting, and wasting, defined as more than two standard deviations below the World Health Organization-determined median scores by age and gender. We also examined severe underweight, severe stunting, and severe wasting. The main exposure of interest was per capita income at the state level at each survey period measured as per capita net state domestic product measured in 2008 prices. We estimated fixed and random effects logistic models that accounted for the clustering of the data. In models that did not account for survey-period effects, there appeared to be an inverse association between state economic growth and risk of undernutrition among children. However, in models accounting for data structure related to repeated cross-sectional design through survey period effects, state economic growth was not associated with the risk of underweight (OR 1.01, 95% CI 0.98, 1.04), stunting (OR 1.02, 95% CI 0.99, 1.05), and wasting (OR 0.99, 95% CI 0.96, 1.02). Adjustment for demographic and socioeconomic covariates did not alter these estimates. Similar patterns were observed for severe undernutrition outcomes. We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India. Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India. Please see later in the article for the Editors' Summary.
Highlights
Macro-economic growth is considered a major, and often the only, policy instrument to improving health and nutrition in developing countries [1,2,3]
We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India
There is a body of research arguing that it is healthier populations, for example with healthy nutritional indicators, that are a prerequisite for increased economic growth and improved standard of living [13,14]
Summary
Macro-economic growth is considered a major, and often the only, policy instrument to improving health and nutrition in developing countries [1,2,3]. The premise is that economic growth will improve incomes, especially among the poor, and increase their access to and consumption of health-promoting goods and services, leading to improved nutritional status This argument has been made in the context of reducing undernutrition in developing countries (Figure 1) [4]. While the first two pathways rely on behavioral change at the individual or household level as a result of improved economic standard of living, the third underscores the role of public investment facilitated either by greater economic growth and potential increases in revenue or independent of it [6,7] The success of such a ‘‘growth-mediated’’ strategy to reducing undernutrition is, neither automatic nor necessary [8,9,10]. Almost half of children under the age of 3 are underweight, about half are stunted, and a quarter are wasted
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
