One size does not fit all. How universal standards for normal height can hide deprivation and create false paradoxes.

Abstract

Public health practitioners and social scientists frequently compare height against one-size-fits-all standards of human growth to assess well-being, deprivation, and disease risk. However, underlying differences in height can make some naturally tall populations appear well-off by universal standards, even though they live in severe states of deprivation. In this article, I describe the worldwide extent of these population differences in height and illustrate how using a universal yardstick to compare population height can create puzzling disparities (eg, between South Asia and sub-Saharan Africa) while also underestimating childhood stunting in specific world regions (eg, West Africa and Haiti). I conclude by discussing potential challenges of developing and implementing population-sensitive standards for assessing healthy development.