We kennen wereldwijd veel landen die razendsnel groeien weg van de status van ontwikkelingsland, maar een nieuw onderzoek, net gepubliceerd in de Lancet, toont dat dit niet per se goed nieuws is voor de kinderen.
Hiervoor vergeleek men de groei van het bruto nationaal product per inwoner met de afname van ondervoeding bij kinderen. Het zou logisch zijn dat meer welvaart (wat BNP toch lijkt te meten), zou betekenen dat minder kinderen ondervoed zouden zijn. De onderzoekers konden echter geen enkele link tussen beide vaststellen.
De reden hiervoor zou zijn dat landen bij wie de economie groeit, het nieuwe geld vooral investeren in sectoren die de economie deden aangroeien. In een commentaar op het onderzoek stelt de hoofdonderzoeker, S.V. Subramanian, India als voorbeeld waar toerisme als industrie een belangrijke rol speelt in de groei van de economie: “I see dramatic improvements in four-lane roads … airports getting fancier, which helps people like me when I’m traveling. However, for the majority of the population, I don’t see improvements for the slums that I pass through every day where I lived.” (bron)
Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries.
Methods
We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0—35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household.
Findings
Sample sizes were 462 854 for stunting, 485 152 for underweight, and 459 538 for wasting. Overall, 35·6% (95% CI 35·4—35·9) of young children were stunted (ranging from 8·7% [7·6—9·7] in Jordan to 51·1% [49·1—53·1] in Niger), 22·7% (22·5—22·9) were underweight (ranging from 1·8% [1·3—2·3] in Jordan to 41·7% [41·1—42·3] in India), and 12·8% (12·6—12·9) were wasted (ranging from 1·2% [0·6—1·8] in Peru to 28·8% [27·5—30·0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989—0·995) for stunting, 0·986 (0·982—0·990) for underweight, and 0·984 (0·981—0·986) for wasting. ORs after adjustment for the full set of covariates were 0·996 (0·993—1·000) for stunting, 0·989 (0·985—0·992) for underweight, and 0·983 (0·979—0·986) for wasting. These findings were consistent across various subsamples and for alternative variable specifications. Notably, no association was seen between per-head GDP and undernutrition in young children from the poorest household wealth quintile. ORs for the poorest wealth quintile were 0·997 (0·990—1·004) for stunting, 0·999 (0·991—1·008) for underweight, and 0·991 (0·978—1·004) for wasting.
Interpretation
A quantitatively very small to null association was seen between increases in per-head GDP and reductions in early childhood undernutrition, emphasising the need for direct health investments to improve the nutritional status of children in low-income and middle-income countries.
