Diet Quality, Child Health, and Food Policies in Developing Countries

Globally, tremendous progress has been made in reducing extreme poverty in the last 25 years. However, the number of poor remains unacceptably high, at just over 1 billion in 2011 compared with 1.2 billion in 2008, creating a widening gap between the living standards of those in the bottom 40 percent and the top 60 percent of the population. According to the recently released Global Monitoring Report, the well-being of low income households still remains below that of households in the top 60 percent directly impacting young children who are 2-3 times more likely to be malnourished than those in the highest wealth quintiles.

While much more works needs to be done to close this gap, importance should be given to the quality of nutritional intakes in improving a children’s overall wellbeing. My recent World Bank working paper discusses a set of issues that need to be addressed in developing food policies for children’s physical and intellectual growth. 

Analyzing the effects of food intakes on health outcomes is a complex topic and involves multiple factors. Stigler (1945) noted that because “the optimum quantity of any nutrient depends upon the quantities of other nutrients available”, the “ultimate health function will doubtless be very complex”. Moreover, households’ food intakes are influenced by cultural, geographical, socioeconomic, and demographic factors. Environmental factors, such as poor sanitation and hygiene, play an important role in children’s physical growth. For example, children in developing countries are unlikely to achieve their full height despite adequate food supplies because repeated episodes of diarrheal and other morbidities exacerbate nutrient loss. At the other extreme, heights in the Netherlands has surpassed all countries since the Second World War, presumably due to the school milk programs that encouraged and rewarded children for drinking up to five glasses of milk daily by becoming “M-brigadiers”.  Availability of nutritious foods at affordable prices for poor households is also a critical factor. In countries where stunting is prevalent due to low calcium intakes, for example, higher productivity in dairy farming and efficiency in food distribution systems can improve children’s diet quality.

The efficacy of food polices is likely to depend on nutritional knowledge incorporated into the design. Moreover, nutrient intakes gradually affect child health, so it is helpful to use alternative tools to evaluate short-term interventions versus long-term food policies. Based on elaborate econometric analyses of data from countries such as Bangladesh, India, Kenya, the Philippines, and Tanzania, the main findings of my paper are:

• The estimated income elasticities of energy and nutrient intakes in India, the Philippines, and Kenya underscored the roles of household incomes for improving diet quality. For micronutrients such as iron, absorption rates are low, and so it is important to focus on “absorbable” iron intakes to reduce deficiencies. For example, it would be helpful to design policies to improve the iron content of staple foods such as rice and beans, while increasing the intakes of vegetables such as orange flesh sweet potato that contain higher quantities of β-carotene. Such policies will gradually benefit large numbers of individuals, although the evaluation of the benefits would require an extended time frame.
• The magnitudes of income elasticities of calcium intakes showed increases with household incomes in India, the Philippines, and Kenya. Dairy products are good sources of calcium and increase the intake of “heme” iron that is readily absorbed. Thus, the promotion of dairy farming is likely to have beneficial effects for child health. Such interventions have been successful in increasing children’s physical growth in developed countries so that less emphasis needs to be placed on short-term evaluations in developing countries.
• The effects of environmental factors such as poor sanitation and water quality on children’s morbidity were emphasized because they hinder nutrient absorption. The evidence on Filipino, Kenyan, and Bangladeshi children showed the importance of good nutritional status assessed via intake of vitamin A, and height, weight and hemoglobin concentration to reduce morbidity. The results for Indian children’s hemoglobin concentration indicated the importance of utilization of healthcare services.
•  For pre-school and school-aged children, food and health policies should improve the nutritional status of younger children, especially when resources are limited. Morbidity levels typically decline with age as immunity systems develop.  Analyses of Filipino and Kenyan data also showed beneficial effects of diet quality for children’s age-adjusted height and weight. Thus, food policies such as maternal supplementation programs during pregnancy to improve birth outcomes, supplementation of lactating mothers to support infant growth, and supplementation programs for preschool children are likely to improve children’s growth. In addition, family planning programs that enable birth spacing reduce demands on the low maternal nutrient stores in developing countries.
• Encouraging livestock production will be helpful for child growth because dairy products increase calcium and heme iron intakes. In addition,  cultivation of fruits and vegetables, even on a small scale, can increase vitamin A and C intakes, which enhance non-heme iron absorption. Although the resources available for dairy farming and vegetable cultivation are often limited, additional revenues from taxing unhealthy processed foods can support higher intakes of animal products by the poor. Sixth, children’s cognitive development is critical for the future supply of skilled labor and for economic development. Improving diet quality in terms of protein and micronutrient intakes will be beneficial for children’s physical and cognitive development. Future gains in economic productivity from education are likely to be substantial, as demonstrated by impressive economic growth in countries such as Japan, South Korea, and China.
• Finally, it is important to design educational programs and indirect taxes on unhealthy processed foods for improving diet quality. A lower burden of chronic disease will, in turn, enable greater healthcare resources for the poor. More elaborate food labeling systems, educational campaigns, and taxes on processed foods that depend on fat, sugar, and salt contents, can improve population health and economic productivity in developing countries.