Alleviating child malnutrition is at the top of the global development agenda. But it is not a recent phenomenon, nor is it restricted to the developing countries of today. In his inaugural LSE lecture, delivered on 16 November 2023, Professor Eric Schneider presented his research on reconstructing long-run historical trends in childhood malnutrition and stunted growth, explaining the factors leading to the large degree of variation in stunting rates across countries and over time.  

The prevalence of child malnutrition has been falling in recent years but remains a persistent global problem. Child malnutrition is often proxied by child stunting, the percentage of children aged 0 to 5 in a population whose height is less than two standard deviations below the WHO child growth standard. Stunting is a key indicator in the Millennium and Sustainable Development Goals. Child stunting is concentrated in South and Southeast Asia and sub-Saharan Africa (Figure 1). Global child stunting has fallen from 33% of children in 2000 to 22.3% of children in 2022. However, there are still 148.1 million children under age five who are stunted today (Unicef et al. 2023). Stunted children experience poorer health, human capital outcomes and lower income later in life. This makes eliminating child stunting a key policy priority for many low- and middle-income countries (LMICs) (Currie 2008; Hoddinott et al. 2013).

Most existing research on child stunting focusses on the past 40 years. Taking a long-run, global perspective on child stunting helps to clarify the determinants of child stunting (Schneider 2023).

Schneider et al. (2023) have reconstructed child stunting rates for 123 countries since the mid-nineteenth century. Stunting rates for 25 selected countries are presented in Figure 2 to give a sense of the historical variation.  Figure 2 below shows the historical evolution of stunting for current high-income countries (HIC) and LMICs, enabling comparison beween these two groups.

Panel A reports the historical stunting experiences of countries currently HICs by the World Bank. While stunting rates appear to always have been relatively low in the European settler colonies in the New World and in Scandinavia, European countries had higher levels of child stunting at the beginning of the twentieth century than many LMICs today. For example, until approximately 1910, the United Kingdom experience higher stunting than Kenya today.

In Western Europe stunting began to decline in the first quarter of the twentieth century. It would take Eastern and Southern European countries till the middle of the century for rates to decline. Stunting rates were exceptionally high in Japan at the end of the nineteenth century, but across the twentieth century Japan saw a complete eradication of child stunting.

Panel B extends the existing data in the Joint Malnutrition Estimates produced by Unicef, WHO and the World Bank back in time for countries currently classified as LMICs. Stunting rates have clearly fallen in LMICs since the mid-twentieth century. South Asian countries also appear to have had higher stunting rates than sub-Saharan African countries throughout time. This gap has been termed the ‘Indian Enigma’; Child stunting is lower in sub-Saharan Africa than in India despite India’s strong economic performance in recent years.

Finally, some LMICs have had surprisingly low stunting rates across the twentieth century. This particularly applies to Cuba, Jamaica and many other Caribbean countries, which had relatively low stunting rates in the mid-twentieth century despite their poverty.

The determinants of child stunting are varied, and in his lecture, Prof Schneider considers population genetic differences in growth; income (GDP per capita growth)l; poor nutrition; unclean water and inadequate sanitation; and poor maternal health.

Professor Schneider’s lecture concluded with three lessons from the historical experience of child stunting decline for the current fight against child stunting:

1. Differences in maternal health between current LMICs and historical Western HICs suggest that interventions that reduced stunting in the West may not be sufficient for some current LMICs.

2. The historical record shows that stunted children can experience catch-up growth, so more research is needed on how to mitigate the damage of stunting for the 148 million children stunted today.

3. No single determinant can fully explain stunting decline, emphasising the importance of a context-dependent approach and of less tangible factors for stunting reduction such as demand for public health provision and societal attitudes toward health and hygiene.

You can watch the lecture in full here.

References

Currie, J. (2008). Child health and the intergenerational transmission of human capital. VoxEU.

Hoddinott, J., Behrman, J. R., Maluccio, J. A., Melgar, P., Quisumbing, A. R., Ramirez-Zea, M., Martorell, R. (2013). Adult consequences of growth failure in early childhood. American Journal of Clinical Nutrition, 98(5), 1170–1178.

Nisbett, N., Harris, J., Headey, D., Bold, M. van den, Gillespie, S., Aberman, N.-L., … Turowska, Z. (2023). Stories of change in nutrition: lessons from a new generation of studies from Africa, Asia and Europe. Food Security, 15(1), 133–149.

Schneider, E. B. (2023). The determinants of child stunting and shifts in the growth pattern of children: A long‐run, global review. Journal of Economic Surveys.

Schneider, E. B., Jaramillo Echeverri, J. et al. (2023). Worldwide child stunting since the mid-nineteenth century.

Unicef, WHO, & World Bank Group. (2023). Levels and trends in child malnutrition: Key findings of the 2023 edition. Geneva.