Jere R. Behrman

Health and nutrition

Publisher Summary Health and nutrition are important as ends in themselves and often are emphasized as critical components of basic needs in developing countries. Cross-country comparisons of standard data suggest that on the average health and nutrition in the developing world falls considerably short of that in the developed world. The chapter presents a review on a number of issues regarding health and nutrition in developing countries and available studies on the determinants of health and nutrition and on their impact on productivity in developing countries. First, the chapter presents a theoretical framework and some issues pertaining to the empirical representation of health and nutrition. The chapter then presents a survey on existing studies of both health and nutrition determinants and on their productivity influence and conclude with some discussion of policy issues and directions for future research. A theoretical framework for the determinants of health and nutrition and their possible productivity impacts is essential to analyze these variables in an organized manner and to be able to interpret empirical studies. The chapter discusses micro production function and demand considerations. The chapter then discusses in brief the supply side and macro relations. Finally, several major econometric problems are reviewed, stating that they are ubiquitous in empirical studies attempting to relate health, nutrition, and socioeconomic variables. Two broad categories of studies of health determinants are of particular interest: those attempting to estimate the reduced-form demand for health outcomes and health-care goods, and those attempting to estimate the underlying health production function.

Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world.

This paper is the third in the Child Development Series. The first paper showed that more than 200 million children under 5 years of age in developing countries do not reach their developmental potential. The second paper identified four well-documented risks: stunting, iodine deficiency, iron deficiency anaemia, and inadequate cognitive stimulation, plus four potential risks based on epidemiological evidence: maternal depression, violence exposure, environmental contamination, and malaria. This paper assesses strategies to promote child development and to prevent or ameliorate the loss of developmental potential. The most effective early child development programmes provide direct learning experiences to children and families, are targeted toward younger and disadvantaged children, are of longer duration, high quality, and high intensity, and are integrated with family support, health, nutrition, or educational systems and services. Despite convincing evidence, programme coverage is low. To achieve the Millennium Development Goals of reducing poverty and ensuring primary school completion for both girls and boys, governments and civil society should consider expanding high quality, cost-effective early child development programmes.

Returns to Birthweight

We use data on monozygotic twins to obtain improved estimates of the effect of intrauterine nutrient intake on adult health and earnings and thus to evaluate the efficacy of programs aimed at increasing birthweight. We use the results to evaluate the bias in cross-sectional estimates and to assess the proposition that health conditions play a major role in determining the world distribution of income. We show that there is considerable variation in the incidence of low birthweight across countries, and our estimates suggest that there are real payoffs to increasing body weight at birth. Increasing birthweight increases adult schooling attainment and adult height for babies at most levels of birthweight, but has no effect on adult body mass. The effect of increasing birthweight on schooling, moreover, is underestimated by 50x if there is no control for genetic and family background endowments as in cross-sectional estimates. We also find evidence that augmenting birthweight among lower-birthweight babies, but not among higher-birthweight babies, has significant labor market payoffs. However, shifting the distribution of birthweights in developing countries to that in the United States would reduce world earnings inequality by less than 1, far less than indicated by the cross-country correlation between per-worker GDP and birthweight.

Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults

BACKGROUND Substantial, but indirect, evidence suggests that improving nutrition in early childhood in developing countries is a long-term economic investment. We investigated the direct effect of a nutrition intervention in early childhood on adult economic productivity. METHODS We obtained economic data from 1424 Guatemalan individuals (aged 25-42 years) between 2002 and 2004. They accounted for 60% of the 2392 children (aged 0-7 years) who had been enrolled in a nutrition intervention study during 1969-77. In this initial study, two villages were randomly assigned a nutritious supplement (atole) for all children and two villages a less nutritious one (fresco). We estimated annual income, hours worked, and average hourly wages from all economic activities. We used linear regression models, adjusting for potentially confounding factors, to assess the relation between economic variables and exposure to atole or fresco at specific ages between birth and 7 years. FINDINGS Exposure to atole before, but not after, age 3 years was associated with higher hourly wages, but only for men. For exposure to atole from 0 to 2 years, the increase was US

Attrition in Longitudinal Household Survey Data: Some Tests for Three Developing-Country Samples

0.67 per hour (95% CI 0.16-1.17), which meant a 46% increase in average wages. There was a non-significant tendency for hours worked to be reduced and for annual incomes to be greater for those exposed to atole from 0 to 2 years. INTERPRETATION Improving nutrition in early childhood led to substantial increases in wage rates for men, which suggests that investments in early childhood nutrition can be long-term drivers of economic growth.

Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries

For capturing dynamic demographic relationships, longitudinal household data can have considerable advantages over more widely used cross-sectional data. But because the collection of longitudinal data may be difficult and expensive, analysts must assess the magnitudes of the problems, specific to longitudinal, but not to cross-sectional data. One problem that concerns many analysts is that sample attrition may make the interpretation of estimates problematic. Such attrition may be especially severe where there is considerable migration between rural, and urban areas. And attrition is likely to be selective on such characteristics as schooling, so high attrition is likely to bias estimates. The authors consider the extent, and implications of attrition for three longitudinal household surveys from Bolivia, Kenya, and South Africa that report very high annual attrition rates between survey rounds. Their estimates indicate that: 1) the means for a number of critical outcome, and family background variables differ significantly between those who are lost to follow-up, and those who are re-interviewed. 2) A number of family background variables are significant predictors of attrition. 3) Nevertheless, the coefficient estimates for standard family background variables in regressions, and probit equations for the majority of outcome variables in all three data sets, are not significantly affected by attrition. So attrition is apparently not a general problem for obtaining consistent estimates of the coefficients of interest for most of these outcomes. These results, which are very similar to those for industrial countries, suggest that multivariate estimates of behavioral relations may not be biased because of attrition. This wold support the collection of longitudinal data.

Will Developing Country Nutrition Improve with Income? A Case Study for Rural South India

This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include childrens educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrolment rate and discount rate.

How does mother's schooling affect family health, nutrition, medical care usage, and household sanitation?

The World Bank and others maintain that the major mechanism for improving nutrition in poor communities is increases in income. Aggregate estimates of food expenditure are consistent with such a possibility, implying income/expenditure elasticities close to one. However, the high degree of aggregation at which such estimates are made means that the considerable increase in price per nutrient as income increases is ignored, and the nutrient elasticities are therefore overstated. Estimates for a rural south Indian sample indicate that this bias is considerable and that the true nutrient elasticities with respect to income may be close to zero. Copyright 1987 by University of Chicago Press.

The Impact of Improving Nutrition During Early Childhood on Education Among Guatemalan Adults

Abstract A mothers education is widely posited to affect positively her own and her childrens health and nutrition in developing economies. We estimate a LISREL system of production functions for maternal and child health and reduced-form relations for nutrition, medical care usage, and household water and sanitation, with latent variable representations of these dependent variables and of community and maternal endowments. If the maternal endowment is excluded, mothers schooling appears to have strong positive effects on health and nutrition. But this effect evaporates when the maternal endowment (i.e., abilities, habits, and health status related to childhood family background) is included, thus raising doubts about standard estimates of the impact of maternal schooling on health and nutrition.

Birth Order, Schooling, and Earnings

Using a longitudinal survey from rural Guatemala, we examine the effect of an early childhood nutritional intervention on adult educational outcomes. An intent-to-treat model yields substantial effects of an experimental intervention that provided highly nutritious food supplements to children, a quarter century after it ended: increases of 1.2 grades completed for women and one quarter SD on standardised reading comprehension and non-verbal cognitive ability tests for both women and men. Two-stage least squares results that endogenise the actual supplement intakes corroborate these magnitudes. Improving the nutrient intakes of very young children can have substantial, long-term, educational consequences.