Economic growth in India has no automatic connection to reducing undernutrition in Indian children and so further reductions in the prevalence of childhood undernutrition are likely to depend on direct investments in health and health-related programs. These are the conclusions of a large study by researchers at the Schools of Public Health at University of Michigan and Harvard University, that is published in this week's PLoS Medicine.
Malavika Subramanyam, S V Subramanian and colleagues collected data from the National Family Health Surveys conducted in India in 1992-93 (28,066 children), 1998-99 (26,121 children) and 2005-06 (23,139 children), which use stratified, representative samples of the population from every state of India. They used the measurements--weight-for-age, height-for-age, and weight-for-height--in these surveys to classify individual children's nutritional status as underweight, stunting or wasting, respectively, as per the World Health Organization Child Growth Standards.
The study reports that the prevalence of underweight decreased from 49.1% in 1992-93 to 43.8% in 1998-99 to 40.2% in 2005-06. Stunting prevalence also decreased while the prevalence of wasting decreased only marginally from 24% in 1992-93 to 22% in 2005-06. Meanwhile, during the study period, the Indian economy grew at an annual rate of 7%-9%. Further, there was substantial variation between states in each of the measures of undernutrition, as well as economic growth, and this enabled the authors to examine whether changes in state economic growth were associated with a reduction in the risk of a child being undernourished in a given state. The authors found that state economic growth was not associated with the risk of underweight, stunting, and wasting.
The authors conclude: "We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India." They add, "Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India."
Funding: No direct financial support or funding was obtained to conduct this study. SVS is supported by a National Institutes of Health Career Development Award (NHLBI K25 HL081275), and the Robert Wood John Health Investigator Award in Health Policy Research. MAS was supported by The Richmond Fellowship from the Harvard Center on the Developing Child at the time when majority of the analysis was conducted. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Subramanyam MA, Kawachi I, Berkman LF, Subramanian SV (2011) Is Economic Growth Associated with Reduction in Child Undernutrition in India? PLoS Med 8(3): e1000424. doi:10.1371/journal.pmed.1000424
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S. V. Subramanian
Harvard School of Public Health
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