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Sunday, June 23, 2013

Economics and infant malnutrition

At the recent G8 Summit on the shores of Lough Erne here in Ireland, a new declaration was signed to chase the big multi nationals for a fairer share of their sales to be paid as tax. Google generated  £11.5bn in profits in the UK and only paid £10m in tax during that period. In the UK in 2011, Apple Sales International generated UK sales valued at $22bn but paid only $10m in tax. In the week before the G8 summit the NGO Save the Children issue an in-depth report also looking at global economic development but with a focus on malnutrition[1].  The main conclusion of this report is that if today’s infants are not properly nourished, the global economic loss in 2030, when these infants reach working age, will be $125 billion.

The first part of this report deals with what is called the “demographic dividend” which is characterised by an increase in the ratio of the population available for work versus the those who cant work because they are too young or too old. It is expected that due to rapidly falling mortality rates and declining fertility rates, many poor countries will have two persons at work-force age for every one person too old or too young to work. Indeed, the IMF have predicted that seven of the ten fastest growing economies in the next five years will be in Africa. Rapidly growing economies require a work force that is physically capable of hard work and a work force, which has achieved its optimal cognitive function. Therein lies the power of adequate nutrition in the first 1000 days.

This first 1000 days refers to the 9 months (36 weeks) of pregnancy plus the first 2 years (104 weeks) of infancy (140*7=980 days). If a child emerges from this period with impaired cognitive and physical potential, the effect is life-long. Iron, for example, is essential for muscle growth but also for the fat sheath (myelin)  that surrounds the nerve cells in the human brain and for the synthesis of the signals (neurotransmitters) that travel from one neuron to the other. Longitudinal studies consistently show that infant anaemia is associated with long-term decline in cognitive capacity, with learning difficulties and ultimately with behavioural disorders. At present, the World Health Organisation estimates that in middle and low-income countries, 47% of infants are anaemic. Iodine is also a major micronutrient deficiency issue and presently some 2 billion people (one third of mankind) have inadequate iodine intake, a third of which are children. Once again, iodine is involved in physical activity since it is an integral part of the thyroid hormone, which not only regulates energy metabolism in the body but also serves to optimise brain development, particularly during pregnancy. One could go on to mention zinc, folic acid, vitamin B12 or omega 3 fats. The bottom line is that poor nutrition during pregnancy and in infancy will lead to permanent loss of physical and mental capacity. Thus if the demographic dividend is to pay off, the present population of mothers and infants must have optimal nutrition for gestation, through 6 months of exclusive breast feeding and through safe and wholesome weaning.

Some 27 years ago I wrote a popular book on nutrition and in it I cited an author who wrote thus of the malnourished: “The light of curiosity absent from children’s eye. Twelve year olds with the physical stature of eight year olds. Youngsters who lack the energy to brush aside the flies about the sores on their faces.  Agonizingly slow reflexes of adults crossing traffic. Thirty year old mothers who look sixty. All are common images in developing countries; all reflect inadequate nutrition; all have societal consequences”. Not a lot has changed except that now we recognise that the focus must be on maternal and infant nutrition. If we get that right, economic growth is possible with the demographic dividend. If we don’t we’ll have very large numbers of unemployed or under-employed young males, a recipe for conflict and social setbacks.

So, returning to the economics of mother and infant malnutrition, the report shows that a 1% increase in height equates to a 2.4% increase in earnings. Infants who were well nourished during the first 1000 days grew up to work on average, 5 hours longer per week than children who had poor nutrition during this period and, in addition, the well nourished infants grew up to earn 20% more per hour than poorly nourished children. In India, the economic cost of childhood malnutrition is estimated at between 0.8 and 2.5% of GDP equivalent to $15-46 billion. In China, another BRICS country[2], the comparable cost of micronutrient deficiency is $15-29 billion.

The UN initiative Scaling Up Nutrition (SUN)[3] is a major international programme to which some 40 countries have signed up to which specifically seeks to address the problem of infant and maternal nutrition and which specifically recognises the economic necessity of proper nutrition in the first 1,000 days. The prospect of 7 of the 10 fastest growing global economies being based in Africa is truly exciting. Google and Apple: pay up please!

[1] (Food for thought: tackling child malnutrition to unlock potential and boost prosperity)

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