The president of the World Bank has warned he will name and shame countries that fail to tackle the malnourishment and poor growth of their children, as part of a mission to rid the world of stunting.
Jim Yong Kim, the former physician who heads the Bank, told the Guardian he would take to the podium at the World Economic Forum in Davos every year to point the finger at governments who failed to live up to promises to tackle a scourge affecting tens of millions of children.
Kim said stunting – which refers to children with a height considerably below the average for their age – was a humanitarian disaster but also an economic issue that held back nations. Malnutrition, the lack of stimulation and toxic environments take their toll on children’s brain development, modern neuroscience shows.
For the sake of their children but also their countries’ future prosperity in a world that increasingly needs an educated workforce with technological skills, governments must take action, said Kim, adding that equality of opportunity was meaningless when children started with such disadvantage. The problem is huge. In India 38.7% of children are stunted, in Pakistan 45% and in the Democratic Republic of the Congo 70%.
Everyone puts all their eggs in the equality of opportunity basket, said Kim. But we’re essentially lying when 25% of children in the world are stunted. Inequality is baked into the brains of 25% of all children before the age of five. So the only way that we can realistically say there is equality of opportunity is if we bring stunting down to zero.
There were certainly other issues, he added, such as the competence of schools. But there was little point complaining that children in the DRC could not read a single letter after going through three or four years of schooling. It might not be because the education’s bad, he said.
It’s a stain on our collective conscience. I think we can start a global movement. My goal is to cut stunting in half. We have 14 years until 2030. We can cut stunting in half in seven years and then end stunting in the world by 2030. That is the only way we can look ourselves in the mirror and say there is equality of opportunity in the world, he said.
Kim pointed to a World Bank-supported programme in Peru as an example of what is possible. It gave conditional cash transfers to the mothers of stunted children, enabling and educating them to give their children nutritious food and stimulation through play. Similar incentives were given to health clinics to support them. If the children did well, monthly payments continued. It was the first time we tried this aggressive, what we called a demand-side intervention. They went from 28% in the mid-2000s to 14% in seven years, he said.
We’re going to say to every country in the world that has a problem with stunting, we’re ready to bring you the Peru formula. We’re willing to provide financing for these conditional cash transfers. Conditional cash transfers are great anyway. They help poor people. They stimulate the economy, they are a great thing to do.
But you have to start making an effort at reducing stunting. Or else every year I’m going to stand up in front of all the potential investors in your country and say – you’re not making any progress on stunting. This has very serious implications for the quality of your workforce into the future, he said.
Scientists have found that all children, regardless of race, should grow 25cm in their first year of life and 12cm in the second.
Only recently has the impact on the brain been explored. Imaging shows fewer neural connections in the brains of stunted children than in those of children who have grown well. That does not necessarily mean they are damaged for life, but their ability to learn can be impaired.
This is probably the root of intergenerational poverty, said Kim. Stunted women who are malnourished become pregnant. Just because they were stunted and malnourished doesn’t mean that their children have to be, but they probably end up not having sufficient nutrition when they are pregnant and they give birth and their children are stunted and it just goes on.
Technological change means that countries will have ever fewer low-skilled jobs in agriculture and manufacturing. In that case, the most important infrastructure we can invest in is grey matter infrastructure, he said.
Many people, including the Nobel economic sciences laureate Amartya Sen, have been arguing for years that investing in people is the way to growth. I think that with the new science of stunting we have now the direct link. If you don’t have light manufacturing and you don’t have low-skilled work in agriculture, you’re left with mostly services. If you are going to compete in the service economy you’re almost certainly going to have to be digitally competent. And you’re almost certainly going to have to be able to learn throughout your lifetime.
What I’m arguing is you need to make first and foremost an investment in your people and specifically you need to make an investment in the grey matter of your children.
Kim believes governments will respond. In 2002, when he was head of the HIV department of the World Health Organisation, he launched a campaign to get 3 million people on antiretroviral treatmentby 2005 and let it be known which countries were lagging behind. Known as 3 by 5, it was controversial, but the initiative resulted in a rapid increase in access to the drugs. There are now 17 million people taking them.
Childhood stunting is a huge problem worldwide, affecting an estimated 162 million children under five in 2012. These are children whose height is considerably below the average for their age. They are below the 5th centile on the child growth charts of the World Health Organisation – which means that fewer than 5% of healthy children would be expected to be their size.
Undenutrition is the prime cause of stunting. Children can be born to a malnourished mother, so they have not grown properly in the womb, or they can have too little nutrition in the first years of life. Stunting can also be the result of recurrent infections such as diarrhoea in places where sanitation is poor. If children are stunted at the age of two, it is unlikely that their growth will catch up with the norm. They are likely to be small and underweight.
Stunted children tend to have poor cognitive development, with underdeveloped brains. Malnourished children also have little energy, resulting in apathy and a lack of curiosity, which means they are unable to learn and are unlikely to be able to escape poverty.
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