International | Malnutrition

The starvelings

Hunger has an even bigger impact on children's health than was thought

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BADAAM lives in the Indian province of Rajasthan. Tetanus killed one of her children in infancy; another is weak from diarrhoea, caused probably by the custom of keeping mother and baby isolated for a month after birth. Yet she is one of the lucky ones: a charity, Save the Children, has been keeping her family alive with food and nutritional advice.

Unicef, the United Nations' children's agency, said this week that fewer than 10m children died before their fifth birthday in 2006—probably the lowest rate ever, and certainly the smallest number since records began in 1960, when twice as many under-fives died, out of a world population half today's level.

Good news—but it could have been still better. Malnutrition is by far the biggest contributor to child mortality, present in half of all cases, says the World Health Organisation. New research in the Lancet, a British medical journal, suggests it may be one of the “big bills left on the sidewalk”—to borrow the phrase that Mancur Olson, an economist, used for describing easily reaped but neglected benefits.

One paper, by Robert Black of Johns Hopkins University and others, reckons underweight births and inter-uterine growth restrictions cause 2.2m child deaths a year (around one every 15 seconds). Poor or non-existent breastfeeding explains another 1.4m. Other deficiencies—lack of vitamin A or zinc for instance—account for 1m. In all, that is 3.5m deaths (once you strip out double counting)—one-third of total child mortality.

Hunger causes disease as well as death. According to the Lancet, malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower educational achievements. Their own children also tend to be smaller.

Previous estimates of hunger's impact were higher, but they treated it as something which exacerbates the problems of diseases such as measles, pneumonia and diarrhoea. Those illnesses were seen as the causes of death; malnutrition counted as a contributing factor. But malnutrition actually causes diseases as well, and can be fatal in its own right. This is the impact the Lancet authors seek to identify. Overall their findings confirm and quantify the WHO's view that hunger is the gravest single threat to the world's public health.

But they do more than that. As the Lancet and Unicef both make clear, dealing with hunger hardly requires a doctorate in the biochemistry of the human body. Breast-feeding advice, food supplements and better hygiene all make a big difference. Most countries know what to do and run pilot programmes that work. But they rarely find the money for full-scale national efforts; the international outfits that might help are, in the Lancet's words, fragmented and dysfunctional.

Yet if the research is right, money for improving nutrition would be the most effective sort of aid around. At the moment, roughly $300m of aid goes to basic nutrition each year, less than $2 for each child below two in the 20 worst affected countries. In contrast, HIV/AIDS, which causes fewer deaths than child malnutrition, received $2.2 billion—$67 per person with HIV in all countries (including rich ones).

Focusing on nutrition and mortality also makes sense, says April Harding of the Centre for Global Development, a Washington-based think-tank, because it forces policymakers to pay attention to health-care systems as a whole, rather than trying to save children “one disease at a time”. Given the scale of the crisis, the case for aid organisations redirecting money and attention to the problem of hunger looks compelling.

This article appeared in the International section of the print edition under the headline "The starvelings"

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