Malnutrition is responsible for much of thesuffering of the peoples of the world. At least one-fifth of the worldwide loss of years of life to death and todisability is due to undernutrition.When more specula-tive estimates are made of the contributions ofdiet-related chronic diseases such as diabetes, obesity,and hypertension and the various components of under-nutrition, some commentators place one half of globalsuffering at the door of malnutrition.

Why Is Public Action Needed?The case for public action to eradicate malnutrition is a strong one, and one that can be forcefully made usingeither ethical or economic arguments. Public action toreduce malnutrition is a moral imperative. Food andnutrition are human rights, enshrined in various conven-tions (most recently the 1989 Convention on the Rightsof the Child). Governments have a duty to ensure thatthese dimensions of human well-being are realized.On the economic side, private markets for health,education, sanitation, and other determinants of goodnutrition are often thin and in any case are beyond thepoors reach. Moreover, access to whatever services areavailable is likely to be unequal, particularly alonggender lines.Womenwhose role is key to goodnutrition throughout the life cycleface discriminationin many parts of the world.

Nutrition is an excellent investment. Improved nutritionempowers people and it empowers communities. Indoing so it fuels the development process and leads topoverty reduction.

Empowering People for PovertyReductionIn a globalizing world, the premium on innovation andcreativity is higher than ever, and malnutrition undercutsboth in a most savage way. Better nutrition improvesintellectual capacity, and improved intellectual capacityincreases an adults ability to access other types ofassets that are essential for increases in labor productiv-ity. An adult who is more productive has a larger set ofavailable livelihood options, which raises lifetime privateearnings in a way that is robust to external shocks suchas disease, unemployment, or natural disaster. Inaddition, improved nutrition status from conception to24 months of age reduces private and public health careexpenditures in ways that reverberate throughout the lifecycle. The intergenerational cycle of poverty is morelikely to be broken when babies get an adequate nutri-tional head start.

No economic analysis can fully capture the benefits ofsuch sustained mental,physical,and social development.At the micro level some cross-section studies have shown

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that the ratio of the percentage improve-ment in adult wage rates over thepercentage improvements in adultnutrition status is greater than one. Otherstudies over time have found that anincrease in birth weight of one poundleads to a 7 percent increase in lifetimeearnings for a sample of U.S.babies. Howsignificant are these estimates at themacro level?

Some researchers have aggregated theliterature on how fetal and infant under-nutrition affects childrens later schoolenrollment, educational attainment,cognitive ability, and lifetime earningsand the literature on how adults nutritionstatus affects their labor productivity. Inthis way they have attempted to capturethe economic costs of undernutrition interms of gross domestic product (GDP)forgone. Estimates published in the 1990sfor several Asian countries indicate thatthe losses to GDP from various compo-nents of undernutrition can be as high as3 percent of national income (Figures 1and 2). However, these estimates areundercounts: they omit some compo-nents of undernutrition such as vitamin Adeficiency and some age groups such as

adolescents; they are not aggregate estimates as we donot know how the various component estimates ofundernutrition add upin terms of boosts to productivity;and they omit losses due to overnutrition.

Diet-related chronic disease also has heavy costs. ForChina the costs amount to 2.4 percent of GDP (Figure 3).This, too, is a gross underestimate because it does nottake into account the lost work due to illness,only death.

Investments in reducing fetal and infant malnutritiongenerate the ultimate positive spillover effectwell-nourished children who are less likely to get diet-relatedchronic diseases such as hypertension and diabetes inadulthood and well-nourished mothers who are lesslikely to give birth to undernourished children. Figure 4shows the estimated link between fetal and childhoodundernutrition and chronic diseases for China and SriLanka. For China, childhood undernutrition is estimatedto be responsible for one-third of diabetes and aboutone-tenth of coronary heart disease and strokes.

Empowering CommunitiesWhile better nutrition empowers people, the processthrough which malnutrition is reduced can alsoempower communities.Unlike most other types ofhuman capital investment interventions,most nutritionprograms are community based. As communitiesdevelop the capacity to undertake assessment,analysis,

FIGURE 1: GDP LOSS FROM REDUCED ADULT PRODUCTIVITYDUE TO SOME FORMS OF UNDERNUTRITION (1990S)

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2.5

2.0

1.5

1.0

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Pakistan Vietnam

Source: Horton 1999

Undernutrition as measuredby growth failure

Iodine Deficiency

Iron Deficiency

0.1

3.3

0.60.3

1 1.1

FIGURE 2: GDP LOSS DUE TO IRON DEFICIENCY (1990S)

2.0

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1.0

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Bangladesh PakistanIndia

Source: Horton 1999

Cognitive losses

Cognitive losses + loss inmanual work

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and action for nutrition interventions, they can apply thiscapacity to other types of development intervention.Community-based nutrition programming can also buildtrust and a shared set of values and norms. Theseelements of social capitalmay well prove to beimportant for peoples ability to generate income andmanage risk. They may also help empower communitiesto hold increasingly decentralized governments toaccount and to empower the decentralized governmentsto hold the communities to their end of the bargain.Qualitative data from a number of studies suggest this isthe case. Quantitative evidence from South Africa andelsewhere shows that social capital enhances peoplesability to earn income and that community control helpsimprove the performance of poverty projects.

Moreover, empowered communities have more to losefrom disruptions and conflict. Reductions in malnutri-tion serve to diminish one of the causes of conflictparticularly if those reductions are achieved through acommunity-led process. Conflict, whether civil or inter-national, destroys peoples lives, their asset base, andtheir livelihoods. Moreover, as countries become moreconnected than ever, instability in one country canquickly spill over to others.

ConclusionImproved nutrition is central to improved income gener-ation, poverty reduction, and more rapid development.

Better-nourished individuals constitutethe bedrock of a nation that respectshuman rights and strives for high laborproductivity. Well-nourished mothers aremore likely to give birth to well-nourishedchildren who will attend school earlier,learn more, postpone dropping out, marryand have children later, give birth to fewerand healthier babies, earn more in theirjobs, manage risk better, and be less likelyto fall prey to diet-related chronicdiseases in midlife.

Communities that are strengthenedthrough the community-based nutritionprogramming process are more likely toaccess central resources and are more

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Costs of lostworkdeath

Total costsHospitalcosts

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FIGURE 3: ECONOMIC COSTS OF DIET RELATEDCHRONIC DISEASE,

CHINA AND SRI LANKA, 1995

Source: Popkin, Horton and Kim 2000

China

Sri Lanka4035302520151050

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Coronaryheart disease

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FIGURE 4: CHRONIC DISEASE AND CHILDHOOD MALNUTRITIONCHINA AND SRI LANKA, 1995

Source: Popkin, Horton and Kim 2000(a) Low birth weight and stunting

China

Sri Lanka

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To order additional copies contact UN ACC/SCN. To download: http://acc.unsystem.org/scn/ or www.ifpri.org

Suggested citation: Lawrence Haddad, "Nutrition and Poverty. In Nutrition: A Foundation for Development, Geneva: ACC/SCN, 2002.

Copyright January 2002 UN ACC/SCN. This document may be reproduced without prior permission, but with attribution toauthor(s) and UN ACC/SCN.

Photo credits: Page 1, World Bank; Page 3, World Bank/Curt Carnemark.

Lawrence Haddad is director of the Food Consumption and Nutrition Division of theInternational Food Policy Research Institute (IFPRI), Washington, D.C. For additionalinformation, contact l.haddad@cgiar.org.

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likely to use them efficiently in a widerange of activities while bringing theirexpertise to bear on the developmentprocess. Empowered and well-nourishedcommunities are also less likely to bedrawn into conflict with all its tragicconsequences. In an increasingly inter-connected world, the premium on goodnutrition is higher than ever.

Suggested ReadingACC/SCN (United Nations AdministrativeCommittee on Coordination/Sub-Committee on Nutrition). 2000. Fourthreport on the world nutrition situation.Geneva: ACC/SCN in collaboration withIFPRI.

Behrman,J.,and M.Rosenzweig.2001.Thereturns to increasing body weight.Unpublished paper,Department ofEconomics,University of Pennsylvania,Philadelphia,Penn.,U.S.A.

Hoddinott, J.,M.Adato,T.Besley,and L.Haddad. 2001. Participation and povertyreduction: Issues, theory,and newevidence from South Africa. FoodConsumption and Nutrition DivisionDiscussion Paper 98. Washington,D.C.:International Food Policy ResearchInstitute.

Gardner,G.,and B.Halweil.2000.Underfed and overfed:Theglobal epidemic of malnutrition.Worldwatch Paper 150.Washington,D.C.:Worldwatch Institute.

Gillespie,S.,and L.Haddad.2001.Attacking the double burdenof malnutrition in Asia and the Pacific. Policy Paper.Manila:Asian Development Bank.

Haddad,L.,and H.Bouis 1991. The impact of nutritionalstatus on agricultural productivity: Wage evidence fromthe Philippines. Oxford Bulletin of Economics andStatistics 53 (1): 4568.

Horton,S.1999.Opportunities for investments in nutritionin low-income Asia. Asian Development Review 17 (1,2):246273.

Maluccio,J.,L.Haddad,and J.May. 2000. Social capitaland welfare in South Africa,1993-1998.Journal ofDevelopment Studies 36 (6): 5481.

Popkin,B.M.,S.Horton,and S.Kim.2000.The nutritiontransition and diet-related chronic diseases in Asia:Implications for prevention. Paper submitted to the AsianDevelopment Bank for the RETA 5824 project.Department of Nutrition and Carolina Population Center,University of North Carolina at Chapel Hill,and MunkCentre for International Studies,University of Toronto.

UNICEF (United Nations Childrens Fund).1998. The stateof the worlds children. Oxford: Oxford University Press.

World Bank.1993.World development report 1993:Investing in health.New York: Oxford University Press forthe World Bank.

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