Friday, February 12, 2016

Want to talk about the economy? Try the economic burden of malnutrition.

Malnutrition in childhood has been linked to suppressed economic opportunities in adulthood. That can impact an entire community.

Want to talk about the economy? Try the economic burden of malnutrition.


By Michael Yudell

Scientists have long known that malnutrition during childhood, especially before a baby’s first birthday, can cause lifelong intellectual and behavioral problems. To make matters worse, a new study links those deficits to suppressed economic opportunities in adulthood, leading to a ripple effect on the surrounding community. The new data adds even more urgency to the need to address this persistent global challenge—one that demographics suggest has an outsized impact here in Philadelphia.

The latest research followed infants in Barbados who had been hospitalized for moderate to severe malnutrition, but were rehabilitated and had no further malnutrition episodes during childhood. As part of a longitudinal study that followed these kids into their 40s, scientists evaluated economic, mental health, cognitive, and general health outcomes. They also measured the findings against those for a group of “healthy comparison children” who had no history of malnutrition and were enrolled in the same schools. The island setting undoubtedly made the task of data collection and 40-plus years of follow-up easier.

What this study found may not be shocking—“neurological consequences of infantile malnutrition, manifest in cognitive compromise, limited educational and occupational opportunities in adulthood”—but it is another important data point in vital efforts to eliminate infant and childhood malnutrition. The authors conclude that the “potential economic costs of early malnutrition and its developmental consequences thus appear to be significant and lifelong.” Example: 80 percent of the malnourished kids did not complete high school and found employment as manual laborers; half of those in the health comparison group attended at least some university.

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Childhood malnutrition is a terrible problem worldwide. According to a recent report from Save the Children, malnutrition affects one in four kids and causes the deaths of 2.6 million children every year. “But malnutrition is not an issue that is limited to the developed world,” Janina Galler, lead author of the Barbados study, told me.  “We forget that [age] zero to three is a very important time to provide adequate nutritional support for children,” said Galler, who is a professor of psychiatry and senior scientist at Harvard Medical School and the Judge Baker Children's Center in Boston. “There is also a large percentage of children in the United States who suffer from hunger.”

But here in the United States and in most of the developed world we approach issues of hunger differently, primarily because we have been so successful at eliminating the most extreme forms of malnutrition, thanks to social welfare programs like food stamps and social security. The terms generally used in the U.S are “failure to thrive,” which “refers to children whose current weight or rate of weight gain is significantly lower than that of other children of similar age and gender” and “food insecurity,” which refers to those with “limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” Both measures can be proxies for hunger, the physical reaction to a lack of nourishment. In the United States failure to thrive is seen in about 5 to 10 percent of children in primary care settings.

According to the latest data from the U.S. Census, households suffering from food insecurity are a growing problem nationwide, increasing from 11 percent to almost 15 percent of the population from 2005 to 2009. That includes the chilling statistic that nearly 6 percent of American households suffer from very high food insecurity (meaning that “food intake of one or more household members was reduced and normal eating patterns disrupted due to inadequate resources for food”).

In other words, people are going hungry.

For Philadelphia, these statistics are a little higher. Nearly 8 percent of households suffer from more serious forms of food insecurity. And in Pennsylvania’s 1st Congressional District, which cuts through some of the city’s poorest neighborhoods, half of residents struggle to purchase enough food to meet their basic needs, a disturbing story that the Inquirer has told in a series of articles (the slide show above, about Imani Sullivan, is from the first article in that series).

Although the data on food insecurity and failure to thrive paint an incomplete picture, we do know that, according to experts, it can be “associated with higher prevalence of inadequate intake of key nutrients” and a host of other behavioral and physiological outcomes. “Paying attention to food insecurity early in life is one of the most important things we can do as a nation,” Mariana Chilton, director of the Center for Hunger-Free Communities at the Drexel University School of Public Health told me. “We know that even the most mild forms of food insecurity are associated with poor social, emotional, and cognitive development in young children,” Chilton added.

With the U.S. poverty rate climbing to a 50-year high, and with cutbacks to government programs supporting the poor — among them, a proposal by Republicans to cut $16.5 billion from the Supplemental Nutrition Assistance Program (SNAP)— food insecurity is sure to rise in the coming years. Childhood poverty is also increasing—the rate rose by nearly one-third between 2000 and 2010. These indicators are bad news for kids. As poverty increases, so too will hunger.

So the next time you hear politicians making political hay by suggesting cuts in anti-poverty programs and the social safety net, think twice, and consider all of the ramifications—both short and long-term—of that path. As Harvard’s Galler knows from her work, malnutrition and hunger can have “an extraordinary impact on the well-being of a nation.”

Particularly the children. 

Read more about The Public's Health.

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About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Dornsife School of Public Health, Drexel University
Jonathan Purtle, DrPH, MSc Assistant Professor, Drexel University School of Public Health
Janet Golden, PhD Professor of history, Rutgers University-Camden
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