By Jessica Fanzo and Sarah Curran
It is often said that a picture can tell a thousand words. Sometimes the same can be said for an indicator. Stunting – a measurement of chronic malnutrition – is one such indicator. Whilst stunting might not be a term that you are familiar with at the moment, expect to hear a lot more about stunting in the future as one of the major indicators to track in development.
It is estimated that 165 million children around the world are stunted. That is to say 165 million children are stunted in their growth, development and future potential. A stunted 5-year-old is on average four to six inches shorter than their non-stunted classmates. But the problem goes much deeper than just being short. Not only are these children not physically as tall, but their brains do not fully grow or function as that of a child with good nutrition. Stunting implies a permanent and irreversible disability to learn and develop to a child’s fullest ability. Aside from the tragic human costs, imagine the implications for the economic development of a country when over the half the population is unable to reach their full capacity. Every single stunted child represents a missed opportunity.
Stunting is a complex biological indicator but it is one that uniquely captures the deep rooted causes of childhood malnutrition. It reflects the persistent poverty of a country, the disruptive wars it has undergone, the inflictions of infectious disease, the poor health care access, sanitation, hygiene and child care, as well as the lack of access to and consumption of nutrient dense foods. It is no coincidence that countries with the highest rates of stunting include Timor-Leste, Yemen and Burundi, where over 50% of the under 5 population are stunted. All of these high burden countries have had turbulent histories that have disrupted essential services in health, education, and critical infrastructure and food supplies. Stunting is indeed a snapshot of a country’s history.
For those children who have been affected, the damage is done, and the challenges ahead will be enormous. But there is hope for future generations. Solutions exist and the cycle of stunting can be broken. It is a preventable condition, but we need to start now. Countries such as Ethiopia, Nepal and Brazil, have achieved great declines in childhood stunting in recent decades and offer valuable lessons.
Agriculture can make a difference. Beyond just producing more food in a country, the food being produced can be more nutritious. New crops and new varieties of traditional crops are being introduced, and the biodiversity of foods grown and in the wild offer enormous potential to improve diet quality and diversity. The health sector has an obvious role to play. Infectious diseases (often preventable through good water and sanitation systems) will inhibit individuals’ ability to absorb key nutrients, no matter how much food is available. Education can also play an important role, not just in the dissemination of information but also in addressing gender inequality which is a key underlying determinant of malnutrition. Good governance and high-level political commitment to tackling the issue is an often underplayed but essential ingredient to success.
Stunting featured prominently on the international agenda over the last few weeks, especially with the pre-G8 “Nutrition for Growth Summit”, which was co-hosted by the Children’s Investment Fund Foundation and the UK and Brazilian governments. The Summit saw vastly increased political and financial commitments to reducing the global number of growth-stunted children. The challenge will now be to turn these political commitments into concrete, evidence-based actions to achieve impact on the ground. Stunting is an indicator that can be tough to move and results will only be achieved through coordinated actions across multiple sectors. Stunting demands and deserves global attention and as we move to a post MDG-era it will likely be one of the most important development indicators to watch.
Jessica Fanzo is an assistant professor of nutrition in the Institute of Human Nutrition and Department of Pediatrics at Columbia University Medical Center in New York. She also serves as the director of nutrition policy at the Center on Globalization and Sustainable Development. Sarah Curran is a program manager in nutrition policy at the center.