Apologies for the inevitable cross posting
Socioeconomic Inequalities in Child Malnutrition in the Developing
World
Adam Wagstaff, Naoko Watanabe
Poverty and Human Resources, Development Research Group
World Bank, September, 2000
Available as PDF file [37p.] at:
<http://econ.worldbank.org/docs/1189.pdf>
".... Despite the development community's shift in emphasis toward
the poor, malnutrition, like other dimensions of poor health, is
concentrated among the worst off. Yet targets are still defined in terms of
population averages. Consider, then, this information about malnutrition
rates among different economic groups in 20 developing countries.
Among the conclusions Wagstaff and Watanabe reach about malnutrition
rates among different economic groups:
* Inequalities in malnutrition almost always disfavor the poor.
* It's not just that the poor have higher rates of malnutrition. The
rate of malnutrition declines continuously with rising living standards. ·
The tendency of poorer children to have higher rates of stunting and
underweight is not due to chance or sampling variability. Inequalities in
stunting and underweight, as measured by the concentration index, are
statistically significant in almost all countries.
* Inequalities in underweight tend to be larger than inequalities in
stunting, which tend to be larger than inequalities in wasting.
* In most cases, whatever the malnutrition indicator, differences in
inequality between countries are not statistically significant.
* Even if attention is restricted to the cross-country differences in
inequality that are statistically significant, interesting conclusions
emerge. Egypt and Vietnam have the most equal distributions of malnutrition,
and Nicaragua, Peru, and, to a lesser extent, Morocco have highly unequal
distributions.
* Some countries (such as Egypt and Romania) do well in terms of both
the average (the prevalence of malnutrition) and the distribution
(equality). Others do badly on both counts. Peru, for example, has a higher
average level of stunting than Egypt and higher poor-nonpoor inequality. But
many countries do well on one count and badly on the other. Brazil, for
example, has a far lower (less than 20 percent) stunting rate overall than
Bangladesh (more than 50 percent) but has four times as much inequality (as
measured by the concentration index).
* Use of an achievement index that captures both the average level and
the inequality of malnutrition leads to some interesting rank reversals in
the country league table. With stunting, for example, focusing on the
achievement index moves Egypt (a low-inequality country) from sixth position
to fourth, higher than Brazil and Russia (two countries with high
inequality)...."
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