1he econom|c rat|ona|e for |nvest|ng |n stunt|ng reduct|on

!ohn PoddlnoLL
1
, Parold Alderman
1
, !ere 8. 8ehrman
2
, Lawrence Paddad
3
, Susan PorLon
4

1
lnLernaLlonal lood ollcy 8esearch lnsLlLuLe,
2
unlverslLy of ennsylvanla,
3
lnsLlLuLe for uevelopmenL SLudles,
4
unlverslLy of WaLerloo
8eneflLs and cosLs over llfe cycle (llg. 1)
lndlvldual sLunLed aL age 36m has 66 lower per caplLa lncome when age 23-42 y (lnCA CuaLemalan daLa,
hoLo 1) lf sLunLlng LreaLed as endogenous (PoddlnoLL !" $%), assume half lncome galns are reallzed.
CosLs of lnLervenLlon (1able 1).
lnLervenLlon package esLlmaLed Lo reduce sLunLlng by 36 (8huLLa !" $%).
redlcLed lncome lncrease 11.4.
Apply Lo predlcLed per caplLa lncomes for 2036-2030 (l.e., flrsL 13 y of worklng llves lf born ln 2013 and sLarL work
when 21 y)

of Lhose sLunLed ln lnfancy (based on currenL lncome levels and pro[ecLed growLh raLes) ln selecLed
counLrles ln whlch sLunLlng wldespread.
.
ConsLrucL neL presenL value of lncreased lncome uslng 3 dlscounL raLe.


~173 mllllon preschool chlldren
sLunLed.
SLunLlng usually develops < 2-3 y
of age.
Marker of sysLemlc dysfuncLlon
durlng senslLlve phase of chlld
developmenL.
Llnked Lo many adverse ouLcomes
relaLed Lo laLer developmenLs over
llfe.
1o assess economlc beneflLs
relaLlve Lo cosLs (8/C raLlo) need
value lmpacLs and cosLs over llfe
cycle.

Introduction
Methods
ln counLrles ln whlch sLunLlng wldespread,
prlmarlly ln SouLh Asla and Sub-Saharan
Afrlca, our esLlmaLes of beneflL/cosL raLlos
are subsLanLlally above one ln Lerms of
economlc beneflLs alone.
1hls suggesLs LhaL lnvesLmenLs ln reduclng
sLunLlng have raLes of reLurn comparable Lo
or beLLer Lhan many oLher uses of publlc
resources, parLlcularly because Lhere are
dlsLrlbuLlonal galns ln Lerms of reduclng
poverLy ln Lhe nexL generaLlon as well as
non-economlc galns such as reduclng chlld
sufferlng.
Conclusions
Cverall goal: Lo generaLe credlble esLlmaLes
of beneflL/cosL raLlos for a plauslble seL of
nuLrlLlonal lnLervenLlons.
Conslderable challenges ln measurlng
beneflLs and cosLs, assumpLlons probably
conservaLlve (e.g., half of lnCA effecL , only
lncome/consumpLlon and noL oLher effecLs,
only effecLs for young adulLs 21-33 y of age -
noL when younger or older,).
LsLlmaLed average beneflL/cosL esLlmaLes
beLween 3.8 (u8C) and 34.1 (lndla), wlLh
medlan of 18 (8angladesh).
All esLlmaLed beneflL/cosL raLlos > 1 even lf
overesLlmaLe by facLor of 2 or 3.
Compare favorably wlLh oLher lnvesLmenLs
LhaL publlc funds wlll compeLe for.
locus on prlvaLe beneflLs, noL soclal beneflLs
LhaL mlghL dlffer from prlvaLe beneflLs and
creaLe efflclency raLlonale for pollcy.
8alses quesLlon why noL more prlvaLe
lnvesLmenL Lo reduce sLunLlng? lnformaLlon
problems? lmperfecL caplLal markeLs?
Slnce Lhose sLunLed Lend Lo be poorer,
dlsLrlbuLlonal (anLl-poverLy) moLlve for use
of publlc resources Lo reduce sLunLlng.
Discussion
8huLLa, Z.A., 1. Ahmed, 8.L. 8lack, S. Cousens, k.
uewey, L. Clugllanl, 8.A. Palder, 8. klrkwood, S.S.
Morrls and PS Sachdev. 2008. "MaLernal and Chlld
undernuLrlLlon 3: WhaL Works? lnLervenLlons for
MaLernal and Chlld undernuLrlLlon and Survlval."
&'(%)*&$+! ,!$%"' $-) .!/!%012!-", 34(3), 41-64.
PoddlnoLL, !., !. Malucclo, !. 8ehrman, 8. MarLorell, .
Melgar, A. 8. Culsumblng, M. 8amlrez-Zea, A. u.
SLeln, and k. M. ?ounL. 2013. 1he consequences of
early chlldhood growLh fallure over Lhe llfe course,"
ulscusslon aper 1073, lnLernaLlonal lood ollcy
8esearch lnsLlLuLe, WashlngLon uC.
PorLon, S., M. Shekar, C. Mcuonald, A. Mahal and !.
8rooks, 2010. 34$%(-5 61 -6"+("(0-7 8'$" 9(%% ("
40:"; World 8ank, WashlngLon uC

References
Figure 2: Benefit/cost ratios for investments to reduce stunting in selected high-burden countries
AbouL 173 mllllon preschool
chlldren are sLunLed, prlmarlly ln
SouLh Asla and Sub-Saharan Afrlca.
Larly-llfe sLunLlng ls llnked Lo a
number of adverse ouLcomes over
Lhe llfe cycle. 1hls sLudy esLlmaLes
economlc beneflL/cosL raLlos for a
number of heavlly-burdened
counLrles, arguably under
conservaLlve assumpLlons. 1hese
beneflL/cosL esLlmaLes range from
3.8 (u8C) Lo 34.1 (lndla), wlLh a
medlan of 18 (8angladesh). 1hese
resulLs suggesL LhaL raLes of reLurn
Lo lnvesLmenLs ln reduclng sLunLlng
are comparable Lo or beLLer Lhan
many oLher uses of publlc
resources, parLlcularly because
Lhere are dlsLrlbuLlonal galns ln
Lerms of reduclng poverLy ln Lhe
nexL generaLlon as well as non-
economlc galns such as reduclng
chlld sufferlng.
Abstract
!ere 8. 8ehrman
unlverslLy of ennsylvanla
Lmall: [behrman[econ.upenn.edu
hone: 1 213 898 7704
WebslLe: hLLp://www.pop.upenn.edu/,
hLLp://economlcs.sas.upenn.edu/
Contact
Intervention
Child
age
range
(months)
Cost per unit
Total cost per
child
Community based
nutrition programs
0 59 $7.50 per child $7.50
Vitamin A supplementation 6-59 $1.20 per year $4.80
Zinc supplementation 6-59 $1.00 per year
(2-3 treatments/year)
$4.00
Multiple micronutrient
powders
6-23 $3.60 per course
(3 courses
recommended)
$10.80
Deworming
12-59
$0.25 per round
(1 round/year)
$1.00
Iron-folic acid
supplementation for
mothers during pregnancy
$2.00 per pregnancy $2.00
Iron fortification of staples
12-59
$0.20 per year $0.80
Universal salt iodization 12-59 $0.05 per year $0.20
Providing complementary
foods
6-23 $0.11 per day
$0.14 per day in India
$56.88
Community based
management of
malnutrition
6-59 $8.13*
































k|sks |n I|rst 1000 Days
1. lnadequaLe food lnLake
2. lnfecLlon
3. regnancy & blrLh compllcaLlons
4. lnadequaLe sLlmulaLlon
I. Cutcomes |n I|rst 1000 Days
a. hyslcal (healLh, nuL sLaLus)
b. CognlLlve
c. SocloemoLlonal
d. LxecuLlve funcLlon
2. Cutcomes |n reSchoo| Ages
(a-d agaln)
3. Cutcomes |n Late Ch||dhood
(a-d , school aLLalnmenL, eLc)
4. Cutcomes |n Ado|escence
(a-d , labor markeL, parLnerlng,
parenLlng , household producLlon)
S. Cutcomes |n Adu|thood
(a-d , labor markeL, parLnerlng,
parenLlng , household producLlon)
Iam|||a| and pub||c
|nvestments w|th|n g|ven
context w|th re|ated costs
6. Cutcomes |n C|d Age
(a-d , labor markeL exlLs,
grandparenLlng , household producLlon,
chronlc dlseases, morLallLy)
I|gure 1: A ||fecyc|e approach to |nvestments |n the I|rst 1000 days 1ab|e 1. er ch||d costs of |ntervent|ons to reduce stunt|ng |n ch||dren under
36 months from norton (2010)
8eneflLs/cosLs ln selecLed hlgh-burden counLrles subsLanLlally exceed one (llgure 2).
Results
hoto 1. Consumpt|on of INCA !"#$%
|n Guatema|a |n 1969-1977