PANEL 2.4 CAN IMPROVING THE UNDERLYING DETERMINANTS OF NUTRITION HELP MEET THE WHA TARGETS?
LISA SMITH AND LAWRENCE HADDAD W
hat would it take to achieve the WHA target of reducing the number of stunted children by 40 percent by 2025— equivalent to a prevalence of about 15 per- cent based on current population projections? Or to go beyond that target? Are the required changes realistic or even possible? We examined this question by model- ing the effects of changes in six underlying determinants of stunting: access to improved water, access to improved sanitation, female secondary school enrollment, gender equality as represented by the ratio of female to male life expectancy, dietary energy supply, and the share of the dietary energy supply derived
from nonstaple foods (Smith and Haddad 2014). Based on a sample of 116 develop- ing countries from 1970 to 2012, we used a regression model1
to predict stunting preva-
lence with different assumed levels of the six determinants. The first table describes three scenarios for the 116 countries. Scenario 1 assumes 2010 levels of the six underlying drivers, and these levels predict a stunting prevalence virtually identical to the actual stunting prev- alence (29 percent). Scenario 2 shows what is needed, in terms of the levels of determinants, to achieve the WHA stunting target of 15 percent by 2025. Scenario 3 reflects required
Access to improved water source (%) Access to improved sanitation facility (%) Female secondary school enrollment (%) Ratio of female to male life expectancy Dietary energy supply per capita (kcals)
Share of dietary energy supply from nonstaples (%) Predicted stunting prevalence (%) Source: Authors of this panel.
Scenario 1: 2010 situation 86 56 67
1.05
2,686 43
29.2
Scenario 2: WHA target for 2025 98 75 98
1.06
2,905 48
15.0
levels for reducing the share of stunted chil- dren to less than 10 percent. Achieving these levels of determinants would be challenging, but several low- and middle-income countries have attained them already.2
How fast would improvements in these determinants need to be made? The second table shows the rates of increase in the six underlying determinants during the 2000– 2010 period as well as the rates needed to achieve scenarios 2 and 3.
LEVELS OF UNDERLYING DETERMINANTS REQUIRED TO MEET AND EXCEED THE WHA TARGET FOR STUNTING REDUCTION Underlying determinant
Scenario 3: Beyond WHA target 98 90 98
1.07
2,930 54
9.9
Except for equality of life expectancy, the required rates of increase in the underlying factors to meet scenario 2 are not unrealis- tic compared with recent historical perfor- mance. The required rates to achieve scenario 3 are higher than they have been in recent years. However, this analysis fails to take into account any scale-up of the critical nutri- tion-specific interventions. If those interventions are indeed scaled up, and their effective- ness improved, the potential to exceed the WHA target at the global level significantly improves.
RATES OF IMPROVEMENT IN UNDERLYING DETERMINANTS REQUIRED TO MEET AND EXCEED THE WHA TARGET FOR STUNTING REDUCTION % annual increase in underlying determinant
Underlying determinant
Access to improved water source (%) Access to improved sanitation facility (%) Female secondary school enrollment (%) Ratio of female to male life expectancy Dietary energy supply per capita (kcals)
Share of dietary energy supply from nonstaples (%) Source: Authors of this panel.
2000–2010 (actual) 0.95 2.21 2.87
0.019 0.48 0.86
To achieve scenario 2 from 2010 to 2025 (15% stunting) 0.92 2.28 3.11
0.049 0.54 0.81
To achieve scenario 3 from 2010 to 2025 (<10% stunting) 0.92 4.07 3.11
0.110 0.61 1.74
DATA GAPS 1. Data are needed on country-level indicators of the strength of health systems.
14 GLOBAL NUTRITION REPORT 2014
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