22 CHAPTER 2
security always will be a priority; without this, education and health will be sacrificed regardless. But the human capital of children must be a simultane- ous priority, because any sacrifice now has lifelong and intergenerational consequences. There is extensive evidence of the interactions among early childhood nutrition, health, and education, as well as between human capital and long-term earning ability. During pregnancy and in the first two years of life, known as the “window of opportunity” for nutrition interventions, nutri- tional losses take their greatest toll, causing damage that is largely irrevers- ible.11 Children under two years of age are growing at a rapid pace and have high nutritional requirements. However, the foods typically provided to com- plement breast milk in low-income countries provide insufficient energy and nutrient content for optimal growth. Additionally, with weak immune systems and living in conditions of poor hygiene and sanitation, young children are highly susceptible to infection, which can exacerbate malnutrition. Approxi- mately half of all deaths of children under age five in developing countries result from the interactions between common infections, such as diarrhea, respiratory infection, measles, and malnutrition (Behrman 2000, 7). Inadequate food supply and quality, poor hygiene and sanitation, and low levels of mater- nal education are all associated with child illness and poor nutritional status. These nutritional impacts interact with education. Poor and malnourished
children are likely to start school later and complete fewer years of schooling than are wealthier and healthier children. Cross-sectional studies in Uganda and Zambia showed that poor children were 10 times and 4 times, respec- tively, more likely than the richest children to enter school late (Grantham- McGregor et al. 2007, 64). Malnourished children were shown to enroll later than healthy children in Ghana, Nepal, the Philippines, and Tanzania (Behrman 2000, 9; Grantham-McGregor et al. 2007, 63). In Tanzania, stunted children were also less likely than healthy children to be enrolled in school at all (Grantham-McGregor et al. 2007, 63). Glewwe, Jacoby, and King (2001) find that better-nourished Filipino children start school earlier and repeat fewer grades. The authors conclude that an increase of 0.6 standard deviation in the height of malnourished children would increase the schooling they com- pleted by nearly one year (Glewwe, Jacoby, and King 2001, 362–363). Alder- man et al. (2001) find that malnutrition decreases the probability of ever attending school, particularly for girls. An improvement of 0.5 in the height- for-age z-scores (HAZ) of preschoolers would increase school initiation by 4 percent for boys and 18 percent for girls, closing the gender gap in enrollment by 20 percent (Alderman et al. 2001, 198). Tracking a cohort of Zimbabwean children over two decades, Alderman, Hoddinott, and Kinsey (2003) find evi-
11Martorell, Khan, and Schroeder (1994) note that growth lost in early years can be only partially regained during later childhood and adolescence when children remain in poor environments.
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