Nutritional status and economic development in sub-Saharan Africa, 1950-1980

Height self-selection of internal migrants in Italy in the second half of the twentieth century

This paper examines internal migrant selection in Italy using individual height data from the 1951 and 1980 birth cohorts of military conscripts. Information on both place of birth and residence of conscripts allows us to compare migrants' heights to the height distributions of their non-migrant peers at the national level and to their populations of origin. Results suggest that migrants from southern Italy were negatively selected at the national level, while a positive selection in height emerged if compared to conscripts who remained in their macro-area of origin. Additionally, we found that migrants from shorter and economically disadvantaged southern regions exhibited a more positive self-selection in terms of education, occupation and health status. These findings remained consistent when using body mass index as an alternative anthropometric outcome or accounting for the North-South return migration in the more recent birth cohort of conscripts.

The Interplay of Dietary Habits, Economic Factors, and Globalization: Assessing the Role of Institutional Quality

BACKGROUND

Dietary habits are pivotal for population health and well-being, yet remain a pressing global issue, particularly in Sub-Saharan Africa (SSA), where economic instability and institutional challenges exacerbate dietary problems. Despite extensive research, there is a notable gap in the literature regarding the direct and interactive effects of institutional quality and inflationary shocks on dietary habits.

METHODS

This study delves into these complex interplays across 44 SSA nations from 2002 to 2022. Employing an innovative entropy method (EM) and the generalized autoregressive conditional heteroskedasticity (GARCH) modeling, the study introduces an inclusive institutional quality index and an inflationary shock predictor as crucial determinants of dietary habits in the literature.

RESULTS

The results from the panel-corrected standard error (PCSE) method and feasible generalized least squares (FGLS) model reveal that per capita GDP, school enrollment rate, government expenditures, globalization index, and urbanization are positively associated with population dietary habits, while inflationary shock, food insecurity, and unemployment rate exert negative influences. Notably, institutional quality acts as a catalyst, amplifying the positive effects of the former group and absorbing the negative impacts of the latter on population dietary habits. Additionally, a dynamic panel causality analysis confirms a bidirectional causality nexus between population dietary habits and all variables, except for inflationary shocks, which demonstrate a unidirectional causality link.

CONCLUSIONS

These findings carry significant policy implications, underscoring the complex dynamics between institutional quality, inflationary shocks, and dietary habits in the region. The bidirectional causality highlights the need for holistic interventions that address economic, social, and institutional factors simultaneously. Moreover, the unidirectional causality of inflationary shocks on dietary habits suggests that stabilizing inflation is critical to protecting dietary habits. These results provide critical insights for policymakers to design targeted interventions aimed at improving nutrition, bolstering institutional frameworks, and ensuring public health resilience in the face of economic and social shocks.

You are What Your Parents Expect: Height and Local Reference Points

Recent estimates are that about 150 million children under five years of age are stunted, with substantial negative consequences for their schooling, cognitive skills, health, and economic productivity. Therefore, understanding what determines such growth retardation is significant for designing public policies that aim to address this issue. We build a model for nutritional choices and health with reference-dependent preferences. Parents care about the health of their children relative to some reference population. In our empirical model, we use height as the health outcome that parents target. Reference height is an equilibrium object determined by earlier cohorts' parents' nutritional choices in the same village. We explore the exogenous variation in reference height produced by a protein-supplementation experiment in Guatemala to estimate our model's parameters. We use our model to decompose the impact of the protein intervention on height into price and reference-point effects. We find that the changes in reference points account for 65% of the height difference between two-year-old children in experimental and control villages in the sixth annual cohort born after the initiation of the intervention.

Height and political activism in rural Aragón (Spain) during the 20th century. A new perspective using individual-level data

This article explores the relationship between the political leanings of more than 1000 men born in the 1870-1970 s in 11 rural Aragonese villages and their biological well-being during childhood and adolescence, proxied by height. The aim is to test whether an individual was more likely to be left-wing if his level of biological well-being was lower and, therefore, with more incentives to fight against the social inequality that had negatively affected his family. Our results confirm that, for most of the study period, there was a strong relationship between shorter height and political activism1 in left-wing parties and organizations.

Child health inequality in Sub-Saharan Africa

We investigate child height inequality and inequality of predicted height in the Sub-Saharan Africa (SSA) region by socioeconomic, demographic and geographical factors. We characterize their changes in age-cohorts (from 0-1 up to 4-5 years old) and determine the contribution of each factor to these changes. We extract data from the Demographic and Health Surveys (DHS) for 33 SSA countries covering the period from 2009 to 2016. Our measure of health is the standardized height of children below the age of five, adjusted by the age and gender distribution in each country. We show that height inequality is lower for older children than for their younger peers. However, the share of inequality caused by our set of factors rises along the age distribution in more than 80% of countries. We find that family background (reflected by maternal education and the household wealth), followed by home infrastructures related to water, toilet and cooking facilities, and the region of residence contribute to explaining the differences observed in child health inequality along the age distribution in SSA.

The association between male height and lifespan in rural Spain, birth cohorts 1835-1939

This article analyses the relationship between male height and age at death and its evolution over time among conscripts born in fourteen villages in north-east rural Spain. A total of 1,488 conscripts born between 1835 and 1939 (and who died between 1868 and 2019) have been included in the analysis (based on the study of 3 sub-periods: 1835-1869, 1870-1899, and 1900-1939). The height data have been obtained from military service conscription records and the demographic and socioeconomic information of the deceased was obtained from parish archives and censuses. The data have been linked according to nominative criteria using family reconstitution methods. For the statistical analysis, we have used ordinary least squares (OLS) linear regressions with heteroskedasticity-robust estimation. The results suggest a positive relationship between height and lifespan in the long-term. For the birth cohorts of 1835-1869, conscripts with a height of 170 cm or more lived on average 7.6 years longer than conscripts measuring less than 160 cm. This difference in life expectancy tended to disappear for the birth cohorts of 1900-1939, benefiting especially the short conscripts who had greater possibilities to increase their average lifespan. The reasons that might explain these changes could reside in the improvements experienced by this group in terms of their living conditions, health and nutrition during the twentieth century.

Did parental care in early life affect height? Evidence from rural Spain (19th-20th centuries)

This article examines the relationship between childhood mortality experienced within families and the height of surviving male children. Sibling mortality, controlled by different socioeconomic and environmental variables, is used as an approximation of the hygienic and epidemiological context and practices within the family. The analysis is based on a sample of 2783 individuals born between 1835 and 1977 in 14 villages in north-eastern Spain. The mortality data were obtained from the parish archives of the reference villages, and the height data from military service records of conscriptions at 21 years of age. The data were linked according to nominative criteria using family reconstitution methods. The results suggest the existence of a strong negative relationship between height and the childhood mortality experienced within families. Children born in families in which 50% of the children died before the age of five were up to 2.3 cm shorter than those of families with childhood mortality of less than 25%. General socioeconomic, hygienic and health improvements reduced childhood mortality, causing this link to gradually disappear between the 1940s and 1970s.

Animal source foods, rich in essential amino acids, are important for linear growth and development of young children in low- and middle-income countries

Growth faltering under 5 years of age is unacceptably high worldwide, and even more children, while not stunted, fail to reach their growth potential. The time between conception and 2 years of age is critical for development. The period from 6 to 23 months, when complementary foods are introduced, coincides with a time when growth faltering and delayed neurocognitive developments are most common. Fortunately, this is also the period when diet exercises its greatest influence. Growing up in an adverse environment, with a deficient diet, as typically seen in low‐ and middle‐income countries (LMICs), hampers growth and development of children and prevents them from realising their full developmental and economic future potential. Sufficient nutrient availability and utilisation are paramount to a child's growth and development trajectory, especially in the period after breastfeeding. This review highlights the importance of essential amino acids (EAAs) in early life for linear growth and, likely, neurocognitive development. The paper further discusses signalling through mammalian target of rapamycin complex 1 (mTORC1) as one of the main amino acid (AA)‐sensing hubs and the master regulator of both growth and neurocognitive development. Children in LMICs, despite consuming sufficient total protein, do not meet their EAA requirements due to poor diet diversity and low‐quality dietary protein. AA deficiencies in early life can cause reductions in linear growth and cognition. Ensuring AA adequacy in diets, particularly through inclusion of nutrient‐dense animal source foods from 6 to 23 months, is strongly encouraged in LMICs in order to compensate for less than optimal growth during complementary feeding.

Refugee camps - A lasting legacy? Evidence on long-term health impact

This paper examines the long-term impact of refugee camps on the health of local residents in Tanzania. Taking height-for-age z-score (HAZ) as a proxy for health, the paper exploits the fact that different birth cohorts were exposed to different stages of the camps' lifecycle. Temporal variation through birth cohorts is combined with geographic variation in a difference-in-difference estimation approach. First, the paper examines the generation that were children at the opening of the camps and are now adults (as of 2012). It finds a negative and localised health effect that has persisted into adulthood. The result is comparable to a 2.9%-5.9% reduction in adult hourly earnings. Second, this paper compares the subsequent generation that was born once the camps were already in operation, and those born after camps closed. It finds no observable difference in the HAZ score between those born during camps operation and in the post-camp period.

Age at menarche in Nigerian demographic surveys

Age at menarche was investigated using data collected from demographic surveys (WFS, DHS) conducted in Nigeria between 1982 and 2018, all of which were based on large representative samples of the female population. Linear-logistic regressions were used to estimate mean age at menarche, its trends and its risk factors. Mean age at menarche had underwent a marked secular decline from 15.02 years for girls born in 1933 to 13.78 years for girls born in 2003. In multivariate analysis, height (stature), body mass index (BMI), level of education and household wealth had independent effects on age at menarche, whereas urban residence had no effect. Socioeconomic gradients were large: +9 years of schooling was associated with a -0.52 year decrease in age at menarche, and +2 standard deviations in household wealth with a -0.33 year decrease. The impact of anthropometry was even greater: +2 standard deviations in height was associated with a -0.99 year decrease in age at menarche, and +2 standard deviations in BMI with a -1.42 year decrease. Northern provinces had a higher mean age at menarche than southern provinces. Compared with independent sources, long-term trends in age at menarche, as well as their fluctuations, appeared to be correlated with trends and fluctuations in income per capita and in under-five mortality, but not with divergent trends in adult height.

Dietary Magnesium, Vitamin D, and Animal Protein Intake and Their Association to the Linear Growth Trajectory of Children from Birth to 24 Months of Age: Results From MAL-ED Birth Cohort Study Conducted in Dhaka, Bangladesh

BACKGROUND

Evidence suggests lack of understanding of the association of specific nutrients with different time points of linear growth trajectory.

OBJECTIVE

We investigated the role of dietary macro- and micronutrients on length-for-age z (LAZ) score trajectory of children across first 24 months of their life.

METHODS

The MAL-ED Bangladesh birth cohort study recruited 265 healthy newborn children after birth. The linear growth trajectory of those children was modeled using latent growth curve modeling (LGCM) technique.

RESULTS

Dietary magnesium intake at 9 to 11 months was positively associated (coefficient β = 0.006, P < .02) with LAZ at 12 months. Animal protein intake at 15 to 17 months, in turn, was positively associated (β = 0.03, P < .03) with LAZ at 18 months. However, vitamin D intake at 15 to 17 months was negatively associated (β = -0.06, P < .02) with LAZ at 18 months. Other micro- and macronutrients did not show any statistically significant association with the linear growth trajectory. We also found that birth weight (β = 0.91, P < .01), treating water (β = 0.35, P < 0.00), and maternal height (β = 3.4, P < .00) were positively associated with intercept. Gender had a significant negative association with the intercept, but a positive association with the slope (β = -0.39, P < .01; β = 0.08, P < .04), respectively. Conversely, birth weight had negative association with the slope (β = -0.12, P < .01).

CONCLUSIONS

Dietary magnesium and animal protein were positively and vitamin D was negatively associated with the linear growth trajectory. Maternal height, birth weight, gender, and treatment of drinking water also played significant roles in directing the trajectory.

Trends in age at menarche and adult height in selected African countries (1950-1980)

Background: The mean age at menarche remains poorly documented in Africa.Aim: To document levels, trends, and determinants of mean age at menarche in selected African populations.Subjects and methods: The World Fertility Surveys recorded the age at menarche in 12 African countries. These surveys were conducted from 1977 to 1983 and were based on large representative samples of national populations. Demographic and Health Surveys provided trends in adult height for the same cohorts.Results: The mean age at menarche was higher in sub-Saharan Africa (14.5 years) than in North-Africa (13.5 years). Age at menarche was declining significantly in all sub-Saharan African countries, but only in one North-African country. The speed of decline in sub-Saharan Africa averaged 0.47 years for a 30-year period, comparable to the speed of decline in Europe. Sub-Saharan African countries with higher increase in female adult height also had larger declines in mean age at menarche. In multivariate analysis, trends in age at menarche were correlated with trends in adult height and child survival.Conclusion: In sub-Saharan Africa, age at menarche was undergoing a transition similar to that of European countries in the nineteenth century and was associated with improving health of young women. North-African countries were more advanced.

Identifying the limits to socioeconomic influences on human growth

Contemporary humans occupy the widest range of socioeconomic environments in their evolutionary history, and this has revealed unprecedented environmentally-induced plasticity in physical growth. This plasticity also has limits, and identifying those limits can help researchers: (1) parse when population differences arise from environmental inputs or not and (2) determine when it is possible to infer socioeconomic disparities from disparities in body form. To illustrate potential limits to environmental plasticity, we analyze body mass index (BMI) and height data from 1,768,962 women and 207,341 men (20-49 y) living in households exhibiting 1000-fold variation in household wealth (51 countries, 1985-2017, 164 surveys) across four world regions-sub-Saharan Africa, South Asia, Latin America, and North Africa and the Middle East. We find that relationships of environmental inputs with both mean height and BMI bottom out at roughly 100-700 USD per capita household wealth (2011 international units, PPP), but at different basal BMIs and basal heights for different regions. The relationship with resources tops out for BMI at around 20 K-35 K USD for women, with growth potential due to environmental inputs in the range of 6.2-8.4 kg/m². By contrast, mean BMI for men and mean height for both sexes remains sensitive to environmental inputs even at levels far above the low- and middle-income samples studied here. This suggest that further work integrating comparable data from low- and high-income samples should provide a better picture of the full range of environmental inputs on human height and BMI. We conclude by discussing how neglecting such population-specific limits to human growth can lead to erroneous inferences about population differences.

Shrinking in a growing economy is not so puzzling after all

Bodenhorn, Guinnane, and Mroz (2017) argue that the diminution of heights during the Industrial Revolution and in the Antebellum U.S. is an artefact of the biased nature of the samples analyzed. We demonstrate that it would be an unfathomable coincidence if men and women all self-selected into scores of completely independent samples in such a way as to bias them in the identical direction. Instead, wWe show that BGM's periodization is flawed and that their statistical models are misspecified, because they fail to consider the extent to which they introduce severe multicollinearity into their regressions. In addition, they fail to specify how they selected the samples they included in their analysis. In contrast, we argue that the economic transition from a predominantly agricultural to an increasingly industrial society was not a smooth process and lags in adjustment led to nutritional stresses. Height of a typical man in the U.S. decreased by 0.75 inches at a time when incomes were growing at a rate of 1.2% per annum. The developing human body of children and youth was sensitive enough to these nutritional stresses to register their effect better than monetary measures could. While nutritional status did decline during the Industrial Revolution in Europe and at the onset of modern economic in the U.S., by the second half of the 19^th century agricultural productivity caught up with the increased demand for foodstuffs and height reversals became a rarity. Thus, although markets adjusted, they did not do so instantaneously. Consequently, physical stature declined during this adjustment process although the wealthy were shielded from the increased price of nutrients. So, the divergence in average incomes and average heights at the threshold of the modern age is not so puzzling after all.

Parental human capital and child health at birth in India

Health at birth shapes an individual's well-being over her life cycle. We categorize the Indian states into high and low infant mortality regions to capture the diverse disease environment and analyze the nature of the association between parental human capital and child survival and nutrition measures at birth. We restrict our analysis only to firstborns to avoid confounding from a number of factors including sex-selective abortions in the higher birth orders. We broadly find that parental human capital, especially maternal health, is a strong and significant predictor of a child's birth outcomes under adverse disease environment. In the rural areas of the high infant mortality states, a 10-centimeter increase in maternal height is associated with 1.7% lower probability of a child dying as a neonate and 5% increase in birth weight around the mean. These estimates suggest that an investment in human capital of the mothers from this region could accompany large gains in survival and nutrition outcomes of their children.

Women's height in several African countries in the first half of the 20th century

Height and its variations in time are considered useful indicators of living conditions in countries and in periods where no written sources are available. Majority of data refer to male stature, whereas data concerning female stature are limited and cover only a short span. This paper investigates the height of 456 women in 6 African countries, born around the end of the 19th century and the beginning of the 20th century. The objective is to provide information on the stature of females from those areas at that time and to compare the results with those from the literature, which refer to more recent times. Data were recovered from original individual forms and/or monographs of the time, and when possible, changes in mean statures were reported, considering two age classes: 20.0-29.9 years and 30.0 years and over. Individual heights were plotted according to year of birth. The main results show tendencies toward height increases in Eritrea and Ethiopia, stable values of stature in Somalia and decreasing heights in women mainly from the oases in Cyrenaica. It has been suggested that these results may reflect the synergic action, with different local modes and intensity, of a changing model of slavery in force at the time, lack of constituted states and continuing civil wars among different ethnic groups, and of an effect of severe droughts in the period under consideration. A comparison with data available on modern populations from 4 of the investigated countries shows that this trend has since changed. Further insights into this suggested trend may be gained from the study of male series.

Dynamics of body time, social time and life history at adolescence

Recent opposing trends towards earlier physical maturation and later social maturation present a conundrum of apparent biological-social mismatch. Here we use life history analysis from evolutionary ecology to identify forces that drive these shifts. Together with findings in developmental science, our life history analysis indicates that adolescence is a distinctive period for biological embedding of culture. Ethnographic evidence shows that mass education is a novel feature of the globalizing cultural configurations of adolescence, which are driven by transformations in labour, livelihood and lifestyle. Evaluation of the life history trade-offs and sociocultural ecologies that are experienced by adolescents may offer a practical basis for enhancing their development.

A review of the evidence linking child stunting to economic outcomes

Background

To understand the full impact of stunting in childhood it is important to consider the long-run effects of undernutrition on the outcomes of adults who were affected in early life. Focusing on the costs of stunting provides a means of evaluating the economic case for investing in childhood nutrition.

Methods

We review the literature on the association between stunting and undernutrition in childhood and economic outcomes in adulthood. At the national level, we also evaluate the evidence linking stunting to economic growth. Throughout, we consider randomized controlled trials (RCTs), quasi-experimental approaches and observational studies.

Results

Long-run evaluations of two randomized nutrition interventions indicate substantial returns to the programmes (a 25% and 46% increase in wages for those affected as children, respectively). Cost-benefit analyses of nutrition interventions using calibrated return estimates report a median return of 17.9:1 per child. Assessing the wage premium associated with adult height, we find that a 1-cm increase in stature is associated with a 4% increase in wages for men and a 6% increase in wages for women in our preferred set of studies which attempt to address unobserved confounding and measurement error. In contrast, the evidence on the association between economic growth and stunting is mixed.

Conclusions

Countries with high rates of stunting, such as those in South Asia and sub-Saharan Africa, should scale up policies and programmes aiming to reduce child undernutrition as cost-beneficial investments that expand the economic opportunities of their children, better allowing them and their countries to reach their full potential. However, economic growth as a policy will only be effective at reducing the prevalence of stunting when increases in national income are directed at improving the diets of children, addressing gender inequalities and strengthening the status of women, improving sanitation and reducing poverty and inequities.

The biological standard of living in pre-modern Korea: Determinants of height of militia recruits during the Chosŏn dynasty

This paper extends the research on the biological standard of living in the Korean peninsula back to pre-modern times. Drawing on militia rosters of the Chosŏn Dynasty from the sixteenth to eighteenth centuries, we tentatively conclude that the final height of Korean men during this period was 166cm and thus slightly above that of modern North Korean men (165cm). On the other hand, the average height of modern South Korean men is 172cm, 6cm more than what we tentatively estimate for pre-modern Korean men. Regression analysis of the height of pre-modern Korean men finds that un-free Koreans ("slaves") were significantly shorter by about 0.6-0.7cm than commoners, whereas the average height of recruits suffering from smallpox did not differ significantly from that of other recruits. Moreover, regional, as opposed to birth-dummy, variables account, and to a significant degree, for most of the differences in height. Whether or not this is a result of socioeconomic differences across provinces or a result of other regionally-varying factors remains an open question.

Towards an anthropometric history of latin America in the second half of the twentieth century

We examine the evolution of adult female heights in twelve Latin American countries during the second half of the twentieth century based on demographic health surveys and related surveys compiled from national and international organizations. Only countries with more than one survey were included, allowing us to cross-examine surveys and correct for biases. We first show that average height varies significantly according to location, from 148.3cm in Guatemala to 158.8cm in Haiti. The evolution of heights over these decades behaves like indicators of human development, showing a steady increase of 2.6cm from the 1950s to the 1990s. Such gains compare favorably to other developing regions of the world, but not so much with recently developed countries. Height gains were not evenly distributed in the region, however. Countries that achieved higher levels of income, such as Brazil, Chile, Colombia and Mexico, gained on average 0.9cm per decade, while countries with shrinking economies, such as Haiti and Guatemala, only gained 0.25cm per decade.

The biological standard of living in Suriname, c. 1870-1975

The physical stature of Surinamese soldiers is estimated to have increased by more than 3cm between 1870 and 1909. In the subsequent four decades, the increase in adult male and female height amounted to 0.3-0.5cm and 0.9-1.0cm per decade, respectively. This increase in height continued and accelerated during the second half of the twentieth century. Height increase among African and Hindustani Surinamese males and females was similar. Height differences between African and Hindustani Surinamese were therefore fairly constant over time, at 4-5cm. Other indicators of nutritional and health status, such as infant mortality, showed continuous improvement, whereas per capita calorie and protein availability improved in the twentieth century.

Early life height and weight production functions with endogenous energy and protein inputs

We examine effects of protein and energy intakes on height and weight growth for children between 6 and 24 months old in Guatemala and the Philippines. Using instrumental variables to control for endogeneity and estimating multiple specifications, we find that protein intake plays an important and positive role in height and weight growth in the 6-24 month period. Energy from other macronutrients, however, does not have a robust relation with these two anthropometric measures. Our estimates indicate that in contexts with substantial child undernutrition, increases in protein-rich food intake in the first 24 months can have important growth effects, which previous studies indicate are related significantly to a range of outcomes over the life cycle.

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

What has driven the decline of infant mortality in Kenya in the 2000s?

Substantial declines in early childhood mortality have taken place in many countries in Sub-Saharan Africa. Kenya's infant mortality rate fell by 7.6 percent per year between 2003 and 2008, the fastest rate of decline among the 20 countries in the region for which recent Demographic and Health Survey (DHS) data are available. The average rate of decline across all 20 countries was 3.6 percent per year. Among the possible causes of the observed decline in Kenya is a large-scale campaign to distribute insecticide-treated bednets (ITN) which started in 2004. A Oaxaca-Blinder decomposition using DHS data shows that the increased ownership of bednets in endemic malaria zones explains 79 percent of the decline in infant mortality. Although the Oaxaca-Blinder method cannot identify causal effects, given the wide evidence basis showing that ITN usage can reduce malaria prevalence and the huge surge in ITN ownership in Kenya, it is likely that the decomposition results reflect at least in part a causal effect. The widespread ownership of ITNs in areas of Kenya where malaria is rare suggests that better targeting of ITN provision could improve the cost-effectiveness of such programs.

Adult height, nutrition, and population health

In this review, the potential causes and consequences of adult height, a measure of cumulative net nutrition, in modern populations are summarized. The mechanisms linking adult height and health are examined, with a focus on the role of potential confounders. Evidence across studies indicates that short adult height (reflecting growth retardation) in low- and middle-income countries is driven by environmental conditions, especially net nutrition during early years. Some of the associations of height with health and social outcomes potentially reflect the association between these environmental factors and such outcomes. These conditions are manifested in the substantial differences in adult height that exist between and within countries and over time. This review suggests that adult height is a useful marker of variation in cumulative net nutrition, biological deprivation, and standard of living between and within populations and should be routinely measured. Linkages between adult height and health, within and across generations, suggest that adult height may be a potential tool for monitoring health conditions and that programs focused on offspring outcomes may consider maternal height as a potentially important influence.

Inferring the economic standard of living and health from cohort height: Evidence from modern populations in developing countries

Average adult height is a physical measure of the biological standard of living of a population. While the biological and economic standards of living of a population are very different concepts, they are linked and may empirically move together. If this is so, then cohort heights can also be used to make inferences about the economic standard of living and health of a population when other data are not available. We investigate how informative this approach is in terms of inferring income, nutrition, and mortality using data on heights from developing countries over the last 50 years for female cohorts born 1951-1992. We find no evidence that the absolute differences in adult height across countries are associated with different economic living standards. Within countries, however, faster increases in adult cohort height over time are associated with more rapid growth of GDP per capita, life expectancy, and nutritional intake. Using our instrumental variable approach, each centimeter gain in height is associated with a 6% increase in income per capita, a reduction in infant mortality of 7 per thousand (or an 1.25 year increase in life expectancy), and an increase in nutrition of 64 calories and 2 grams of protein per person per day relative to the global trend. We find that increases in cohort height can predict increases in income even for countries not used in the estimation of the relationship. This suggests our approach has predictive power out of sample for countries where we lack income and health data.

The influence of inequality on the standard of living: worldwide anthropometric evidence from the 19th and 20th centuries

We provide empirical evidence on the existence of the Pigou-Dalton principle. The latter indicates that aggregate welfare is - ceteris paribus - maximized when incomes of all individuals are equalized (and therefore marginal utility from income is as well). Using anthropometric panel data on 101 countries during the 19th and 20th centuries, we determine that there is a systematic negative and concave relationship between height inequality and average height. The robustness of this relationship is tested by means of several robustness checks, including two instrument variable regressions. These findings help to elucidate the impact of economic inequality on welfare.

Measuring catch-up growth in malnourished populations

BACKGROUND AND AIM

Numerous recent studies measure catch-up growth by regressing adult or pre-adolescent height on early childhood height. Using simple statistical theory and data from a healthy and well-nourished population, this paper shows that these tests are uninformative about the extent of catch-up growth. The study also provides new empirical evidence on pubertal catch-up growth using longitudinal data for rural Tanzania.

SUBJECTS AND METHODS

The 1970 British Cohort Study is used to demonstrate the flaws in the recent literature using regression techniques to study catch-up growth. The data for the empirical analysis come from the Kagera Health and Development survey-a longitudinal study spanning two decades. The final sample includes 540 children whose heights are measured in early childhood and in adulthood. Catch-up growth is measured as the change in height-for-age z-score over time.

RESULTS

The mean HAZ-score in the cohort improves from -1.86 in early childhood to -1.20 in adulthood. Without catch-up growth, children would have been 4.5-5 centimetres shorter adults. Graphical analysis shows that most of this catch-up growth takes place in puberty.

CONCLUSION

Catch-up growth after early childhood is possible. Puberty seems to offer an opportunity window for recovery.

Global variance in female population height: the influence of education, income, human development, life expectancy, mortality and gender inequality in 96 nations

Human height is a heritable trait that is known to be influenced by environmental factors and general standard of living. Individual and population stature is correlated with health, education and economic achievement. Strong sexual selection pressures for stature have been observed in multiple diverse populations, however; there is significant global variance in gender equality and prohibitions on female mate selection. This paper explores the contribution of general standard of living and gender inequality to the variance in global female population heights. Female population heights of 96 nations were culled from previously published sources and public access databases. Factor analysis with United Nations international data on education rates, life expectancy, incomes, maternal and childhood mortality rates, ratios of gender participation in education and politics, the Human Development Index (HDI) and the Gender Inequality Index (GII) was run. Results indicate that population heights vary more closely with gender inequality than with population health, income or education.

BIOSOCIAL COMPARISON OF MID-UPPER ARM CIRCUMFERENCE IN THE TWO KOREAS

Anthropometric differences between the two Koreas are of considerable public and scientific interest given the unique socio-political status of North Korea and the fact that the nations share the same genetic ancestry. This study provides new biosocial evidence on these differences by analysing mid-upper arm circumference (MUAC) as a human welfare indicator. This is the first study to compare the nutritional status of adults surveyed inside North Korea with South Koreans. The MUAC measurements of 2793 North Korean women obtained through a household survey conducted in 2002 were compared with those of 1428 South Korean women surveyed around 2003. Comparative analysis was conducted by plotting centiles and calculating mean differences in MUAC by age. This paper finds that the MUAC of the South Koreans was on average 2.8 cm greater than that of their North Korean peers, with MUAC gaps ranging from 1.6 cm to 3.9 cm and becoming more pronounced with age. This research confirms previous studies on height and weight in the two Germanies and in the two Koreas that have shown that biosocial performance is worse in socialist economies as compared with free-market regimes.

Health safety nets can break cycles of poverty and disease: a stochastic ecological model

The persistence of extreme poverty is increasingly attributed to dynamic interactions between biophysical processes and economics, though there remains a dearth of integrated theoretical frameworks that can inform policy. Here, we present a stochastic model of disease-driven poverty traps. Whereas deterministic models can result in poverty traps that can only be broken by substantial external changes to the initial conditions, in the stochastic model there is always some probability that a population will leave or enter a poverty trap. We show that a 'safety net', defined as an externally enforced minimum level of health or economic conditions, can guarantee ultimate escape from a poverty trap, even if the safety net is set within the basin of attraction of the poverty trap, and even if the safety net is only in the form of a public health measure. Whereas the deterministic model implies that small improvements in initial conditions near the poverty-trap equilibrium are futile, the stochastic model suggests that the impact of changes in the location of the safety net on the rate of development may be strongest near the poverty-trap equilibrium.

The relationship between height and economic development in Spain, 1850-1958

We investigate the relationship between height and some economic-development indicators in modern Spain by means of a recently constructed times series of data on conscripts. We estimate a Vector Autoregressive Equilibrium Correction Model (VECqM) to quantify the height and GDP per capita response to various living-standard indicators. We observe that conditions that perpetuate an elevated level of sickness and mortality and that raise the relative price of consumption goods tend to impede human growth, as reflected in a decline in average adult height, whereas factors that promote the purchase of health services and that help to open up the economy to international trade and ideas have tended to have an opposite effect from the 1850s onward. Our results also indicate that neither the level of per capita GDP nor its growth rate has a unidirectional relation to various measures of living standards, chiefly adult stature. Instead, our findings suggest that there may be behavioral factors (e.g., emphasis on health services), political factors (e.g., degree of openness), and economic factors (e.g., relative consumer costs to GDP deflator) whose affects may have been influenced the level of GDP, over the sample period.

Trends in the association between height and socioeconomic indicators in France, 1970-2003

Average physical stature has increased dramatically during the 20th century in many populations across the world with few exceptions. It remains unclear if social inequalities in height persist despite improvements in living standards in the welfare economies of Western Europe. We examined trends in the association between height and socioeconomic indicators in adults over three decades in France. The data were drawn from the French Decennial Health Surveys: a multistage, stratified, random survey of households, representative of the population, conducted in 1970, 1980, 1991, and 2003. We categorised age into 10-year bands, 25-34, 35-44, 45-54 and 55-64 years. Education and income were the two socioeconomic measures used. The slope index of inequality (SII) was used as a summary index of absolute social inequalities in height. The results show that average height increased over this period; men and women aged 25-34 years were 171.9 and 161.2 cm tall in 1970 and 177.0 and 164.0 cm in 2003, respectively. However, education-related inequalities in height remained unchanged over this period and in men were 4.48 cm (1970), 4.71 cm (1980), 5.58 cm (1991) and 4.69 cm (2003), the corresponding figures in women were 2.41, 2.37, 3.14 and 2.96 cm. Income-related inequalities in height were smaller and much attenuated after adjustment for education. These results suggest that in France, social inequalities in adult height in absolute terms have remained unchanged across the three decades under examination.

Health and wealth in Uzbekistan and sub-Saharan Africa in comparative perspective

The study investigates the magnitude of differences in child and adult mortality by wealth in Uzbekistan, a former soviet country of Central Asia, and compares it with similar indicators from sub-Saharan Africa. Data were derived from Demographic and Health Surveys. An "Absolute Wealth Index" was built from data on goods owned by households and quality of housing, and scaled from 0 to 12. Wealth was distributed evenly in Uzbekistan, with a symmetric distribution around a mean of 5.5 modern goods. In sub-Saharan Africa, on the contrary, the wealth distribution had a lower mean (2.5) and was highly skewed towards the left, revealing a high proportion of very poor people. Adult and child mortality levels were lower in Uzbekistan. Despite these major differences, the relationships between mortality indicators and the wealth index were similar in the two cases. The magnitude of mortality differentials by wealth was of the same order in both cases, with gradients ranging from 2.5 to 1 for child mortality and 1.5 to 1 for adult mortality (poorest versus richest). However, mortality levels remained lower in Uzbekistan than in sub-Saharan Africa at the same level of wealth for both children and adults. A similar relationship was found between nutritional status and wealth index in both cases. On the contrary, there were no differences by wealth in use of health services and level of education in Uzbekistan, whereas wealth gradients were steep for the same variables in sub-Saharan Africa. The study suggests that mortality differentials were primarily due to nutritional status, and not to access and use of health services or to education. The discussion focuses on health and social policies during the colonial and post-colonial period that have produced these patterns.

Health trends in Sub-Saharan Africa: conflicting evidence from infant mortality rates and adult heights

We investigate trends in cohort infant mortality rates and adult heights in 39 developing countries since 1961. In most regions of the world improved nutrition, and reduced childhood exposure to disease, have lead to improvements in both infant mortality and adult stature. In Sub-Saharan Africa, however, despite declining infant mortality rates, adult heights have not increased. We argue that in Sub-Saharan Africa the decline in infant mortality may have been due to interventions that prevent infant deaths rather than improved nutrition and childhood morbidity. Despite declining infant mortality, Sub-Saharan Africa may not be experiencing increases in health human capital.