(introduction...)

Human resource development essentially refers to strategies that lead to well-informed, well-nourished, healthy, empowered people. This chapter will focus primarily on the allocation and use of public resources in the social sectors, particularly health and education. Such allocations offer one means of addressing social inequities and enhancing human capabilities and resources in that they provide the poor with access to services and opportunities they would otherwise not have. Nutrition is one important outcome of such an investment in human resources, as well as an input into the development of future human (and economic) resources, as illustrated in Figure 1.4.

The associations between economic and nutrition trends at national level were shown earlier Figure 3.1. The residuals⁶ of these associations, for each country, plotted against their respective percentage government allocations to health and education combined are given in Figure 4.1. The underlying reasoning is that the part of nutrition change not accounted for by economic growth might be expected to be related to the degree to which government resources are channelled towards health and education. In addition to this, other nutrition-related activities (not funded through health and education) would need to be taken into account to get a clearer picture, and this is discussed in Chapter 5. The expectation that countries improving more than expected (i.e. with negative residuals) tend to have a greater emphasis on human resource development (measured here by higher health and education allocations) is generally borne out. The expected association is present, if weak. Those points substantially below the residual 0-line indicate countries with prevalence changes better than expected from economic growth; these include Malaysia, Thailand and Zimbabwe. Those countries in Figure 4.1 below the regression line (whose slope is different from zero at P=0.08) may have some further prevalence improvement to be accounted for, possibly through direct nutrition programmes (see Chapter 5).

⁶ The definition of residual is given in Box 4.1.

Box 4.1: Prevalence Change, Economic Growth, and Health/Education Expenditures

Social expenditure has short-term (e.g. health) as well as important long-term inter-generational effects (e.g. education) on human well-being, including nutrition. Of particular interest here are the long-term effects of current investments in nutrition, health and education on the nutritional status of the next generation. The educational status of mothers is known to be a consistent predictor of the quality of care their children receive and of their nutritional status and survival prospects (Cleland and van Ginneken 1988, Cochrane et al. 1980). In India as in many other countries, the variable with the strongest relationship with child nutritional status in the National Family Health Survey 1992-93 was maternal education (IIPS 1995, Gillespie 1995).

As well as the inter-generational effects of education on nutrition, there are effects in the opposite direction. Improving nutrition may improve educability - that is the returns in terms of learning for a given investment in education (Pollitt et al. 1993). A better nourished, less hungry, child is more attentive and able to learn more easily. A better educated person is in turn likely to be more receptive to innovation and to seek out and benefit from opportunities for change more readily. There are many other positive mutually reinforcing or virtuous cycles involving nutrition, education and health that operate both through the life cycle and over generations (e.g. see Figure 1.4). One example at a more immediate level is the positive link between the height and body composition of the mother (which is in turn affected by nutrition throughout her early childhood growth period) and the birthweight of her future offspring (Martorell et al. 1996).

Governments that invest in health, education and welfare can thus anticipate long-term benefits in both nutrition and economic productivity. Such a channelling of economic resources by the state into the social services of health, education, welfare, water and sanitation, housing, etc, has also been referred to as "social support". Developing countries that do not wait for growth before strengthening social services to protect the poor and nutritionally-vulnerable within the population, nave been described by Dreze and Sen (1989) as adopting a "support-led security" approach to development. These authors have shown that the "economic growth equivalent" of well-planned social support in its effect in reducing infant mortality rates (and probably improving nutrition) is very large.

In another study of social support and economic growth, von Braun (1990) found that in the mid-1980s, low-income countries (with per caput GNP below US$ 500) spent about 11 % of central government budgets on social services. As a country's per caput GNP increased, both its absolute and relative social expenditure also increased. A "threshold" appeared to exist at around US$ 500-600 per caput GNP (e.g. Indonesia), above which both the absolute per caput social expenditure and its relative share of GNP appear to rise considerably. At this threshold, 5-10% of a country's GNP, on average, was allocated to social expenditures, amounting in practice to between US S25-50 per caput per year. By the time a country had reached the upper middle-income bracket of approximately per caput GNP of US$ 2200 (e.g. Malaysia), about 25% government expenditure was on average allocated to social services. The threshold is relevant for nutrition in that it represents the point in the economic growth process above which a relatively sudden increase in the potential to improve nutrition through social support appears possible.

Obviously this potential may or may not be utilized, depending on the priority a government gives to equity in social expenditures as well as the amount and type of such expenditure. Nutritionally-vulnerable sections of the population are unlikely to benefit much from increasing the numbers of doctors in cities, for example, nor through an emphasis on higher as opposed to primary education. There are many countries, e.g. Brazil, where health expenditure, although substantial, is skewed towards curative health care in large hospitals in developed urban areas, rather than improving outreach of good quality primary health care to marginalized communities. The quality of social support, and its coverage of sections of the population where malnutrition is most widespread and severe, will ultimately determine in large part its indirect nutritional impact. Access to primary health care services of adequate quality through well-stocked, well-run centres is fundamental, in addition to access to adequate water and sanitation systems. The promotion and preferential support to basic primary health care interventions such as immunization, growth monitoring, oral rehydration therapy, essential drugs, and the promotion and support of breastfeeding are other priorities for nutrition.