ANNEX A - The significance of small body size in populations

Extract from: ACC/1989/PG/2
English
page 7

There is a debate about the concept of "small but healthy" concerning whether small body size is in itself significant for a lasting normal life. The implications of this for policies could be far-reaching, because of the widespread failure of populations of developing countries to reach genetic potential.

The Sub-Committee examined the issue and approved the following statement to ACC:

"The human response to adverse conditions during early life is a slowing of normal physical growth and development. When this failure of growth occurs in early childhood, it can persist throughout life, as smaller stature and weight in comparison to values seen in unconstrained populations.

"It is the factors associated with the process of becoming small, not the state of being small, that are the real concern, albeit both are marked by achieved size. Although the small individual may be healthy at a particular time, the conditions that have caused this smallness are basic deprivations, including poor diet and ill-health, frequently due to poverty. The reason that economic disadvantages and poor social performance are observed to be associated with smallness is that these frequently occur in conditions where health and diet are poor. But the resultant smallness itself - with two exceptions noted below - is not a primary factor perpetuating these conditions. Small achieved body size is often an indicator that conditions have detrimentally affected human development and may be continuing to do so in the population.

"With two exceptions it is not considered that 'being small' - as opposed to becoming small - is in itself harmful to the individual. One exception lies in the relationship between body size (lean body mass) and maximal physical working capacity as well as perhaps the capacity for sustained work (endurance). The other exception lies in the linkage between maternal size and infant birthweight - the inter-generational linkage of smallness and risk.

"Failure of growth in the individual may be a symptom of an underlying diet or health problem warranting intervention. It can also be seen as a marker of a high-risk environment.

"Smallness seen at the population level is explicit evidence for a generalized public health problem calling for policies and programmes designed to alleviate social and economic deprivations, in addition to direct public health interventions."

The Sub-Committee proposes that this position be drawn to the attention of United Nations member agencies and other interested parties, to contribute to the correct interpretation of conditions in developing countries.

Source: Report of 15th Session of the ACC/SCN, UNICEF, New York, February 1989, para 19-21.