|Essays on Food, Hunger, Nutrition, Primary Health Care and Development (AVIVA, 480 p.)|
|24. Positive Deviance in Child Nutrition: a Discussion|
The most important cause of the shift to the left in the weight distribution curve of children in the Third World is low household income, or paraphrasing Zeitlin et al. (1990): "excessively deficient income".
Positive deviance type interventions attempt to change the shape of the normal curve by bringing the nonpositive deviants more to the center of the curve. This skewing is unnatural in contrast to shifting the entire curve to the right. The latter is what would happen if household food security were permanently strengthened for the majority. I remain sceptical that the curve could he shifted to the right by changing behavioral patterns. This would be especially true for patterns such as those derived from maternal experiences during childhood and marital experiences which figure prominently in the Zeitlin et al. (1990) monograph.
The socioeconomic status of the poorest children in developed countries mostly explains their weights falling below 1.5 or 2 standard deviations from the median even if the persistence of negative deviant behaviors may explain a part of their being at the far left end of the curve.
The additional outreach components of a program to achieve positive deviance goals in the Third World can become prohibitively expensive. So far networks of village health workers have not proven to be capable of doing this effectively and massively enough in the absence of strong empowerment and redistributive measures.
Should we not, therefore, recognize that positive deviance interventions may be more appropriate to situations where household food security has been achieved? This can then move the far-left deviants of the weight curve more towards the center