Cover Image
close this bookFood and Nutrition Bulletin Volume 14, Number 3, 1992 (UNU Food and Nutrition Bulletin, 1992, 119 pages)
close this folderContributors References
View the document(introductory text...)
View the documentHistory, design, and objectives of the INCAP follow-up study on the effects of nutrition supplementation in child growth and development
View the documentAbstract
View the documentAuthor's note
View the documentHypothesis of the follow-up study
View the documentDesign considerations
View the documentSynopsis of the history of the follow-up
View the documentConclusion
View the documentReferences
View the documentData collection of the INCAP follow-up study: Organization, coverage, and sample sizes
View the documentAbstract
View the documentIntroduction
View the documentSubjects
View the documentTests, examinations, measurements, and interviews
View the documentOrganization and logistics of the data collection
View the documentTraining, supervision, and data flow
View the documentPrimary health care activities
View the documentCoverage rates
View the documentConcluding remark
View the documentAcknowledgements
View the documentReferences
View the documentOverview of long-term nutrition intervention studies in Guatemala, 1968-1989
View the documentAbstract
View the documentIntroduction
View the documentThe INCAP longitudinal study
View the documentThe follow-up study
View the documentFuture research directions
View the documentConclusion
View the documentAcknowldegements
View the documentReferences

Conclusion

Until recently, the nutrition community has had few data to offer those who demanded to see results on the impact of nutrition programmes. An exhaustive review of the literature of supplementary feeding programmes aimed at mothers and children [10] is a case in point. The authors concluded that the impact on growth was small. They went on to list the many reasons why larger effects were not found, including that often too little food was provided to make a difference. They also raised the possibility that growth may not have been the only or even the most important health benefit. This study has been widely quoted but is often misinterpreted. Many have abstracted from it the gloomy view that one should not invest in nutrition because it will not make much difference.

Fortunately, the situation has changed. Better-designed evaluations from around the world provide a more positive outlook [26]. Programmes are also more effective because much has been learned about management and design features. New research, including the present follow-up study, has contributed to a growing consensus that, when nutrition interventions effectively increase dietary intake in those who need it, they do indeed result in appreciable effect. It should be stressed that these dietary improvements may be achieved through many types of programmes and not only through targeted supplementary feeding.

Another development is that, whereas the nutrition community used to worry about justifying the economic returns to nutrition programmes, many economists have come to accept the value of the programmes even before they have been provided with conclusive results. In the 1960s and 1970s one often read about the problem of trade-offs between development and social services. Allocation of resources to social services was frequently seen as occurring at the cost of more immediately productive investments in rural areas [27]. For this reason, many saw the provision of these social services as self-defeating in the long run.

The rhetoric has changed. For example, the World Bank's current strategy for reducing poverty adopts a two-part approach [28]. The first component is to seek broadly based economic growth. The second involves the provision of social services in order to increase the capacity of the poor to respond to opportunities arising from economic growth. Rather than a problem of trade-offs, services, including better nutrition, are implicitly recognized as necessary for economic development.

Some have suggested that the follow-up study, by examining the links between nutrition and productivity, is pursuing issues that should best be left alone. If economists and planners seem already convinced of these relationships, why bother? Advocates of nutrition also fear that the proposition that good nutrition is a human right will be weakened by reference to other arguments, such as those about productivity. None of these views deter us. Fashions come and go, and this would seem to apply to development policies as well. It is possible that the World Bank strategy will differ in ten years. It remains important to study whether or not nutrition in early childhood contributes to human capital formation and to economic productivity. To the degree that these linkages can be demonstrated, they offer a powerful counter-argument to those who might view nutrition programmes as competing with economic development. If these links exist, nutrition may be seen a necessary and important component of economic development. Nutrition programmes would then be more appropriately viewed as long-term economic strategies. Demonstration of these linkages would provide support to those politicians and planners who have come to accept the importance of nutrition as a human right and for its contributions to economic development. It is also hoped that this demonstration would strengthen their resolve to improve the nutrition status of needy populations.