1.3 The case for investing in nutrition

"Approximately half of the economic growth achieved by the United Kingdom and a number of Western European countries between 1790 and 1980, has been attributed to better nutrition and improved health and sanitation conditions, social investments made as much as a century earlier" (UNICEF, 1997a, p. 17).

The social and economic costs of poor nutrition are huge. Investing in nutrition makes good economic sense because:

it reduces health care costs. Preventing low birthweight and stunting reduces childhood mortality and morbidity and their substantial health costs. Pelletier et al. (1993) estimated that over half the child deaths in developing countries can be attributed to underweight and its effect on infectious disease. Children hospitalised for severe undernutrition experience a higher case-fatality rate and a longer duration of stay than children in hospital for other reasons (Atakouma et al., 1995).

it reduces the burden of non-communicable diseases. Diabetes, heart disease and cancers in adult life are very costly conditions to diagnose, manage and treat, and are already distorting the health budgets of the developing world. Preventing early undernutrition may reduce the risk of these conditions in later life (as reviewed by Scrimshaw, 1997). Public health programmes to reduce the dietary contribution to these diseases are also cost-effective.

it improves productivity and economic growth. Undernourished children become smaller adults with reduced physical capacity. Productivity of adults who are undernourished - even on a short-term, seasonal basis - is impaired. Better health leads to longer working lives, reduced absence due to illness and more productive days. Such differences at the individual level contribute to a country's economic growth (Spurr, 1987).

it promotes education, intellectual capacity and social development. Undernutrition during fetal life and infancy can damage a child's mental development and impair capacity to learn. Undernutrition is associated with delayed enrollment in school and with absences from school - and it can be difficult for a child to catch up, Healthier children are expected to live longer, healthier lives. They are therefore more likely to capitalise on the benefits of schooling (Pollitt, 1990). Education is the cornerstone of social development.

The cost-effectiveness of preventive programmes is well recognised as far exceeding those of therapy. Even in the USA (a country with low levels of undernutrition, but without universal access to antenatal care) the National Accounting Office concluded that providing the Women, Infants and Children (WIC) supplementation programme to pregnant women reduced first-year medical costs for US infants by $1.19 billion in 1992, offsetting the cost of the programme (Avruch and Cackley, 1995). Evidence from this Commission's Report implies far greater economic gains when undernourished mothers are assisted.

No economic analysis can fully encompass the benefits of sustained mental and physical development from childhood into adult life. Healthy adults with the physical capacity to maintain high work outputs, and with intellectual ability to flexibly adapt to new technologies, are a huge national asset. Figure 1.2 illustrates the links between improving nutrition and boosting economic growth.

Global financial institutions like the World Bank are now clear about the importance of investing in nutrition:

"... resources put into nutrition are an investment with significant returns, today and in the future." (World Bank, 1992, p. 1)