Undersized in the Andes: poverty and health in children

There is plenty of evidence that children who are stunted as a result of poor nutrition in their early years are not only at a physical disadvantage from being short; they fall behind their classmates in cognitive and psychosocial development too.

Professor Jo Boyden of Oxford's Department of International Development is director of Young Lives, a 15-year study of the impact of poverty on children, designed to inform policymaking. Young Lives is a collaboration with partners in Ethiopia, India (in the state of Andhra Pradesh), Peru and Vietnam. In total 12,000 children, born into poor families either in 1994–95 or 2001–02, have been enrolled.

Beginning in 2002, and with follow-up surveys so far in 2006 and 2010, the Young Lives team has visited the children and their primary caregiver to collect information on their household consumption, diet, growth, health, their beliefs about themselves and their hopes for the future. The data provide a rich resource that is freely available for other researchers to use.

'We are interested in health as a measure of the impact of social and economic factors', says Professor Boyden, 'as a predictor of other outcomes, and also as a measure of the impact of social interventions designed to protect children from the effects of poverty.' One area of interest is the relationships between children's nutrition, growth and psychological development. In Peru, for example, a country that has enjoyed increasing wealth but widening inequalities between rich and poor, approximately 30 per cent of the children in the study are stunted, and several investigations have focused on what that means for the children as they grow up.

'Children who are stunted are likely to lag behind their peers', says Professor Boyden, 'not only in their cognitive abilities, but on psychosocial measures such as self-esteem that have a strong bearing on their ability to cope as adults.' The data have also revealed a link with climate. Children born in the high Andes to mothers who are pregnant or breastfeeding when bitter frosts restrict their diets are more likely than those born in warmer times to be delayed in their cognitive development at the age of 4–5 years.

Research officer Dr Inka Barnett is exploring a further paradox: she finds that in over 14 per cent of the Peruvian families, a stunted child has an overweight mother. Dr Barnett's work makes it clear that interventions to improve the diet of Peruvian households need to be tailored to reflect the different needs of family members.

'Our purpose in collecting health data is to highlight the burden that ill health imposes on poor families, the many factors such as climate that affect poor children's health and nutrition, and the importance of good health and nutrition for other areas of children's lives', says Professor Boyden.