Presentation

CHILD NUTRITION IN CHINA: WITH SOME COMPARISON TO INDIA

WANG ZHEN INSTITUTE OF ECONOMICS, CASS 11, NOV, 2013

Introduction • Continued from Stanford discuss on child nutrition. • Trends of child nutritional status in China; underlying determinants; policy framework; with some comparison to India; and talk about the further step • Data sources: – WHO, UNICEF – Ministry of Health, China; Ministry of Health and Family Welfare, India – Original sources: China Food and Nutrition Surveillance System (CFNSS), conducted by CDC China; – National Family Health Survey (NFHS), conducted by MoHFW India; NFHS-1: 1992-93; NFHS-2: 1998-99; NFHS-3: 2005-06

Indicators on child nutritional status • Anthropometric indicators of nutritional status • Z-score: Z=(X-S)/SD – X: height, weight, or other measures; S: standards from WHO (NCHS); SD: standard deviation

• HAZ: Height for Age; if HAZ below minus two, refers to STUNTING, implying chronic, long term undernutrition; • WAZ: Weight for Age; if WAZ below minus two, refers to UNDERWEIGHT, implying a composite form of undernutrition ; • WHZ: Weight for Height; if WHZ below minus two, refers to WASTING, implying acute, short term undernutrition.

%

40 35 30

32.3

Stunting

Underweight

Wasting

25 20 15 10

12.6

9.4 3.4

5 0

4.2 1990

1992

1995

1998

2000

2002

2005

2008

2009

2.3 2010

• Overview: Child nutritional status in China: • Undernutrition prevalence decreased very quickly; child nutritional status improved obviously. • In 2010: the stunting prevalence in Europe: 8.2% [4.1-15.8%]; underweight: 1.8% [1.1-2.9%]; wasting: 1.6% [0.7-3.3%]

%

70 60

66.2

Stunting

Underweight

Wasting

59.5

50

47.9 43.5

40 30 20

20

21.3

10 0 1990

• •

1992

1993

1997

1999

2006

Overview: Child nutritional status: India Undernutrition prevalence decreased with a fast speed; But still at a high level; much higher compared with China.

60 % 50

57.1 50.7

51 44.4

47.9 43.5

Stunting Underweight Wasting

38

40 30 21.1

20

19.8

20

19.8 14.2

10

3.9

11.7 6.9 2.4

4.52.9

0 1993

1999

2006

1992

India

• Comparison between India and China: • India: NFHS-1, NFHS-2, NFHS-3 • In 2006 (2005), India: China – Stunting 47.9%: 11.7% – Underweight 43.5%: 4.5% – Wasting 20%: 2.9%

1998

China

2005

45 40

%

Stunting Boy

Stunting Girl

35

Underweight Boy

Underweight Girl

30

Wasting Boy

Wasting Girl

25 20 15 10 5 0

1990

• • • •

1992

1995

1998

2000

2002

2005

2009

2010

Gender differential: China Girl’s nutritional status, in most of the years, is better than boy’s. Only three points that girl’s indicators worse than boy’s. However, the differences are very small, and most of the differences are insignificant statistically.

WAZ

HAZ

WHZ

Underweight

Stunting

wasting

Boy

Girl

Total

Boy

Girl

Total

Boy

Girl

Total

Prevalence

3.54%

3.26%

3.41%

9.85%

8.93%

9.42%

2.44%

2.15%

2.30%

Mean

0.130

0.086

0.109

-0.235

-0.175

-0.207

0.367

0.259

0.316

Prevalence

0.3327

0.0488

0.2298

Mean

0.0176

0.0081

0.0000

p(F-test between boy and girl)

• Gender differential of child nutritional status, China, 2010 • Prevalence (%): there is no significant difference between boy’s and girl’s; • Mean of WAZ, HAZ and WHZ: the mean scores of the three indicators show that boy’s score is higher than girl’s significantly, implying that girl’s nutritional status worse than boy’s.

4 3.5 3

3.6

%

3.5

2.8 1993

1999

2006

2.5 1.9

2

1.7

1.5

1.4

0.9

1 0.5

1.3

1.2

0.8 0.6

0.5

0.4

0.3

0.5

0 -0.1

-0.5 -1

India

China

India

China -0.8

India

China

-0.8

-1.5 Stunting

• Boy’s-Girl’s:

Underweight

Wasting

– +: prevalence of boys higher than girls, implying boy’s worse nutritional status than girl’s – -: prevalence of boys lower than girls, implying boy’s better nutritional status than girl’s

• India, as well as China, girl’s nutritional status hardly to say being worse than boy’s.

• Urban-rural differential of child nutritional status: • There is an obvious urban-rural differential of child nutritional status, although the differential became narrow in the last two decades. • Especially in poor rural areas in China, child nutrition is the worst; 5-6 times higher than urban areas.

Underlying determinants affecting child’s nutritional status

• Family income and nutrition in-take: • Maternal status: – – – –

Health Education Caring Income

• Affordability and availability of public health service – Vaccination

• Public health expenditures • Social protection • Water and living environment

• Comparison of factors affecting child’s nutrition: India vs. China • China’s better than India in all the nine factors

Policy framework • • •

“National Program of Action for Child Development in China”: 1990s, 2001-2010, and the newest one, 2011-2020; Issued by State Council The goal, task, and policy on child nutrition are designed: Goal (2011-2020): – – – –

• • •

stunting prevalence: under 7% underweight prevalence: under 5% low birth weight prevalence under 4% child anemia (under 5) under 12%

Strategy and measures: 13 measures are designed, including to increase public expenditure on child development, strengthening health care system for child. Improving child nutritional status: – – –

promoting mother breastfeeding Intervention on supplementary nutrient feeding; Implement intervention programs on child nutrition and health for pre-school children; (the State Council has implemented the "Nutrition Improvement Plan for Rural Compulsory Education Students" in 2011);

Discussion

• How to explain the very different performance of child nutritional status in China and India? The two countries have very different social, economic, and cultural environment; but, are there some similarities affecting child nutritional status? – – – –

Income gradient: Family planning, and China’s one-child policy: Intervention programs: Policy framework:

• Challenges faced by China on child nutrition: – Urban-rural gap, with quick urbanization process, becoming a “within-urban dualism” that the gap between urban locals and rural migrants. – Left-behind children, lack of parents’ caring.

• Comparable datasets: it is possible to make comparative analysis: – China: CHNS (China Health Nutrition Survey), panel data, 1989, 1991, 1993, 1997, 2000, 2004, 2006, 2008, conducted by CDC of China; public dataset. The design is very similar to CFNSS. – India: NHFS (National Health and Family Survey)

• Further step?

THANK YOU!