Chapter FiveThe Economic Costof Malnutrition

John Hoddinott
Deputy Director,
Poverty Health and Nutrition Division, International Food Policy Research Institute(IFPRI) Washington DC, USA

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“Money is a needful and precious thing, and when well used, anoble thing, but I never want you to think it is the first or only
prize to strive for.”Louisa May Alcott, American novelist (1832–1888)
65

Key messages•	Chronic undernutrition and micronutrient
deficiencies are prevalent across thedeveloping world.
•	In addition to its substantial human costs,
undernutrition has lifelong economic
consequences.
•	There exist feasible solutions to many
dimensions of undernutrition.
•	Fighting undernutrition has considerable
economic benefits, most notably in termsof improving schooling, cognitive skills
and economic productivity.
•	Spending that reduces both chronic
undernutrition and micronutrient
deficiencies is an excellent investment ineconomic terms; it is one of the smartest
ways to spend global aid dollars.

The problem of widespread undernutrition
Around 165 million preschoolchildren suffer from chronic
undernutrition. Because of inadequate food intake, repeated
infection or both they fail to grow at the same rate as
healthy, well-fed children. Millions more suffer fromdeficiencies in micronutrients such as vitamin A, iron,
iodine and zinc – a phenomenon sometimes called ‘hidden
hunger’. Deprivation in a world of plenty is reason enoughfor investments that reduce undernutrition. Attacking these
problems is also good economics.

Hunger, food insecurity and undernutrition
Hunger, food insecurity and undernutrition are related but
not synonymous. Hunger is “A condition, in which people
lack the basic food intake to provide them with the energy
and nutrients for fully productive lives” (Hunger Task
Force, 2003). Food security exists when all people, at all
times, have physical, social and economic access to
sufficient, safe and nutritious food which meets their dietaryneeds and food preferences for an active and healthy life
(United Nations, Food and Agriculture Organization). As
discussed here and elsewhere in this book, nutrientsprovided by food combine with other factors, including the

Malnourished children eating rice in Kakuma Refugee Camp, Kenya
Source: Mike Bloem PhotographyChapter Five | The Economic Cost of Malnutrition | John Hoddinott

health state of the person consuming the food, to produce“nutritional status.” Undernutrition reflects an absence ofmacro- or micronutrients which may be exacerbated bydebilitating health stresses such as parasites.

Both macro- and micronutrient deficiencies have insidiouseffects on neurological development. Iodine deficiency
adversely affects development of the central nervous system
leading to loss of IQ and mental retardation. Iron is needed
to make brain chemicals (neurotransmitters) that aid in
A powerful investment to reduce hunger and food insecurity
concentration; iron deficiency constrains cognitiveis increased spending on agricultural research anddevelopment in children. Chronic undernutrition has
development. This includes research that enhances drought,
neurological consequences that lead to cognitive
heat and salt tolerance, identifying and disseminating
impairments. The prefrontal cortex is especially vulnerable
varieties with enhanced yield potential, increasing milk yields
to undernutrition with the result that undernourishedand soil diagnostics that would permit optimal combinations
children can suffer from attention deficits and reducedof organic and inorganic fertilizers. This investment has fiveworking memory. Other neurological insults resulting from
benefit streams: i) increases in welfare gains resulting fromchronic undernutrition include damage to the parts of thelower prices faced by consumers; ii) welfare gains frombrain responsible for spatial navigation and motor skills,
reduced yield volatility; iii) the option value of reduced yield
The parts of the brain (axons) responsible for transmitting
volatility resulting from climate change; iv) productivity gains
signals from one neuron (brain cell) to another are damaged
derived from the impact of increased caloric consumption on
by chronic undernutrition with the result that these signals
worker productivity; and v) the income gains in adulthood
are passed more slowly and inefficiently.
resulting from reduced undernutrition in early life. An
additional $8 billion dollars per year would, by 2050, reduce These malign effects can be exacerbated by the interactions
the number of hungry people in the world by 210 million.
that occur, or do not occur, between children and theircaregivers. For example, delayed development of motor
skills such as crawling and walking, together with lethargy
and increased incidence of illness in undernourished
Undernutrition and its consequences –infants, reduces their interactions with adults and withphysical and neurologicaltheir environment.
The first thousand days, in utero and the first two years after
birth, are critical for a child’s physical and neurologicaldevelopment. During this period, children’s nutritional statusis affected by the quantity and quality of food they consume.
Exclusive breastfeeding in the first six months conveys criticalbenefits and it is vitally important that complementary foods
introduced after this contain the right quantities of macronutrients – calories and protein – as well as micronutrients.
What happens when these are lacking? As discussed
elsewhere in this book, children need energy to grow. Where
this energy is absent, or where a child is repeatedly ill with
infections that divert energy from growth while suppressing
appetite, children fail to grow at a healthy rate. Studies thathave followed children from infancy through to adulthoodfind that this lost growth is never fully regained and so these
individuals end up shorter in height than they would havebeen if their diets had been adequate and they had not been
subject to repeat infection. Vitamin A deficiencies kill.
Current estimates suggest that more than 145,000 deaths inchildren under five occur each year because children lackvitamin A. This number has significantly declined in recent
years due to the improved reach of vitamin A capsule
distribution programs. Zinc deficiency affects children’s
physical growth and leads to increased susceptibility to anumber of infections including diarrhea and pneumonia.

Girls in a classroom in Kakuma Refugee Camp, Kenya
Source: Mike Bloem Photography

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Chapter Five | The Economic Cost of Malnutrition | John Hoddinott

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Undernutrition and its consequences– economic
The persistently malign effects of undernutrition in early life havesignificant economic consequences in adulthood. A number ofstudies show that shorter individuals have lower earnings inadulthood although the precise reason for this – the direct
effect of height on physical productivity; the social benefits
associated with height – vary from place to place. There isevidence that undernutrition in early life, manifested as low
birth weight, increases susceptibility to coronary heart disease,non-insulin dependent diabetes, and high blood pressure – theBarker hypothesis. However, the biggest economic
consequences are those resulting from neurological damage.
Studies that have followed undernourished preschoolchildren
find that they attain fewer grades of schooling and develop poorer
cognitive skills such as those relating to problem solving. By
contrast, there is strong evidence that interventions that combat
undernutrition in early life convey lifelong benefits.
Everywhere in the world, schooling and cognitive skills arevital for success in the labor market. A useful rule of thumbis that every additional grade of schooling raises wages by
eight to 12 percent. So individuals without such skills andwith less schooling earn lower wages, which makes it more
likely that they will be poor.

The fetal programming concept“A consequence that is also emerging more clearly is the impact
of stunting and subsequent disproportionate and rapid weightgain on health later in life. These long-term effects are referred toas the fetal programming concept: Poor fetal growth, small size atbirth and continued poor growth in early life followed by rapid
weight gain later in childhood raises the risk of coronary heartdisease, stroke, hypertension and type 2 diabetes. Attaining
optimal growth before 24 months of age is desirable; becoming
stunted but then gaining weight disproportionately after 24months is likely to increase the risk of becoming overweight anddeveloping other health problems.
“As stunted children enter adulthood with a greater
propensity for developing obesity and other chronic
diseases, the possibility of a burgeoning epidemic of poor
health opens up, especially in transitional countries
experiencing increasing urbanization and shifts in diet andlifestyle. This epidemiological transition could create new
economic and social challenges in many low- and middleincome countries where stunting is prevalent, especiallyamong poorer population groups.”
Source: UNICEF Improving Child Nutrition 2013

Case study
A series of studies led by Professor Reynaldo Martorell at
Emory University, have shed light on the long-term
benefits of improving nutritional status in young children.

of additional information that was collected, it is possible
to draw causal inferences of the effect of the high-proteinenergy drink.

More than four decades ago, between 1969 and 1977,
two nutritional supplements - a high-protein-energy drink
called Atole and a low-energy drink devoid of protein
called Fresco – were provided to preschoolchildren in four
villages in eastern Guatemala. Between 2002 and 2004,individuals who had been exposed to this intervention
were traced throughout Guatemala and interviewed about
their schooling, marital histories, living conditions andparticipation in the labor market. They took reading,
vocabulary and problem-solving tests. Their heights andweights were measured as were the heights and weights of
their children. Because these supplements were randomly
assigned across villages, and because of the care withwhich the intervention was implemented and the wealthFor both men and women, access to atole significantly
raised scores on reading, vocabulary tests and on tests ofproblem-solving ability more than twenty-five years after theintervention had concluded. For men, access to atole
increased wages by more than 40 percent. (There was no
impact on women’s wages largely because relatively few
women participated in work outside the home.) The benefitsof atole were intergenerational. Offspring of women exposed
to atole had higher birth weights and were taller comparedwith offspring of women exposed to fresco.
The Guatemala study provides powerful evidence of thelong-term investments that reduce chronic undernutrition.

Chapter Five | The Economic Cost of Malnutrition | John Hoddinott

The economics of reducing undernutrition
The human and economic costs of undernutrition would
seem to make a compelling case for investments – purposive
actions by governments, non-governmental organizations
and the private sector – to reduce undernutrition. Some ofthese investments – such as increasing girls’ schooling,
improving the health and status of women (“healthy mothersfor healthy children”) and improved water and sanitation – areimportant development objectives in their own right. But what
about direct interventions to reduce macro- and micronutrient
deficiencies? Are these good investments?
A number of studies have looked at the costs of theseinvestments relative to the economic benefits that theywould provide. There is an element of uncertainty
surrounding these calculations – as there is with any
benefit: cost analysis – because they rely on estimating thecosts of these interventions today and calculating the streamof economic benefits that accrue over the decades that follow.
With that caution in mind, a good economic investment is
an investment where the benefit:cost ratio exceeds one; thatis to say that for every dollar spent today on investments to
reduce undernutrition, the future stream of economic
benefits valued in today’s terms exceeds one dollar.
Measured in this way, there is overwhelming evidence thatinvestments to reduce micronutrient deficiencies andchronic undernutrition have high benefit:cost ratios:• Every dollar spent iodizing salt generates $30 in
economic benefits;• Every dollar spent on iron supplements for mothers
and children aged six to 24 months generates $24 ineconomic benefits• Every dollar spent on vitamin A generates economic
benefits estimated to be $40 or more
• Reducing chronic undernutrition requires bundlingmicronutrient interventions such as those that reduce
vitamin A, iodine and iron deficiencies with the provision ofother micronutrients (such as zinc powders needed toreduce the duration and severity of diarrhea), andenergy-dense foods. Also important is communication withmothers and other caregivers about the importance of
these for healthy child growth. The costs associated withdoing so vary across countries as do the benefits but in a
typical developing country, every dollar spent on thisbundle generates around $18 in economic benefits

By the standards of economics, these are impressively highbenefit:cost ratios. Not only that, the costs of theseinvestments are trivially low. In addition to current
expenditures spent combatting undernutrition, an
additional annual investment of about $650 million dollars
a year – less than two dollars from every North Americanand western European – would be enough to eliminate
vitamin A deficiency in the 95 million preschoolchildren
who are vitamin A deficient, iodine deficiencies affecting
nearly two billion people and anemia affecting 80 million
pregnant women. A larger investment is needed for thebundle of interventions needed to reduce chronic
undernutrition – current estimates suggest that around nineand half billion dollars per year would reach 90% ofchildren in the 34 countries that account for 90% of theburden of undernutrition in the developing world.

The Copenhagen Consensus
The origin of the Copenhagen Consensus dates back to
2002, and a small team of people headed by Bjorn
Lomborg, then Director of the Danish Environmental
Assessment Institute. Funded for a period of time by theDanish government, the Copenhagen Consensus Centre is athink tank which “commissions and conducts new research
and analysis into competing spending priorities. In particular
we focus on the international community’s effort to solve
the world’s biggest challenges and on how to do this in themost cost-efficient manner.”
In 2004, 2008 and 2012, the Copenhagen Consensus Centre
held a series of global conferences. At each, an expert panel,including four Nobel Laureates, looked at twelve major global
challenges, deliberating the question: “If you had $75 billion
for worthwhile causes, where should you start?” The experts
were informed by 30 economic research papers by eminent
scholars which provided cost-benefit analyses for a range ofpotential interventions. In each round, the panel foundinvestments to reduce micronutrient deficiencies and chronic
hunger to be among the best investments that could be madewith these funds. In 2012 the panel ranked ‘Interventions to
Reduce Chronic Undernutrition in Preschoolers’ to be thehighest-ranking solution.

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#2

Copenhagen
Consensus 2012

Best Investment
Copenhagen Consensus 2004:–> Providing micronutrientsTOP INVESTMENT PRIORITIESSolving the69#1

Best Investment
Copenhagen Consensus 2008:–> M
 icronutrient supplements
for children (vitamin A, zinc)#1

World’s Challenges

Best Investment

What are the best ways of advancing global welfare(especially in developing countries)? Should
US$75 billion be available over a 4-year period?
HUNGER & MALNUTRITION

Amount allocatedper year in
US $ Bill. Dollars

BUNDLED MICRONUTRIENT INTERVENTION
TO FIGHT HUNGER & IMPROVE EDUCATION

3.0

MALARIA COMBINATION TREATMENT

0.3

CHILDHOOD IMMUNIZATION

1.0

DEWORMING

0.3

TB TREATMENT

1.5

R&D TO INCREASE YIELD ENHANCEMENTS

2.0

EFFECTIVE EARLY WARNING SYSTEMS

1.0

ARMED CONFLICTSURGICAL CAPACITY

3.0

CHRONIC DISEASEHEPATITIS B IMMUNIZATION

0.12“One of the most

EDUCATION
INFECTIOUS DISEASE

CLIMATE CHANGE    compelling investments   – to get nutrients to the    world’s undernourished

NATURAL DISASTERS

Vernon Smith, Nobel Laureate Economist

POPULATION GROWTH
BIODIVERSITY”WATER & SANITATIONTOTAL:
US $75 BILLIONOVER FOUR$100 PER CHILDYEARSLOW-COST DRUGS FOR ACUTE HEART ATTACKS

0.2

SALT REDUCTION CAMPAIGN

1.0

SOLAR RADIATION MANAGEMENT

1.0

CONDITIONAL CASH TRANSFERS

1.0

HIV VACCINE R&D

0.1

INFORMATION CAMPAIGN ON SCHOOL BENEFITS

1.34

BOREHOLE AND HAND-PUMP INTERVENTIONS

1.89

$30
PAY-OFF

Micronutrient
provision

Improved Health,
Schooling & Productivity

Complementary
foods

LEADS TO
Treatment forworms | diarrhea

Behaviorchange programs

EQUALS
Chronic undernutrition
in developing countries-36%$1 SPENT

Sight and LifeThe Developmental Course of Human Brain Development
Experience-dependent synapse formation
Neurogenesis in the hippocampus
Synaptogenesis(-3 months to 15–18 years?):

Neurulation(18–24 prenatal days)

Receptive language area/
speech production (angulargyrus/Broca’s area)

Cell migration(6–24 prenatal
weeks)

Seeing/hearing (visual cortex/
auditory cortex)

Prefrontal
cortex

Myelination (-2 months to 5–10 years)

Higher cognitive functions(prefrontal cortex)

Adult levels of synapses- 9 -8 -7 - 6 - 5 - 4 - 3 - 2 - 1 0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 30 40 50 60 70
Age (Months)
Age (Years)
Age (Decades)

Conception

BirthThis figure shows that the rapid period of brain development occurs within the 1,000-day window between the start of awoman’s pregnancy and her child’s second birthday.
Source: Thomson, Nelson (2001) Developmental Science and the Media.

Thomson, Nelson (2001) Developmental Science and the Media

Death

Chapter Five | The Economic Cost of Malnutrition | John Hoddinott

Global estimates of undernourishment(hunger) 1969-2010
PeriodRegional estimates of undernourishment
1990-2008

Number ofundernourished(millions)

Prevalence(percentage)

1969-71875

33

1979-81850

25

1990-92848

16

1995-97792

14

2000-02836

2006-08

1990-1992
Africa1995-1997

2000-2002

2006-2008

Northern
AfricaSub-SaharanAfrica170.9m5.0m

165.9m193.6m5.4m

188.2m203.3m5.6m

197.7m223.6m6.1m

217.5mLatin America
and theCaribbean

Asia

Oceana

14

850

13

54.4m

2009

1023*

18

2010

925*

16

607.1m

0.7m

53.4m

526.2m

0.8m

50.8m

565.7m

1.0m

47.0m

567.8m1.0m

Hunger and Malnutrition, Copenhagen Consensus 2012

FAO, State of Food Insecurity in the World, 2012

Projected change in World Commodity Prices presented as a percent change between baseline
2010 and baseline 2050
Beef

Pork

Lamb

Poultry

Milk

20%

55%

3%

47%

8%

Rice

Wheat

Maize

MilletSorghum

34%

40%

56%

12%

32%

Other Grains

SoybeanSoybean Oil

Rapeseed

Rapeseed Oil

14%

24%

51%

47%

92%

HungerHunder andand Malnutrition,
Malnutrition, Copenhagen
Copenhagen Consensus
Consensus 2012
2012

70

Chapter Five | The Economic Cost of Malnutrition | John Hoddinott71

Per child cost of interventions to reduce stunting and mortality at age 36 months
Intervention

Child agerange
(months)

Cost per unit

Total
cost perchild

Community based nutrition programs that provide informationon breastfeeding, complementary feeding, handwashing, anddistribute micronutrient powders and iron-folate supplements

0–59$7.50 per child$7.50

Vitamin A supplementation

6-59$1.20 per year

$4.80

Therapeutic zinc supplementation for
management of diarrhea

6-59$1.00 per year
(assumes two or threetreatments per year)$4.00

Multiple micronutrient powders

6-23$3.60 per course; 3
courses recommended$10.80

Deworming

12-59$0.25 per round; one roundrecommended per year

$1.00

$2.00 per pregnancy$2.00

Iron-folic acid supplementation
for mothers during pregnancy
Iron fortification of staples

12-59$0.20 per year

$0.80

Universal salt iodization

12-59$0.05 per year

$0.20

Providing complementary foods to 80 percent of children in
South Asia, 50 percent in Africa and East Asia, 10 percent
elsewhere

6-23$0.11 per day$0.14 per day in India$56.88Community based managementof severe acute malnutrition

6-59

$8.13

Hunger and Malnutrition, Copenhagen Consensus 2012

Benefit: cost estimages of investments that reduce stunting

Discount rate

23.8% income increase

15% income increase

5%

3%

5%

3%

Bangladesh

Increased income, NPV:
Cost:
Benefit: Cost ratio:

3647
96.1
38.0

7165
96.1
74.6

2303
96.1
24.0

4523
96.1
47.1

Ethiopia

Increased income, NPV:
Cost:
Benefit: Cost ratio:

2289
96.1
23.8

4496
96.1
46.8

1445
96.1
15.0

2838
96.1
29.5

Kenya

Increased income, NPV:
Cost:
Benefit: Cost ratio:

3713
96.1
38.6

7295
96.1
75.9

2344
96.1
24.4

4605
96.1
47.9

India

Increased income, NPV:
Cost:
Benefit: Cost ratio:

7875
111.6270.6

15470
111.62
138.6

4972
111.6244.5

9767
111.62
87.5

Hunger and Malnutrition, Copenhagen Consensus 2012

NPV = net present value

Chapter Five | The Economic Cost of Malnutrition | John Hoddinott

Baseline projections for people
at risk of hunger in 2010, 2025 and 2050

Baseline projections of malnourishedchildren in 2010, 2025 and 2050

72

RegionPeople at
Risk of Hunger(millions)RegionNumber of
MalnourishedChildren (millions)

Projected Year
East Asia and Pacific
Europe and Central Asia
Latin America and the Caribbean
Middle East and North Africa
South Asia
Sub-Saharan Africa
Developing
Developed
World

2010
177
23
60
17
318
240
835
49
884

Projected Year
East Asia and Pacific
Europe and Central Asia
Latin America and the Caribbean
Middle East and North Africa
South Asia
Sub-Saharan Africa
Developing
Developed
World

2010
20
4
8
4
74
41
150
12
163

2025
131
23
61
21
310
275
821
50
870

2050
122
21
45
24
235
268
716
50
766

Hunger and Malnutrition, Copenhagen Consensus 2012

2025
13
3
7
3
65
44
135
12
147

2050
8
3
4
2
50
39
106
12
118

Hunger and Malnutrition, Copenhagen Consensus 2012

Benefit: cost ratios of micronutrient interventions
26 Intervention: Supplements, mothers and

Fe
Iron

children 6-24 months
Previous Estimates

New Estimates

Current Estimates ofcost per beneficiary

-

23.8

$0.96

RAJ

RAJ

26 Intervention: Biofortification

Fe
Iron

26 Intervention: Supplements, pregnant mothers

Fe

Previous Estimates

New Estimates

82-140

8.1

RAJ

-

Iron

HOR

Fe
Iron

7.8
HAR

-

Fe
Iron

New Estimates

9.1

HOR

-

6.7

CASEY 2011

I 15-520

Previous Estimates

Fe
Iron

-

53

HAR

26

-

<$0.01HOR

New Estimates

Current Estimates ofcost per beneficiary

81

$0.05

-

Iodine& IronCurrent Estimates ofcost per beneficiary

$0.17

HOR

-

37

$1.20
HOR

New Estimates

2.5
RAJ

2-5
HOR

HAR

Current Estimates ofcost per beneficiary

$0.25
HOR

Intervention: Supplement

A 4.3-43

Previous Estimates
BAH

Vitamin A

30

Current Estimates ofcost per beneficiary

RAJ

Intervention: Doubly fortified salt

I Fe Previous Estimates

New Estimates

HOR

30

Iodine26 Intervention: Home fortification

Previous Estimates

Current Estimates ofcost per beneficiaryIntervention: Salt Iodization

Current Estimates ofcost per beneficiary

26 Intervention: Fortification of wheat flour

Previous Estimates

New Estimates

BAH

$2.00
HOR 2010

New Estimates

BAH

16.7
HAR

53

Current Estimates ofcost per beneficiary

26 Intervention: Fortification, general

Previous Estimates

Previous Estimates

11.6-19

Zn
Zinc

6.1-250HAR

New Estimates

Current Estimates ofcost per beneficiary

12.5

$0.29

RAJ

RAJ

Intervention: Supplement
Previous Estimates-

New Estimates

Current Estimates ofcost per beneficiary

2.85

$1.26

RAJ

RAJ

Hunger and Malnutrition, Copenhagen Consensus 2012. Casey GJ, Sartori D, Horton SE, Phuc TQ, Phu LB, et al, 2011. Weekly Iron‐Folic Acid supplementation with Regular
Deworming Is Cost‐Effective in Preventing Anaemia in Women of Reproductive Age in Vietnam. PLoS ONE 6(9) 23723. doi:10.1371/journal.pone.0023723. BAH Behrman, J.,
Alderman, H., and Hoddinott, J., 2004. Hunger and Malnutrition, in B. Lomborg (ed.) Global crises, Global solutions, Cambridge University Press, Cambridge UK. HAR Horton,S., H. Alderman and J. Rivera, 2008. Hunger and Malnutrition. Copenhagen Consensus 2008 Challenge Paper, Copenhagen Consensus Center, Copenhagen. HOR Horton,S., A. Wesley and M.G. Venkatesh Mannar, 2011. Double‐fortified salt reduces anemia, benefit: cost ratio is modestly favorable. Food Policy, 36(5): 581‐587. HOR 2010 Horton,S., M. Shekar, C. McDonald, A. Mahal and J. Brooks, 2010. Scaling up nutrition: What will it cost? World Bank, Washington DC. RAJ Rajkumar, A.S., C. Gaukler, and J. Tilahun,
2012. Combating Malnutrition in Ethiopia: An Evidence‐Based Approach for Sustained Results World Bank: Washington DC.

Chapter Five | The Economic Cost of Malnutrition | John Hoddinott

73

Malnutrition and obesity
The word “malnutrition” encompasses undernutrition,
deficiencies in macro- and micronutrients, and what issomewhat inelegantly termed overnutrition, excessive
caloric intake, exacerbated by diseases such as diabetes andlow levels of physical activity. Overweight and obese
individuals are one manifestation of overnutrition.
Overweight and obesity are significant public healthproblems in much of the developed world and increasingly
in middle income countries such as Brazil and Mexico.
Across the developing world, however, undernutrition is the
major form of malnutrition.

My personal view
John Hoddinott

Deputy Director,
Poverty Health and Nutrition Division, International Food
Policy Research Institute (IFPRI) Washington DC, USA

There is intrinsic value in eliminating
undernutrition – it is simply the rightthing to do. But beyond this, it isgood economics too. Investments in
reducing chronic undernutrition andmicronutrient deficiencies haveconsiderable economic benefits.

An astonishing return on investment“Improving nutrition is in fact a precondition to achieving
many of the Millennium Development Goals (MDGs):
eradicating poverty and hunger, reducing child mortality,
improving maternal health, combating disease, empowering
women and achieving universal primary education.
“Research shows that children who are well nourished,especially in the critical 1,000 day window between
conception and the child’s second birthday, receive thestrong start in life they need to grow, fight disease, learn
more in school, and earn more as adults. They also grow up
to help lift their countries out of poverty: a 2010 study
found that investing in nutrition can increase a country’s
GDP by at least 2–3 percent each year. And in May of thisyear, the Copenhagen Consensus panel of experts, which
included no fewer than four Nobel Laureates, found thatproviding micronutrients to children under five is the single
smartest way to spend global aid dollars. Every $1 spentyields $30 – an astonishing return on investment ratio by
any measure. We cannot improve health and promote
development without addressing micronutrient deficiencies.
Micronutrients have a key role to play in nourishing theworld’s people, building strong families and creating vibrantand economically sustainable communities.”
Klaus Kraemer, Sight and Life

Further reading
Behrman J, Alderman H, Hoddinott J. Hunger andmalnutrition. In: Lomborg B (ed) Global crisis,
global solutions. Cambridge: Cambridge University
Press, 2004.
Horton S, Shekar M, McDonald C et al. Scaling up
nutrition: What will it cost? Washington, DC: World
Bank, 2010.
Hoddinott J, Rosegrant M, Torero M. Investments to
reduce hunger and undernutrition. In: Lomborg B(ed) Copenhagen Consensus 2012. Cambridge:
Cambridge University Press, 2013.
Hoddinott J, Maluccio J, Behrman J et al. Effect of anutrition intervention during early childhood on
economic productivity in Guatemalan adults. Lancet
2008;371:411-416.