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!