CHILD NUTRITION IN CHINA: WITH SOME COMPARISON TO INDIA

WANG ZHENINSTITUTE 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.

• 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%]

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

higher compared with China.

• 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%

• 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.

• 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.

• Boy’s-Girl’s: – +: 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!