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.
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?