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  • Merimepodib Vollmer and colleagues distinctive multilevel mo

    2019-05-16

    Vollmer and colleagues\' distinctive multilevel modelling has potential weaknesses that warrant further investigation. The authors imply that tremendous statistical power is derived from the availability of Demographic and Health Survey data for about 460 000 children and their households. But because GDP per person is measured nationally, Vollmer and colleagues have only 121 observations for their key variable of interest. There is a vast number of economic reports on the problems of using GDP per person as a welfare measure, especially in the short term, and especially in developing countries with very weak national accounts systems. Indeed, several of the authors of this paper are well aware of that literature, having written on the subject previously. But the little cross-country variation in their data exacerbates the measurement error bias and makes it difficult to document strong associations with individual-level nutrition outcomes. It therefore would be beneficial if Vollmer and colleagues could show that their regression model would not bias all country-level coefficients downwards. Without a convincing explanation for why the available work (which documents substantially stronger cross-country and within-country relations between income and nutrition) should be dismissed, the authors\' concluding interpretation should be tempered; a pro-poor growth strategy, and other means of income support, might actually complement the direct nutritional investments that the authors advocate.
    We thank Harold Alderman and colleagues for their engagement with our study findings. Indeed, we acknowledged the importance of their earlier investigations (and others) in our study (see in the Article). Alderman and colleagues agree with our main conclusion that the contribution of economic growth to the Merimepodib in early childhood undernutrition in developing countries is very small. Since we noted that there was no significant association in a substantial number of analytical specifications and that the coefficient itself was very small in most of the specifications, we believe this conclusion is well supported by our analysis. Alderman and colleagues do not provide any evidence to change this fundamental conclusion of our study. The key critique stated by Alderman and colleagues in their Correspondence is that the role of economic growth in reductions in child undernutrition should not be dismissed. Unfortunately, little evidence is provided to support this statement. Economic growth does not necessarily benefit poor households. Even if economic growth did lead to substantial improvements in the incomes of individuals, and especially those from poor households, these changes would still affect mainly one of the proximal risk factors that can causally reduce undernutriton—ie, access to sufficient food and micronutrients. Indeed, in countries such as India, where food inflation has been rampant, there is hardly any evidence that income improvements have vastly outstripped the food inflation, especially for poor people. In fact, the evidence suggests a decline in caloric consumption in India. More importantly, a reduction in child undernutrition is also dependent on other risk factors that are unlikely to improve automatically from increases in household incomes. These include access to clean water and sanitation, access to treatment to reduce recurring morbidities, and prevention of infection through immunisation. Improvements in these disorders are more affected by robust public investments, which often depend more on the policy and political environment than on the availability of resources. In many of the countries included in our analysis, there is no compelling evidence that economic growth has led to improvements in the above mentioned determinants of child undernutrition. For instance, a recent analysis finds alarmingly high contamination rates of water from so-called improved water sources in India.