Dec 7 — In October, the Malaysian government told the World Health Organization (WHO) that it has established a special whole-of-government committee to address the issue of stunting among children in the country. According to news reports, this special committee has approved the 2022-2030 National Strategic Plan to Address the Problem of Stunting in Children.
In Malaysia, more than two out of ten children below five are stunted. At 21.8%, Malaysia’s child stunting rate is higher than lower middle-income countries like Ghana (17.5%) and even conflict-ridden areas such as Palestine (7.4%) and Iraq (12.6%). Malaysia’s national rate is more than three times higher the overall 6 percent prevalence of upper middle-income countries, of which Malaysia is one. In fact, Kelantan’s stunting rate (34%) is higher than countries with far lower GDP per capita, such as Zimbabwe and Swaziland.
What do these numbers mean? Stunting is the failure of children to reach their full potential height for their age; in other words, a stunted child means that they are short for their age. From a technical viewpoint, children are considered as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median.
The WHO Child Growth Standards median is derived from a six-year-long study that studied approximately 8500 children from widely different ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman, and the USA). The key — and interesting — takeaway from this study is the finding that average growth is strikingly similar around the world when conditions for child growth are optimal. The study found that variability in children’s growth until the age of five years were caused by factors unrelated to genetics or ethnicity, and were more influenced by nutrition, environment, and healthcare differences. The findings of this study therefore suggests that a child growing up in Kuala Kangsar can have a similar growth trajectory as a child in Oslo despite their different genetic background.
But stunting is about much more than height. Stunting reflects a child’s growth conditions during the first 1,000-days, which encompasses conception and the first two years of the child’s life. During this period, a child’s growth and brain development is at its most rapid and most sensitive to any disruption. In fact, studies show that the foundations of a person’s lifelong health are largely set during this window, with research suggesting that stunting is largely irreversible after the first 1000 days. The effects of stunting within this crucial window can exert devastating and almost irreversible consequences, both in the short and long run.
In the short-term, stunting can result in increased risk of mortality and morbidity from infections such as diarrhoea, which is a direct cause of chronic malnutrition. Infections decrease nutritional intake through reduced appetite, direct loss of nutrients in the gut and the diversion of nutrients away from growth towards immune response. This increased susceptibility to infectious diseases can lead to a vicious cycle of infection and malnutrition. In the longer term, stunting heightens the risk of adult obesity, which can lead to health issues like type-2 diabetes and cardiovascular disease. Numerous studies have discovered the association between stunting in early childhood and obesity later in life. Young children were reported to be both stunted and overweight in some populations. Additionally, research indicates that stunting in early childhood may increase the risk of elevated blood pressure in adulthood.
Stunting also impacts the education outcomes of children. Stunted children are reported to be less likely to enrol in school or enrol late, with studies reporting that those who were stunted as children had less total schooling than non-stunted children. A large body of research exists that shows a strong link between stunting and cognitive development. These studies indicate that stunted children usually display delayed development of motor skills such as crawling and walking, and exhibit diminished exploratory behaviour. Unsurprisingly, stunted children were found to have lower mathematics achievement, reading comprehension, and receptive vocabulary than children who were never stunted.
The effects of stunting not only hamper stunted children’s educational achievements but also their economic outcomes as adults.
In the Philippines, researchers found an association between stunting with individuals’ work status (either working, unemployed, or informal work). The study found that stunting at childhood is linked with the reduced likelihood of employment in the formal work sector 20 years later. This association was even more pronounced among young males: higher height-for-age at the age of two years was linked with a 40% increase in the likelihood of formal work, which is commonly linked with greater job stability, regular hours, higher wages and employment benefits.
Stunting can also lower the future income-earning ability of stunted children. It is estimated that adults who were stunted during their childhood earn 20% less in their working life compared to non-stunted individuals – each additional centimetre of adult height can be associated with an almost 5% increase in wage rates.
Child stunting as such has potentially serious social and economic costs for the labour market and overall economic development of the country. A 2018 World Bank study by Galasso and Wagstaff sought to calculate how much lower a country’s per capita income is today due to the effects of childhood stunting on its adult workers. It was shown that countries lose, on average, 7% of per capita income because of stunting. The World Bank in its 2019 Economic Monitor for Malaysia had also explicitly identified child stunting as a ‘significant constraint’ on the country’s human capital development and in turn, long-term productivity gains. This is why stunting can result in serious social and economic costs for the labour market and overall economic development of the country.
With such potentially high socioeconomic costs for the country, stunting must be a policy priority for the new government under Anwar Ibrahim’s leadership. The Covid-19 pandemic has exacerbated and amplified the consequences of stunting disproportionately, especially among disadvantaged populations. Without immediate action, we risk preventing future generations from being able to achieve their fullest potential, with serious ramifications for the country. The change of government must not mean the premature death of the aforementioned national strategic plan to address stunting, but must be seen as a fresh opportunity to centre the wellbeing of our nation’s children. For all our sakes, we must act.
*Derek Kok is Research Analyst at the Jeffrey Cheah Institute on Southeast Asia at Sunway University. His research focuses on social protection policies for children.
**This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
