Cover: Schooling and Wage Income Losses Due to Early-Childhood Growth Faltering in Developing Countries

Schooling and Wage Income Losses Due to Early-Childhood Growth Faltering in Developing Countries

National, Regional, and Global Estimates

Published in: The American Journal of Clinical Nutrition, v. 104, no. 1, July 2016, p. 104-112

Posted on Jul 14, 2016

by Gunther Fink, Evan D. Peet, Goodarz Danaei, Kathryn Andrews, Dana C. McCoy, Christopher R. Sudfeld, Mary Smith Fawzi, Majid Ezzati, Wafaie Fawzi

Research Question

  1. What is the total value of lifetime earnings lost because of impaired early-life growth at the individual, country, regional, and global levels?

BACKGROUND: The growth of >300 million children <5 y old was mildly, moderately, or severely stunted worldwide in 2010. However, national estimates of the human capital and financial losses due to growth faltering in early childhood are not available. OBJECTIVE: We quantified the economic cost of growth faltering in developing countries. DESIGN: We combined the most recent country-level estimates of linear growth delays from the Nutrition Impact Model Study with estimates of returns to education in developing countries to estimate the impact of early-life growth faltering on educational attainment and future incomes. Primary outcomes were total years of educational attainment lost as well as the net present value of future wage earnings lost per child and birth cohort due to growth faltering in 137 developing countries. Bootstrapped standard errors were computed to account for uncertainty in modeling inputs. RESULTS: Our estimates suggest that early-life growth faltering in developing countries caused a total loss of 69.4 million y of educational attainment (95% CI: 41.7 million, 92.6 million y) per birth cohort. Educational attainment losses were largest in South Asia (27.6 million y; 95% CI: 20.0 million, 35.8 million y) as well as in Eastern (10.3 million y; 95% CI: 7.2 million, 12.9 million y) and Western sub-Saharan Africa (8.8 million y; 95% CI: 6.4 million, 11.5 million y). Globally, growth faltering in developing countries caused a total economic cost of $176.8 billion (95% CI: $100.9 billion, $262.6 billion)/birth cohort at nominal exchange rates, and $616.5 billion (95% CI: $365.3 billion, $898.9 billion) at purchasing power parity–adjusted exchange rates. At the regional level, economic costs were largest in South Asia ($46.6 billion; 95% CI: $33.3 billion, $61.1 billion), followed by Latin America ($44.7 billion; 95% CI: $19.2 billion, $74.6 billion) and sub-Saharan Africa ($34.2 billion; 95% CI: $24.4 billion, $45.3 billion). CONCLUSIONS: Our results indicate that the annual cost of early-childhood growth faltering is substantial. Further investment in scaling up effective interventions in this area is urgently needed and likely to yield long run benefits of $3 for every $1 invested.

Key Findings

  • The economic costs of stunted growth in developing countries are substantial.
  • On average, children in developing countries lost 0.5 years of educational attainment because of impaired early-life growth.
  • The average loss of lifetime earnings is $1,400 per child.
  • The resulting global economic loss is about $176.7 billion.


  • Interventions to reduce the burden of early-life growth are urgently needed from a public health perspective.
  • Efforts to address stunted growth among children less than 5 years old worldwide could yield long term benefits of $3 for every $1 invested.

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