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Concluding remarks


Until recently, the nutrition community had few data to counter those who questioned the impact of nutrition programs. An exhaustive review of the literature of supplementary feeding programs aimed at mothers and children published by Beaton and Ghassemi in 1982 is a case in point. The authors concluded that the impact of nutrition supplements on growth was small. They went on to list the many reasons why larger effects were not found, including that, often, too little food was provided to make a difference. They also raised the possibility that growth may not have been the only or even the most important health benefit. This study has been widely quoted but is often misinterpreted. Many have abstracted from it the gloomy view that one should not invest in nutrition because it will not make much difference.

Fortunately, the situation has changed. There are now better-designed evaluations from around the world that provide a more positive outlook Jennings et al., 1991). The programs are also more effective, because much has been learned about management and design features. New research, including the follow-up study reported here, has contributed to the growing consensus that nutrition interventions, when they effectively increase dietary intakes in those who need it, do indeed result in appreciable impact. It should be stressed that these dietary improvements may be achieved through many types of programs and not only through targeted supplementary feeding.

Another development is that although the nutrition community used to worry about justifying the economic returns to nutrition programs, many economists have come to accept the value of nutrition programs even before they have been provided with conclusive results. In the 1960s and 1970s, one often read about trade-offs between development and social services. Allocation of resources to social services was frequently seen as occurring at the cost of more immediately productive investments in rural areas (Lele, 1975). For this reason, many saw the provision of social services as self-defeating in the long run.

The rhetoric has changed. For example, the World Bank's current strategy for reducing poverty adopts a two-part approach (World Bank, 1991). The first approach seeks broadly based economic growth. The second approach concerns the provision of social services in order to increase the capacity of the poor to respond to opportunities arising from economic growth. Rather than a problem of trade-offs, social services, including better nutrition, are implicitly recognized as necessary for economic development.

Some have suggested that the follow-up study, by examining the links between nutrition and productivity, is examining issues that should best be left alone. If economists and planners seem already convinced of these relationships, why bother? Advocates of nutrition also fear that the proposition that good nutrition is a human right will be weakened by reference to other arguments, such as those about productivity. None of these views deter us. Fashions come and go, and this would seem to apply to development policies as well. It is very possible that the World Bank strategy will differ in 10 years. It remains very important to study whether or not nutrition in early childhood contributes to human capital formation and economic productivity. To the degree that these linkages can be demonstrated, they offer a powerful counterargument to those who view nutrition programs as competing with economic development. If these links are demonstrated, nutrition may be seen as a necessary and important component of economic development. Nutrition programs would then be more appropriately viewed as long-term economic strategies. Demonstration of these linkages can provide support to those politicians and planners who have come to accept the importance of nutrition as a human right and for its contributions to economic development. It is hoped that this demonstration will strengthen their resolve to improve the nutritional status of needy populations.

Acknowledgments


Data collection for the INCAP longitudinal study was supported for the most part by contract HD 5-0640 from NICHD. The study was undertaken by a large multidisciplinary team led initially by Dr. Cipriano Canosa and, for most of its history (1970-1977), by Robert E. Klein. The follow-up study was supported by an RO1 grant (HD22440) to Reynaldo Martorell; coinvestigators included Drs. Juan Rivera, Jere Haas, Jean Pierre Habicht, and Ernesto Pollitt.

References


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Notes


1 At the time of the original study Dr. Martorell was affiliated with the Institute of Nutrition of Central America and Panama (INCAP) in Guatemala City, Guatemala.


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