title: Understanding the null-to-small association between increased macroeconomic growth and reducing child undernutrition in India: role of development expenditures and poverty alleviation.
abstract: Empirical evidence suggests that macroeconomic growth in India is not correlated with any substantial reductions in the prevalence of child undernutrition over time. This study investigates the two commonly hypothesized pathways through which macroeconomic growth is expected to reduce child undernutrition: (1) an increase in public developmental expenditure and (2) a reduction in aggregate income-poverty levels. For the anthropometric data on children, we draw on the data from two cross-sectional waves of National Family Health Survey conducted in 1992-1993 and 2005-2006, while the data for per capita net state domestic product and per capita public spending on developmental expenditure and headcount ratio of poverty were obtained from the Reserve Bank of India and the Government of India expert committee reports. We find that between 1992-1993 and 2005-2006, state-level macroeconomic growth was not associated with any substantial increases in public development expenditure or substantial reductions in poverty at the aggregate level. Furthermore, the association between changes in public development expenditure or aggregate poverty and changes in undernutrition was small. In summary, it appears that the inability of macroeconomic growth to translate into reductions in child undernutrition in India is likely a consequence of the macroeconomic growth not translating into substantial investments in development expenditure that could matter for children's nutritional status and neither did it substantially improve incomes of the poor, a group where undernutrition is also the highest. The findings here build a case to advocate a 'support-led' strategy for reducing undernutrition rather than simply relying on a 'growth-mediated' strategy. Key messages Increases in macroeconomic growth have not been accompanied by substantial increases in public developmental spending or reduction in aggregate poverty headcount ratio in India. Association between increases in public development expenditure or poverty headcount ratios and changes in child undernutrition, in particular, child stunting, is small to null. Reducing the burden of undernutrition in India cannot be accomplished solely relying on a growth-mediated strategy, and a concerted support-led strategy is required.
authors.affiliation: Institute of Economic Growth, Delhi University Enclave, Delhi, 110 007, India.
authors.forename: William
authors.initials: W
authors.lastname: Joe
authors.affiliation: Athena Infonomics, Chennai, India.|Faculty, Institute of Mental Health, Social Sciences and Trans-disciplinary Research, Chennai, India.
authors.forename: Ramaprasad
authors.initials: R
authors.lastname: Rajaram
authors.affiliation: Harvard Center for Population and Development Studies, Cambridge, MA, USA.|Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
mesh_terms: D000293:Adolescent; D000328:Adult; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D057217:Economic Development / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D005102:Health Expenditures; D006306:Health Surveys; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000517:prevention & control*; D008423:Maternal Age; D009752:Nutritional Status; D011203:Poverty / Q000517:prevention & control* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: India; development expenditure; economic growth; growth-mediated strategy; poverty; stunting; support-led strategy; undernutrition