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Malnutrition and economic development

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Presentation by Olivier Ecker at the event: “Tackling food security and nutrition in Egypt: challenges and opportunities” Launch of the findings from the Household, Income, Expenditure and Consumption …

Presentation by Olivier Ecker at the event: “Tackling food security and nutrition in Egypt: challenges and opportunities” Launch of the findings from the Household, Income, Expenditure and Consumption Survey , Tuesday 21 May in Cairo, Egypt.


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  • 1. Malnutrition and Economic Development:Explaining Egypt’s ExceptionalismWFP/CAPMAS/IFPRI Workshop “Tackling Food Security and Nutrition in Egypt:Challenges and Opportunities”, Cairo, 21 May 2013Contributors: Rawia El-Batrawy (CAPMAS), Dr. Clemens Breisinger (IFPRI),Dr. Heba El-Laithy (Cairo Univ.), Marc Nene (Tufts Univ.), Perrihan Al-Riffai (IFPRI)Financial support: IFAD; CGIAR Research Program on Policies, Institutions and MarketsDr. Olivier Ecker
  • 2. Motivation and Outline Malnutrition slows economic growth (2-3% GDP lost) and deepens povertythrough productivity losses (10% of lifetimes earnings) from poor physicalperformance and cognitive capacity as well as increased health care costs. Chronic undernutrition is still the main nutritional problem across thedeveloping world, but overnutrition and associated diseases are risingrapidly.Overview1. Egypt’s main nutritional challenges:a) Growth-nutrition disconnectb) Double burden of malnutrition (coexistence of under- andovernutrition)2. Egypt’s food subsidy system: A key driver of the nutritional challenges?3. Determinants of malnutrition: preliminary estimation results4. Conclusions and policy implications
  • 3. Growth-Nutrition DisconnectPrevalence of stunting among children under 5 years (%)General trendSource: Own estimation based on World Bank’s WDI data, complemented with IMF’s WEO, UNSTAT, and 2010/11 HIECS data.1978Egypt199219952000200320052011GDP per capita (US$)
  • 4. Double Burden of MalnutritionGeneral relationshipEgyptYemenIraqSample averageSaudi ArabiaKuwaitMoroccoSample averagePrevalence of obesity among womenaged 15 years and older years (%)Prevalence of stunting amongchildren under 5 years (%)Source: Own estimation based on World Bank’s WDI data, complemented with IMF’s WEO, UNSTAT, and 2010/11 HIECS data.
  • 5. Egypt’s Food Subsidy SystemTwo food subsidy programs:1. Baladi bread (5 piasters per loaf)  universal2. Food rations: rice, edible oil, sugar, dried black tea  restricted to card holders Although the system has never been designed to reduce malnutrition, food subsidies atthat scale and scope are likely to have significant effects on people’s diet and nutritionalstatus. The subsidies keep the prices of rationed foods constant and far below market prices,increasing the relative costs of more nutritious (non-subsidized) foods. The quotas of food rations considerably exceed quantities recommended for a healthydiet.Food ration beneficiaries Poorest 2 3 4 Richest TotalHouseholds holding ration cards (%) 74 72 69 66 59 68Urban 65 61 58 60 49 59Rural 76 77 74 74 75 75Family members registered onhousehold ration card (%)92 100 114 133 183 122Urban 97 108 123 150 198 133Rural 91 96 106 118 166 115Source: Own estimation based on 2010/11 HIECS data.
  • 6. Preliminary Estimation Results (1)Determinants of chronic undernutrition among children aged 6-59 monthsNote: ***, **, *, † Statistically significant at the 1%, 5%, 10%, and 15%.level. Source: Own estimation based on 2010/11 HIECS data.Child height-for-age z-score Child stuntingRegression model OLS LogisticSample Urban Rural Urban RuralExpenditure per capita (EGP/d) 0.017* 0.028 -0.018* -0.028sq. 0.000* 0.000 0.000* 0.001Baladi bread subsidy benefit per capita (EGP/d) 0.042 -0.039 -0.012 0.019Ration card (1=yes, 0=no) 0.305 -0.069 -0.368 -0.226Food ration subsidy benefit per capita (EGP/d) -0.473 0.391 0.655 -0.045Household size -0.030 -0.045** -0.001 0.075***Child age (months) -0.067*** -0.068*** 0.050** 0.033*sq. 0.001*** 0.001*** -0.001 -0.001**Primary education of woman (1=yes, 0=no) -0.320* -0.352*** 0.204 0.190†Secondary education of woman (1=yes, 0=no) 0.164 0.191† -0.001 -0.201†Sewerage coverage in PSU (%) 0.094 0.014 -0.226* 0.096Constant -0.313 0.059 -0.986* -1.232***Observations 1,262 2,217 1,262 2,217F/Chi-sq. 1.57* 3.37** 18.02† 40.13***R-sq./pseudo R-sq. 0.014 0.017 0.011 0.014In urban areas, child stuntingdeclines with increasing income upto a certain income level and risesthereafter.
  • 7. Preliminary Estimation Results (2)Determinants of overweight among (non-pregnant) women aged 15-49 yearsNote: ***, **, *, † Statistically significant at the 1%, 5%, 10%, and 15%.level. Source: Own estimation based on 2010/11 HIECS data.Female BMI Female overweightRegression model OLS LogisticSample Urban Rural Urban RuralExpenditure per capita (EGP/d) -0.010** 0.157*** -0.006*** 0.065***sq. -0.002*** -0.001***Baladi bread subsidy benefit per capita (EGP/d) 0.031† 0.055†sq. -0.019** -0.043 -0.013*** -0.003Ration card (1=yes, 0=no) -0.592* -0.445 -0.297* -0.176Food ration subsidy benefit per capita (EGP/d) 2.141* 1.940† 1.238** 0.047sq. -1.996** -2.151* -0.981** -0.023Household size -0.042 -0.025 -0.009 -0.002Age (years) 0.568*** 0.636*** 0.232*** 0.227***sq. -0.005*** -0.007*** -0.002*** -0.002***Primary education (1=yes, 0=no) 0.664*** 0.432*** 0.138† 0.181**Secondary education (1=yes, 0=no) -0.580*** 0.067 0.048 -0.014Sewerage coverage in PSU (%) 0.478** 0.707*** 0.178* 0.395***Constant 16.080*** 13.692*** -3.961*** -4.408***Observations 5,136 6,689 5,136 6,689F/Chi-sq. 114.7*** 147.9*** 939.8*** 1,191***R-sq./pseudo R-sq. 0.212 0.210 0.132 0.127In urban areas, female overweight rises withincreasing consumption of baladi bread andsubsidized food rations up to a certain incomelevel and declines thereafter. In rural areas, foodration subsidies have the same effect (though it isless robust).In urban areas, female overweight declines withincreasing income. In rural areas, it rises withincreasing income up to a certain income leveland declines thereafter.
  • 8. Preliminary Estimation Results (3)Determinants of the double burden of malnutrition at household and individual levelNote: ***, **, *, † Statistically significant at the 1%, 5%, 10%, and 15%.level. Source: Own estimation based on 2010/11 HIECS data.Stunted child and overweight woman Stunted and overweight childRegression model Logistic LogisticSample Urban Rural Urban RuralExpenditure per capita (EGP/d) -0.016 0.004 -0.001 -0.003sq. 0.000 0.000Baladi bread subsidy benefit per capita (EGP/d) 0.161 -0.079 -0.093 0.073sq. -0.048 0.019Ration card (1=yes, 0=no) -1.404*** 0.102 -1.930*** -0.981**Food ration subsidy benefit per capita (EGP/d) 4.939** -1.493 6.844** 3.336sq. -4.050* 1.759 -5.857† -4.090Household size 0.084† 0.141*** 0.053 0.071**Child age (months) -0.015*** -0.012*** -0.007 -0.011**Womans age (years) 0.019† -0.006Primary education of woman (1=yes, 0=no) -0.021 0.162 -0.076 -0.172Secondary education of woman (1=yes, 0=no) 0.278 -0.177 -0.313 0.069Sewerage coverage in PSU (%) 0.113 0.231† 0.280 0.185Constant -1.396*** -1.293*** -1.544*** -1.789***Observations 1,006 1,706 1,160 2,080Chi-sq. 29.54*** 37.81*** 17.92* 22.88**Pseudo R-sq. 0.026 0.020 0.018 0.013In urban areas, the double burdenof malnutrition rises withincreasing consumption ofsubsidized food rations anddeclines thereafter.
  • 9. Conclusions and Policy Implications Egypt faces two key nutritional challenges:1. Severe growth-nutrition disconnect2. Double burden of malnutrition Both nutritional challenges are exceptionally pronounced in Egypt. Economic growth is good but is not enough to improve nutrition. Egypt’s food subsidy system incentivizes unbalanced diets and hasdetrimental nutritional effects, particularly in urban areas. In the debate about reforming the food subsidy system, nutritional concernsshould be addressed. To significantly reduce malnutrition, nutrition intervention programs areneeded (while highly cost-effective interventions are available). Other countries such as Brazil provide important lessons on how to createsocially inclusive economic development and bring down chronic childundernutrition successfully.