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Jere R. Behrman, Professor of Economics at the University of Pennsylvania. He was one of the speakers at the IV Development Week of the Navarra Center for International Development (University of Navarra).

Benefits of improving child health outweigh costs

Fri, 07 Aug 2015 11:03:00 +0000 Published in El País (Future Planet)

Currently, more than 200 million children under the age of 5 - more than four times the total population of Spain - are at risk of not being able to reach their potential due to chronic malnutrition and poverty. They are found in regions at development around the world, but are particularly concentrated in South Asia and sub-Saharan Africa. This is a great human loss that must be addressed for its intrinsic importance alone. But it also comes at a great cost to these children and their families, as well as to the societies in which they live.

Several factors threaten the adequate progress of these children: prenatal care and nutrition of mothers during pregnancy are inadequate, breastfeeding is not prolonged for the first six months of life, nutrient intake after breastfeeding is insufficient, infectious diseases - often caused by poor sanitation and water - are a burden, and parents and other caregivers provide little verbal and intellectual stimulation.

These factors increase the likelihood of morbidity and mortality in children, which, in addition to the human costs, entail economic costs: both in terms of resources devoted to sick children and the inevitable possibility that children will not become productive adults.

The scientific evidence about the extent of these factors and their impacts is becoming increasingly robust. A central lesson from recent programs of study is that these early-stage conditions have important life-cycle implications. The results of systematic programs of study are illuminating, as shown in the following examples sample .

We now know that getting a low birth weight baby (less than 2.5 kg) to a normal weight status in an income country leave results in productivity gains when the baby becomes an adult.

Another experience that has been learned from took place in Guatemala, where an attempt was made to improve the nutrition of children by providing a protein supplement during their first two years of life. When they reached adulthood three or four decades later, their cognitive skills increased as much as would have been achieved with an extra course or two of schooling; the fees of male wages increased by 40%; and in the case of women who had taken the supplements as children, their children's birth weights rose by more than 100 grams average.

Similarly, an intervention in Jamaica that involved home visits to mothers to teach them how to stimulate their malnourished infants and young children reduced the likelihood that they would engage in violent activities when they grew up, and two decades later their wages were 25% higher than those of their predecessors.

Based on these and related programs of study , numerous analysts and advocates have emphasized that the first thousand days after conception, up to two years of life, constitute a very relevant period for neural development . While there is some controversy about the extent to which growth can be 'caught up' at later ages, there seems little doubt that early life is a very important period and that, even if later catch-up is possible, the costs may be relatively higher than the costs of prevention during this period.

But from an economic point of view, those interventions at early ages that have substantial impacts on the life course are not sufficient to claim that they are good investments. Are the benefits of these impacts greater or less than the costs they entail? This is a difficult question, because both the impacts and the costs tend to be multiple, uncertain and spread over years. In that sense, for comparability, costs and impacts should be described in similar terms (e.g., in euros) and should be adjusted in case there are early benefits that can be reinvested.

Considering these aspects, the cost-benefit ratio of some interventions has been estimated to date. A large issue of cases suggests that the benefits are higher than the costs, which is a great attraction for investment.

For example, a study analyzing 17 countries with high fees malnutrition and stunting found economic benefits in those adults whose nutrition was improved during the first two years of life. From average, for every euro invested in reducing chronic malnutrition that leads to stunting in two-year-olds, there was a perceived increase in productivity as children grew older equivalent to about 18 euros. Another research analyzed in 73 countries at development - with a total population of 2.69 billion people - the cost-benefit ratio when preschool enrollment was increased by 50%. It showed that there was at least 7 euros of gain for every euro invested (the benefit was estimated to be between 7.8 and 17.6 euros).

These data are in line with the estimates of the Copenhagen consensus, which periodically calculates the cost-benefit ratio in various policies for countries in development, aimed at improving international trade, reducing environmental degradation, increasing schooling for early childhood investment... According to this consensus, investments in early life, especially in nutrition topic , are among the investment options with the highest returns.

It is deplorable that more than 200 million children under the age of 5 are at risk of not reaching their full human potential in countries at development. Scientific evidence shows that investing in them is an opportunity that brings great benefits not only for individuals, but also for their families and society as a whole.