Nutrition as indicator for poverty reduction 将营养纳入脱贫指标 Chen Chunming 陈春明 Nutrition Surveillance Team Chinese Center for Disease Control and Prevention

Nutrition is essential to the first goal of MDG-eradicate poverty and hunger 营养对实现千年发展目标第一目标－消除贫困与饥饥饿的意义 Income poverty and non-income poverty 收入贫困与非收入贫困 Change of nutritional status of poor rural during 1990-2000 1990至2002年中国贫困地区营养状况的变化 Nutrition assessment on poverty alleviation 脱贫的营养评价

Nutrition is essential to poverty reduction 营养对消除贫困的意义 Malnutrition slows economic growth: 1.Direct losses in productivity due to poor physical status, 2.Indirect losses due to poor cognitive function 3.Losses due to increased health care cost 营养不良造成经济增长减慢－来自: 1 体格发育不足造成劳动生产率降低的直接损失 2 认知功能差造成的间接损失 3 医疗开支增加的损失

Evidences 证据 1% height deficit due to early childhood stunting causes 1.4% productivity reduction in adult life 由于儿童早期生长迟缓造成得成年身高矮1％，可降低劳动生产率1.4％ Eradication of anemia in adults can increase productivity 5-17% 消除成人贫血可增加劳动生产率5-7% Low birth weight children loss IQ 5 points 低出生体重儿童损失智商5分 Stunted children loss IQ 5-11 points 生长迟缓儿童可损失智商5-11分

Iron deficiency anemia children loss IQ 8 points 缺铁性贫血儿童可损失智商8分 Iodine deficiency disorder children loss 10-15 points 碘缺乏儿童可损失智商10-15分 Fetal under-nutrition and malnutrition under age of 2 cause increased chronic disease risk, such as hypertension, diabetes and CHD risk in adult life 胚胎至2岁期间的营养不良可导致成年高血压、糖尿病和冠心病的危险增加

Impact of 10 points IQ loss 丢失10分智商的影响 高能力 High capacity population

Impact of 10 points IQ loss 丢失10分智商的影响 低能力 Low capacity population

Target for poverty reduction 扶贫目标 MDG target for poverty reduction includes income poverty and non-income poverty 千年发展目标的减贫目标包括收入贫困和非收入贫困 Even target of income poverty reduction may be achieved, the non-income poverty target could be far lag behind 即使降低收入贫困目标达到，非收入贫困目 标的降低还可能远远滞后

Non-income poverty includes nutrition, human development and human capital formulation, under nutrition is strongly linked to income poverty 非收入贫困包括营养、人才发展和人力资本，营养不良对收入贫困有很大影响

Income poverty收入贫困 Low food Frequent Hard Frequent Large Intake infection physical pregnancies families labor 食物不足 频繁感染 重体力劳动 频繁妊娠 大家庭 Malnutrition 营养不良 Direct loss in Indirect loss in Loss in resources Productivity from productivity from from increased poor physical poor cognitive health care costs status development & of ill health 体格发育不足带来 schooling 疾病造成医疗开支增加 劳动生产率降低 智力发育及入学问题 带来间接劳动生产率 下降

Change of nutrition status of rural China (1) Food security achieved, dietary pattern of rural residents shifted positively 食物保障已解决，膳食结果趋于合理 Achieved food security食物保障: Energy intake 能量摄入 2300 Kcal /day Shift of dietary pattern膳食模式转变: ( Energy share of CHO and fat ) Rural - getting better 谷类供能比Cereals  to 61.5% 脂肪供能比Fat↑ to 27.5% 动物性食物供能比Animal food ↑ 4.5%pt. Changes in Dietary Intake: 2002 vs.1992 % of Energy share Year Urban Rural Fat 1992 28.4 18.6 2002 35.0 27.5 Cereals 57.4 71.7 48.5 61.5 Animal food 15.2 6.2 17.6 10.7

(2) The situation of poor rural household 贫困农户的膳食情况 Year % of poor households 贫困户％ Energy intake Kcal/day 能量摄入 % RDA 达到推荐量％ Energy share from cereals % 谷类供能比 1995 4.1 2003 83 76 1998 2.5 1864 78 79 2000 2.7 2034 85 The existing poor population is even harder in terms of dietary quality. 目前仍处于贫困的农户膳食质量更差

(3) Comparison of poor rural (PR) w general rural (G) 贫困农村与一般农村比较 5岁以下儿童营养不良患病率% (2000) Underweight Stunting 低体重率 生长迟缓率 地区 B男 G女 Total B男 G女 Total 农村R 13.2 14.7 13.8 20.0 20.7 20.3 ( 9.2 9.3 9.3) (17.7 16.8 17.3) 一般G 9.1 11.4 10.1 14.3 15.3 14.8 较贫困P 20.8 20.8 20.8 30.5 30.7 30.6 (13.8 15.0 14.4) (29.4 29.3 29.3) 全国N 10.7 11.8 11.4 15.7 16.2 16.0 ( 7.8 7.8 7.8) (14.8 13.8 14.3) * 红 色-2002

(4) Changes of Prevalence of Malnutrition during 1990-2002 1990-2002儿童营养不良率的变化 Underweight% Stunting% 低体重率 生长迟缓率 Urban Rural National Urban Rural National 城市 农村 全国 城市 农村 全国 * 1990 8.0 22.6 20.0 9.4 41.4 35.0 * 1995 4.6 17.8 14.4 8.9 39.1 31.6 1998 2.7 12.6 9.6 4.1 22.6 16.7 2000 3.4 13.8 11.4 2.9 20.3 16.0 2002 3.1 9.3 7.8 4.9 17.3 14.3

(5) Comparison of western with Eastern Malnutrition of children under 5 东西部比较－ 5岁以下儿童营养不良患病率 West 西部 East 东部 1998 Underweight 低体重% 19.0 9.1 P<0.001 Stunting 生长迟缓% 31.3 17.2 P<0.001 2000 Underweight 低体重% 21.6 9.6 P<0.001 *13.8 生长迟缓 % 30.8 14.5 P<0.001 *20.2 * National average

Peak prevalence of underweight 低体重率高峰年龄段 U 月龄

Peak prevalence of stunting 生长迟缓率高峰年龄段 月龄

Net Present Value of Losses 损失净现值(2001) Productivity losses due to malnutrition 营养不良的劳动生产率损失(非收入贫困对收入贫困影响） (impact of non-income poverty on income poverty) Nutritional Problem Net Present Value of Losses 损失净现值(2001) China 全国 West 西部 ¥ b % of GDP* Stunting 生长迟缓率 16.6 0.22 5.2 0.43 Iodine Deficiency 碘缺乏 19.8 0.18 7.3 0.31 Anemia (adults)成人贫血 65.8 0.73 18.2 1.08 Anemia (children)儿童贫血 259.9 2.88 71.4 4.25 Total 总计 362.1 4.01 102.1 6.07 *China’s 2001 GDP=¥9035 b or ¥7078/capita, **West 2001 GDP=¥1682 b or ¥4687/capita

Productivity loss in future due to child anemia, 2001 Gansu 甘肃省儿童贫血造成的未来10年劳动生产力的损失 B Yuan 亿元 If anemia reduce 30%, 10 yeareconomic loss is 6.7b yuan 如贫血率降低30％，10年可减少经济损失67亿元 If anemia% keeps no change, 10year economic loss is 20.6b yuan 如贫血率无下降，未来10年损失为206亿元

Cost-benefit of reduction of anemia prevalence 降低儿童贫血率的成本效益 假设婴幼儿每天补充强化辅食补充品需要0.5元 根据2000年第五次人口普查数据，甘肃省农村1岁以下儿童数是26万,每个孩子平均补充时间是12个月，十年需要的总费用大约是4.5亿，与其成年以后10年能减少的劳动生产力的损失比较，成本与效益之比初步估计是1:15 以贫困地区4000万人口计,6－18月龄儿童每年有120万，一年约需2.2亿人民币（4000x2%x1.5x180=2.2亿)

Indicators for assessment of poverty reduction 贫困的评价指标 Nutrition indicator as a non-income poverty indicator should be included in the plan for f poverty reduction 营养指标应作为非收入贫困指标纳入扶贫计划 Nutrition goal should be added to the income goal 扶贫收入目标之外，应设营养目标

Recommendations on indicators for assessment of poverty alleviation 评价脱贫指标建议 Recommendation will be: Minimum requirement for poverty alleviated— 脱贫的最低指标： 1.Energy intake >2100/person/day 能量摄入>2100 2.Cereal energy share <75% of total energy intake 谷类食品供能比<75% 3.Prevalence of stunting of children aged 3 3岁儿童生长迟缓率

Background information for the recommendation 建议依据 1 Population with energy intake <1500 kcal/day or protein intake <50g/day: 人均能量摄入低于1500千卡或蛋白质摄入低于50克的人群: Risk of chronic hepatitis is higher than that of population with intakes over this level, RR=1.46 and 1.45 repectively. Attributalbel Risk is 32.4% and 31.0% 其慢性肝炎的患病率高于摄入水平在此值之上的人群， 其相对危险度分别为1.48和1.45 归因危险度分别为32.4%和 31.0%

Energy/protein intake & cereals energy share 不同收入农村住户热能、蛋白质和谷类热能比 of rural households 不同收入农村住户热能、蛋白质和谷类热能比 Income of households 最低5% Lowest 10% (6%-9%) 15% (10 -14 %) 20% (15-20%) 1998年 能量摄入 kcal Energy 1855 1988(2118) 2074(2245) 2119(2256) 蛋白质 g Protein 56.8 59.0 (61.1) 60.8 (64.4) 62.2 (66.4) 谷类热能比% Cereal energy % 77.0 74.3(71.7) 73.2(70.9) 72.7(71.7)

10% 15% 20% 2000年 能量摄入kcal 蛋白质摄入,g 谷类热能比% Income of households 最低5% Lowest 10% (6%-9%) 15% (10 -14 %) 20% (15-20%) 2000年 能量摄入kcal Energy intake 1750 1788(1825) 1880(2065) 1896(1943) 蛋白质摄入,g Protein 44.9 47.1 (49.3) 50.6 (57.5) 51.9 (55.9) 谷类热能比% Cereal energy share% 85 82.1(79.4) 80.5 (77.0) 78.9 (74.3)

建议依据 2 Dietary intake of poor households 贫困户膳食能量摄入 Year %poor households 贫困户％ Energy Kcal/man* 能量摄入 % RDA 供给量％ %E Cereal 谷类供能比 Protein g 蛋白质 克 1995 4.1 2003 83 78 56 1998 2.5 1862 79 2000 2.7 2034 85 53 * Reference man 以标准人计

建议依据3 Peak prevalence of stunting 生长迟缓率高峰年龄段 月龄

Thank you! 谢谢！