Stunting and wasting in a growing economy

A new paper is out, with the title “Stunting and wasting in a growing economy: Biological living standards in Portugal, 1924-1994”. You can find the CEPR (gated) version here, and an open access version here.

In this paper, we document the remarkable progress that happened for the living standards of children and young adults in Portugal during the second half of the 20th century. Portugal’s real income per head grew by a factor of eight during the second half of the twentieth century, a period of fast convergence towards Western European standards of living. To which extent was there a reflection of this progress on the wellbeing of people?

We use a new sample of 2000 children to document trends in the prevalence of stunting and wasting in the city of Lisbon, from 1945 to 1994. We additionally use a sample of 17,000 young adult males covering the entire country which shows similar trends.

We find that the prevalence of stunting and wasting fell quickly in the 1950s and 1960s, for both males and females. Natually, 20 year-olds lagged behind children and the county also lagged behind Lisbon. But life improved for everyone, and it did so for females as much as for males. Stunting and wasting were considerably higher for infants than children (as we show in the paper), at least partly due to selection of survivors. Child mortality was high but steadily declining over our period.

For children (2 to 10 years of age), for example, the prevalence of wasting (being underweight, usually due to malnourishment or diseases) fell sharply from about a quarter to close to zero:

The results for stunting (children well below the normal height for a given age) are similar:

Comparison of stunting in Lisbon vs. Portugal for 20 year-old males show that standards of living were higher in Lisbon, but there were improvements over time in the country overal over time, with the timing of the improvements in Lisbon ahead of elsewhere:

In the paper, we discuss the causes of these trends: changes in income and public policy which affected the ontogenetic environment of children. The income and health improvements which happened in Portugal over the second half of the 20th century led to the improvements that we document. From around 1950, infrastructure improved considerably, both with regards to water access, sewage, and quality of dwellings. This decreased the incidence of diarrhea and other digestive diseases that commonly affect children. Infant mortality due to digestive diseases up to 3 y.o. fell, and literacy levels among children also steadily rose from the late 1920s. Later, these became more informed parents, who presumably took better decisions.

The macroeconomic progress which occurred in Portugal during the second half of the 20th century was associated with considerable improvements in the living standards of ordinary citizens including children and young adults. That progress began under the Estado Novo regime and further continued under democracy. As a result of this joint progress, Portugal was transformed during the 1945-1994 half century from a country with dismal development outcomes into a modern developed country as far as health outcomes are concerned.

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