why are Indian children short?

introduction to a conference
on sanitation, stunting,
and growing human capital

Dean Spears – 2 August 2013

 thank you.
• Centre for Development Economics at DSE
– Abhijit Banerji
– Ashwini Deshpande
– J.V. Meenakshi
– Surjeet Singh
• World Bank Water & Sanitation Programme
– Shalini Agrawal
– Sonali David
– Manish Kumar
economists’ conference rules, not seminar rules
the importance of development in the first two years of life

one: why height?

 height versus weight
• exercising and going on a diet
– sometimes makes me thinner
– never makes me shorter
– weight is about “net nutrition” recently
– “net” of losses to disease and energy spent

• in contrast, height is about early life health

and net nutrition
– and early life is a very important time
UNICEF: “The first two years are forever”
height relative to healthy norms

Indian children, 2005 DHS

 aren’t some people genetically
taller or shorter than others?
of course!

Early life
each of us disease, he
has a genetic alth, and
potential nutrition
height shape
whether
we reach it
 small kids? big deal!
• height is not the only thing developing in the
first few years life
• the same early life health that helps bodies
grow tall also helps brains grow smart
• height predicts (on average):
– cognitive achievement
– adult occupation class, employment, wages
– adult health, mortality, and happiness
– promotion of people in large organizations (!)
height and cognitive achievement
earnings, men in Mexico (Vogl, 2012)
 if we know about the
average height of a
population, we know many
important things
an “Asian Enigma?”

two: why are children in India so

short?
 Indian children: below the trend

source: Jayachandran and Pande, 2013

 how tall are Indian-origin children
in South Africa? “White”
“Indian”
“Coloured”
“African”

data: NiDS, National Income Dynamics Survey

 when environments
change, population heights change

source: Angus Deaton

what threats to child health are
particularly bad in India?

too many
there are germs in feces, which get
onto children’s fingers and
feet, into water and foods, and
wherever flies go
• diarrhea  direct loss of food
• enteropathy  no absorption
• energy consumption fighting disease
three: open defecation
and child height
R² = 54%
merely wealth? controlling for GDP changes little
differences from country averages
 would any “good” property
similarly predict height?
Explaining stunting internationally is challenging:
Many indicators are potentially correlated with child height.

association with average child height, across DHS country-years

female calorie open
variable: electrifi. democracy breastfeed. fed liquids
literacy deficit defecation

association: 0.0143* -0.00251* 0.00675* -0.0274* -0.109+ 0.0102* -1.239*

(0.00267) (0.00120) (0.00254) (0.0117) (0.0605) (0.00292) (0.226)

 The other variables cannot explain
international differences in child height, after
accounting for open defecation and GDP.

association with child height, across DHS country-years

female calorie open
variable: electrifi. democracy breastfeed. fed liquids
literacy deficit defecation

association: 0.00348 0.0000230 -0.00271 -0.0119 -0.103* 0.00320

(0.00327) (0.000964) (0.00226) (0.00787) (0.0370) (0.00208)

open defecation -0.880* -1.002* -0.918* -0.843* -1.003* -0.939* -1.002*
(0.205) (0.157) (0.141) (0.212) (0.153) (0.164) (0.156)
GDP per capita       
years       

Goes away with country FEs

region trends
a double threat: open defecation amid
high population density
population densty: Indian states
as countries
the South Asia – Sub-Saharan Africa gap
• restrict the sample to South Asia and Sub-
Saharan Africa
• measure the difference between South Asia and
Africa
• how much does statistically controlling for open
defecation reduce the difference between
South Asia and Africa?
the South Asia – Sub-Saharan Africa gap
 paper: www.riceinstitute.org
• Indian districts where open defecation
decreased by more between the NFHS-1 and
NFHS-2 saw greater increases in child height,
on average

• re-weighting child-level Indian NFHS-3 data to

match the distribution of sanitation facing
African children in comparable DHS data can
more than eliminate the India-Africa gap
 open defecation: a threat to
human capital
• child height is an important economic variable
because so much is developing in the first two
years
• Indian children are exceptionally short; shorter
children within India achieve less, on average
• open defecation can statistically account for
international variation in child height
• if so, then sanitation would be a
health, economic, and human development
priority