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

020

4060

80100

120140

160180

non-IDDIDD

高能力High capacity population

Impact of 10 points IQ loss丢失 10 分智商的影响

020

4060

80100

120140

160180

non-IDDIDD

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 resourcesProductivity from productivity from from increasedpoor 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 ChinaChange of nutrition status of rural China (11) ) 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.

% of Energyshare

Year Urban Rural

Fat 1992 28.4 18.6

2002 35.0 27.5

Cereals 1992 57.4 71.7

2002 48.5 61.5

Animal food 1992 15.2 6.2

2002 17.6 10.7

Changes in Dietary Intake: 2002 vs.1992

(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 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1998Underweight低体重 % 19.0 9.1 P<0.001Stunting生长迟缓 % 31.3 17.2 P<0.001 2000 Underweight 低体重 % 21.6 9.6 P<0.001 *13.8Stunting 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

0

5

10

15

20

25

30

Month

% GR

PR

U

月龄

05

1015202530354045

Month

%

城市 一般农村 贫困农村

U

GR

PR

U

GR

PR

月龄

Peak prevalence of stunting生长迟缓率高峰年龄段

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 ProblemNet Present Value of Losses

损失净现值 (2001)

China 全国 West 西部

¥ b % of GDP*

¥ 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

0

5

10

15

20

25

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

If anemia reduce 30%, 10 yeare

conomic 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

B Yuan亿元

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 )

Cost-benefit of reduction of anemia prevalence降低儿童贫血率的成本效益

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 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)

Income of households

最低 5%

Lowest10%

(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 hous

eholds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 78 79 56

2000 2.7 2034 85 85 53

* Reference man 以标准人计

05

1015202530354045

Month

%

城市 一般农村 贫困农村

U

GR

PR

U

GR

PR

月龄

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

Thank you!

谢谢！