Tuesday, July 15, 2014

Water & sanitation in India

Pretty different from concerns about the popularity of instant coffee, but the NYT has a really nice piece today about how sanitation problems stunt the growth of children in India. Even children who get enough to eat are exposed to pathogens regularly since sanitation is so bad: many people defecate outdoors, and the rivers where people bathe and even brush their teeth are full of contaminants.

The article links to a few peer-reviewed journal articles, including this one in PLOS One. Reviewing Indian data from 1992, 1998, and 2005, they find that undernutrition has declined (i.e. nutritional status is improving) but that social disparities persist. In particular, improvements in better-off households were faster and stronger than in poorer households.

Another article in top-ranked health journal the Lancet notes that GDP growth on its own is not sufficient to improve child nutritional status.

That's an interesting review of the data, and another piece noticed something more particular: Muslims do better than Hindus in India as far as infant survival even though they are poorer. The authors hypothesize that this might have to do with rules about sanitation: where to defecate and how to keep oneself and one's household clean.

Finally, a paper that's not yet published (as far as I know) but still available as a working paper by Dean Spears is available from the World Bank. This seems to me hugely important: sanitation explains child health even better than GDP. Wow.

Somehow, though, they missed another pretty relevant of research. Last summer two  great researchers documented that Indian children are shorter for their ages than African children, meaning that their nutritional status is worse. They don't point the finger at sanitation, though, but note that their is an extraordinarily large gradient in birth order. First born children are substantially better off than subsequent children.

I wonder if there is any overlap. Are firstborns exclusively breast-fed for a longer time, protecting them somewhat from ingesting dangerous bacteria? Do firstborns stay indoors more so they aren't outside running around and playing in unsanitary conditions?

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