Is There Catch‐Up Growth? Evidence from Three Continents
| Published date | 01 August 2016 |
| Date | 01 August 2016 |
| DOI | http://doi.org/10.1111/obes.12117 |
470
©2015 The Department of Economics, University of Oxford and JohnWiley & Sons Ltd.
OXFORD BULLETIN OF ECONOMICSAND STATISTICS, 78, 4 (2016) 0305–9049
doi: 10.1111/obes.12117
Is There Catch-Up Growth? Evidence from Three
Continents*
Sudhanshu Handa†,‡ and Amber Peterman‡
†Department of Public Policy, University of North Carolina, CB #3435 Abernathy Hall
Chapel Hill, NC 27599-3435, USA (e-mail: shanda@email.unc.edu)
‡UNICEF Office of Research - Innocenti, Piazza SS Annunziata 12Florence, 50122, Italy
(email: apeterman@unicef.org)
Abstract
The ability to correct deficiencies in early childhood malnutrition, what is known as catch-
up growth, has widespread consequences for economic and social development. While
clinical evidence of catch-up has been observed, less clear is the ability to correct for
chronic malnutrition found in impoverished environments in the absence of extensive and
focused interventions. This paper investigateswhether nutritional status at early age affects
nutritional status a few years later among children, using panel data from China, South
Africa and Nicaragua. The key research question is the extent to which state dependence
in linear growth exists among young children, and what family and community level
factors mediate state dependency. The answer to this question is crucial for public policy
due to the long-term economic consequences of poor childhood nutrition. Results show
strong but not perfect persistence in nutritional status across all countries, indicating that
catch-up growth is possible though unobserved household behaviours tend to worsen the
possibility of catch-up growth. Public policy that can influence these behaviours,especially
when children are under 24 months old, can significantly alter nutrition outcomes in South
Africa and Nicaragua.
I. Introduction
The ability to correct childhood undernutrition, or for children to display ‘catch-up growth’,
has important population-level implications for economic and social development.Accord-
ing to recent estimates, over one-third of all children under the age of five in developing
countries suffer from some form of nutritional deficiency, with approximately 27% clas-
sified as underweight, 31% exhibiting stunting and 10% exhibiting wasting (UNICEF,
JEL Classification numbers: I12, I18
*The authors thank Harold Alderman, David Guilkey, Eve Leckey, Shadi Eskaf and participants at theAnnual
Meetings of the Population Association ofAmerica for helpful comments on earlier drafts. The views expressed in
this article are those of the authors and not the policies or views of affiliated institutions.
Is there catch-up growth? 471
2006).1These health outcomes are costly to individuals and society. Even in moderate
forms, early nutritional deficiencies have been linked to a range of adverse outcomes in
later life, including grade attainment (Alderman et al., 2001; Hoddinott et al., 2013), cog-
nitive capacity (Glewwe,Jacoby and King, 2001; Paxson and Case, 2008; Hoddinott et al.,
2013), earning potential as adults (Strauss and Thomas, 1998; Grantham-McGregor et al.,
2007) and increased risk of delivery complications for adult women,adolescent obesity and
childhood mortality (Popkin, Richards and Montiero, 1996; Martorell, 1997; Ong et al.,
2000). It is estimated that more than half of deaths among children under age five, and
15% of total disability-adjusted life years lost in developing countries is due to underlying
undernutrition (WHO, 2005). These consequences of undernutrition add up to large eco-
nomic losses for nations – gross domestic product totals in Africa and Asia are estimated
to be less than 90% of what they would be in the absence of undernutrition alone (IFPRI
2014). With such large potential damage associated with earlychildhood stunting, the key
question is whether, at the aggregate level, early linear growth deficits can be corrected in
the short term to enable children to reach their full developmental potential.
The term ‘catch-up growth’ was first introduced in the early 1960s to describe a phase
of rapid linear growth under favourable circumstances which allowed a child to accelerate
towards his or her preillness growth curve (Prader,Tanner and von Harnack, 1963).2Since
human growth follows a fairly regular curve throughout the life course, theoretically a
period of height velocity above the statistical limits of normality following a period of
growth inhibition should be identifiable and sensitive to various interventions (Boersma
and Wit, 1997). Although catch-up growth has been observed in laboratory and clinical
settings, a key question is whether these clinical studies translate to the real world.That is,
at the population level, and in the absence of sustained, focused intervention, is catch-up
growth possible? The existingsocial science literature is mixed on the possibility of catch-
up growth in ‘natural’settings. This is due to differences in the definition of catch-up growth,
measurement of nutritional status, age ranges, lag lengths and statistical methodology,
including the treatment of endogeneity (see next section for references). The objective
of this paper is to present a systematic discussion of the concept of catch-up growth, its
application in social science research, and to provide more robust evidence of its existence
by using independent population levelpanel data from three developing countries spanning
different continents, races, cultures, and economic environments: China, SouthAfrica and
Nicaragua. The application of a common statistical approach to samples from such widely
diverse populations allows us to comprehensively test the hypothesis of catch-up growth
as a possible universal phenomenon among children in developing countries.
Our empirical approach to this question is guided by a dynamic household economic
model of human resource decision-making. In such a model, households apply current
health inputs (food, care, medicine) to prior observed health status to achieve a desired
1Classifications include moderate and severe forms of underweight (below minus two and minus three standard
deviations from median weight-for-age of reference population), stunting (below minus two and three standard
deviations from median height-for-age of reference population) and wasting (below minus two and three standard
deviations from median weight-for-length of reference population) according to WHO standard cutoffs. Data used
was from the most recent availableyear by country, during the period 1996–2005.
2The term ‘catch-down growth’has also been used to describe a decrease in the linear growth curve. Most research
on interventions has been more concerned with improving nutrition standards rather than inhibitors of growth, and
has therefore focused on catch-up growth.
©2015 The Department of Economics, University of Oxford and JohnWiley & Sons Ltd
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