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Cost of poor child growth in developing world: $177 billion in lost wages for children born each year

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Toronto, ON, Boston, MA – Early life growth faltering in low- and middle-income countries results in a US $176.8 billion reduction in potential career earnings for children born each year, according to new Harvard T.H. Chan School of Public Health research funded by Grand Challenges Canada.

Representing the first in-depth study of the economic impact of early life growth faltering (when a child's physical growth is below the normal range for healthy children) in low- and middle-income countries, the research was published today in the American Journal of Clinical Nutrition (ajcn.nutrition.org).

Led by scientists at the Harvard T.H. Chan School of Public Health and funded by the Government of Canada through Grand Challenges Canada's "Saving Brains" program, the study finds that early life growth faltering is associated with an estimated 69.4 million years of lost educational attainment per 'birth cohort' (all children born in a single year), which is highly predictive of adult incomes.

Says Professor Gunther Fink, senior author and associate professor at the Harvard T.H. Chan School of Public Health: "Our estimates suggest that we are losing at least US $177 billion of potential career earnings per birth cohort due to early life growth faltering in developing countries. By quantifying the impact that early childhood development has on personal and national economic well-being, our study provides further evidence for investing in early childhood development."

According to the study, every dollar invested in eliminating early life growth faltering would yield a three dollar return.

"Several recent studies have estimated the cost of providing a comprehensive package of critical interventions to children," the paper says. "At the country level, the annual intervention cost for such a package is estimated to be US$100 or less per child for the majority of developing countries."

"Assuming that this comprehensive package could prevent 20% of all growth faltering, a cost of $100 per child and year suggests a benefit-cost ratio of about 3:1, not taking into account other long-term benefits generated by increased human capital and improved long-term health outcomes."

The economic costs of early life growth faltering are largest in South Asia (US$ 46.6 billion), Latin America (US$ 44.7 billion) and sub-Saharan Africa (US$ 34.2 billion). Countries with the most to gain in terms of future annual income and educational attainment are India (US$ 37.9 billion), Mexico (US$ 18.5 billion), and China (US$ 13.3 billion).

By calculating per 'birth cohort', the study captures the education and future income loss for all children born in a single year, assuming that they will participate in the labor market for 40 years, entering the labor market at the age of 20 and retiring at the age of 60.

Early life growth faltering results from a large number of risk factors such as poor nutrition, prematurity, low breastfeeding rates and early exposure to infection, but does not include cognitive or socio-emotional factors like stimulation and play.

"The true cost of developmental delays in low- and middle-income countries is likely much larger than US $177 billion per birth cohort," adds Professor Fink. "We made conservative assumptions and only captured losses due to physical growth delays, not accounting for cognitive or socio-emotional delays. This further emphasizes the economic benefits that could be created by a more comprehensive package of early life interventions improving all domains of development."

Says Dr. Peter A. Singer, Chief Executive Officer of Grand Challenges Canada: "$177 billion is a big paycheque that the world is missing out on – about half a percentage point of GDP of these countries! If we truly want the so-called developing world to develop, we have to stop wasting the world's most precious economic and social asset and ensure children thrive."

The importance of children thriving, not just surviving, is emphasized in the United Nations Sustainable Development Goals and is central to the Every Woman Every Child Global Strategy for Women's, Children's and Adolescent's Health.

While conservative, the new US $177 billion figure is significantly larger than estimates in the Every Woman Every Child Global Strategy for Women's, Children's and Adolescent's Health, which calculated that investing in early childhood and adolescent health and development would yield US $100 billion in demographic dividends by 2030.

The study follows previous work by the same Canadian-funded Saving Brains team that found that one-third of 3- and 4-year-olds in low- and middle-income countries don't reach basic milestones in cognitive and/or socio-emotional growth. That PLOS Medicine study is available here: bit.ly/1Y598lJ

The Saving Brains program supports new approaches to ensure children thrive by protecting and nurturing early brain development, providing a long-term exit strategy from poverty. Saving Brains has invested a total of $41 million in 107 innovations, and recently launched its fifth Request for Proposals: bit.ly/1IRaEgk

To date, over 20,000 children have accessed Saving Brains innovations designed to improve early child development. Given the early stage of the innovations, the full impact will occur in the coming years as the most promising of these innovations transition to scale.

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Appendix: Total career losses per birth cohort due to early life growth faltering in developing countries

Country / Birth cohort size in 2010, in thousands / Total career loss per birth cohort, in US$ millions

Afghanistan: 1092.5 / 744.5

Algeria: 874.9 / 982.9

Angola: 1010.8 / 2168.6

Antigua and Barbuda: 1.5 / 11.4

Argentina: 747.8 / 1692.5

Armenia: 41.1 / 29.7

Azerbaijan: 192.9 / 289.7

Bahamas: 5.6 / 50.9

Bahrain: 19.2 / 52.3

Bangladesh: 3248.2 / 1995.9

Barbados: 3.5 / 33.1

Belize: 7.7 / 22.8

Benin: 359.9 / 130.2

Bhutan: 14.3 / 27.2

Bolivia: 253.4 / 328.7

Botswana: 52.3 / 414.9

Brazil: 3123.5 / 11418.0

Burkina Faso: 661.1 / 155.6

Burundi: 420.6 / 143.4

Cambodia: 365.3 / 130.7

Cameroon: 795.1 / 508.6

Cape Verde: 11.0 / 8.9

Central African Republic: 155.7 / 46.1

Chad: 563.9 / 231.4

Chile: 238.1 / 0.0

China: 16475.5 / 13328.1

Colombia: 784.1 / 3037.7

Comoros: 24.7 / 18.3

Congo: 153.9 / 193.1

Costa Rica: 71.8 / 162.8

Cote d'Ivoire: 768.1 / 568.8

Cuba: 123.2 / 201.0

Democratic People's Republic of Korea: 356.4 / 106.9

Democratic Republic of the Congo: 2890.2 / 604.2

Djibouti: 22.1 / 16.5

Dominica: 1.0 / 4.0

Dominican Republic: 219.2 / 408.8

Ecuador: 326.4 / 1017.5

Egypt: 2228.6 / 2174.3

El Salvador: 111.0 / 326.3

Equatorial Guinea: 26.5 / 216.2

Eritrea: 171.0 / 88.1

Ethiopia: 3046.3 / 1397.2

Fiji: 18.5 / 8.8

Gabon: 48.2 / 169.2

Gambia: 73.6 / 26.5

Georgia: 58.5 / 15.2

Ghana: 816.0 / 455.2

Grenada: 2.0 / 10.0

Guatemala: 422.4 / 1725.3

Guinea: 427.3 / 83.6

Guinea-Bissau: 63.0 / 14.9

Guyana: 14.5 / 28.1

Haiti: 266.1 / 158.7

Honduras: 175.2 / 564.2

India: 26594.7 / 37869.8

Indonesia: 5051. / 9056.7

Iran (Islamic Republic of): 1349.3 / 3296.8

Iraq: 1104.3 / 273.2

Jamaica: 49.6 / 0.0

Jordan: 183.4 /127.4

Kazakhstan: 363.2 / 1141.2

Kenya: 1481.7 / 1351.9

Kiribati: 3.0 / 4.7

Kuwait: 66.8 / 0.0

Kyrgyzstan: 140.7 / 23.6

Lao People's Democratic Republic: 175.7 / 92.7

Lebanon: 64.6 / 47.4

Lesotho: 57.9 / 107.4

Liberia: 145.4 / 22.8

Libyan Arab Jamahiriya: 137.1 / 569.1

Madagascar: 752.2 / 379.1

Malawi: 608.7 / 408.0

Malaysia: 476.5 / 564.2

Maldives : 7.1 / 14.2

Mali: 694.2 / 179.1

Marshall Islands: 1.0 / 2.5

Mauritania: 125.8 / 51.0

Mauritius: 15.3 / 18.3

Mexico: 2375.7 / 18486.3

Micronesia (Federated States of): 2.5 / 7.3

Mongolia: 64.0 / 51.7

Morocco: 678.3 / 910.1

Mozambique: 1000.1 / 479.5

Myanmar: 1020.7 / 350.8

Namibia: 66.2 / 421.3

Nepal: 621.9 / 404.6

Nicaragua: 126.9 / 125.1

Niger: 828.8 / 405.4

Nigeria: 6562.0 / 6445.0

Palestine, State of : 137.3 / 22.4

Oman: 67.8 / 333.5

Pakistan: 5118.2 / 5542.7

Panama: 73.8 / 350.6

Papua New Guinea: 206.9 / 481.7

Paraguay: 139.6 / 240.1

Peru: 614.1 / 1563.5

Philippines: 2307.4 / 4355.3

Qatar: 20.6 / 134.3

Rwanda: 361.7 / 507.7

Samoa: 5.2 / 6.7

Sao Tome and Principe: 6.1 / 2.5

Saudi Arabia: 609.4 / 1338.5

Senegal: 508.9 / 175.3

Seychelles: 1.7 / 1.9

Sierra Leone: 224.9 / 43.4

Solomon Islands: 17.0 / 31.5

Somalia: 432.0 / 245.9

South Africa: 1110.6 / 9537.6

Sri Lanka: 350.7 / 153.5

St. Lucia: 2.9 / 14.4

St. Vincent: 1.9 / 7.3

Sudan: 1257.9 / 1378.2

Suriname: 10.0 / 40.8

Swaziland: 36.8 / 166.1

Syrian Arab Republic: 492.1 / 450.9

Taiwan: 241.7 / 941.5

Tajikistan: 230.7 / 52.1

Thailand: 782.7 / 2207.2

Timore Leste: 42.3 / 29.4

Togo: 239.9 / 44.2

Tonga: 2.8 / 5.3

Trinidad and Tobago: 20.0 / 60.5

Tunisia: 189.0 / 96.6

Turkey: 1306.1 / 4236.4

Turkmenistan: 110.0 / 142.0

Uganda: 1493.7 / 1379.7

United Arab Emirates: 89.2 / 371.8

United Republic of Tanzania: 1873.4 / 1414.0

Uruguay: 49.9 / 201.1

Uzbekistan: 639.5 / 220.1

Vanuatu: 6.5 / 20.5

Venezuela: 598.6 / 2461.6

Viet Nam: 1537.9 / 1016.4

Yemen: 813.4 / 904.9

Zambia: 585.4 / 1266.9

Zimbabwe: 506.5 / 162.4

About Grand Challenges Canada

Grand Challenges Canada is dedicated to supporting Bold Ideas with Big Impact® in global health. We are funded by the Government of Canada and we support innovators in low- and middle-income countries and Canada. The bold ideas we support integrate science and technology, social and business innovation – we call this Integrated Innovation®. Grand Challenges Canada focuses on innovator-defined challenges through its Stars in Global Health program and on targeted challenges in its Saving Lives at Birth, Saving Brains and Global Mental Health programs. Grand Challenges Canada works closely with Canada's International Development Research Centre (IDRC), the Canadian Institutes of Health Research (CIHR) and Global Affairs Canada to catalyze scale, sustainability and impact. We have a determined focus on results, and on saving and improving lives. http://www.grandchallenges.ca

About Saving Brains

Saving Brains is a partnership of Grand Challenges Canada, Aga Khan Foundation Canada, Bernard van Leer Foundation, Bill & Melinda Gates Foundation, The ELMA Foundation, Grand Challenges Ethiopia, Maria Cecilia Souto Vidigal Foundation, Palix Foundation, UBS Optimus Foundation and World Vision Canada. It seeks and supports bold ideas for products, services and implementation models that protect and nurture early brain development relevant to poor, marginalized populations in low- and middle-income countries. http://www.savingbrainsinnovation.net

About Harvard T.H. Chan School of Public Health

Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives–not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health. http://www.hsph.harvard.edu

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