For Chunling Lu, PhD, joining the Lancet Series on Early Child Development was a natural extension to her previous research activities, and she tells CRN that it has been one of the most inspiring experiences in her research career.
More than 250 million children under age 5 are at risk of not reaching their full developmental potential. A poor start in life can lead to consequences when these children reach adulthood, including poor health, low earnings and social tensions. But scientific evidence has the potential to pinpoint effective interventions that could change the lives of millions of people for the better. The Lancet Early Childhood Development Series was launched in 2016 to put a spotlight on the magnitude of the problem as well as effective interventions, with case studies from diverse regions that illustrate how governments can take steps to scale up proven interventions.
Health economist Chunling Lu, PhD, of the Division of Global Health Equity, contributed to the series last fall in an article about the prevalence and economic impact of children exposed to risk factors such as poverty or stunting in developing countries. Lu recently spoke to CRN about the inspiration for her work and the challenges she and her colleagues face.
CRN: Why did you become a health economist, and why did you join the Lancet Series on Early Child Development?
I grew up in China and spent part of my childhood living with my grandparents in a poor rural village.
My dad told me that my grandma gave birth to 12 children, but only four survived due to lack of medical care and sufficient food, and the situation had not changed much 50 years later when I was living in the village.
As an economist, I am devoted to advancing knowledge of effective global health financing for improving health outcomes in developing countries. After giving birth to my son in the United States, the memories of my childhood and grandma’s story woke up from a corner of my mind and became a main driving force for my research. I’ve focused on child and maternal health since then. Before this study, I had been working on evaluating the impact of investments in child and maternal care on reducing child mortality, and investigating the role of a community-based health care financing approach in improving child nutrition status in countries such as Rwanda. Joining the Lancet Series on Early Child Development is a natural extension to my previous research activities and has been one of the most inspiring experiences in my research life.
CRN: What was the most surprising part of your study?
The study is about the level and prevalence of children under age 5 who have been exposed to stunting or poverty in developing countries. The past two years I’ve spent on this study have been a journey of discovering and learning. We observed a noticeable reduction in both number and prevalence of children at risk of poor development, but the progress was uneven across regions. For example, we were surprised to find that after excluding China and India from the picture, there was almost no change in the number of children exposed to poverty or stunting between 2004 and 2010. We also didn’t see improvement in the disparity of the prevalence between low and middle income countries.
CRN: What have been the leading causes of the decrease in child poverty between 2004 and 2010 (in India and China, for example)? Why has high child poverty persisted elsewhere?
The reduction of child poverty in China and India is mainly driven by their economic growth. During the period between 2004 and 2010, the average GDP growth rate was about 11 percent in China and 8 percent in India. In China, for example, a large number of rural populations have migrated into urban areas and found jobs there, and this lifted many rural households out of poverty. Meanwhile, the governments in both India and China started to place poverty reduction on their priority list. In China, for example, households living in poverty were identified and provided with cash or other living materials to meet their basic needs. Households with children in school received cash for children’s meals and school materials. While progress has been made in China and India, it is important to note that a large disparity in risk exposure still exists, between rural and urban areas and needs to be addressed.
CRN: What’s the most challenging part of studying early childhood development interventions?
The most challenging part is the availability of data. Compared to previous studies, we are now benefitting from increased accessibility to data, but we still needed to conduct imputation, where we replace missing data with substituted values for 32 countries that have no information on their poverty ratios. This process can introduce bias or affect the representativeness of the results. To continue monitoring the global progress and provide accurate evidence to policy-makers and other stakeholders, we need to invest in data and research.
CRN: Why are children particularly susceptible to poverty? And what causes stunting? What are some of the most challenging day-to-day circumstances that these young children in poverty face?
As young children depend on others for the care related to their growth and development, they are particularly vulnerable to poverty. Impoverished children are more likely to grow up to be impoverished parents, who, in turn, will have children in poverty. This is a vicious generational cycle, and the consequences of childhood poverty is often permanent. Stunting, associated with inadequate nutrition, repeated illness and poor health care is also an irreversible condition after the age of 2. For children living in poverty, every day they face challenges such as starving, no safe shelter and lack of medical care when ill. As indicated in the Lancet Series, personal and societal economic costs of inaction are high. While effective interventions have been identified, more investment is needed to scale them up in developing countries. Investing in children is investing our future, and we need to unite all forces to do it.