Academic journal article Journal of Health Population and Nutrition

Effect of Wealth Inequality on Chronic Under-Nutrition in Cambodian Children

Academic journal article Journal of Health Population and Nutrition

Effect of Wealth Inequality on Chronic Under-Nutrition in Cambodian Children

Article excerpt


Despite impressive advances in health in recent decades, many in developing countries remain vulnerable to food insecurity, under-nutrition, and ill health (1). These problems tend to be particularly severe in countries recovering from recent wars or civil unrest (2). In such settings, health and nutritional benefits of economic growth tend to be concentrated among the advantaged groups (3-8). Cambodia is one such country where decades of civil war and violent conflicts have led to displacement, loss of livelihood, extreme poverty, and hunger for millions. Thirty-four percent of the country's population is estimated to be absolutely poor (with an earning of less than US$ 1 per day), mostly concentrated in rural areas lacking many basic amenities. A vast majority of the population does not have adequate access to food, clean drinking-water, or healthcare (9). More than one-third of the population is estimated to be chronically undernourished. The problem of under-nutrition is particularly severe for young children (10). Recent improvements in economic conditions are believed to have benefited the rich more than the poor, and the effects of this wide and apparently growing economic inequality on health and nutrition are poorly understood (3,11).

In Cambodia, as in many other developing countries, under-nutrition is one of the leading causes of childhood morbidity and mortality. Under-nutrition among children is often caused by the synergistic effects of inadequate or improper intake of food, repeated episodes of parasitic or other childhood diseases, such as diarrhoea, and improper care during illness (12). On the other hand, childhood under-nutrition affects physical and cognitive growth, impairs the immune system, and increases the risk of morbidity and mortality (13-15). In developing countries around the world, an estimated 148 million children are stunted, 127 million are under-weight, and 46 million are wasted (16). According to a recent comparative risk assessment by the World Health Organization, under-nutrition is estimated to be, by far, the largest contributor to the global burden of disease (17).

Past research has linked childhood nutrition to education and nutritional status of mothers, employment of fathers, feeding practices, including breastfeeding, water supply and sanitation, access to healthcare, prevalence of parasitic and infectious diseases, health-seeking behaviour, race/ethnicity, rural residence, and social network and family support (3,18-24). Demographic characteristics, such as age and sex of child, birth interval (both preceding and following), and age of mother at childbirth, have also been associated with child nutrition (23,25).

Economic growth does not benefit all sections of the society equally, and the resulting economic inequality within a country affects different sections of the society differently. Economic well-being at the household level operates mainly through availability of better food, more hygienic living conditions, and better access to health services in affecting the health and nutritional status of children.

A number of studies have shown that children in poorer households tend to be more under-nourished than children in better-off households (3,4,20,26-28). Social deprivation has also been linked to nutritional status of children (29). However, the relationship between economic inequality and nutritional status of children is not conclusive. Arecent study in Mexico found that household poverty was not a necessary condition for children to be under-nourished (19). Another recent study in Ecuador found inconsistent evidence of a relationship between economic inequality and childhood under-nutrition (11). A study in Cambodia found that feeding practices, health-seeking behaviour, and personal hygiene are more important determinants of acute under-nutrtion in children than food insecurity (18). A good discussion of the linkages between economic and health inequalities has been provided by Wagstaff (30,31). …

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