Hunger and Malnutrition: Review of Copenhagen Consensus Challenge Paper 2004

This paper reviewed Copenhagen challenge paper on hunger and malnutrition in 2004 alongside opponents‟ perspectives. The original challenge paper identified direct cost of malnutrition on health such as low birth weight and macronutrients deficiencies among children between ages 0-5 year. Indirect cost on economy such as low productivity due to poor cognitive development among children and absence of adult workers from work due to illness from poor nutrition were also identified. However, the original challenge paper significantly failed to address factors that could have led to the prevalence of malnutrition and hunger while proffering solution to these challenges. Hence, this paper empirically examine the relationship between undernutrition and these factors which include level of economic development, household income, access to improved water and level of calories intake. A cross section dataset of 52 developing countries for the year 2011 were analysed, the correlation matrix table and scattered graph plot results show that there are fairly strong negative correlation between malnutrition proxy by prevalence of undernutrition and (i) household income (poverty) proxy by GNI per capita; (ii) economic development proxy by GDP per capita and (iii) Access to improved water. However, the correlation between undernutrition and depth of calories deficit proved very strong and was positive. Thus, more attention need to be given to macroeconomic policies that will improve the life of the people in the economy and alleviate poverty. Basic amenities such improved and portable water should also be provided for the populace especially in developing countries where incidence of malnutrition are prevalence.


INTRODUCTION
The consequences of hunger and malnutrition such as maternal death and micronutrient deficiencies (low birth weight, underweight, stunting and severe wasting) have been widely discussed in several literatures. However, combating these challenges among others had gone beyond just writing an academic paper. Thus, every four year since 2004, many economists and academic scholars always have the opportunity to produce a more practicable and feasible paper to solve several challenges facing the world today which include hunger and malnutrition on the platform of Copenhagen consensus. URL: www.onlinesciencepublishing.com | October, 2016

Aims of the Study
This paper aims to review the Copenhagen consensus challenge paper on hunger and malnutrition 2004, the opponents" view, the comments from the panel, key theoretical backgrounds and policy issues. It will also cover an empirical research on couple of hunger and malnutrition challenges not addressed and/or partially addressed by the challenge paper and those issues raised by the opponents.

Objectives of the Study
In a more succinct manner, this paper has the following specific objectives: The rest of the study are as follows: section two briefly reviews the challenge literature which covered the challenge paper itself, opponents and panels" comments, as well as key theoretical and policy issues; section three discusses data and methodology employed; section four deals with analysis and findings; section five, conclusion.

Challenge Paper-Behrman et al. (2004)
The authors started the challenge paper by firstly described the nature and measurement of hunger and malnutrition. They describe the nature of these challenges as the lack of basic food intake with necessary nutrients and energy that could support productive lives. However, according to Hunger Task Force report, the nutrients provided by food combine with other factors and health status of the persons taken the food are used to measure their nutritional status (as cited in Behrman et al. (2004)).
The prevalence of anaemia among pre-school children is also an indicator of measuring malnutrition but this is due to micronutrient deficiency such as lack of iron which normally cause low haemoglobin (Behrman et al., 2004). Also Diarrhoea, fevers and some infections could occur as a result of Vitamin A deficiency. Apart from life severe damage to the status of any children with micronutrient deficiencies, they are also vulnerable to maternal death. Haddad (2013) estimates 2.3 million children died in 2011 because they were undernourished.

The Opportunities, Benefits and Costs
The four opportunities with benefits and costs identified are discussed below:

Reduce Prevalence of Low Birth Weight (LBW)
The main objective of this opportunity is to reduce LBW among infant. As mentioned in the previous section above, LBW is intrauterine growth retardation resulting from short maternal stature, poor maternal nutrition before or during pregnancy, infection and smoking.  As it can be inferred from table 1 above, the intervention programme mainly take form of: (1) Treatments for women with asymptomatic bacterial; (2) Treatments for women with presumptive STD; and (3) Drugs for pregnant women with poor obstetric history. Other policy programmes include: exclusive breastfeeding promotion and provision of micronutrient supplements such as Vitamin A, Iron, Zinc and Folate. They use plausible assumption and Present Discounted Value (PDV) approach at 3% to 5% discount rates to arrive at benefits-cost in the magnitude of $580 per infant.
However, benefits include: reduced mortality and morbidity rate are direct benefits while economic benefits include: (1) saving of resources in reducing mortality and cost on neonatal care; (2) increased labour productivity as a result of low mortality and morbidity rate which will enhance schooling.

Infant and Child Nutrition and Exclusive Breastfeeding Promotion
This opportunity aims to promote integrated child care and intensive pre-school programmes with considerable nutrition for poor families. As mentioned in opportunity 1, authors also include promotion of breastfeeding in hospital in which norm has been promotion of use of infant formula.
The benefits here are similar to those mentioned under opportunity 1. However, mortality and health care costs are expected to reduce. Also, cognitive development and improved nutritional stature will increase schooling rate and reduce number of repeaters in school. The benefit-cost can be seen in the  Improved in water and sanitation as well as Investments in women"s education are also expected to convey benefits in terms of reduced malnutrition and health care cost.

Reducing the Prevalence of Deficiencies of Iron, Vitamin A, Iodine and Zinc
The main objective of this opportunity is to reduce micronutrient deficiency among children under six years old and to also target the same among women within child bearing age. However, targeting women within child bearing age with necessary micronutrient supplements as mentioned in table 3 above will lead to reduction in ""LBWthat will manifest in terms of birth outcome and cognitive functions"" (Behrman et al., 2004). The benefit-cost of making this micronutrient supplements available per child under six year and woman of child bearing age are highlighted in the table 3.

Investment in Technology in Less Develop Country Agriculture
The objective of the authors here is to provide opportunities that will improve method of farming in order to grow high yield grains with enriched micronutrients. The idea here is not just to make food available but must be the one that will improve nutrition status. As it can be inferred from table 4 above, improved cultivars could increase genetic material in seeds that will permits high yield grain. Table 4 above shows the benefits-to-cost evaluation of the intervention programme and benefits as highlighted by the authors.

The Opponents' Perspectives-Simon Appleton and Svedberg (2004)
The major criticisms received by this challenge paper houvering around the evaluation methods used in arriving at the benefits-costs figures on which challenge papers were ranked by the panel. Other general issues like poverty, famine and hunger were also claimed to have been ignored or less discussed. Some other intervention instruments of alleviating under-nutrition were also reported to have been overlooked.

Evaluation Methods
Appleton (2004) argued that empirical literatures upon which authors drawn their evidences are rather fragmentary and partial which often drawing on developed country"s data and frequently subject to serious methodological limitations.
For instance, Appleton argued further that, the derivation of some of the key figures are often unclear and sometimes reflect assumptions based on judgement. Even though he did not totally agree that these judgements appear flawed or biased in a particular direction but the tentative nature of the empirical evidence and consequent uncertainty over key magnitudes may warrant discounting the estimates by some arbitrary "risk premium". This sometimes tend to understate or overstate benefit-cost figures.

Under-Nutrition and Poverty
Svedberg (2004) argued that less attention was given to the link between poverty, hunger and malnutrition. However, bivariate regression was run between prevalence of child stunting (children under 5 years with height below normal) and log of GNI per capita of 67 developing countries for 1998-2002 period.
The relationship was negative and statistically significant at the 0.000 level with adjusted R square of 0.536. Source: Svedberg (2004) From the above scattered graph, Svedberg therefore drawn conclusion that per-capita economic growth is very low in many developing countries and even negative in some cases, hence, households cannot (on average) exert stronger effective demand for essential private consumption goods, including more and nutritionally better food. He however suggests that the search for improved micro-level interventions and targeting methods must continue, but caution that in the absence of higher economic growth rates in the poor countries, there is scant hope for realising the Millennium objective of alleviating the prevalence of child under-nutrition.

Other Intervention Instruments
Svedberg (2004) argued that child health and under-nutrition are intimately inter-related. He added that some child ill health reduction instruments such as immunisation against TB, DPT, polio and measles, oral rehydration therapy and child disease control practices (e.g treated malaria bed-nets and improved drugs) could have been included in opportunity 2 by the authors. According to him, child health can be improved upon by applying and further promoting the above mentioned intervention instruments.
The idea of Svedberg here is that these intervention instruments are quite less expensive and efficient going by their viral application in 1990s in many developing countries. The fact that, these interventions sometimes come in form of aid from international organisations and require less effort and money to administer them, then the authors should have included them in their opportunity 1 and 2.

Famine and Hunger
Appleton (2004) understood that the authors may be naive about famine in this challenge paper probably due to the fact that this might have been partly addressed by opportunities for reducing civil conflict considered in a companion challenge paper. According to him, famine appears increasingly to be aftermath of conflict or war and therefore suggests interventions to reduce risk of famine such as contingencies for emergency food-for-work schemes.

Comments by The Panel
The panel then choose to rank 17 out of 38 solutions, as they found there were insufficient information on the others. They divided the 17 solutions into "Very Good," "Good," "Fair" and "Bad" projects. However, controlling HIV/AIDs was ranked number one with whooping sum of $27billion followed by provision of micro-nutrients (i.e opportunity 3 of the challenge paper) as the second best solution to malnutrition with recommendation of $12 billion to solve this problem.

A Nobel Laureate, Professor Douglass North of Washington University in Saint Louis was among the experts that recommended provision of micronutrients as number two on the priority lists of 2004
Copenhagen consensus result. According to him: "Today 3.5 billion people lack iron. It is extremely important to do something about malnourishment, especially among children. I give that proposal a very high priority." Development of new agricultural technology (opportunity 4) was also rated good and ranked number 5 best solution for global challenges.

Theoretical Concepts of Famine and Hunger
Sen (1981) came up with alternative approach to famine apart from availability approach. According to Brown and Eckholm (as cited in Sen (1981)) the traditional approach to famine is refers to FAD (Food Availability Decline). By this they mean, a sudden, sharp reduction in the food supply in any particular geographic location which usually resulted in widespread hunger and famine.
However, Sen argue through his entitlement approach that famine can still occur where there were no significant decline in the food availability. Osmani (1993) explained conceptual elements of Sen"s entitlement approach to famine in a clearer manner. According to him, Sen"s entitlement approach of famine are built upon three basic concepts, viz: the endowment set, the entitlement-mapping (or Emapping, for short), and the entitlement set. Endowment set is the combination of all resources owned by a person "legally" i.e in the course of social norms (e.g tangible assets-land, equipment, animal, etc., and intangible assets such as knowledge and skills, labour power, etc.). The entitlement set on the other hand, refers to all possible combinations of goods and services that a person can legally obtain through the resources of his endowment set. However, entitlement mapping or E-mapping (e.g farmer production: input-output ratio, labour exchange: wage rate-food price) is the link between endowment set and entitlement set.
Meanwhile, entitlement failure will occur when in the process of entitlement mapping, an individual cannot use his endowment set to meet the entitlement set, and then starvation begins. This will result to a famine when the starvation affects a large number of people in the society at the same time. Devereux (2001) argued that Sen failed to elaborate four limitations of his entitlement approach. He therefore dug down those limitations to support his arguments. Devereux agree with Sen that, household may "choose to starve" themselves by rationing food consumption in order to protect endowment set (asset) but stressing that Sen failed to incorporate a situation whereby intra-household power relation could lead to "choosing to serve others". He also argued that Sen ""failed to recognise individuals as socially embedded members of households, communities and states, as well as failure to recognize that famines are political crises as much as they are economic shocks or natural disasters"".
The arguments of Sen and Devereux above show that, poverty may not necessarily lead to hunger as people may choose to starve themselves in order to protect their assets from being sold for food consumption. Furthermore, intra-household superiority relation can also lead to the way food might be rationed and therefore lead to dependent member being starved.

The Key Economic Implications
There are economic implications of hunger and malnutrition for countries where these two are prevalent. Apart from direct consequences such as stunting, underweight, and wasting, many economic losses have been identified as a result of these direct consequences.
According to World Food Programme and UNICEF Report (2006) Productivity losses to individuals are estimated at more than 10 percent of lifetime earnings while Gross domestic product (GDP) lost to malnutrition runs as high as 2 to 3 percent in some countries. The report further states that, many of the MDGs, including the goal for poverty reduction may not be achieved unless malnutrition is tackled.
The productive and cognitive gains of reducing malnutrition among children and adult have been linked with human capital development which in turn contribute toward economic development.

Figure-2. The relationship between improved child nutrition and economic development
Source: Martorell (1999) Similarly, Cleaver et al. (2006) describe lost productivity per individual worker as method to estimate economic loss to a nation where malnutrition is prevalent. They also make reference to 2004 Food and Agricultural Organisation (FAO) report, where annual economic loss in Nigeria due to malnutrition in children under 5 in 1994 was estimated by this method and stood at $489 million, or about 1.5 percent of GDP. Popkin and others (as cited by Cleaver et al. (2006)) estimated that obesity and related noncommunicable diseases cost China about 2 percent of its GDP each year.
According to Gillespie et al. (as cited in Martorell (1999)) as well as relationship depicted in figure 2 above, investment in nutrition, health, and education programmes will enhance human capital through increased productivity and cognitive capability.

Policy Issues
The policy issue here is that looking at the relationships depicted in figure 2, there is need for government of the countries where these challenge of hunger and malnutrition are prevalent to embark on effective policies that will alleviate the challenge in the following areas: 1. Education and health policies:-As pointed out in figure 2, adequate and well targeted investment in social sector like health and education will improved child nutrition and enhanced human capital. This will overall lead to increased productivity i.e economic growth.

2.
Macroeconomic policies:-Microeconomic policies that will improve the standard of living of the people in developing countries should be centre of focus. This is because there are some instances whereby GDP figures of some of these countries will actually look good but the populace URL: www.onlinesciencepublishing.com | October, 2016 are actually wallowing in abject poverty. There is a link between poverty and malnutrition as suggested by Svedberg (2004).

Data and Sources
The study used cross-section data of 52 developing countries for the year 2011 from world development indicator (WDI). Cross-section data of developing countries were choosen because they represent the areas where the challenge is more prevalent and 2011 will shed more light about what has happened since 2004 when the challenge paper was published.

Data Description
The data collected and their description for the purpose of this study are shown in the table below:

Methodology
The study employed cross-section analysis with the use of descriptive statistics, scattered graph and bivariate correlation via Microsoft Excel. They are suitable methods in which objectives of the study set out in section one could be achieved. Also, Svedberg (2004) uses bivariate scattered graph to examine correlation between prevalence of child stunting (children under 5 years with height below normal) and log of GNI per capita of 67 developing countries for 1998-2002 period.

ANALYSIS OF FINDINGS
This section analysed and interpret the results of a new research on the links between under-nutrition, economic development, household income, access to quality water and low level of calories intake in 52 developing countries. It also aims to consolidate the contributions of 2004 challenge paper itself and the comments from the opponents.

Descriptive Statistics
The descriptive statistics in   Table 8 below is a correlation matrix table which shows the strength of the bivariate correlation between the variables of interest using the first column and the rows.   The scattered graph and correlation table above depict a negative correlation between prevalence of undernourishment and log of GNI per capita and fairly strong with correlation coefficient of -0.54. This means that under-nutrition reduces as household income increases in these 52 developing countries investigated. However, looking at the scattered graph, few of these countries have undernourished population below 20% with GNI per capita of 8% point and above while majority with undernourished population of 20% and above have GNI per capita below 8% point.

b) Interpretation and analysis of results for objective number two-Direction and strength of
correlation between under-nutrition and economic development.

Figure-4. Correlation between prevalence of undernourishment and Log of GD per capita of 52 developing countries in year 2011
Source: Author"s empirical results (2015),

via Microsoft Excel
The result here is almost the same with the first objective, still negative correlation which is fairly strong with -0.53 coefficient and statistically significant at 1% level. The implication is that as economy develop, the level of under-nutrition reduces. These two results consistent with (Martorell, 1999;Svedberg, 2004).
This has to do majorly with overall improved standard of living and reduce poverty.  The result also indicates a negative correlation between under-nutrition and access to improved water.
The correlation is fairly strong as it can be depicted from table 9 with correlation coefficient of -0.59. This means that as the people in the rural area have more access to improved water source, under-nutrition reduces.
d) Interpretation and analysis of results for objective number four-Direction and strength of correlation between under-nutrition and calories intake deficiency. The result from the scattered graph above shows that there is a very strong positive correlation between under-nutrition and low calories intake. The correlation coefficient is +0.98 as it can be inferred from table 9. This indicates that as calories intake deficiencies increases, under-nutrition also increases in these 52 developing countries investigated by the study. Calories intake deficiency may also cause productivity loss because of loss of energy require to perform piece of work.

CONCLUSION AND RECOMMENDATIONS
The empirical study carried out in this paper had been able to address part of the issues raised against 2004 challenge paper and also revealed other issues that need to be addressed. These are opportunities neglected or overlooked by challenge paper 2004. They include the link between under-nutrition; and economic development (i.e GDP per capita) (Appleton, 2004) improved water source, poverty (i.e household income-GNI per capita) and calories intake deficiency.
The findings of this study shows that there are fairly strong negative correlation between undernutrition and economic development; household income (poverty) and improved water source while there is a very strong positive correlation between under-nutrition and calories intake deficiency. Thus, more attentions need to be given to these areas in subsequent challenge papers. However, if the four opportunities are well considered, the potential benefits as shown in the results of the study will be reduction in malnutrition.