Growth and Anaemia: The Invisible Side
In much of the West, hunger is often seen as the defining feature of poverty. This association is not without merit: the first Millennium Development Goal (MDG) set by the United Nations aimed explicitly at reducing both hunger and poverty. Historically, poverty lines themselves were designed around nutritional thresholds. Unsurprisingly, food assistance programs remain central to anti-poverty efforts, with large-scale subsidies in regions such as the Middle East, Indonesia, and India. However, the logistics of delivering food aid at scale are often complex and fraught with inefficiencies.
One widely accepted idea in development economics is that the inability to secure adequate food represents a classic “poverty trap.” Poor nutrition reduces physical and cognitive productivity, which in turn perpetuates low income and poverty. This issue may be even more acute for the working poor, who often engage in physically demanding labour that requires a higher caloric intake.
Yet empirical evidence complicates this narrative. An influential study by Jensen and Miller (2008) explored food consumption patterns in China. In two provinces, they randomly selected poor households to receive a large subsidy for a staple food—rice in one region and wheat noodles in the other. Contrary to expectations, recipients of the subsidy often reduced their consumption of the subsidized staple and instead increased their intake of more expensive, tastier items such as shrimp and meat. The net effect was that overall caloric intake remained unchanged or even declined for some households. These findings suggest that the poor do not necessarily seek to maximize calorie or nutrient intake but rather make food choices based on taste preferences and variety.
The case of India provides further insight. Despite decades of rapid economic growth, per capita calorie consumption has declined steadily. This trend spans all income groups and nutrient categories, except for fat. Importantly, this decline is not attributable to falling incomes or rising food prices—real incomes have risen, and food prices have decreased relative to non-food items. One plausible explanation involves improvements in health infrastructure, particularly water and sanitation. Reduced incidence of diarrheal diseases and lower rates of physical labour may have decreased caloric requirements.
Globally, food scarcity is no longer the dominant constraint it once was. In 1996, the Food and Agriculture Organization (FAO) estimated that global food production was sufficient to provide every person on the planet with at least 2,700 calories per day. Advances in agricultural technology and the diffusion of high- yield crops like the potato—responsible for an estimated 12% of the global population increase between 1700 and 1900—have played a critical role in this achievement. Today, where starvation persists, it is largely a problem of distribution and access, not absolute supply.
Historical perspectives further illustrate the interplay between nutrition and economic capacity. Nobel laureate Robert Fogel demonstrated that during the Middle Ages and Renaissance, food production in Europe often fell short of providing sufficient calories for the entire working population. This shortfall manifested in widespread begging, as many individuals lacked the physical strength to work. Moreover, food scarcity coincided with episodes of witch-hunting (1500–1800), particularly during periods of crop failure or reduced fish stocks. Single women, especially widows—considered unproductive but still dependent on food—were disproportionately targeted. In grim economic logic, such scapegoating reflected attempts to reallocate scarce resources to those deemed economically valuable.
In recent years, the effects of the national Qali Warma program in Peru (or its current iteration) on anaemia have received limited scholarly attention. As my previous discussion tried to explain, studying the effectiveness of food policies is tricky business. To the best of my knowledge, only one peer-reviewed journal article has examined this issue, yielding discouraging findings (Francke and Acosta, 2021). The evidence presented in that study indicates that the program cannot be credited with reducing either anaemia or chronic child malnutrition. Furthermore, the number of months a child participates in the program is not statistically significant in any of the specifications—suggesting that treatment intensity does not contribute to improvements in either outcome. A plausible explanation is food substitution between the school and the household, where home- prepared breakfasts may contain higher levels of iron and protein compared to those provided by Qali Warma (Lavado et al., 2019; Francke and Acosta, 2021). Evaluating the effectiveness of our primary public policy tool for combating anaemia is therefore of critical importance.
References:
Francke, P. and Acosta, G. (2021). Impacto del programa de alimentación escolar Qali Warma sobre la anemia y la desnutrición crónica infantil. Apuntes, 48(88):151–190.
Jensen, R. T. and Miller, N. H. (2008). Giffen behavior and subsistence consumption. American Economic Review, 98(4):1553–1577.
Lavado, P., Barrón, M., et al. (2019). Evaluación de impacto del programa nacional de alimentación escolar Qali Warma: informe completo.
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