Dealing with stunting

In a recent World Bank forum, noted health economist Dr. Alex Herrin asked if the Department of Education (DepEd) is making any particular provisions for schoolchildren with weak cognitive abilities due to biological stunting. He asked: While we have special education programs for autistic and mentally disabled children, does the DepEd give focused attention to the 33 percent of our schoolchildren with similar special needs arising from severe malnutrition in their early childhood?

The DepEd representative replied in the negative, but others were quick to its defense, citing that the agency faced enough other  urgent problems to be burdened with yet another special program.

Still, I believe Dr. Herrin raised a valid point. These children, after all, make up one in every three Filipino children in school—an exceptionally higher proportion than in most of our neighbors. As of 2015, 33.4 percent of Filipino children 5 years old and younger were stunted, hardly changed since the 1990s, when it was in the higher 30s. It’s worse for children aged 3 years and below, with 38.6 percent stunted. Vietnam’s 5-and-under stunting prevalence was 23.3 percent in 2010. Thailand had 10.5 percent in 2015. Malaysia had 20.7 percent in 2016. Singapore was already down at 4.4 percent even back in 2000. Only Indonesia’s 37 percent was comparable to ours, although their government is now being lauded for its headstrong campaign to bring it down.

Why is stunting such a threat? It’s not about height (although that’s important, too). Because 90 percent of brain development is known to happen before the age of 5, a child who is severely malnourished, hence stunted at that age, will never reach full brain and physical development. Brain scans show that brains of stunted children, as opposed to well-nourished ones, have far less “white matter” that determine brain capacity.

In short, a child stunted at age 5 is damaged for life, and condemned to lower cognitive skills and physical ability. Given our numbers, we seem destined to be among the shortest, and possibly least mentally capable, among Southeast Asians. In fact, a cross-country study done in the early 2000s ranked the Philippines last among its Asean peers in terms of average IQ of the population.

In recent years, I’ve constantly sounded the alarm that unless we act urgently, our much-vaunted “demographic sweet spot”—referring to how our population will be dominated by working-age Filipinos in the decades ahead—may actually be a demographic time bomb. This is because one in every three of our working-age Filipinos who will dominate our population in 2040 would be the same stunted young children of today—hence of lower intellectual capacity, productivity and general health status than could be.

The urgent imperative is to bring down stunting prevalence as rapidly as possible. Peru cut theirs in half in just eight years, from 28 to 14 percent from 2008 to 2016. We clearly could benefit from studying how Peru managed to do it, and the World Bank has amply documented that story to help others follow Peru’s example.

Meanwhile, we have about the same proportion of stunted schoolchildren beyond 5 years old already in our elementary and high schools since at least the 1990s. They have great difficulty in school because of weak cognitive ability and poor health. Dr. Herrin’s point is that treating these students no differently from the two-thirds who are not stunted could either cause them to be left behind, or lead teachers to lower their standards to accommodate them—and the latter has been more likely. Through time, this leads to the overall lowering of our basic education standards. That is why tailored and focused DepEd support to the one-third of schoolchildren afflicted by stunting, as Dr. Herrin suggests, makes great sense.

I’ve heard those who understand the stunting problem go as far as conclude that we elect the kind of leaders we get because too many of our voters today were the malnourished and stunted children of yesteryears. Even if only for that reason, we need to properly deal with stunting, whether in the child’s first 1,000 days, or in school well beyond that.

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