PARTI

1. BACKGROUND AND I N T R O D U C T I O N
1.1. Background
1.2. The Challenges: The Five Ws
1.3. Main Objectives and Plan of the Book
1.4. The Focus on Sub-Saharan AfricaIn International Comparison
1.5. Limitations of the Study
1.5.1. Limited Coverage of Food-security Issues
1.5.2. U n d e r n u t r i t i o n versus Malnutrition
1.5.3. Chronic U n d e r n u t r i t i o n versus F a m i n e
1.5.4. Intra-household Allocation of N u t r i e n t s
1.5.5. O n Reasons for Poverty

2. CHARACTERIZATION AND MEASUREMENT O F U N D E R N U T R I T I O N :

CONTROVERSIES AND CONSENSUS
2.1. Introduction
2.2. Undernutrition: Overview of Paradigms
2 . 2 . 1 . T h e Energy Identity a n d the Energy Balance
2.2.2. T h e Genetic Potential Paradigm
2.2.3. T h e Adjustment a n d Adaptation Paradigm
2.3. Different Measurement Approaches
2.4. Direct Estimates of Minimum Energy Balance
2 . 4 . 1 . Observed Energy Intake
2.4.2. Simulated M i n i m u m Energy Expenditures
2.5. Indirect Estimates of Minimum Energy Balance
2 . 5 . 1 . Anthropometric Failure
2.5.2. Physical-activity Failure
2.5.3. Health and Capability Failures
2.6. Summary and Conclusions

P A R T II

3. A M O D E L O F N U T R I T I O N AND E C O N O M I C PRODUCTIVITY
3.1. Introduction
3.2. Related Theory
3.3. The Model
3 . 3 . 1 . T h e Short-term Calorie Expenditure Function
3.3.2. T h e L o n g - t e r m Calorie Expenditure Function
3.3.3. T h e Calorie Revenue F u n c t i o n
3.4. Optimal Work Effort, Body Weight, and Calorie Intake
3.5. Comparative Statics
3 . 5 . 1 . Exogenous Changes in the Revenue F u n c t i o n
3.5.2. Inter-individual C o m p a r i s o n
3.6. Summary and Conclusions

RELATED E M P I R I C A L EVIDENCE
4.1. Introduction
y
4.2. Nutritionists Estimation of Calorie Expenditure Requirements
4.3. Calorie-Income Elasticity Estimates
4.3.1. Theory
4.3.2. Estimation Technique, M e a s u r e m e n t s , and Data
4 . 3 . 3 . Empirical Findings
4.4. Nutrition and Labour Productivity
4.4.1. Theory
4.4.2. Estimation Technique, M e a s u r e m e n t s , and D a t a
4 . 4 . 3 . Empirical Findings
4.5. Discussion
4 . 5 . 1 . Theories
4.5.2. M e a s u r e m e n t s a n d D a t a
4 . 5 . 3 . O m i t t e d Variables
4.5.4. Sensitivity to Estimation Techniques and
Measurements
4.5.5. Simultaneity a n d Choice of I n s t r u m e n t Variables
4.5.6. Time-series Predictions versus Cross-sectional
Observations
4.6. Summary and Conclusions

P A R T III
U N D E R N U T R I T I O N : T H E FAO ESTIMATES
5.1. Introduction
5.2. The FAO Model
5.2.1. T h e Estimation M e t h o d
5.2.2. Parameter Estimation M e t h o d s
5.2.3. T h e Limited Aims with the F A O Estimates
5.3. Data and Estimates
5.3.1. Parameter Estimates
5.3.2. T h e Estimated Prevalence of U n d e r n u t r i t i o n
5.4. Sensitivity of Estimates
 5.4.1. C o m b i n i n g Different F A O a n d I B R D Parameter
Values
5.4.2. Sensitivity of F A O Estimates of P O U in
Africa in 1990/2
5.4.3. Correlation between P O U a n d N P C C A
5.5. Concluding Remarks

6. CALORIE AVAILABILITY I N SUB-SAHARAN AFRICA

6.1. Introduction
6.2. Calorie Availability in Sub-Saharan Africa
6.2.1. T h e F A O Estimation M e t h o d
6.2.2. T h e F A O Calorie Availability Estimates
6.2.3. Composition of Calorie Sources
6.3. Sources of Estimation Errors
6.3.1. T h e F A O F o o d Production Estimates
6.3.2. T h e F o o d T r a d e Estimates
6.3.3. Conversion from Production to C o n s u m p t i o n
6.3.4. Size of Population
6.4. Biased Estimates: A priori Reasons
6.4.1. Acknowledged Biases
6.4.2. Incentives for U n d e r r e p o r t i n g
6.5. Biased Estimates: Methodological Reasons
6.5.1. Acreage Estimates
6.5.2. Yield Estimates
6.6. Comparative Evidence from India and Pakistan
6.7. Concluding Remarks

7. CALORIE INTAKE AND DISTRIBUTION: ESTIMATES F R O M T H E

C O N S U M P T I O N SIDE
7.1. Introduction
7.2. Household Consumption Surveys and Calorie Intake
7.2.1. M e a s u r e m e n t M e t h o d s
7.2.2. Estimates
7.2.3. Selection Biases
7.2.4. Observation a n d M e a s u r e m e n t Biases
7.2.5. T h e Ideal Estimates: T h e D o u b l y Labelled
Water M e t h o d
7.3. Comparing Estimates of Different Types
7.3.1. C o m p a r i n g F C S s using Different M e t h o d s
7.3.2. C o m p a r i n g F C S with FBS Estimates
7.3.3. C o m p a r i n g with the D o u b l y Labelled Water M e t h o d
7.4. Further use of Food Expenditure Surveys
7.4.1. Household Expenditure Surveys in SSA:
Methodological Shortcomings
 7.4.2. Representativeness of Surveys
7.5. Low- versus High-cost Calorie Expenditures
7 . 5 . 1 . Hypothesis
7.5.2. Evidence
7.5.3. Caveats
7.6. Distribution of Calorie Intake
7.6.1. Measurements
7.6.2. Estimates
7.7. Summary and Conclusions

8. M I N I M U M CALORIE-EXPENDITURE REQUIREMENTS FOR INDIVIDUALS

8.1. Introduction
8.2. Estimating Individual and Household Minimum
Energy Requirements
5
8.2.1. Individuals M i n i m u m Energy Requirements
8.2.2. F r o m Individuals to Households
8.3. Body Weight and BMR
8.3.1. M i n i m u m Body Weight
8.3.2. Body Weight and B M R
8.3.3. Intra-individual Adaptation of Metabolism
8.3.4. Inter-individual Variance in Metabolism
8.3.5. Inter-ethnic Variance in Metabolism
8.4. Minimum Physical Activity
8 . 4 . 1 . Biological M i n i m u m Physical Activity Requirement
for Adults
8.4.2. Economical M i n i m u m Physical Activity
R e q u i r e m e n t for Adults
8.4.3. M i n i m u m Physical Activity for Children
8.4.4. Sensitivity of Requirement N o r m s
8.5. Summary and Conclusions

9. F R O M INDIVIDUAL CALORIE REQUIREMENTS TO PER-CAPITA

CALORIE C U T - O F F P O I N T S
9.1. Introduction
9.2. Calorie Cut-off Points and Requirement/Intake Distribution
9 . 2 . 1 . Estimating the Prevalence of U n d e r n u t r i t i o n in
the Ideal Situation
9.2.2. Estimating U n d e r n u t r i t i o n in the Actual Situation
9.3. The FAO and IBRD Calorie Cut-off Points
9 . 3 . 1 . C o m p a r i n g F A O with I B R D
9.3.2. T h e Inter-linkage between the C C O P and the
NPCCA
9.3.3. C C O P s with Different Requirement and Intake
Distributions
 9.3.4. Introducing Normal Distribution of Intake and
Requirement
9.4. One-dimensional CCOPs and Two-dimensional Undernutrition
9.4.1. T h e M o d e l
9.4.2. T h e Simulated Size of the Bias
9.4.3. F u r t h e r Considerations
9.5. Summary and Conclusions

10. AGGREGATE ESTIMATIONS OF PREVALENCE OF UNDERNUTRITION:

SCOPE FOR IMPROVEMENTS?
10.1. Introduction
10.2. Summary of Main Findings
10.2.1. Sensitivity of the U n d e r n u t r i t i o n Estimates
10.2.2. T h e National Per-capita Calorie Availability
Estimates
10.2.3. T h e Calorie Distribution Estimates
10.2.4. Individual Calorie R e q u i r e m e n t
10.2.5. T h e Calorie Cut-off Points
10.3. The Scope for Improving the FAO Estimates
10.3.1. Possible Improvements in the Short T e r m
10.3.2. Possible Improvements in the L o n g T e r m
10.3.3. Remaining Unresolvable Problems
10.4. A re Alternative Methods Calledfor?
10.4.1. Estimating U n d e r n u t r i t i o n by C o u n t r y
10.4.2. Monitoring Changes in U n d e r n u t r i t i o n over T i m e
10.4.3. Identifying U n d e r n o u r i s h e d Individuals a n d
Households
10.5. Concluding Remarks

P A R T IV

11. ANTHROPOMETRIC INDICATORS OF UNDERNUTRITION:

MEASUREMENTS AND EVIDENCE
11.1. Introduction
11.2. Measurements, Data, and Norms
11.2.1. Child M e a s u r e m e n t s
11.2.2. T h e Height and Weight N o r m s
11.2.3. Acceptable Deviation from the N o r m s (the
Cut-off Points)
11.3. The Anthropometric Status of Children in SSA
11.3.1. Height and Weight Failure of Children in SSA
11.3.2. Change over T i m e
11.3.3. Anthropometric Status by Rural/Urban Area
and Regions
 11.3.4. A n t h r o p o m e t r i c Status by Age
11.3.5. A n t h r o p o m e t r i c Status by G e n d e r
11.4. Sub-Saharan Africa in International Comparison
11.4.1. Levels and C h a n g e over T i m e
11.4.2. Rural/Urban Differences
11.4.3. Differences by Age a n d G e n d e r
11.5. Anthropometric Status of Adults
11.5.1. M e a s u r e m e n t s and N o r m s
11.5.2. Evidence o n Adult Anthropometric Failure
11.6. Comparing Children with Adults
11.7. Summary and Conclusions

12. ANTHROPOMETRIC INDICATORS: MEASUREMENT AND

SELECTION BIASES?
12.1. Introduction
12.2. Genotypical versus Phenotypic Height Differentials
1 2 . 2 . 1 . T h e o r y a n d Test M e t h o d s
12.2.2. T h e o r y : Adaptation
12.2.3. Evidence on Child Growth-rate Potential
12.2.4. Evidence on Genetic Potential for
Final Adult Stature
12.3. Biases in Weight Norms and ReportedAge of Children
12.3.1. Biased Weight N o r m s ?
12.3.2. Biases in the R e p o r t e d Age of Children
12.4. Representativeness of the Anthropometric Evidence
12.4.1. Representative Countries?
12.4.2. Representative Samples?
12.4.3. Representative Individuals?
12.5. The Time Dimension
12.5.1. Inter- a n d Intra-year Fluctuations
12.5.2. L o n g - t e r m T r e n d s
12.6. Summary and Conclusions

13. ANTHROPOMETRIC STATUS: AN INCOMPLETE INDICATOR OF

UNDERNUTRITION
13.1. Introduction
13.2. Anthropometric Failure: Is it Necessary and/or Sufficient for
Undernutrition ?
13.2.1. T h e Missing Physical Activity Dimension
13.2.2. A Simple M o d e l
13.3. Anthropometric Cut-off points and Genetic Potential
13.3.1. T h e Height Cut-off Point
13.3.2. Underestimation of Genetic Potential Failure:
A Simple M o d e l
 13.4. Choice of Anthropometric Indicator
13.4.1. Interrelationship between A n t h r o p o m e t r i c
Indicators
13.4.2. W h a t Biological Shortcomings a n d Risks are
Conventional A n t h r o p o m e t r i c Measures
Indicating?
1 3. 5. The Composite Index of Anthropometric Failure
13.5.1. Underestimation of Overall A n t h r o p o m e t r i c
Failure by Conventional Indicators
13.5.2. Simulating Overall Prevalence of A n t h r o p o m e t r i c
Failure
13.6. Summary and Conclusions

14. ANTHROPOMETRIC FAILURE: MORBIDITY AND MORTALITY RISKS

14.1. Introduction
14.2. Anthropometric Failure and Morbidity
14.2.1. Synergism
14.2.2. Disease as Cause of Anthropometric Failure
14.2.3. Anthropometric Failure a n d I m m u n o c o m p e t e n c e
14.2.4. Anthropometric Failure a n d Specific Diseases
14.2.5. Remaining Uncertainty a b o u t Causality
14.3. Anthropometric Failure and Mortality
14.3.1. Anthropometric Failure as a Direct versus an
Indirect Cause of D e a t h
14.3.2. T h e Relationship Between A n t h r o p o m e t r i c
Failure and Mortality
14.3.3. Estimated Relationship
14.3.4. Inter-regional Differences at Face Value
14.4. Estimated Share of Child Deaths Attributed to
Anthropometric Failure
14.4.1. M e t h o d
14.4.2. D a t a
14.4.3. Results
14.5. Caveats
14.5.1. Influence of U s e of Different Estimation
Techniques and D a t a
14.5.2. Representative Countries?
14.5.3. Representative Samples?
14.6. Significance and Sensitivity Test
14.6.1. Significance of Difference
14.6.2. Sensitivity Test
14.7. Child Anthropometric Failure and Impairments in Adulthood
14.7.1. Cognitive a n d Psychomotoric Capability
14.7.2. Adult Stature a n d Morbidity/Mortality
 14.7.3. A n t h r o p o m e t r i c Status and Reproduction
14.7.4. Adult Stature a n d Physical Work Capacity and
Productivity
14.7.5. Caveat: L o w Stature has M a n y Explanations
Besides U n d e r n u t r i t i o n
14.8. Summary and Conclusions

PARTY
15. O N REASONS FOR C H I L D MORTALITY AND A N T H R O P O M E T R I C FAILURE
15.1. Introduction
15.2. Economic Causes of Child Deprivation
15.2.1. Hypotheses a n d M o d e l s Tested
15.2.2. D e p e n d e n t Variables a n d D a t a
15.2.3. Explanatory Proxy Variables and D a t a
15.3. Cross-country Regressions
15.3.1. E c o n o m e t r i c Specifications
15.3.2. Results
15.4. Separating Income and Public Intervention Effects
15.4.1. Direct versus Indirect Effects of I n G N P c on
D e p e n d e n t Variables
15.4.2. Excluding a n d Including the I n c o m e Variable
15.5. Regional Differences and Outliers
15.5.1. Regional D u m m y Variables
15.5.2. Identification of Outliers
15.6. Discussion and Interpretation of Results
1 5 . 6 . 1 . D a t a Inaccuracies?
15.6.2. C r u d e Proxy Variables?
15.6.3. Selection Bias?
15.6.4. O m i t t e d Variable Bias?
15.6.5. Reverse Causality?
15.7. Summary and Conclusions

16. EXCESS MORTALITY, E C O N O M I C G R O W T H , AND P U B L I C ACTION

I N SUB-SAHARAN AFRICA
16.1. Introduction
16.2. Public Action and Human Well-being
16.2.1. Public Intervention: Objectives and Instruments
16.2.2. W h a t Public Actions Influence H u m a n Well-being?
16.2.3. Quality a n d Targeting of Public Interventions
16.3. Mortality, Educational Attainment, and Growth: Recent
Developments in Output Indicators
16.3.1. Child Mortality
16.3.2. Educational Attainments
 16.3.3. Economic G r o w t h
16.4. The Public Health Sector
16.4.1. Public Health Provision: Quantitative I n p u t
Indicators
16.4.2. Public Health Provision: Qualitative I n p u t
Indicators
16.4.3. Recent Reforms
16.4.4. Targeting of H e a l t h Services
16.5. The Public Education Sector
16.5.1. Public Education Services: Quantitative I n p u t
Indicators
16.5.2. Public Education Services: Qualitative I n p u t
Indicators
16.5.3. Targeting of Education Services
16.6. Economic Growth and Demand for Education
16.6.1. Estimated R e t u r n s on Education
16.6.2. Declining Returns on Education?
16.7. Summary and Conclusions

17. GROWTH, PUBLIC ACTION, AND WELL-BEING: WHAT CAN

SUB-SAHARAN AFRICA LEARN FROM OTHERS?
17.1. Introduction
17.2. What African Countries Could Learn from Others
17.2.1. T h e Growth-cum-Equity-Oriented Countries as
Models
17.2.2. T h e Equity-Oriented Countries as M o d e l s
17.2.3. Conflict Between Public Action and Rapid
Growth?
17.3. Growth, Public Action, and Poverty Alleviation: Cross-country
Evidence
17.3.1. G r o w t h and I n c o m e Distribution
17.3.2. G r o w t h and Poverty Reduction
17.3.3. Poverty Reduction a n d Mortality Decline
17.3.4. H u m a n Capital and G r o w t h
17.4. Growth and/or Equity-Oriented Development in SSA:
Required Policy Changes
17.4.1. Required Policy Changes for G r o w t h
17.4.2. Required Policy C h a n g e for Equity-Oriented
Development
17.5. Prospects for Reform
17.5.1. Preconditions for C h a n g e in Political Priorities
17.5.2. Why G r o w t h is Necessary (but n o t Sufficient) for
Enhancing Well-being
17.6. Summary and Conclusions
SYNTHESIS AND CONCLUSIONS
18.1. Introduction
18.2. Why the FAO Measurement Approach Fails
18.2.1. T h e What Question
18.2.2. T h e Who Question
18.2.3. T h e Where Question
18.2.4. T h e When Question
18.2.5. T h e Why Question
18.3. Why Anthropometrics are Preferable
18.3.1. T h e What Question
18.3.2. T h e Who Question
18.3.3. T h e Where Question
18.3.4. T h e When Question
18.3.5. T h e Why Question
18.4. Undernutrition versus other Reasons for Mortality
18.4.1. A n t h r o p o m e t r i c Failure and Mortality Risk
18.4.2. Estimated Share of Deaths Attributable to
Undernutrition
18.5. Contrasting Sub-Saharan Africa and South Asia
18.5.1. Puzzle O n e : Extent of U n d e r n u t r i t i o n , the
F A O versus W H O
18.5.2. Answer to Puzzle O n e : T h e F A O Estimates
for Africa are Biased
18.5.3. Puzzle Two: Anthropometric Failure and
Mortality Reversals
18.5.4. Answer to Puzzle Two: Inadequate Health-care
in SSA
18.6. The Policy Routes Ahead
18.6.1. Public Action: Policy Requirements and Prospects
18.6.2. E c o n o m i c Growth: Policy Requirements and
Prospects
18.7. The FAO Plan ofAction: A Critical Assessment
18.7.1. Reduction of U n d e r n u t r i t i o n : Where?
18.7.2. Reduction of U n d e r n u t r i t i o n : How?
18.7.3. Final Remark