There’s a brilliant paper in this month’s Bulletin of the World Health Organization: Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974–2007 [stunting is low height-for-age*]. The findings of the paper, taken from the Abstract, are:
Over a 33-year period, we documented a steady decline in the national prevalence of stunting from 37.1% to 7.1%. Prevalence dropped from 59.0% to 11.2% in the poorest quintile and from 12.1% to 3.3% among the wealthiest quintile. The decline was particularly steep in the last 10 years of the period (1996 to 2007), when the gaps between poor and wealthy families with children under 5 were also reduced in terms of purchasing power; access to education, health care and water and sanitation services; and reproductive health indicators.
This figure shows the results:
Prevalence of stunting (%), by wealth quintile, over the 33 year period 1974−2007
The authors conclude:
In Brazil, socioeconomic development coupled with equity-oriented public policies has been accompanied by marked improvements in living conditions and a substantial decline in child undernutrition, as well as a reduction of the gap in nutritional status between children in the highest and lowest socioeconomic quintiles.
The paper has good data on the percentages, by wealth quintile, of households served by public water supply, by public sewerage systems, and with flush toilets:
Percentage of households with piped water supply connection, by wealth quintile, in 1996 and 2007/07
Percentage of households with flush toilets, by wealth quintile, in 1996 and 2007/07
Percentage of households with sewerage connection, by wealth quintile, in 1996 and 2007/07
So Brazil seems to be doing rather well for its poor!
*Note: two good references on stunting:
(1) Early childhood diarrhoea and helminthiases associated with long-term linear growth faltering (International Journal of Epidemiology 2001: 30, 1457−1464), and
(2) Child undernutrition, tropical enteropathy, toilets, and handwashing (The Lancet 2009: 374, 1032−1035) [see also blogs of 18 September and 23 September 2009].