China’s National Nutrition Improvement Program and a parenting intervention: supporting the development of poor, rural and left-behind children
Looking at averages, the public health story and education in China has been one of remarkable improvements. Substantial progress in poverty reduction and reductions in under-5 mortality and maternal mortality in China comprised not insubstantial contributions to global progress toward the Millennium Development Goals. Due to policy initiatives over the last decade, primary education enrollment and access to health insurance are nearly universal. Policy attention to education and health has increased in China and the targets remain ambitious for all citizens, as evidenced by the most recent five-year plan.
However, underlying improvement in average metrics are strong placed-based inequalities, including rural-urban discrepancies in public health and education indicators such as access to pre-primary education, mortality, stunting, wasting and anemia. In addition, millions of Chinese children (58 million aged 18 and younger in 2007, according to the All China Women’s Federation) grow up with limited access to their migrant parents; these are the so-called left-behind migrant children and they constitute a large fraction of all children in some rural areas.
If the observed discrepancies in health and access to early education translate into large discrepancies in human capital later in life, it may exacerbate the inequality of development in China. The children who are born today must support an increasing number of older people, so their productivity is very important. A key question, then, is to what extent China will support the early development of the health and human capital of its most disadvantaged children, and how much of a difference proposed interventions could make to reduce inequality.
Dr. Kin Bing Wu and Dr. Liu Bei presented their work on non-experimental and experimental studies in Hunan, Yunnan and Qinghai that indicate promising results for early childhood education interventions and nutritional supplementation for very young children. Dr. Mary Young presented preliminary steps toward an impact evaluation plan of the National Nutrition Improvement Program of the Chinese MOH, a large-scale program that will implement universal nutrition supplementation for 6-24 month old children in 699 targeted poor counties by 2015.
Dr. Young and her team aim to gather longitudinal evidence on the impact of the nutrition intervention, but they also hope to incorporate an additional treatment arm to investigate the impact of adding an enriched caregiving component, a local adaptation of the Abecedarian approach that will target children’s parents or surrogate caregivers. Results from the evaluation of the added enriched caregiving intervention could suggest important policy steps to address the unique developmental challenges facing the left-behind migrant children. In summary, the study would have important implications not only for the study of inequality prevention in China but also for advancing our understanding of the developmental consequences of raising a child apart from their parents and how to mitigate adverse effects – a critical policy issue in the current Chinese context.
By Rebecca Mary Myerson