Archivos Latinoamericanos de Nutricion, Vol. XXV, 1975.
CLAUDIO SCHUFTAN
schuftan@gmail.com
Abstract
Malnutrition and cultural deprivation are not the ultimate causes of poor performance of school age children, although they are two of the more immediate causes. Data from a study carried out in the early 1970s in a semirural school near Santiago, Chile, support the view that the complex underlying condition is poverty as reflected in low socioeconomic and low cultural/educational status of families. The data led us to conclude that the problem of low school performance cannot be resolved by nutritionists and/or educators alone: the social causes of malnutrition and cultural deprivation must be acted upon simultaneously. Failure to do so helps to explain the often limited success of programs using conventional food supplementation and or intellectual stimulation approaches.
Old is the controversy about the relative importance of malnutrition, on the one hand, and cultural deprivation, on the other, in impairing the intellectual development of children (CRAVIOTO, DELICARDIE and BIRCH, 1966; COLLIS and JANES, 1968; BIRCH, 1972; TIZARD, 1974; BROZEK, 1978; POLLITT, 1980; BALDERSTON, 1981).
Consequently, we decided, back in 1970, to undertake a study (SCHUFTAN et al., 1975) based on the following hypothesis (see Fig. 1);
As a syndrome, poverty accounts for the higher rates of malnutrition and cultural deprivation seen in children living in city slums or poor rural areas. The protracted effect of these factors on the development of the central nervous system is responsible for the incomplete expression of the genetically determined intellectual potential of the children. In turn, this results in sub-optimal intellectual functioning as measured in tests of intelligence (IQ), and in poor school performance.
A study guided by this model, was carried out in Santiago, Chile, in a random sample of children stratified by age, sex, and grade.
Figure 1: The Poverty Syndrome and its consequences: Original model antedating the study (10 = Intelligence Quotient) AVAILABLE FROM THE AUTHOR
The families of the children had the following socioeconomic characteristics:
1. By occupation, the heads of household were mostly agricultural laborers (landless) and small independent farmers.
2. The average household size was 8.7 persons and the median income per household was $ 36 per month (range: $ 11 to $ 86).
3. Nineteen percent of the mothers and 21% of the fathers were illiterate. As regards formal education, 30% of the mothers and 21 % of the fathers had completed only the third grade; 47% of the mothers and 51% of the fathers had completed sixth grade, and only 3% of the mothers and 6% of the fathers had completed junior high school.
4. As for the exposure to mass media, 92% of the surveyed households listened to the radio: 35% regularly read the newspaper: 40% had books at home: 36% went to the movies; and 28% owned a television set.
5. The mothers’ IQ tests (Wechsler Adult Intelligence Scale, WAIS) (WECHSLER, 1955) showed that 89% of the mothers had IQs below 90.1
1 This test had been adapted, but not standardized for use in Chile.
The children were studied in reference to three sets of variables:
1. Somatic characteristics:
a. Body dimensions and weight
b. Signs of specific nutrient deficiencies
2. Intellective ability and achievement:
a. IQ test (Wechsler Intelligence Scale for Children, WISC) (WECHSLER, 1949).
b. Performance test in the Spanish language and in mathematics (standardized by grade).
3. Diet:
a. Twenty-four hour dietary intake (recall by the mothers)
b. Seven day food consumption (records)
The biomedical and psychological findings were as follows:
1. Heights of more than half of the children were below the 10th percentile of the normative population.
2. Weights of more than half of the children were below the 25th percentile of the normative population.
3. The average child in the first grade was about 3.3 kg below the reference weight and 9 cm below the reference height. This deficit tended to become smaller in the higher grades.
4. Sixty-one percent of the children had IQs below 90.2
5. Performance in the Spanish language and mathematics tests and the IQ tests tended to be better, although not significantly so, in the higher grades. According to the arbitrary grading system that was used, average performance in Spanish language was 43 for the first and second grade and 51 for grades five through eight. In mathematics, the equivalent figures were 47 and 49. The average IQ scores were 85 for the first and second grade, 88 for the third and fourth grade and 95 for the fifth through eighth grade.
2 The WISC test had been standardized for use in Chile.
To test our initial hypothesis, the variables were correlated using Kendall’s tau coefficients (SIEGEL, 1956).3 The results obtained were slightly different from those predicted (see Fig. 2).
3 Kendall’s tau coefficient is a non-parametric statistic for measuring the degree of correlation between paired variables. In KENDALL’S coefficient of partial covariation the effects of variation by a third variable upon the relation between the X and Y variables are eliminated (or kept constant through statistical control).
Figure 2 The Poverty Syndrome and its consequences: Suggested structure after correlating the variables under study (SED = socioeconomic deprivation; CD = cultural deprivation; IQ = Intelligence Quotient) AVAILABLE FROM THE AUTHOR
There was a very high correlation (p = 0.00003) between the indexes of socioeconomic 4 and cultural deprivation. 5 Consequently these variables may be considered as the central and indivisible nucleus of the Poverty Syndrome. These conditions characterize the child’s everyday environment.
4 The Sepulveda Occupational Categories were used (SEPULVEDA, 1968). This instrument was at the time the best socioeconomic classification tool in use in Chile.
5 An Index of Cultural Deprivation was constructed on the basis of the education of the parents, exposure to mass media, and mothers IQs. Classical index construction techniques were used (GUILFORD, 1965) and the index showed good discrimination power.
We also found a significant correlation between the children’s IQ and the indicators of socioeconomic and cultural deprivation (p = 0.01 and 0.006 respectively). For relative heights, 6 as indicators of chronic malnutrition («stunting»), the corresponding values were p = 0.008 and 0.02 respectively. IQs and relative heights were highly correlated as well (p = 0.02).
This led us to place these two variables (low IQs and height deficits) in a second «circle» surrounding the Poverty Syndrome nucleus, and to consider them as consequences of the poor socioeconomic/cultural environment that surrounds the children (Fig. 3).
In contrast to IQs, school performance correlated neither with the indicator of malnutrition nor with the socioeconomic/cultural deprivation nucleus. School performance correlated only with the children’s IQs (p = 0.04) and it is through this nexus that we postulate it relates to the Poverty Syndrome.
Figure. 3 Alternative representation of the Poverty Syndrome with its socioeconomic and cultural deprivation nucleus and the correlations of this core with the intelligence and nutritional indexes, as well as, indirectly, with the school performance (SED = socioeconomic deprivation; CD = cultural deprivation; IQ = Intelligence Quotient) AVAILABLE FROM THE AUTHOR
The practical implications of our findings are far-reaching. If our goal is to assure a proper physical and mental development of the child, we have to recognize that traditional nutritional and educational intervention programs, typically attack the consequences of the problem, without affecting or modifying the primary factors. We firmly believe that supplemental feeding programs (school breakfasts and lunches, milk distribution programs) or early cultural and intellectual stimulation efforts (nurseries, day care centers, kindergartens, special programs in elementary school) by themselves do not solve the basic problem and will not significantly improve the intellectual performance of complexly deprived children.
Our Findings suggest that, in the context of our study cultural deprivation is not statistically separable from socioeconomic deprivation. If we want to solve the problem we have to attack it at its socioeconomic and cultural roots.
Only in this way shall we be able to solve the problem of low intellectual performance of undernourished children. According to our analysis, the problem does not start with malnutrition; malnutrition is the consequence of a chain of events that starts with the poverty surrounding the child. Besides the pressing need for food, there is the need for a more equitable distribution of income and the need for a more equitable access to health care, education and culture. The brain needs an adequate supply of nutrients and intellectual stimulation to develop and function optimally. Poverty deprives the poor child of both. This condition is particularly deleterious very early in life.
Our results allow us to make a judgement about the sequence of interventions needed to improve low intellectual performance in poor children. The order of such a sequence can be determined by asking ourselves which of the variables considered to lead to low intellectual performance (and depicted in Figs. 1, 2, and 3) deserves greater emphasis in attempting to solve the problem in global terms.
The answer to this question has three parts:
1. We neither have the adequate tools nor the means to improve intellectual performance directly by acting upon the intellective abilities or the specific kinds of performances of children at school.
2. On the other hand, we do have some possibilities to act upon the nutritional constraints on a short-term basis, by removing the economic constraints responsible for malnutrition through subsidizing income by providing additional food to the family. Unfortunately, nutrition intervention does not solve the problems of malnutrition and its consequences in the long run.
3. We are left with the option of moving towards removal of the socioeconomic constraints. This will mean implementing a whole series of economic measures, such as land reform, comprehensive rural development, employment generation, a more equitable taxation system, higher minimum wages, and a number of other measures (cf. SCHUFTAN, 1979).
If our hypothesis is correct, removing this dominating constraint of poverty will improve the nutritional status and the intellectual performance of deprived populations in the long run.
In principle, these ideas represent nothing new to the majority of us. What is important is that the conclusions emerging from our analysis force us to look beyond our narrow approach to applied nutrition, applied education or applied psychology (or any other social science, for that matter).
If the problem is seen in the perspective presented here, and actions and programs are reoriented accordingly, the final goals can be achieved by eradicating poverty, the true cause of low intellectual performance in areas of chronic malnutrition.
References
BALDERSTON, J.C.: Investigating the web of poverty – The need for research. In: Malnourished Children of the Rural Poor: The Web of Food, Health, Education, Fertility and Agricultural Production. J. BALDERSTON, A. WILSON, M. FREIRE. M SIMONEN (Eds.), pp. 1-22. Aubrey House, Boston. MA. 1981.
BIRCH, H.G.: Malnutrition, learning and intelligence. Am. J. Public Health, 63, 773-784 (1972).
BROZEK, J.: Nutrition, malnutrition and behavior. Annu. Rev. Psychol., 29, 157-177 (1978).
COLLIS, W.R.; JANES, M.: Multifactorial causation of malnutrition and retarded growth and development. In: Malnutrition, Learning and Behavior. N SCRIMSHAW, J. GORDON (Eds.), pp. 55-71. MIT Press. Cambridge. MA, 1968.
CRAVIOTO, J.; DELICARDIE, E.R.; BIRCH H.G.: Nutrition, Growth, and Neurointegrative development: An experimental and ecological study. Pediatrics. Suppl. No. 2, Part II. 38, 319-325 (1966).
GUILFORD, J.P.: Fundamental Statistics in Psychology and Education. 4th ed. McGraw-Hill, Tokio, 1965.
POLLITT, E.: Poverty and Malnutrition in Latinamerica: Early Childhood Intervention Programs, Praeger, New. York. 1980.
SCHUFTAN, C.; VALENZUELA, M.; LOPEZ, V.; ZAPATA, R.; JAQUE, G.; GATTAS, V.; AGUAYO, M.: Bajo rendimiento escolar: Desnutrición o deprivación cultural? Arch. Latinoam. Nutr., 25 121-134 (1975).
SCHUFTAN, C.: Household purchasing-power deficit: A more operational indicator to express malnutrition, Ecol. Food Nutr., 8, 29-35 (1979).
SEPULVEDA, O.: Clasificación Nacional de las Ocupaciones. Instituto de Sociología, Universidad de Chile, Santiago, 1968.
SIEGEL, S.: Nonparametric Statistics for Behavioral Sciences. McGraw-Hill, New York, 1956.
TIZARD. J.: Early malnutrition, growth and mental development in man. Bri.. Med. J.. 30. 169-174 (1974).
WECHSLER, D.: Manual for the Wechsler Intelligence Scale for Children. Psychol. Corp., New York, 1949.
WECHSLER, D.: Wechsler Adult Intelligence Scale. Psychol. Corp.. New York, 1955.
Claudio Schuftan
Saigon, Vietnam
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