The mitigating effect of social protection on undernourishment during economic downturns: A longitudinal study of 46 low- and middle-income countries over the last two decades

IF 4.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Social Science & Medicine Pub Date : 2024-09-26 DOI:10.1016/j.socscimed.2024.117365
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Abstract

Background

Low- and middle-income countries (LMICs) are particularly vulnerable to the adverse effects of economic downturns on the Prevalence of Undernourishment (PoU). Our study aimed to evaluate the impact of Social Protection and Labor Programs (SPL) on PoU in 46 LMICs from 2001 to 2019, and to estimate SPL mitigating effects during economic downturns.

Methods

This cohort study used a multi-country ecological design with two-ways fixed effects multivariable linear regression models, adjusted for relevant demographic, socioeconomic, and contextual variables. Interaction terms between economic downturns and SPL were used to evaluate SPL mitigating effects.

Findings

Our study cohort displayed an average 15.30% PoU and 34.34% SPL coverage in the initial year, contrasting with 8.58% PoU and 43.81% SPL coverage in the final year. A 10% SPL coverage was associated with a 0.51% PoU reduction (95%CI: 0.04–0.99) across all countries and 0.78% reduction within the poorest subgroup. SPL have been able to prevent an estimated 1.01 billion (95% UI: 0.16–1.86) cases of undernourishment over the study period in the 46 LMICs. Economic downturns were associated with a 4.55% PoU increase (95% CI: 1.28–7.81) in all countries, and a 6.06% PoU increase in the poorest subgroup. High SPL coverage during the downturns had significant mitigating effects, reducing an overall 1.17% PoU for every 10% SPL coverage in all countries, and 1.81% PoU in the poorest nations.

Interpretation

Amid the ongoing multiple global crises, expanding the coverage of social protection could effectively mitigate the potential increases in undernourishment during economic downturns, contributing to the achievement of nutrition-related Sustainable Development Goals in LMICs.
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经济衰退期间社会保护对营养不良的缓解作用:对过去二十年 46 个中低收入国家的纵向研究。
背景:中低收入国家(LMICs)特别容易受到经济衰退对营养不良患病率(PoU)的不利影响。我们的研究旨在评估2001年至2019年期间社会保护和劳工计划(SPL)对46个中低收入国家营养不良患病率的影响,并估计SPL在经济衰退期间的缓解效果:这项队列研究采用了多国生态设计,使用双向固定效应多变量线性回归模型,并对相关人口、社会经济和环境变量进行了调整。经济衰退与 SPL 之间的交互项用于评估 SPL 的缓解效应:我们的研究队列在最初一年的平均PoU和SPL覆盖率分别为15.30%和34.34%,而在最后一年的PoU和SPL覆盖率分别为8.58%和43.81%。在所有国家,10% 的 SPL 覆盖率可使 PoU 降低 0.51%(95%CI:0.04-0.99),而在最贫困的亚群中,PoU 可降低 0.78%。在研究期间,在 46 个低收入和中等收入国家中,SPL 能够预防约 10.1 亿例营养不良(95% UI:0.16-1.86)。在所有国家中,经济衰退导致营养不良人数增加了 4.55%(95% 置信区间:1.28-7.81),而在最贫穷的分组中,营养不良人数增加了 6.06%。在经济衰退期间,SPL 的高覆盖率具有显著的缓解作用,在所有国家,SPL 的覆盖率每提高 10%,PoU 就会降低 1.17%,而在最贫困国家,PoU 则会降低 1.81%:在当前的多重全球危机中,扩大社会保护的覆盖面可有效缓解经济衰退期间营养不良现象的潜在增长,有助于低收入和中等收入国家实现与营养相关的可持续发展目标。
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来源期刊
Social Science & Medicine
Social Science & Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
9.10
自引率
5.60%
发文量
762
审稿时长
38 days
期刊介绍: Social Science & Medicine provides an international and interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization. We encourage material which is of general interest to an international readership.
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