The Basic Determinants of Malnutrition: Resources, Structures, Ideas and Power

The United Nations Children’s Fund (UNICEF) framework on the “causes of malnutrition and death” famously sets out factors at immediate, underlying and basic levels which shape outcomes for child nutrition. These include the relationship between nutrient intake and immunity at the immediate level, which is underpinned in turn by access to food and health systems, adequate childcare, and sanitary environments at the underlying level. These food, health and care aspects have been well described and evidenced, not only in the original UNICEF paper but in a large literature summarised in the most recent Lancet series on nutrition. It is the basic determinants at the base of the framework – which cover a range of social, economic and political drivers affecting malnutrition in all its forms – that have been much less studied, defined and understood. This paper offers a structure for understanding the complex mix of factors that make up the basic determinants. We review literature from multiple fields and disciplines, shaped from within our background in development studies and its allied disciplines such as geography, anthropology, political science and development economics. Apart from economics, these are literatures with which the field of nutrition has limited engagement, but which provide important evidence on the drivers of malnutrition, as well as suggesting options for addressing the basic determinants of malnutrition in practice.