Disentangling wealth and stunting: structural and macroeconomic determinants of child nutrition across countries

Background: This study investigates whether the observed negative relationship between national income and child stunting prevalence reflects short-term causal effects or long-term structural differences between countries. Methods: A balanced panel of 104 countries from 2000 to 2020 was analyzed using pooled ordinary least squares and two-way fixed effects estimators. Robustness checks included lagged specifications, Hausman tests, and dynamic panel System Generalized Method of Moments models with clustered standard errors. Results: Approximately 95% to 96% of the observed income–stunting association was attributable to cross-sectional differences rather than short-run within-country dynamics. While pooled ordinary least squares suggested that a 1% increase in gross domestic product per capita was associated with a 0.84 percentage-point reduction in stunting prevalence, the within-country effect declined to 0.03 percentage points after controlling for country and year effects. No statistically robust short-run within-country association was detected between aggregate consumer price index inflation and stunting prevalence. Conclusions: The findings suggest that child stunting is shaped more by long-term structural determinants than by short-run macroeconomic fluctuations. Policies should prioritize sustained investments in institutional quality, health systems, sanitation, maternal education, human capital, and social protection.