Almost half of Guatemalan children under five are malnourished, the vast majority rural Maya kids. This is a hidden human tragedy of epic proportions, each of these lives stunted – corporeally and figuratively – just as they are getting started. While we should not reduce this to just economic impact, it is nonetheless significant that the World Bank estimates that chronic malnutrition costs Guatemala hundred of millions of dollars a year in lost GDP. (See this recent PBS Newshour report that features Roger Thurow.)

Yet Guatemala is not a poor country. The GDP per capita of about $4000 may seem low, but worldwide it puts the country at the lower end of “middle income countries.” Guatemala does have a very high gini index of inequality, and by any measure rural Maya peoples are the most disadvantaged. Such structural conditions directly affect health and nutrition, what Paul Farmer calls structural violence. Jonathan Metzl advocates for what he terms structural competency in clinical interventions, which calls on an ethnographic sensibility to understand root causes and larger contexts.       

In Guatemala, efforts led by Dr. Peter Rohloff through Wuqu’ Kawoq have taken a holistic approach to understanding malnutrition. In a new paper in Maternal and Child Nutrition, Rohloff and colleagues find that mothers often lack autonomy in making food decisions and that stunting is not recognized as such when it is the norm for the community. Most surprisingly, they find that land ownership, even among upwardly mobile farmers growing broccoli and other crops for export, is not correlated with a drop in childhood chronic malnutrition. In the vein of Farmer and Metzl, understanding the full context here certainly includes the political economic structures but also, crucially, the dynamic trajectories of cultural change, including the appeal of junk food. 

In the Wall Street Journal, Matt Ridley argues that one of the smartest forms of foreign aid is in malnutrition prevention and treatment: for every $1 invested in malnutrition, $59 in societal benefits are produced.  One of the best investments in Guatemala, then, is Mani+: see what we are doing about malnutrition through the Mani+ project at .