New research led by LSE reveals that high‑income countries once suffered severe child stunting comparable to rates seen in many low‑ and middle‑income countries today, offering powerful evidence that child stunting can be eliminated globally.

Large and rapid reductions in child stunting are possible on a global scale, a new study from the London School of Economics and Political Science (LSE) published in BMJ Global Health has found.

Child stunting - a key indicator of long-term undernutrition and illness in early childhood, with lasting effects on health and development - affected an estimated 148.1 million children in 2022. Although global stunting rates have declined from 47.2% in 1985 to 22.3% in 2022, little was previously known about stunting trends before the mid‑1980s.

For the study, the researchers systematically reviewed more than 900 historical growth studies, reconstructing child stunting rates for 122 countries from the early 19th century to the present.

They found that many countries now classed as high‑income (HIC) had very high levels of child stunting in the early twentieth century, comparable to rates currently seen in many low‑ and middle‑income countries (LMICs).

These results, the authors argue, show that today’s LMICs can eliminate stunting and that historical experience in HICs offers practical lessons for doing so.

Through their analysis, the researchers found that early‑twentieth‑century stunting rates were higher than previously understood, especially in Western and Southern Europe, where rates placed them close to the highest levels observed globally today.

Urbanisation, poor sanitation and high disease exposure were key drivers of stunting in these countries. Improvements in clean water, hygiene and health behaviours, even before antibiotics or modern healthcare systems were widely available, played a major role in reducing stunting.

Likewise, Japan and South Korea recorded stunting rates above 70 per cent in the early 1900s but eradicated stunting by the 1980s, with Japan’s rate of decline after WWII among the fastest ever recorded.

The remarkable decline of child stunting in East Asia and parts of Southeast Asia suggests that eliminating high stunting rates is possible and that genetic differences in height potential between populations cannot explain stunting rates in LMICs today.

The authors note that Japan's rapid stunting decline after WWII reflected improvements in many broad indicators of development: GDP per capita grew by 8.2 per cent annually in the 1950s, life expectancy increased by eight years and the diet diversified to include more animal protein. These factors interacted with and complemented each other, facilitating large improvements in child health. Thus, the researchers argue, broad-based development is needed rather than specific interventions targeting just one determinant of stunting like malnutrition or sanitation.

Japan saw a 250g increase in average birthweight between 1900 and 1970, suggesting that improving maternal health and nutrition and tackling gender inequalities in healthcare can also be critical to lowering stunting rates.

The research also shows that countries with relatively low historical stunting, such as the Caribbean, may offer valuable models for understanding early, effective prevention.

The authors note that these insights also have implications beyond child health. Today’s ageing populations grew up in very different nutritional environments, meaning historical malnutrition may shape current patterns of longevity and disease.

Going forwards, the researchers argue that eliminating child stunting is achievable for all countries but requires more than just adequate nutrition and infrastructure. Changes in hygiene behaviour, sanitation practices and broader public health measures are essential.

With nearly 150 million children still affected, the authors assert that recognising how quickly past societies have reduced stunting could inform efforts to accelerate progress in today’s LMICs.

Commenting on the findings, lead author of the study Professor Eric Schneider from the Department of Economic History at LSE said: “One of the most important lessons from history is that today’s rich countries were not always well nourished or healthy. Many once had child stunting rates as high as those seen in poorer countries today, and they reduced them within a few decades. That perspective matters for how we think about what is possible now.”


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For a copy of the study, please visit: The decline of child stunting in 122 countries: a systematic review of child growth studies since the 19th century