Presentation by Olivier Ecker at the event: “Tackling food security and nutrition in Egypt: challenges and opportunities” Launch of the findings from the Household, Income, Expenditure and Consumption Survey , Tuesday 21 May in Cairo, Egypt.

1. Malnutrition and Economic Development:
Explaining Egypt’s Exceptionalism
WFP/CAPMAS/IFPRI Workshop “Tackling Food Security and Nutrition in Egypt:
Challenges and Opportunities”, Cairo, 21 May 2013
Contributors: Rawia El-Batrawy (CAPMAS), Dr. Clemens Breisinger (IFPRI),
Dr. Heba El-Laithy (Cairo Univ.), Marc Nene (Tufts Univ.), Perrihan Al-Riffai (IFPRI)
Financial support: IFAD; CGIAR Research Program on Policies, Institutions and Markets
Dr. Olivier Ecker

2. Motivation and Outline
 Malnutrition slows economic growth (2-3% GDP lost) and deepens poverty
through productivity losses (10% of lifetimes earnings) from poor physical
performance and cognitive capacity as well as increased health care costs.
 Chronic undernutrition is still the main nutritional problem across the
developing world, but overnutrition and associated diseases are rising
rapidly.
Overview
1. Egypt’s main nutritional challenges:
a) Growth-nutrition disconnect
b) Double burden of malnutrition (coexistence of under- and
overnutrition)
2. Egypt’s food subsidy system: A key driver of the nutritional challenges?
3. Determinants of malnutrition: preliminary estimation results
4. Conclusions and policy implications

3. Growth-Nutrition Disconnect
Prevalence of stunting among children under 5 years (%)
General trend
Source: Own estimation based on World Bank’s WDI data, complemented with IMF’s WEO, UNSTAT, and 2010/11 HIECS data.
1978
Egypt
1992
1995
2000
2003
2005
2011
GDP per capita (US$)

4. Double Burden of Malnutrition
General relationship
Egypt
Yemen
Iraq
Sample average
Saudi Arabia
Kuwait
Morocco
Sample average
Prevalence of obesity among women
aged 15 years and older years (%)
Prevalence of stunting among
children under 5 years (%)
Source: Own estimation based on World Bank’s WDI data, complemented with IMF’s WEO, UNSTAT, and 2010/11 HIECS data.

5. Egypt’s Food Subsidy System
Two food subsidy programs:
1. Baladi bread (5 piasters per loaf)  universal
2. Food rations: rice, edible oil, sugar, dried black tea  restricted to card holders
 Although the system has never been designed to reduce malnutrition, food subsidies at
that scale and scope are likely to have significant effects on people’s diet and nutritional
status.
 The subsidies keep the prices of rationed foods constant and far below market prices,
increasing the relative costs of more nutritious (non-subsidized) foods.
 The quotas of food rations considerably exceed quantities recommended for a healthy
diet.
Food ration beneficiaries Poorest 2 3 4 Richest Total
Households holding ration cards (%) 74 72 69 66 59 68
Urban 65 61 58 60 49 59
Rural 76 77 74 74 75 75
Family members registered on
household ration card (%)
92 100 114 133 183 122
Urban 97 108 123 150 198 133
Rural 91 96 106 118 166 115
Source: Own estimation based on 2010/11 HIECS data.

6. Preliminary Estimation Results (1)
Determinants of chronic undernutrition among children aged 6-59 months
Note: ***, **, *, † Statistically significant at the 1%, 5%, 10%, and 15%.level. Source: Own estimation based on 2010/11 HIECS data.
Child height-for-age z-score Child stunting
Regression model OLS Logistic
Sample Urban Rural Urban Rural
Expenditure per capita (EGP/d) 0.017* 0.028 -0.018* -0.028
sq. 0.000* 0.000 0.000* 0.001
Baladi bread subsidy benefit per capita (EGP/d) 0.042 -0.039 -0.012 0.019
Ration card (1=yes, 0=no) 0.305 -0.069 -0.368 -0.226
Food ration subsidy benefit per capita (EGP/d) -0.473 0.391 0.655 -0.045
Household size -0.030 -0.045** -0.001 0.075***
Child age (months) -0.067*** -0.068*** 0.050** 0.033*
sq. 0.001*** 0.001*** -0.001 -0.001**
Primary education of woman (1=yes, 0=no) -0.320* -0.352*** 0.204 0.190†
Secondary education of woman (1=yes, 0=no) 0.164 0.191† -0.001 -0.201†
Sewerage coverage in PSU (%) 0.094 0.014 -0.226* 0.096
Constant -0.313 0.059 -0.986* -1.232***
Observations 1,262 2,217 1,262 2,217
F/Chi-sq. 1.57* 3.37** 18.02† 40.13***
R-sq./pseudo R-sq. 0.014 0.017 0.011 0.014
In urban areas, child stunting
declines with increasing income up
to a certain income level and rises
thereafter.

7. Preliminary Estimation Results (2)
Determinants of overweight among (non-pregnant) women aged 15-49 years
Note: ***, **, *, † Statistically significant at the 1%, 5%, 10%, and 15%.level. Source: Own estimation based on 2010/11 HIECS data.
Female BMI Female overweight
Regression model OLS Logistic
Sample Urban Rural Urban Rural
Expenditure per capita (EGP/d) -0.010** 0.157*** -0.006*** 0.065***
sq. -0.002*** -0.001***
Baladi bread subsidy benefit per capita (EGP/d) 0.031† 0.055†
sq. -0.019** -0.043 -0.013*** -0.003
Ration card (1=yes, 0=no) -0.592* -0.445 -0.297* -0.176
Food ration subsidy benefit per capita (EGP/d) 2.141* 1.940† 1.238** 0.047
sq. -1.996** -2.151* -0.981** -0.023
Household size -0.042 -0.025 -0.009 -0.002
Age (years) 0.568*** 0.636*** 0.232*** 0.227***
sq. -0.005*** -0.007*** -0.002*** -0.002***
Primary education (1=yes, 0=no) 0.664*** 0.432*** 0.138† 0.181**
Secondary education (1=yes, 0=no) -0.580*** 0.067 0.048 -0.014
Sewerage coverage in PSU (%) 0.478** 0.707*** 0.178* 0.395***
Constant 16.080*** 13.692*** -3.961*** -4.408***
Observations 5,136 6,689 5,136 6,689
F/Chi-sq. 114.7*** 147.9*** 939.8*** 1,191***
R-sq./pseudo R-sq. 0.212 0.210 0.132 0.127
In urban areas, female overweight rises with
increasing consumption of baladi bread and
subsidized food rations up to a certain income
level and declines thereafter. In rural areas, food
ration subsidies have the same effect (though it is
less robust).
In urban areas, female overweight declines with
increasing income. In rural areas, it rises with
increasing income up to a certain income level
and declines thereafter.

8. Preliminary Estimation Results (3)
Determinants of the double burden of malnutrition at household and individual level
Note: ***, **, *, † Statistically significant at the 1%, 5%, 10%, and 15%.level. Source: Own estimation based on 2010/11 HIECS data.
Stunted child and overweight woman Stunted and overweight child
Regression model Logistic Logistic
Sample Urban Rural Urban Rural
Expenditure per capita (EGP/d) -0.016 0.004 -0.001 -0.003
sq. 0.000 0.000
Baladi bread subsidy benefit per capita (EGP/d) 0.161 -0.079 -0.093 0.073
sq. -0.048 0.019
Ration card (1=yes, 0=no) -1.404*** 0.102 -1.930*** -0.981**
Food ration subsidy benefit per capita (EGP/d) 4.939** -1.493 6.844** 3.336
sq. -4.050* 1.759 -5.857† -4.090
Household size 0.084† 0.141*** 0.053 0.071**
Child age (months) -0.015*** -0.012*** -0.007 -0.011**
Woman's age (years) 0.019† -0.006
Primary education of woman (1=yes, 0=no) -0.021 0.162 -0.076 -0.172
Secondary education of woman (1=yes, 0=no) 0.278 -0.177 -0.313 0.069
Sewerage coverage in PSU (%) 0.113 0.231† 0.280 0.185
Constant -1.396*** -1.293*** -1.544*** -1.789***
Observations 1,006 1,706 1,160 2,080
Chi-sq. 29.54*** 37.81*** 17.92* 22.88**
Pseudo R-sq. 0.026 0.020 0.018 0.013
In urban areas, the double burden
of malnutrition rises with
increasing consumption of
subsidized food rations and
declines thereafter.

9. Conclusions and Policy Implications
 Egypt faces two key nutritional challenges:
1. Severe growth-nutrition disconnect
2. Double burden of malnutrition
 Both nutritional challenges are exceptionally pronounced in Egypt.
 Economic growth is good but is not enough to improve nutrition.
 Egypt’s food subsidy system incentivizes unbalanced diets and has
detrimental nutritional effects, particularly in urban areas.
 In the debate about reforming the food subsidy system, nutritional concerns
should be addressed.
 To significantly reduce malnutrition, nutrition intervention programs are
needed (while highly cost-effective interventions are available).
 Other countries such as Brazil provide important lessons on how to create
socially inclusive economic development and bring down chronic child
undernutrition successfully.