A new paper published on September 17 says that while the average height of people across the world is increasing, the average height of Indians is actually falling.

The paper examines the trends in the heights of Indian men and women between the age groups of 15-25 and 26-50 based on the National Family and Health Surveys – and concludes that India’s indicators are actually getting worse.

This is a worrying situation. Height is one of the most basic indicators of nutrition as well as public health and is directly linked to a country’s standard of living. It also reflects social and economic factors such as income and caste. Thus a fall in average heights indicates India is regressing on public health as well as economic goals.

“We believe, in the context of an overall increase in average heights worldwide the decline in average height of adults in India is alarming and demands an urgent enquiry,” write the authors of the paper.

Losing stature

The study, titled “Trends of adult height in India from 1998 to 2015: Evidence from the National Family and Health Survey”, by Krishna Kumar Choudhary, Sayan Das, and Prachinkumar Ghodajkar from the Centre of Social Medicine and Community Health, Jawaharlal Nehru University compared data from three NFHS rounds – NFHS-II (1998–’99), III (2005–’06), IV (2015–’16) – to look at changes in height over the years.

NFHS is carried out by the Union Ministry of Health and Family Welfare and is one of the foremost Indian sources to study public health and evaluate existing policies. The survey is representative of households across India at both the state and the national level. The latest NFHS-V survey (2019-’20) was conducted across 6 lakh households.

The researchers found out that between NFHS-III (2005-’06) and NFHS-IV (2015-’16), Indians in the 15-50 age bracket – with the exception of women between the ages 26-50 – have experienced a decline in their average height.

Women between 15-25 saw a decline in their mean height by 0.12 cm, while women between 26-50 showed an improvement by 0.13 cm. During the same period, men between 15-25 saw a decline of 1.10 cm in their mean height and those between 26-50 years had a decline of 0.86 cm.

Distribution of mean height of men according to the age. Source: Trends of adult height in India from 1998 to 2015: Evidence from the National Family and Health Survey.

The paper brings out a troubling mismatch between economic growth and public health. Between NFHS-II and NFHS-III, women between the ages of 15-25 saw their average height increase by 0.84 cm. However, the average age of this group saw a decline between NFHS-III and NFHS-IV. This is notable since in NFHS-IV, this group corresponds to a generation born right after India’s liberalisation, characterised by high economic growth.

Notably, disadvantaged groups have been especially impacted by this trend. For women in the ages 15-25, between NFHS-III and NFHS-IV, the average height of tribal women saw a decline of 0.42 cm while women from the poorest wealth fell by 0.63 cm. This is significantly worse than the average decline for the entire age group (0.12 cm).

Distribution of mean height of women according to the age. Source: Trends of adult height in India from 1998 to 2015: Evidence from the National Family and Health Survey.

In the age group of 26-50, women from the poorest wealth category saw a significant decline in their average height – 0.57 cm – while women from the middle, richer and richest wealth categories saw their average heights improve. Women from urban areas saw their average heights improve by 0.20 cm while rural women only saw an increase of 0.06 cm.

Men between the age groups of 26-50 from urban areas saw the sharpest decline in average height, with the highest fall being 2.04 cm in Karnataka.

Why it matters

While height is influenced by genetics, non-genetic factors such as nutrition and environment play a significant role as well. Variables such as household characteristics (such as number of siblings and class) and caste have a bearing on an individual’s nutrition and growth. Height is also highly correlated with wealth. People from the Scheduled Castes and Scheduled Tribes communities are, on average, shorter than those belonging to Other Backward Class and Upper Castes.

Thus, a person’s height is a marker of physical well-being and standard of living. Studying height could therefore lead to a better understanding of the impact of health policies.

Height, in turn, is also linked to productivity. According to World Bank estimates, a 1% loss in adult height due to childhood stunting can lead to a 1.4% loss in economic productivity. According to a study by industry body Assocham and consultancy firm EY, India loses around 4% of its gross domestic product every year due to its citizens being malnourished.

Malnutrition is one of the gravest problems India faces currently. Credit: Reinhard Krause/Reuters

Studying average height will also help us know the results of our nutritional policies better. For instance, a study cited in the paper says that mid-day meals have lowered the rates of stunting in children.

Given the importance of height in measuring public health, the results of the study are worrying. This is especially so when the average height of humans worldwide is increasing.

India’s public health situation

India has had a history of faring poorly on health metrics. Currently, it is 94 out of 107 countries, as per the 2020 Global Hunger Index. It has one-third of the world’s stunted children. It also has the most number of children who are underweight according to their height.

To make matters even more troubling, public health indicators seem to be getting worse. As per NHFS-V (2019-’20), which has released its phase-1 data from 22 states and Union Territories, child nutrition levels have further worsened since NHFS-IV (the dataset used by this paper). This could also mean an increase in child stunting, which would be the first time this has happened in twenty years. In the past four years, seven out of ten major states saw an increase in the number of underweight children.

In addition, the Covid-19 pandemic in 2020 and 2021 has impacted public health severely. A survey conducted by Jean Drèze and Anmol Somanchi showed that 53%-77% respondents were eating less during the pandemic than the period before. Further, data from the Centre for Monitoring the Indian Economy shows a sharp decline in the consumption of nutrient and protein rich food, across all income groups, during the pandemic.