Why we need to rethink the strategy and time frame for achieving health-related Millennium Development Goals

Targets and interventions for the Millennium Development Goals (MDG) related to reducing hunger (MDG 1) and child mortality (MDG 4) have ignored the role of intergenerational influences on health. In this study, the comparative importance of intergenerational and contemporaneous factors for achieving MDGs 1 and 4 targets was evaluated. A database of 735 970 children from 109 Demographic and Health Surveys conducted between 1991 and 2008 in 54 countries was compiled. Modified Poisson regression models were used to estimate the association between child mortality/undernutrition and maternal education, wealth and height. Stochastic simulations of regression results were then used to evaluate changes in maternal height, education and wealth required to halve stunting and underweight and to reduce mortality by two-thirds. At mean height, 25 years of education were needed to achieve a two-thirds reduction in mortality, and halving the prevalence of stunting and underweight required 23 years and 17 years of education, respectively, for the poorest wealth quintile. When height was increased from the mean by 25 cm, the prevalence of both growth outcomes was halved, even for those with no education and in the poorest wealth quintile. These results indicate that contemporaneous interventions will achieve MDG targets more readily in populations with greater accumulated health stock.