Stunting: As many as 50 percent of children can be affected
The second stream of Palmer's research agenda seeks physical, cultural and, ultimately, political answers to the problem of
developmental stunting in sub-Saharan Africa. The United Nations Children's Fund (UNICEF) estimates that 800 million people
in the world are stunted. In some villages of sub-Saharan Africa, nearly half the children are affected by the syndrome.
Why does a human ailment draw a veterinarian's attention? For one thing, Palmer says, humans become stunted because they don't
get enough protein in the first 1,000 days of life—and malnutrition and protein production are areas veterinarians deeply
understand. "These children never really get to their physical norms," Palmer says. "Their height shows up as reduced but
their weight for height may actually look quite normal. The tragedy is that physical stunting is just the outward sign. There's
also a good deal of cognitive stunting."
Cognitive stunting has far-reaching effects—Palmer has met with U.S. Rep. Adam Smith, the ranking member of the House Armed
Services Committee, on the issue because Washington is seeing a connection between this disease and massive instability in
parts of the world.
"People ask me, 'Why does this matter to us?'" Palmer says. "Well, this matters to us because young men who are cognitively
stunted are not healthy for anybody." Cognitive stunting is associated with societal volatility when these unstable, underdeveloped,
vulnerable children become boy soldiers, get involved with terrorist cells and so on. The U.S. government interest in stunting
and its effects is keen, Palmer says.
But the condition is not always immediately recognizeable. Malnutrition has two faces, Palmer explains. One face is that of
the starving child who is simply not getting enough calories. Those children are ravenous, he says. When relief workers put
a high-energy supplement in front of them in the form of gruel, they devour it.
Protein malnutrition has a different face. These children aren't skin and bones; they're just stunted in terms of height and
cognitive ability. Surprisingly, they aren't hungry. In fact, they generally refuse food. Even when they're put on an emergency
feeding program, they improve temporarily and then relapse into protein malnutrition and chronic malabsorption syndromes,
This is not a battle veterinarians should be afraid to join, Palmer says. His words pick up strength as he wades into the
issue. "Physicians are not afraid to jump into those kinds of problems," he says. "Yet veterinarians have often seemed reluctant."
Physicians, he continues, tend to look at stunting as a problem that begins with the food going into the mother. But they
don't think about what happens before that. "Where does the food come from? What's the access? What's the availability? What's
Veterinarians, on the other hand, have tended to do the opposite, which is focus on animal productivity. "We're not afraid
to look at those issues, but we want to stop when it gets to the household," he says.
And the household may be that critical interface between science and custom that goes well beyond the comfort zone of either
physicians or veterinarians. The nagging question here relates to the distribution of food within the family. In a January
lecture at the university, Palmer suggested that a partial solution to stunting could be as simple as families allocating
eggs to pregnant mothers.
"Veterinarians cannot be afraid to talk about maternal child nutrition," he says. "We understand every aspect of that. There
is really nothing very unique about a human mother versus a bitch or a cow or anything else. We understand the basic principle
and we need to be willing to cross that divide."
But the relationship between livestock and human health in the parts of the world where Palmer works is not simply about nutrition.
He suggests imagining a rural Kenyan suddenly transported to an American city. He'd look around and think everyone in America
was wealthy. But if he stayed around awhile, he'd notice big differences in wealth. The same is true, Palmer says, for a visitor
to Kenya. If the visitor looked around long enough, he'd see several strata of wealth. And looking around, of course, is what
"If you walk onto a premises and you can see four head of cattle, I'll bet if you look at the questionnaire where we ask about
malaria nets—the question is, 'Did you sleep under a bed net last night?'—that family will have answered 'yes,'" Palmer says.
Four head of healthy livestock makes a huge difference in quality of life for a family in the developing world, he says—the
difference between being able to afford a malaria net and being exposed to disease, for example. Four head means the family's
assets are higher, nutrition is better and children are more likely to attend secondary school. "There is very good economic
data on this," he says. "You see this tremendous effect that correlates very strongly with the presence of healthy livestock."