Integrating Environmental Indicators in Stunting Eradication Strategy

Stunting remains one of the most urgent global public health concerns. According to the World Health Organization (WHO), 23.2% of children under the age of five worldwide were affected by stunting in 2024. All children need the right amount of nutrition at the right time to grow and develop well; but it goes beyond that. Besides food security and nutrition, environmental indicators are an overlooked key factor that also determines one’s development and wellbeing.

Beyond Nutrition

Impacting one in five young children globally, stunting is a form of impaired growth and development in children. WHO defines children as stunted “if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median.”

Stunting not only impairs an individual’s physical appearance but also their health and cognitive development. Moreover, at a large scale, it negatively impacts long-term national productivity and resilience as well.

While countries worldwide have put some efforts to end stunting, existing strategies have been focusing primarily on improving food security and nutrition. Consequently, policies tend to emphasize food procurement, supplements, and nutritional counseling. While these interventions are important, they fall short of addressing the deeper and more complex root causes, such as multidimensional poverty and unsustainable food systems.

Furthermore, scientific evidence increasingly shows that nutrition alone cannot fully resolve the problem. Like many health challenges, stunting is inseparable from the environment in which children live, grow, and play. Within the UNICEF Conceptual Framework on the Determinants of Maternal and Child Nutrition, environmental indicators in stunting eradication are part of the broader category of resources, highlighting their crucial role in supporting adequate healthy food, health services, and caregiving conditions.

Environmental Indicators in Stunting

A study by Goodarz Danaei and colleagues, published in The Lancet Global Health (2016), analyzed data from 137 low- and middle-income countries. The findings revealed that while undernutrition accounted for 27.9% of stunting cases, poor environmental quality contributed an additional 21.7%. The remaining percentages were attributed to perinatal complications and overlapping socioeconomic factors.

Day by day, many children live around invisible air pollution, clear water that hides microbial toxins, and soil stripped of its natural capacity. Across rural villages in sub-Saharan Africa, urban slums in South Asia, and flood-prone communities in Southeast Asia, environmental hazards are silently affecting children’s development.

For instance, exposure to fine particulate matter (PM2.5)—a major air pollutant—has been shown to impair nutrient absorption by triggering systemic inflammation, respiratory infections, appetite loss, and oxidative stress. Meanwhile, water contaminated with microbial pathogens causes recurrent diarrheal episodes and contributes to a chronic inflammatory condition known as Environmental Enteric Dysfunction (EED). EED damages the lining of the small intestine, inhibiting the absorption of nutrients.

Thus, in regions where the air is heavily polluted and clean toilets, safe drinking water, and waste management are lacking, stunting would continue being an issue even when there is enough food to eat. The risks are further intensified for children with existing micronutrient deficiencies. These children are more biologically vulnerable to the effects of pollutants, including neurotoxic heavy metals such as lead, mercury, and cadmium, which can impair brain development and cognitive function.

Incomplete Strategy and Insufficient Funding

Unfortunately, in many developing countries, environmental monitoring systems exclude these hazards. Concentrations of PM2.5 and the presence of heavy metals in drinking water are frequently absent from routine air and water quality assessments. Land quality monitoring remains narrow in scope, focusing largely on vegetation cover or green space while overlooking critical aspects like soil contamination and fertility.

Take Indonesia, for example. Indonesia has formally established a system to monitor its environmental quality through the Environmental Quality Index (IKLH). Regulated under the Ministry of Environment and Forestry Regulation No. 27 of 2021, the IKLH combines data on water, air, land, and marine conditions into a single index.

However, as of 2024, the index still does not include key indicators such as PM2.5 concentrations in air quality and the levels of heavy metals like lead, mercury, and cadmium in water quality assessments. Land monitoring also focuses mostly on physical coverage—such as forest area and green space—without yet reflecting soil health or contamination levels.

Institutional limitations further constrain these efforts. The Indonesian government has implemented substantial budget cuts to the environmental sector in 2025. These reductions further threaten to erode the government’s ability to collect reliable environmental data, enforce pollution controls, and protect public health.

Better Stunting Eradication Strategy

To truly confront the complete causes of stunting, governments must invest in robust, science-based environmental monitoring systems that incorporate validated health-related indicators. These systems should measure environmental indicators such as ambient air pollution, waterborne toxins, and soil degradation in ways that are regionally disaggregated, publicly accessible, and policy-relevant. Such an integrated approach aligns with the One Health principle, recognizing the interconnectedness of human, animal, and environmental health.

Addressing stunting without accounting for environmental risks is akin to planting seeds in contaminated soil—children may grow, but never to their full potential. If the global community is serious about the health and wellbeing of all, then stunting must be treated not only as a nutritional crisis, but also as an environmental one. Amid the triple planetary crisis–-climate change, pollution, and biodiversity loss—integrating environmental indicators in stunting eradication strategies has become more urgent than ever.

Editor: Nazalea Kusuma

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