40
Economist Investigates How Anemia 
Impacts Education in India
Rajesh Kumar Rai (Harvard University) and Sebastian Vollmer 
(University of Göttingen). The project received funding 
from the Alexander von Humboldt Foundation, the Swedish 
Research Council and the West Bengal State Department of 
Health and Family Welfare in India. 
The latest study builds on an earlier one in which Kumar 
and fellow researchers helped evaluate the results of an 
iron fortification school lunch program for students ages 7 
and 8 in India. That study showed that fortification reduced 
anemia but did not affect students’ performance in school. A 
forthcoming study, set to launch in summer 2024, will look 
at iron fortification for children ages 3 to 5. The research 
hypothesis is that an early-age nutritional intervention among 
preschoolers would make a significant impact on physical and 
cognitive development. 
“Our findings have implications for policymakers who 
want to improve educational outcomes and reduce 
poverty,” Kumar said. 
“Effective policies are based on evidence. We need more 
rigorous statistical analysis to examine the causal relationship 
between anemia and education. 
“This work ties into my larger research agenda, which explores 
the intersection of global health and poverty reduction. I want 
to use my academic research to support human dignity by 
helping to identify evidence-based health policies that will 
make a tangible difference in people’s lives.”
In low- and middle-income countries, anemia reduction efforts 
are often touted as a way to improve educational outcomes 
and reduce poverty. A new study, co-authored by global health 
economics expert Santosh Kumar, evaluates the relationship 
between anemia and school attendance in India, debunking 
earlier research that could have misguided policy interventions. 
Kumar, associate professor of development and global health 
economics at the Keough School and core affiliated faculty with 
the Pulte Institute, co-authored the study which was published 
in Communications Medicine.  
The study investigated whether there was a link between 
anemia and school attendance in more than 250,000 
adolescents ages 15 to 18. Earlier studies had shown a link 
between anemia and attendance, even after accounting 
for variables such as gender and household wealth, Kumar 
said. But he said the new study, which applied more rigorous 
econometric statistical analysis, did not find such a link.
“Most previous research on this topic has used conventional 
study designs or focused on small geographical areas, which 
limits its policy relevance,” Kumar said. “Earlier estimates may 
have been distorted by unobserved household factors related 
to both anemia and school attendance. So in this study, we 
focused on the relationship between anemia and attendance 
among adolescents who were living in the same household. 
 
“Ultimately,” Kumar said, “we found that the link between anemia 
and schooling is more muted than previously suggested by 
studies that did not consider household-level factors.” 
The findings have important implications for policymakers 
seeking to improve education in low- and middle-income 
countries like India, Kumar said, which has widespread school 
attendance issues and struggles with health conditions such as 
anemia caused by iron deficiency (particularly in children and 
adolescents). The country has pushed to improve educational 
outcomes, in keeping with the United Nations’ Sustainable 
Development Goals, Kumar said. But to achieve that, he said, 
more research is needed to pinpoint an evidence-based 
intervention. 
The latest study is part of an ongoing project to do that work. 
The study was co-authored with Jan-Walter De Neve (University 
of Heidelberg), Omar Karlsson (Lund University in Sweden), 
38 | Health and Well-being
The Pulte Institute for Global Development
Santosh Kumar’s research focuses on the economics of global health 
and economic development in low- and middle-income countries.

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