Nutrition, Public Health, and Macroeconomic Stability as Determinants of Food Security in Middle-Income Countries

Food security in middle-income countries is a growing phenomenon, becoming more relevant than ever before. This study examines the effects of government expenditure, nutrition, and sustainability on health and food security in middle-income countries, with a focus on child stunting under macroeconomic constraints. It measures the impact on the empirical environment, accounting for relevant macroeconomic constraints that affect child stunting. Using the System Generalized Method of Moments (System–GMM) model to control for endogeneity and persistence in food security, a panel data set of 35 middle-income countries over the period 2000–2023 is employed. The results reveal strong persistence in food security dynamics (β = 0.642, p < 0.01). Government health expenditure significantly improves food security (β = −0.481, p < 0.01), whereas inflation (β = 0.074), public debt (β = 0.028), and exchange rate depreciation (β = 0.516) increase food insecurity. Child stunting was positively associated with food insecurity (β = 0.219, p < 0.01), whereas sustainability was associated with improved food security outcomes (β = −0.273, p < 0.05). The long-run effect of government health expenditure (−1.344) substantially exceeds its short-run impact, highlighting the importance of sustained investment. The findings underscore the need for integrated policies that combine public health investment, macroeconomic stability, and sustainability-oriented development to strengthen food security and reduce chronic malnutrition in middle-income countries.