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Policy Brief 1: Is Healthier Wealthier? A look at the relationship between health and development, with a focus on nutrition.

Abstract

Better health leads to better education attainment, which will lead to a better job and increased productivity. In turn, leading to increased income, lower poverty, and an increase in life expectancy; overall an increase in development. On the other hand, an individual from a more developed country will be wealthier and better able to live a healthier life. A wealthier individual will be better educated, obtain a better job that pays more, and will be able to do the same for their children. We would theoretically assume that an increase in income would lead to a decrease in undernutrition, a key component in measuring health. However, empirical evidence shows conflicting information about the link between income and nourishment. It can be concluded that this is the result of poor data collection, with little consideration for money and food distribution or the quality of the food being consumed. We should strive to reform the way we collect data to account for this disparity, and put in place policy that would educate the public on the importance of nutrition and the difference between healthy and cheap calories.

When measuring economic development within a country, we consider multiple variables usually including education, health, and income. While these, and many other variables may be examined individually, they are all linked such that a change in one variable will lead to a change in the other variables. In general we expect a highly developed country to have high education attainment, high life expectancy, and a high income. (Ehrenpreis & Lennock, 2003)

Essentials of Global HealthJune 13, 2014David Dingus: 11403109

(Gapminder, 2012)

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The adage goes: “health before wealth”. The argument is that the healthier a population, the wealthier they will become. A healthier child will be able to attend school more regularly and will be less distracted by illness when they are in class. Additionally, a healthy child receives the nutrition they need for cognitive growth. This means they will better be able to grasp concepts, retain them, and understand them. This growth in education as a result of being healthier will give the child a higher skill set and help them in finding a better job. This higher skill set will also allow them to be more productive when they work, thereby increasing their income. This means that a healthy child will be better prepared for retirement and less dependent on their children. Rather than having many children, and using them as in investment for the future, there is an incentive to have fewer children. As a result of having fewer children, the resources that would once have been shared amongst a large family will now be distributed amongst a smaller family. This will allow for individual children to receive better healthcare, better nutrition etc. In effect, repeating the cycle and leading to continued economic growth and development. (Ehrenpreis & Lennock, 2003) (Bloom & Canning, 2000)

It is clear that good health can lead to more wealth, but one could also argue that “wealthier is healthier” is equally as meaningful. When examining the relationship between development and health we can look at the same relationship as before, but in reverse. When an individual has a high level of economic development, we interpret that they have a high income and will have greater resources to invest in their education and health. They will acquire a skill set that will allow them to obtain a job with good pay and grow their wealth. This will result in greater productivity, a higher income, and allow them to save and provide for their retirement. Because of their high levels of health, they will have an increased life expectancy, but will be able to provide for their retirement independently. This means that they choose to have fewer children, and can invest more in each individual child, since they will not need to rely on children to take care of them in old age. As a result, more money can be spent on nutrition and health services for both themselves and their children, which leads to a lower infant and child mortality rate. Their children will also receive better nutrition and be more successful in school. Research shows that more education leads to increased health due to health education and awareness. Once again the

pattern will continue. In this case, the high level of development and wealth means higher levels of health from childhood through adulthood, and to longer life expectancy for both themselves and their children. (Pritchett & Summers, 1996)

It can be concluded that health has a multidimensional impact on development and development on health. While there are many factors comprising health, nutrition is a key component. Undernutrition and undernourishment remain key battlegrounds in development as they negatively impact the development process. An undernourished child will not receive the necessary nourishment to fight infectious disease and illness, which will culminate in an increase in child mortality. The children that do survive will have lower education attainment as they will have missed more days of school from being out sick, and not being able to focus in class as a

Essentials of Global HealthJune 13, 2014David Dingus: 11403109

“Healthy school lunches mean students are getting the nourishment they need to power their minds and bodies to learn.”

-Ann Cooper

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result of being hungry and/or sick. Additionally, they will have slower cognitive development. They may exhibit traits of permanent wasting or stunting, in that they they will always be smaller and weaker. As such, they will be less productive both physically and cognitively as a result of their smaller skill set. In sum, a child exposed to long-term undernourishment and undernutrition will have a lower income, and live in higher poverty. (Klasen, 2008)

Theoretically one would expect a higher level of income to lead to a lower level of undernourishment and undernutrition. However empirical evidence does not confirm this. A recent study found that income had increased on average 230% over a given period in India, but this has had little impact on child undernutrition in India over the same period. (Berkman, Kawachi, Subramanian, & Subramanyam, 2001]) Undernutrition means not enough calories, whereas under-nourishment is not having enough vitamins and minerals. One would expect the two to have a negative relationship with income. Meaning that as income increases, undernourishment and under-nutrition would decrease, but research has shown this not to be the case. In one study, the Caribbean was found to have the highest rate of undernourishment, but low poverty, undernutrition, and child mortality. Sub-Saharan Africa was found to have the highest rate of

poverty and child mortality, but only moderate under-nutrition. Finally, South Asia was found to have high undernutrition, with only moderate poverty, under-nourishment, and child mortality. In other words, we have arrived at regional paradoxes with respect to the relationship between under-nutrition, undernourishment and income. (Klasen, 2008)

Three factors can be used to explain this mismatch between theory and empirical evidence, where one would expect: an increase in income to result in decreased undernourishment and undernutrition. The first is that the research is not considering income distribution and access to food. Income levels may have increased, but perhaps the increase was concentrated amongst the upper elite, with little increase being seen in the poorer parts of the population. This would mean that although GDP per capita has increased, many people have seen little to no increase in their income, and therefore are not able to buy additional food. Second, studies only consider food expenditure, without accounting for waste, how that food is distributing amongst the population, or within individual households. Furthermore, research is based on total calories, and not the quality of the food, i.e. level of vitamins and nutrients in that food. In other words, as long as there is a net increase in purchased calories, the data would show that individuals should be getting more of the food they need. However, individuals may be buying cheaper calories from foods containing high animal fat and sugar, and less of the foods with the vitamins and nutrients

Essentials of Global HealthJune 13, 2014David Dingus: 11403109

Low

Moderate

High

Carribean Sub-Sahran Africa South Asia

Poverty UndernutritionUndernourishment Child Mortality

“we have arrived at regional paradoxes with respect to the relationship between undernutrition, undernourishment and income.”

-Klasen

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they need. This results in even more health problems such as heart disease and diabetes. Finally, one also has to consider the reliability of the data. Currently, there are no set standards in data measurement, nor does it take into account seasonal variation, or the different caloric requirements of different populations. (Klasen, 2008)

Solutions to these issues require reform from two different approaches. The first in the way in which the research is conducted, and the second with changing individual consumption preferences through education.

To begin, research must be conducted in a way that accounts for waste and distribution. Such as by including a standard waste deduction in the data, and also adopting uniform methods in data collection. Next, data concerning food consumption must also consider distribution of income and therefore distribution or access to food. This way an increase in consumption by one cohort would not reflect a net gain in consumption amongst the entire population. Finally, the types of foods being consumed should be considered, so that low nutrient and vitamin rich foods receive a lower weight than more nutritious foods. (Klasen, 2008)

Finally, in addition to reforming the way in which the data is collected, it is even more important that the population, and specifically children, receive the nourishment they need. To ensure this, a public campaign could be started to educate the public on the importance of healthy nutrition and the difference between healthy and cheap calories. Further action can be taken by subsidising education and providing free quality meals at school, with foods rich in healthy calories. In this way, children would begin to learn from a young age what is healthy, and pass these traits onto their children. This would result in a change in social norms and eventually lead to a healthier and therefore wealthier population.

References

Bloom, D. E., & Canning, D. (2000). The Health and Wealth of Nations. Science, New Series, 287, 1207-1209. Retrieved from http://www.jsotr.org/stable/3074691 !Berkman, L. F., Kawachi, I., Subramanian, S. V., Subramanyam, M. A. (2011). Is Economic Growth Associated with Reduction in Child Undernutrition in India. PLoS Med, 8 (3) http://dx.doi.org/10.1371/journal.pmed.1000424 !Ehrenpreis, D., & Lennock, J.(2003). Good health: A cornerstone of development. OECD Observer, 237. Retrieved from http://www.oecdobserver.org/news/archivestory.php/aid/999/Good_health:_A_cornerstone_of_development.html !Gapminder. (2012). Gapminder World Map [Chart]. Retrieved from http://www.gapminder.org/downloads/world-pdf/#.U5mkOBaZZua !Klasen, S. (2008). Poverty, undernutrition, and child mortality: Some inter-regional puzzles and their implications for research and policy. The Journal of Economic Inequality, 6 (1), 89-115. Retrieved from http://link.springer.com/article/10.1007%2Fs10888-007-9056-x !Pritchett, L., & Summers, L. H. (1996). Wealthier is healthier. The Journal of Human Resources, 31, 841-868. Retrieved from http://www.jstor.org/discover/10.2307/146149?uid=3737864&uid=2129&uid=2&uid=70&uid=4&sid=21103848601701

Essentials of Global HealthJune 13, 2014David Dingus: 11403109