HEALTH, NUTRITION AND

DEVELOPMENT
BALINO, LAZARO, MARTINEZ, VALENZUELA
 I. INTRODUCTION
What is health?
O What are the indicators of health according to international
standards?

U What are the indicators of health according to the Philippines,

DOH?
II. TRENDS IN DEVELOPING COUNTRIES
T III. ISSUES
How is poverty related to health?
L How is the environment related to health?
How is economics related to health?
I - Health and development
- Health and productivity

N - Health and government spending/ medical budget

IV. POLICY IMPLICATIONS

E Allocation of budget to the poor

Distribution between rural and urban areas
Utilizing health auxiliary workers
Information dissemination
What is health?
The absence of disease and infirmity
(common definition by people)

a state of complete physical, mental, and social

well-being and not merely the absence of
disease or infirmity (WHO 1948)
Measuring Health Status

•Individual assessment by qualified health professionals in

order to determine the health status of the population but
this is an expensive way to measure the health status of the
entire population

•Morbidity (sickness) and Mortality (death)

•Morbidity statistics seldom are adequate

•Mortality statistics are considerably better

 What are the indicators of health
according to international standards?
•Mortality and Burden of Disease (16)

•Health Service Coverage (16)

•Risk Factors (9)

•Health Systems Resources (2)

 What are the indicators of
health according to Philippine
standards?
Population
41,839,950 (49.7) = Female
42,401,391 (50.3) = Male
84,241,341 (January 24, 2005)
88,574,614 (August 1,2007)

Livebirths
Total number of live births per year
1,766,440
Undocumented live births (no birth certificate) = not
included
Morbidity: Ten Leading Causes By Sex
2004
Acute Lower RTI and Pneumonia = 776, 562 (888.8 Males, 868.0 Females)
Total Deaths
Total deaths per year
2000
366,931
NCR (Metro Manila) = 63,413
Fetal Deaths
Total fetal deaths per year
It encompasses any death of a fetus after 20 weeks of gestation or 500 gm
2000
10,360 NCR (Metro Manila) = 2,333 Region 4 (Southern Tagalog) = 2,253 Region 7
(Central Visayas) = 1,056
Maternal Mortality

2004
Maternal Mortality by Main Cause
Other Complications related to pregnancy occurring in
the course of labor, delivery
and puerperium = 844 (0.5/1000)

Infant Mortality

2004
Infant Mortality: Ten (10) Leading Causes
Bacterial sepsis of newborn = 3,402 (2/1000)

Mortality

2004
MORTALITY: TEN LEADING CAUSES BY SEX
Heart Diseases: 40,361= Males 30,500 = Females
(84.8/100,000)
Immunizable Disease
2000
Mortality Among Immunizable Diseases (Under 1; 1-4, 5-9; 10-14 Years)
Measles (B05)
Under 1 = 412 (20.9)
1-4 = 877 (11.5)
5-9 = 504 (1.1)
10-14 = 34 (0.4)

Selected Causes of Diseases

2000
Selected Causes of Death by Region
Disorder of the Heart (60,417), Pnuemonia (32,637), All Forms of
tuberculosis (27,557)
Child Mortality

2000
Ten (10) Leading Causes of Child Mortality By Age-Group
(1-4, 5-9, 10-14) & Sex
1-4 years = Pnuemonia (1,540 males, 1,341 females,
37.76)
5-9 years = Accidents ( 1,044 males, 618 females, 17.82)
10-14 years = Accidents (938 males, 440 females, 15.88)
 HEALTH
IN
DEVELOPING
COUNTRIES
In most developing countries that are dependent on
agriculture, income and consumption of the poor are prone to
significant fluctuations

According to the World Bank Report in 1990 and 1992, in

using $275 and $370 as the poverty lines expressed in 1985
PPP prices, they found out that the absolute number of poor
people rose between 1985-1990 and most came from large
families with large numbers of children as dependents

Poverty and undernutrition problems are found especially in

low income countries or developing countries
(World Development Report WB 1996)- there were twice as many female illiterates as
there were males in 1995- 45% and 24% respectively

In developing countries, PEM or protein-energy-malnutrition is prevalent

-Marasmus
-Kwashiorkor

In contrast, in developed countries there is inadequate consumption of calories and

protein among the elderly and rich anorexics

In Asia, the most prevalent health problem in children are hookworms due to poor
hygiene

Most of the developing countries still are gender- bias depriving women of the access
to health and education
Much of the population of the developing countries
experience hunger on a day-to-day basis, most of them live in
rural areas

Another trend in developing countries is that the urban poor

people are growing hungry this is due to the rapid rising
urban population compared to that of the rural

In developing countries, low productivity is the cause of

environmental degradation

Developing countries not only are devastated by hunger and

environmental degradation but also natural and man-made
disasters such as typhoons, wars that worsen the condition of
the people

There has also been an increase in maternal mortality in

developing countries although shortage of data hinders the
estimation of the extent to which health is severed in
developing countries
ISSUES ON HEALTH
 How is poverty related to
health?
1. Undernutrition is a correlate of poverty
2. Poverty is brought about by
inequalities not only in the world but
within a country
3. Nutrition is used as a basis for
determining poverty in a country
Countries like the US and India are
using them
POVERTY MEASURES BECOME INSENSITIVE TO HEALTH:
1. Overall expenditure or item-by-item consumption
-income represents capacity to consume not consumption
-If income falls, does consumption for nutrients also fall? Do people
sacrifice food for other stuff if consumption falls?
-If consumption falls, does it mean that people become poorer? What
about wealthy people who become anorexic?

2. Absolute or relative
- the concept of poverty may vary from society-to-society, hence the
concept of what constitutes one’s basic needs including food, shelter
and clothing may be dependent on the society’s norms
-poverty lines are absolute and hence not reflective of the individual
concerns that each have in a population
3. Temporary or chronic poverty
- In most developing countries that are dependent on
agriculture, income and consumption of the poor are prone
to significant fluctuations
- It is easier to learn of the extent of poverty by looking at
the effects of chronic poverty in the household

4. Households or individuals
- The issue is that the distribution of expenditures within
the household is not accounted for
- Women, the elderly and children present problems of
measuring households
- There are fixed costs in a household in running a
household regardless of the size of the family
 POVERTY MEASURES:
- The article discussed measures of poverty such as Head Count Index,
Headcount Ratio, Poverty Gap Ratio and Income gap ratio.
- Basically, the point here is that poverty lines are not enough,
determining who the poor are is just the first step; it’s addressing the
poverty problem that is the major issue.
- Those below the poverty line need to be discriminated in order to
allocate the resources well
- Who would you give the money to? How will the inequality among
the poor be solved?
- Scarcity of assets and poverty are closely related, the poor usually
found in rural, landless or near landless areas
 INTERCONNECTIONS BETWEEN
POVERTY AND UNDERNUTRITION
a. Adequate levels of food and nutrient consumption
b. The effects of undernutrition especially on children
-muscle wastage, stunting, increased susceptibility to infection,
cognitive skills
c. Chronic undernutrition in adults diminishes: muscular
strength, immunity to disease, capacity to do work
d. Low nutrition can feed on a person’s capacity to work hence
perpetuate state of poverty

Disclaimers:
a. The relationship between increases in income and increases
in nutrition may not be strong
b. Poverty should not be identified with undernutrition because
there are some that are temporarily poor or anorexics on the
other hand
c. It may be possible for the poor to be undernourished while at the same
time direct nutrition supplements may have a greater impact on
undernutrition than an increase in income
d. nutritional requirements may vary from person to person
e. relationship of income to nutrition vary from country-to-country

OTHER VARIABLES IN THE POVERTY-UNDERNUTRITION

INTERCONNECTION:
a. Health may be desirable (physically and economically) if nutritional
levels are low to begin with. Hence, income increases may automatically
translate to increase in nutrition.
b. Consumption may be driven by social status and not by nutritive value.
 INCOME AFFECTS NUTRITION IF NUTRITION IS BASED ON
CALORIE CONSUMPTION:

Disclaimers:
a. If income levels fall below the minimum, individuals might
resort to other means of acquiring nutrients (relatives, gov’t)

b. The assumption is that as income increases, the individuals

substitute these sources meaning that an elasticity of 0.6 and
0.8 is indicative of high elasticity of nutrition to income

- (Table 8. 4 Elasticities of calorie demand to household

budget) – calorie elasticity is estimated at sample means,
budget measured by household incomes, budget measured by
household expenditure- Behrman, Foster, and Rosenzweig
1994 Table 4
Findings:
Nutrition do not entirely drive household decision making
Poorer households react more to changes in their budgets by buying
more nutrients
Peak and Lean season may have an effect on consumption through
income increases. Elasticity are high in the lean season especially for
the landless and near landless
 POVERTY AND THE HOUSEHOLD
The poor may not afford to share poverty equally

Unequal sharing depend on the health and productivity of the family member

Unequal division’s potential merit is that it helps some individuals to be

minimally productive

“life boat ethic”

unrealistic: in order to maximize the household capacity, one person will be left
to starve

Who are the individuals sacrificed in the life boat ethic?

- Females both adult and children
- Old and sick
Old members:

less of a position to provide these capabilities

(Kochan 1996) expenditures on the elderly vary

systematically with measures at their earning ability

WOMEN

Gender bias

Women provide household tasks which men earn income

Even both are engaged on monetary employment but wages

to women are lower
NUTRITIONAL DEPRIVATION

nutrition intake vs. nutrition requirement

- Not enough to observe that women receive less nutrition
than men
 POVERTY AND THE HOUSEHOLD
- Not enough to observe that women receive less nutrition than men
this discrepancy could be resolved if the shortfall is measured relative to stated
requirements

What are the requirements? How are the requirements measured?

SEN: Women have extra nutritional requirements like the pregnant women and
lactating mothers

allocation decisions that do not have direct opportunity costs:

a. implied cost of dowry

b. female children are not expected to pay off in larger incomes

c. infant mortality
Problems about household and poverty:

a. lack direct data on intra-household

allocation

b. no precise notion of requirements

In order to answer the problem,

supplementary research must be made with
regards to differential, educational
attainment, direct anthropometric indicator
differential nourishment or indicators of
mortality and morbidity
 How is the environment related
to health?
• “some diseases are caused by factors in the environment--
• “environmental sanitation”--- prevention of contamination of water, soil,
food from disease causing agents.
• 1st issue---lack of proper sewage systems in rural areas
• Ex: contamination of water ways and farming lands
• 2nd issue--- lack of space, ventilation, sunlight due to crowded spaces in
urban areas
• Ex. Dumpsite issues, pollution of urban water ways, air pollution due to
excessive C02 emissions
• The issues involving the environment not only involves health but also the
government’s allocation of resources for infrastructure development both
in the urban and rural areas
How is economics related to
health?
A. Humans are resources (Human Capital, Labor Force)
B. The effects of a declining life expectancy
less productive labor----
not enough people to replace the old labor
too old or too young - too old to be as productive as the
present labor force or too young to be as skilled as the
present labor force
lowers the return to investments in education----
 Invest smaller amounts per person in skills?
substitute capital for labor
 (pero magkaka-underemployment)
Private sector cutbacks on health benefits
Graph page 352—relationship between life expectancy at
birth and GNP per capita
• S.Preston---parabolic graph
• 1930-1960
• *10-25% increase attributed to improvements in health
• while 75-90% attributed to other factors: literacy/education/ spread of
health technologies/ values
• ***page 353---
• Shift from infections ,parasitic and respiratory-- cancer , heart and
circulatory and diseases
• Problem: parasitic conditions and malnutrition is hard to detect
especially for places experience these diseases as the norm .
C. EFFECTS OF HEALTH ON DEVELOPMENT

• THERE IS NO ONE WAY TO QUANTIFY THIS.

• health increases human potential
• everyone benefits from health
– more strength ,stamina, concentration
• Helps improve increase productivity in work and in
school
• Higher school attendance for children, better
concentration
• Improves quality of the human resource
• Long term effect—improve human resource for the
future
 D. HEALTH AFFECTS PRODUCTIVITY

POVERTY, CREDIT, AND INSURANCE

Credit : The poor are unable to obtain loans.

1. Lack of collateral

2 Reasons Why Collateral is Charged

a. The project to which the loan is being applied may
be genuinely unsuccessful.
b. Collateral is a means to prevent intentional default
on the part of the borrower.

2. Incentives to repay for the poor are limited

Energy balance

1. Energy input : Access to food is the same as access to income.

2. Resting metabolism: The energy required to maintain body
temperature, sustain heart and respiratory action, supply the
minimum energy requirements of resting tissues, and support ionic
gradient across cell membranes
3. Energy required for work: Energy needed to carry out physical labor.
4. Storage and borrowing: Well-fed people worry about energy
surplus. People who suffer undernutrition worr about energy deficit.
Nutrition and work capacity

• If a low-income-undernutrition-low-income circle
is possible in poor countries, why is it not
possible for some groups of people in rich
countries?
– A low-income-undernutrition-low-income
circle cannot exist in isolation because of the
overall supply of labor.
– If the labor market is tight, the returns to
work are high even though a person may
have low work capacity to start with. These
high returns permit the individual to have
adequate nutrition and then raise his work
capacity over time.
• Can’t people simply borrow their way out of the vicious circle?
– The credit market may simply be closed to poor individuals.
– There may be no way to make the undernourished poor better off
without some amount of redistribution from the portion of the
population with greater access to income and assets. (Pareto
optimal)

• If work capacity affects future work output, won’t employers wish to

offer long-run contracts that take advantage of this?
-It is unlikely that an employer will make a long-run contract with his
employee just to extract future gains from enhanced work capacity
because there is no guarantee that the employee will be around on
the next day.
-If a person in good health can be identified by other employers, the
market will bid up the wage rate for such an employee.
• If such long-run relationships were somehow
in place for other reasons, would this have an
effect on nutritional status?

– It might, but in a relationship where

nutrition is used positively by the employer
to build up work capacity on the part of her
employee, there must be a separate factor,
or set of factors, that makes the
relationship inflexible in the sense that the
employee is costly to replace.
But how do you measure? - Problems with measuring Social costs and
Social BenefitsSSS
• difference in data (between different countries---( ex. South East Asia and
China)
• little or no observed change in productivity
• humans can adopt ( despite health conditions humans have the ability to
adopt or at extreme cases even ignore their disease and continue to work)
• ---Still health is something desirable----
AND ANOTHER THING:

Health expenditures can increase the availability or productivity of non-

human resources
-e.g. unusable land with endemic disease causing agents page 357
-“Prevention is better (and cheaper) than the cure…
-Savings can be invested somewhere else
HEALTH AS A SOCIAL COST
• Reduces death rate , inc. population growth
• A decline in death rates may encourage a drop in
fertility--- (still the change is relatively small)
• Values and ethical considerations on controlling
population and birth must also be considered

SOME INDICATORS THAT WE COULD MEASURE (look at)

• MALNUTRITION
• Average Daily Calorie intake increased in the 1960s at all
levels of gdp per capita
• 1989---ADCI exceeds the minimum daily requirements of
approximately 2,300 in almost all countries w/ GDP per
capita of ppp $ 2000
• *those with less than ppp$1000 (ss Africa and SE asia) fall
below minimum
Example:
• ADCI- * people can live on less than the minimum daily requirements
• 1st issue--- Asians are relatively smaller (although asian “smallness” of weight and
height is not entirely genetic but is also rooted on nutrition----- case of JAPAN and KOREA…
• 2nd issue---average calorie intake do not tell us how the calories ( IN THE
FOOD) is distributed
• *disparity between rich and poor in low income countries---poor people can eat less
than 2000 calories a day while the rich can still each as much as 3500 even though they
are both from a relatively low income country
• *so we should look at the malnourished people
• E.g. Children
• stunted---too short for their age
• underweight—too light for their age
• PCM---- protein calorie malnutrition---observing should also consider other nutrients
not just calories..
• *lack of specific nutrients
• -causes different diseases
• *lack of vitamins- causes blindness, lack of iron causes anemia table—page 361
• *usually mas tinitignan ang calories as measures for malnutrion kesa sa ibang nutrients
FOOD CONSUMPTION—people need to eat
• income determines food consumption
• income elasticity for food is low
• Changes in price of food alter a household’s
purchasing power
• * the price of staple foods are basic indicators of
welfare among the poor and the political stability in most
low income countries
• Substitution effect—SHIFT OR GO HUNGRY
• E.g. A. Sen--- famine---“precipitous drop in overall
food supply”--- in most famines, there are actually no drop
in food supply but rather there is disparity in the
accessibility and distribution
• FOOD Security--- condition where all people have
access to enough food at all times to permit a healthy
lifestyle
• Prices and consumption—do not necessarily
determine nutrition Quantity and Quality
• Cultural beliefs and tastes also affect consumption
• “INCOME+ PRICES+TASTES”---refer to somebody
else’s report
 HEALTH AND MEDICAL SERVICES- SOME
ISSUES

• MEDICAL SERVICES----relatively low spending on medical

services-----TABLE p. 367
• -Costly Costs of going to hospitals
• -Uneven access and distribution
• Concentration on urban centers
• Urban bias--- elites, nationalism
-Elites are usually based in the urban centers
-Nationalism- “Kaya rin namin yan” attitude
• -technology mindedness, transfer of inappropriate
technology?
-trade off :high technology in urban centers versus more
facilities to take care of smaller more common
diseases in rural areas
• referrals—patients in rural areas are often referred to
the clinics and hospitals at the urban centers
• ***POOR people are left with less than favorable
ALTERNATIVES
• --- albularyo, herbalists etc…???? cheaper, nearer in
rural areas
• -low expenditures -- little or no improvement for
facilities –especially in rural areas)
• -doctors of poor countries ---tend to leave for
abroad--- greener pastures…
• -balance between preventive and curative
treatment: prevention is better( and cheaper than
the cure)
POLICY IMPLICATIONS
 1. Distinctions should be made on the temporary and
chronic poverty problems (temporary are caused by
economic shocks that are subtle)

2. in light of the known discrimination against women in

the household, additional intrahousehold data must be
obtained

3. Additional indicators for Intrahousehold studies need

to be in place:
- Differential educational attainment
- Direct anthropometric indicators of differential
nourishment
- Differential mortality and morbidity indicators
4. Absolute notions of poverty should be supplemented by relative and
subjective notions to capture distortions
 
5. A national policy on iron supplementation for infants and young children
should be put in place.

6. Allocation of budget to the poor through Intrahousehold data

7. Distribution between rural and urban areas

8. Utilizing health auxiliary workers

9. Information dissemination
10. Women empowerment in government policies through
improvement of living conditions, health car e and safer water
supply

11. Education of women that in turn affect the entire household

through proper child care

12. To combat hunger, production must be increased through :

a. focusing on technology that raise agricultural
productivity
b. directing more resources to agriculture
c. preventing environmental degradation
d. sharing resources more equitably (giving access to
land women and the landless)- this reduces poverty and improves
distribution of income
e. addressing global warming and reducing agricultural
tariffs and subsidies in rich countries

13. Providing farmers roads, warehouses, electricity and

communication to bring them closer to markets
14. Utilization of the international community  to address to key issues that
affect developing countries:
a. agricultural subsidies in rich countries inhibit agricultural growth
thus affecting food security and farm productivity
b. Global warming caused by greenhouse gases heavily emitted by
developed countries worsen weather conditions ushering more natural
disasters

15. We already have the MDGs in place, all we have to do is to make sure that
the government is doing its part in upholding these goals :
Goal 4 : Reduce Child Mortality
Goal 5 : Improve maternal health
Goal 6 : Combat HIV/AIDS, malaria and other diseases
16. Many of the major causes of death in developing countries
should have been preventable if there were readily available
bednets, antibiotics, trained attendants, basic hygiene and
health education

17. Increase of public spending on health

18. Seeking official development assistance for poor countries

19. Opening for the poor access to clean water and sanitation
by :
a. increasing resources (low cost technology or waste
water treatment infrastructure
b. Increasing inequity (taxes should be payed in full by
the rich, women and girls in the household are being
discriminated in their access to water and sanitation)
c. maintenance of water and sanitation delivery systems
d. limiting environmental damage- rational water use