power point presentation in econ 191

8/8/2019 Power point presentation in ECON 191

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HEALTH, NUTRITION AND

DEVELOPMENT

BALINO, LAZARO, MARTINEZ, VALENZUELA



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I. INTRODUCTION

What is health?

What are the indicators of health according to international

standards?What are the indicators of health according to the Philippines,

DOH?

II. TRENDS IN DEVELOPING COUNTRIES

III. ISSUES

How is poverty related to health?How is the environment related to health?

How is economics related to health?

- Health and development

- Health and productivity

- Health and government spending/ medical budgetIV. POLICY IMPLICATIONS

Allocation of budget to the poor

Distribution between rural and urban areas

Utilizing health auxiliary workers

Information dissemination



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) = Male84,241,341 (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 DeathsTotal 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 inthe 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

2000Selected 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)



HEALTHIN

DEVELOPING

COUNTRIES



In most developing countries that are dependent onagriculture, 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 1985PPP 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 inlow 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 countryCountries 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 theconcept of what constitutes ones basic needs including food, shelter

and clothing may be dependent on the societys 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 onagriculture, 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 ahousehold 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; its addressing thepoverty 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 persons capacity to work hence

perpetuate state of poverty

Disclaimers:

a. The relationship between increases in income and increases innutrition 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 persone. 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 automaticallytranslate 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, govt)

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

substitute these sources meaning that an elasticity of 0.6 and0.8 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 byhousehold 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 buyingmore 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 HOUSEHOLDThe poor may not afford to share poverty equally

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

Unequal divisions potential merit is that it helps some individuals to beminimally 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 indicatordifferential nourishment or indicators of

mortality and morbidity



How is the environment related

to health?� ³some diseases are caused by factors in the environment--

� ³environmental 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 inurban 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 asthe present labor force or too young to be as skilledas 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 352relationship between lifeexpectancy 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 detectespecially 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 inschool

� Higher school attendance for children, betterconcentration

� Improves quality of the human resource

� Long term effectimprove human resource for thefuture



POVERTY, CREDIT, AND INSURANCE

Credit : The poor are unable to obtain loans.

1. Lack of collateral

2 Reasons Why Collateral is Chargeda. The project to which the loan is being applied may

be genuinely unsuccessful.

b. Collateral is a means to prevent intentional defaulton the part of the borrower.

2. Incentives to repay for the poor are limited

D. HEALTH AFFECTS PRODUCTIVITY



Energy balance

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

2. Resting metabolism: The energy required to maintain bodytemperature, sustain heart and respiratory action, supply theminimum energy requirements of resting tissues, and support ionicgradient 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 circleis possible in poor countries, why is it notpossible for some groups of people in richcountries?

± A low-income-undernutrition-low-incomecircle cannot exist in isolation because of theoverall supply of labor.

± If the labor market is tight, the returns towork are high even though a person mayhave low work capacity to start with. Thesehigh returns permit the individual to haveadequate nutrition and then raise his workcapacity over time.



� Cant 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. (Paretooptimal)

� If work capacity affects future work output, wont 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 capacitybecause there is no guarantee that the employee will be around onthe next day.

-If a person in good health can be identified by other employers, themarket 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 employerto 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 andChina)

� 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 alllevels of gdp per capita�1989---ADCI exceeds the minimum daily requirements of approximately 2,300 in almost all countries w/ GDP per capitaof ppp $ 2000

�*those with less than ppp$1000 (ss Africa and SE asia) fallbelow minimum



Example:

� ADCI- * people can live on less than the minimum daily requirements

� 1st issue--- Asians are relatively smaller (although asian smallness of weight andheight 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 THEFOOD) is distributed

� *disparity between rich and poor in low income countries---poor people can eat lessthan 2000 calories a day while the rich can still each as much as 3500 even though theyare both from a relatively low income country

� *so we should look at the malnourished people

� E.g. Children

� stunted---too short for their age

� underweighttoo light for their age

� PCM---- protein calorie malnutrition---observing should also consider other nutrientsnot just calories..

� *lack of specific nutrients

� -causes different diseases

� *lack of vitamins- causes blindness, lack of iron causes anemia tablepage 361

� *usually mas tinitignan ang calories as measures for malnutrion kesa sa ibang nutrients



FOOD CONSUMPTIONpeople need to eat

� income determines food consumption

� income elasticity for food is low

� Changes in price of food alter a households

purchasing power� * the price of staple foods are basic indicators of

welfare among the poor and the political stability in mostlow income countries

� Substitution effectSHIFT OR GO HUNGRY

� E.g. A. Sen--- famine---precipitous drop in overall

food supply--- in most famines, there are actually no dropin food supply but rather there is disparity in theaccessibility and distribution

� FOOD Security--- condition where all people have access to enough food at all times to permit a healthy

lifestyle

� Prices and consumptiondo not necessarily determine nutrition Q uantity and Q uality

� Cultural beliefs and tastes also affect consumption

� INCOME+ PRICES+TASTES---refer to somebody elses 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 versusmore facilities to take care of smaller more commondiseases in rural areas�referralspatients in rural areas are often referred to theclinics and hospitals at the urban centers



� ***POOR people are left with less than favorableALTERNATIVES

� --- 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

productivityb. 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 incomee. 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 bydeveloped 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 MortalityGoal 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 healtheducation

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 bythe 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

power point presentation in econ 191

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