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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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O
U
T
L
I
NE
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
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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
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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)
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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
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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
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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)
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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)
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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)
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HEALTHIN
DEVELOPING
COUNTRIES
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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
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(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
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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
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ISSUES ON HEALTH
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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� 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 .
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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
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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
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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.
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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.
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� 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.
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� 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.
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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
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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
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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
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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
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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
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� ***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)
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POLICY IMPLICATIONS
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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
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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
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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
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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
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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