7. Health and nutrition (H. Ameye)
Note: the whole time we will talk about %-point, not % (but I always wright %)!!!
1. Introduction
World Health Organization (1948) defines health as: “Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity.”
- Fundamental human right
- Fundamental in the attainment of peace and security
- It is a value to all (major risk to help now during COVID)
- High levels of health inequalities
Why study health and development?
- Health tends to be lower in developing countries:
They have widespread disease:
o Geo-climatic environment: along the equator, hot climate which is good for the spread
of the disease
o Institutions: less developed so function less well, corruption where resources don’t go
to building hospitals etc.
o War: disabilities, act of violence so breakdown of the systems, starvation, spread of
pandemics, depression increases after the conflict, …
Children and young adults most affected: insecure future (non-HIV life expectancy/mortality: if
you are only going to live 50 years, you are going to invest less in your future than if you were
going to be 70 years old. This gives behavioral responses! In manufacturing and agriculture,
health is more important than in countries running in the services sector because they have
manual labor (need to be strong))
Typically more physically demanding work: good health and nutrition even more important
- Vicious cycle of underdevelopment and bad health = Health-poverty-trap: health affects poverty and
poverty affects health.
At both macro- and micro level
Health and income are endogenous variables
Model of nutrition, health and income
Micro-level: Formal model of the relationship between health and earnings. How health and income affect
each other!
L = labor input per worker (e.g. hours of labor input)
h = health
E = earnings per worker
,Assume labor is only input (not capital) and earnings are linearly related to labor input:
- W = the wage per unit of labor input
Determinants of health:
- α = elasticity of health with respect to earnings
- X = other factors which affect health (medical technology, vaccines, medication, …)
Relationship between workers' health and their labor input:
β = elasticity of labor input with respect to health
Three endogenous variables: health, labor input, and earnings
Solving the three equations, we can find earnings as a function of the parameters of the model:
Then we can examine the effect of different changes that the economy might experience. F.e.: change in
wages W:
Recall that the parameter X represents factors other than earnings which affect health.
As in previous slide, we can solve for health with respect to these external factors (X):
= They influence each other in a feedback mechanism
, Health improvements have a direct effect but also an indirect effect:
- Healthier workers supply more labor input and earn higher wages
- Higher earnings will also feedback to even better health
This model shows how the variables influence each other!
Macro-level:
Historical examples: Robert Fogel, quantified the contribution of better nutrition to economic growth in the UK
between 1780 and 1980
- In 1780, 20% of the adults were unable to do any work because of malnutrition
- In 1980, this was no longer an issue
- So the production per worker increased (over these 200 years) by 56% due to better nutrition
- Improved health (nutrition) explains almost half (%) of the eco growth in production over this period
“Health and welfare during Industrialization” by Steckel & Floud (2008)
WHO Core Health Indicators:
- We need measures/indicators to determine and analyze health.
- Global reference list of 100 core indicators by the global community to provide information about the
health situation and trends.
- Health status: life expectancy, fertility, state of certain diseases, morbidity, …
- Risk factors of health: nutrition, infections, environmental risk factors, noncommunicable diseases,
injuries, …
- Service coverage: HIV, TBC, Malaria, …
- Health systems: quality and safety of care, access, health workforce, health information, …
, Health
The average number of life expectancy at birth for every country that has the data:
- The average number of years that a newborn is expected to live if current mortality rates continue to
apply.
- Large disparities!
- The darker: the higher the life expectancy (Canada, Japan, Oceania, …)
- The lighter: the lower the life expectancy (Africa, South Asia)
Healthy life expectancy (HALE) at birth
- Doesn’t take into account the quality of life!
- Average number of years that a person can expect to live in "full health" by taking into account years
lived in less than full health due to disease and/or injury.
- The illnesses are much more common in developing countries!
- The previous inequality
- Low: Africa, Middle East and Asia: due to a high disease burden OR due armed conflice/violence.
Measure of health:
Note: the whole time we will talk about %-point, not % (but I always wright %)!!!
1. Introduction
World Health Organization (1948) defines health as: “Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity.”
- Fundamental human right
- Fundamental in the attainment of peace and security
- It is a value to all (major risk to help now during COVID)
- High levels of health inequalities
Why study health and development?
- Health tends to be lower in developing countries:
They have widespread disease:
o Geo-climatic environment: along the equator, hot climate which is good for the spread
of the disease
o Institutions: less developed so function less well, corruption where resources don’t go
to building hospitals etc.
o War: disabilities, act of violence so breakdown of the systems, starvation, spread of
pandemics, depression increases after the conflict, …
Children and young adults most affected: insecure future (non-HIV life expectancy/mortality: if
you are only going to live 50 years, you are going to invest less in your future than if you were
going to be 70 years old. This gives behavioral responses! In manufacturing and agriculture,
health is more important than in countries running in the services sector because they have
manual labor (need to be strong))
Typically more physically demanding work: good health and nutrition even more important
- Vicious cycle of underdevelopment and bad health = Health-poverty-trap: health affects poverty and
poverty affects health.
At both macro- and micro level
Health and income are endogenous variables
Model of nutrition, health and income
Micro-level: Formal model of the relationship between health and earnings. How health and income affect
each other!
L = labor input per worker (e.g. hours of labor input)
h = health
E = earnings per worker
,Assume labor is only input (not capital) and earnings are linearly related to labor input:
- W = the wage per unit of labor input
Determinants of health:
- α = elasticity of health with respect to earnings
- X = other factors which affect health (medical technology, vaccines, medication, …)
Relationship between workers' health and their labor input:
β = elasticity of labor input with respect to health
Three endogenous variables: health, labor input, and earnings
Solving the three equations, we can find earnings as a function of the parameters of the model:
Then we can examine the effect of different changes that the economy might experience. F.e.: change in
wages W:
Recall that the parameter X represents factors other than earnings which affect health.
As in previous slide, we can solve for health with respect to these external factors (X):
= They influence each other in a feedback mechanism
, Health improvements have a direct effect but also an indirect effect:
- Healthier workers supply more labor input and earn higher wages
- Higher earnings will also feedback to even better health
This model shows how the variables influence each other!
Macro-level:
Historical examples: Robert Fogel, quantified the contribution of better nutrition to economic growth in the UK
between 1780 and 1980
- In 1780, 20% of the adults were unable to do any work because of malnutrition
- In 1980, this was no longer an issue
- So the production per worker increased (over these 200 years) by 56% due to better nutrition
- Improved health (nutrition) explains almost half (%) of the eco growth in production over this period
“Health and welfare during Industrialization” by Steckel & Floud (2008)
WHO Core Health Indicators:
- We need measures/indicators to determine and analyze health.
- Global reference list of 100 core indicators by the global community to provide information about the
health situation and trends.
- Health status: life expectancy, fertility, state of certain diseases, morbidity, …
- Risk factors of health: nutrition, infections, environmental risk factors, noncommunicable diseases,
injuries, …
- Service coverage: HIV, TBC, Malaria, …
- Health systems: quality and safety of care, access, health workforce, health information, …
, Health
The average number of life expectancy at birth for every country that has the data:
- The average number of years that a newborn is expected to live if current mortality rates continue to
apply.
- Large disparities!
- The darker: the higher the life expectancy (Canada, Japan, Oceania, …)
- The lighter: the lower the life expectancy (Africa, South Asia)
Healthy life expectancy (HALE) at birth
- Doesn’t take into account the quality of life!
- Average number of years that a person can expect to live in "full health" by taking into account years
lived in less than full health due to disease and/or injury.
- The illnesses are much more common in developing countries!
- The previous inequality
- Low: Africa, Middle East and Asia: due to a high disease burden OR due armed conflice/violence.
Measure of health:
