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Chapter 5: Poverty and its Effect on Nutrition: Some Questions Based on the Asian Experience24, by Rizwanul Islam25


Introduction
Interlinkage between Poverty and Nutrition: A Conceptualization
The Record on Poverty Alleviation In Asia
Effect of Poverty on Nutrition
References

24 An earlier version of this paper was presented at the Symposium on Nutrition and Poverty in connection with the UN ACC/SCN 24th Session, Kathmandu, 17-21 March 1997.

25 Deputy Director, Development Policies Department, International Labour Office, Geneva. Views expressed in this paper do not necessarily reflect those of the ILO.

Introduction

In commonsense parlance, nutritional status is usually associated with food intake which, in turn, is taken to be dependent on income. And hence poverty is regarded as a major cause of low level of nutrition. In reality, the situation may of course be different as certain aspects of nutrition may be influenced by factors other than food intake.26 Also, level of income may not be the only determinant of food intake. The issue of the effect of poverty on nutrition is thus less straightforward than it might appear.

26 For a good overview of various strands of theories in this regard, see Osmani (1997).
As there are different measures/indicators of both poverty and nutritional status, some order may be brought into an analysis by first selecting the measure(s) that will be used. One commonly used measure of poverty is the so-called "head-count ratio" which uses the notion of poverty line. The latter, in turn, is usually determined with reference to a nutritional norm converted into a minimum food basket and income needed to ensure access to such a basket (and, of course, other items of basic needs). People (or households) having incomes below the level thus determined are identified as poor - according to this measure.

Nutritional status can be indicated in various ways. One simple indicator is the number of calories consumed by an individual during a given period of time. In addition, one may want to look at the intake of protein and nutrients. Level of child nutrition - indicated by their weight for age or height - is often used as an important index of the nutritional status of a society. Other indicators, e.g., neonatal and postnatal mortality, infant mortality, low birth weight of babies could also be used.

For purposes of the present paper, I shall concentrate basically on availability/intake of calories and child nutrition.

While the main purpose of the present paper is to examine the effect of poverty and nutrition, it starts by attempting a conceptualization of the interlinkage between poverty and nutrition; the record on poverty alleviation in Asia is then reviewed, and finally the effect of poverty on nutrition is examined.

Interlinkage between Poverty and Nutrition: A Conceptualization

Figure 10 depicts a framework for conceptualizing the interlinkage between poverty and nutrition. In this framework, nutritional intake and status is both an effect and a cause of income-earning opportunities of individuals and households. As an outcome, the nutritional status of individuals is influenced, among other factors, by the amount and type of food that is consumed. That in turn is influenced largely by the employment and income-earning opportunities available to household members. A given level of income may of course be distributed differently by households between food and non-food items which, in turn, will affect the nutritional outcomes of given levels of income. The box on distribution of household consumption between food and non-food items which has been put between the boxes of income and individual food consumption reflects this additional aspect in the chain of causation. Finally, employment and income-earning opportunities at the household level are linked to production activities within as well as outside the household.

The level of nutrition is not only an outcome of the production-employment-income nexus, it can also influence this nexus through, for example, the relationship between workers' productivity and their nutritional intake. Indeed, individuals' energy intake (through food consumption) can influence their energy expenditure (through work). It may, therefore, be possible to influence production by improving the nutritional levels of workers.

Several development policy variables may influence the above-mentioned elements in the chain of causation between production, income, consumption and nutrition. First, in addition to income and employment, the ability of households to obtain food can be influenced by a host of policies aimed at providing the poor with access to food. Such policies may include public distribution of food at subsidized prices as well as other instruments for influencing market prices and availability of food.

Second, policies related to health and education can also influence nutritional status without necessarily working through the income-food-nutrition nexus. Female education (especially covering child care and other nutrition-related aspects) and public health interventions (e.g., those related to drinking water, sanitation and immunization) are examples of such areas of interventions which can influence nutritional outcomes without having to work through the income route.

Figure 10: Interdependence between Poverty and Nutrition

Source: Adapted from Szal and Thorbecke (1986).
What is important to note is that nutritional status is influenced by both food and non-food factors. Some of the non-food factors (e.g., education, awareness about hygiene and nutrition) go beyond the "privately consumed" items of basic needs and fall in the realm of "socially provided" basic needs. In that sense, poverty may not be the only factor affecting the level of nutrition. This is especially the case with child nutrition, and as regards postnatal, neonatal and infant mortality. One could, of course, argue that the availability of socially provided basic needs is also a reflection of the overall income/poverty of a country (as opposed to individuals or households). And in that broad sense, poverty could still be regarded as the dominant factor affecting nutrition.

The Record on Poverty Alleviation In Asia

Before coming to the empirical analysis of the effect of poverty on nutrition, it would be useful to have an overview of the record on poverty alleviation in Asia. Table 22 provides this picture in a qualitative manner for rural areas of selected countries of Asia. The picture drawn here is based on an assessment of a large number of studies. A few general conclusions may be drawn from Table 22 and the studies on which it is based. First, the performance of the Asian countries in poverty alleviation was better in the 1970s and 1980s compared to the 1960s, when only three countries had attained clear success. The situation had deteriorated in four out of the ten countries under discussion. During the 1970s, the situation improved in five countries. In the first half of the 1980s, five countries achieved a decline in poverty; and in the second half, another two countries were able to reverse the deteriorating trend.

The countries which achieved notable success in poverty alleviation included China, Indonesia, Malaysia and Thailand. India and Pakistan were also able to get out of the rising trend in poverty. On the other hand, the performance of Bangladesh, Nepal, Philippines and Sri Lanka has been disappointing.

Table 22: The Record on Alleviation of Rural Poverty in Selected Asian Countries

Country

1960s

1970s

1980s

Bangladesh



+ -

China

+

+

+

India

?

?

+

Indonesia

?

+

+

Malaysia

-

+

- +

Nepal

-

-

-

Pakistan

-

+

+ -

Philippines

=

-

? -

Sri Lanka

+

-

-

Thailand

+

+

- +

Note: - denotes deterioration; + denotes improvement; = denotes no change;? denotes unclear. Two signs for the same decade denotes a change in trend. (For example, + - denotes an improvement in the early part followed by deterioration in the later part.)

Source: Islam (1990). Updated by using Khan (1997).

Amongst the South Asian countries, India and Pakistan achieved sustained reduction in poverty in the 1980s. Although there was a temporary setback in India after the introduction of economic stabilization and structural adjustment programmes in 1991, the situation improved again in 1993-94 (Sen, 1997). Although direct evidence on poverty is not available for more recent years, it can be surmised from indirect indicators that India has been able to continue its trend of poverty reduction after 1993-94. Between 1994-95 and 1996-97, growth of GDP increased from 5 to 7% per annum. While the inflation rate remained under control, agriculture also attained satisfactory rates of growth (Bhalla, 1997).

In Pakistan, the trend of poverty reduction remained uninterrupted during 1969-70 to 1987-88. But with the introduction of the structural adjustment programme in 1987-88, the incidence of poverty started rising.

Amongst the other countries of South Asia, Nepal and Sri Lanka experienced a rising trend in the incidence of poverty. Although Sri Lanka succeeded in reducing poverty in the 1960s, the trend was reversed in the following decades. Despite the lack of time-series data on Nepal, available evidence seems to indicate that there has been no reduction in poverty during the 1970s and the 1980s. On the other hand, what has happened in Bangladesh remains a debatable subject. Some studies indicate a reduction in poverty by the mid-1980s, although others contend this finding. But after 1985-86, the weight of evidence appears to indicate a rise in poverty.

The record of South-East Asian countries in poverty alleviation is much better compared to that of South Asia. For example, Indonesia has achieved continuous improvement both in the 1970s and 1980s. In Malaysia, although the trend of improvement was broken during 1980-83, it has continued since then. Similarly, Thailand also suffered a setback during 1980-85, but poverty alleviation has continued after that (Islam, 1990). China was able to maintain the positive trend in poverty reduction up to the mid-1980s. But after that there was no further progress. Indeed, in the rural areas the rate of poverty reduction declined dramatically after 1985; and after the early 1990s, there has been no further reduction in poverty. In the urban areas, poverty reduction continued till the end of 1980s; but the number of poor increased dramatically in the early 1990s (Khan, 1997).

The experience of the Philippines is quite different from that of other South-East Asian countries. After the deterioration in the 1970s, the poverty situation improved in the 1980s; but the incidence of poverty started increasing again after 1988-89.

Effect of Poverty on Nutrition

If poverty is measured in the manner mentioned earlier (i.e., with reference to a nutritional norm and the ability of individuals or households to attain this norm), it would, almost by definition, imply a low level of nutrition. The real income of a household is indeed an important determinant of its access to food which, in turn, is a major determinant of the nutritional status of its members. The measurement of these variables is not at all straightforward; and their relationship may be influenced - among other factors - by the manner in which they are measured. As a result, empirically estimated relationships among these variables do not always lead to consistent findings. Indeed, one review of the relevant literature (Tabatabai, 1989) cited evidence both in support of and against the hypothesis of a positive relationship between income and nutritional status. Other recent studies also point to a wide range of estimates of income elasticity of demand for calories and other micronutrients.

Table 23 puts together data on per capita income and availability of calories for 12 countries of Asia, and Figure 11 provides a graphical representation of this data set. It is quite clear from this figure that the relationship between income and calorie is at least non-linear. One may of course point out that it is only natural for per capita calorie intake to taper off after a decline in level of income. While this is plausible, what is important to note is that a reasonable level of calorie intake is possible even at low levels of income if there are public policies aimed at the satisfaction of basic food needs of the poor. For example, China and Malaysia are having similar levels of calorie intake at vastly different levels of income. There is a similar pair situation in India and Thailand.

Public development policy can play a very important role, as was demonstrated by the examples of China and Sri Lanka till the late 1970s. The institutional framework of production in China in the post-revolutionary period (particularly after the introduction of the commune system) guaranteed all able-bodied workers a job, satisfying such basic human needs as food, shelter and clothing. In addition, there was effective public action to meet the needs of those unable to work. It was thus possible to remove hunger and malnutrition without achieving very high rates of growth of production or spectacular increases in incomes.

Sri Lanka is also well-known for its long history of direct public action in food distribution, education and health services. The Government distributed rice at a heavily subsidized price to the entire population from the 1940s until 1978. This policy helped to maintain an adequate level of nutrition amongst people of low-income groups.

It thus appears that it is possible to break the direct link between nutrition and income through suitable development policies. One can in fact distinguish nutritional achievement induced by income from that achieved through development policies,

Table 23: Per Capita Income and Calorie Supply in Selected Asian Countries


GNP per capita (US$)
1993

Daily calorie supply per capita
1992

1. Bangladesh

220

2,019

2. China

490

2,729

3, India

300

2,395

4. Indonesia

740

2,755

5. Malaysia

3,140

2,884

6, Mongolia

390

1,899

7. Nepal

190

1,957

8. Pakistan

430

2,316

9. Philippines

850

2,258

10. Sri Lanka

600

2,275

11. Thailand

2,110

2,443

12. Vietnam

170

2,250

Source: UNDP, Human Development Report 1996. Oxford University Press.
Also, in certain situations, increases in household income may not lead to improvements in the nutritional level of individual members. For example, gender bias (towards male members) in the infra-household distribution of food may lead to lower levels of nutrition amongst women than should be possible at given levels of income. Similarly, "demonstration effects" may divert disproportionately large shares of income to non-food items of consumption in low-income households. While it may be difficult to subject such hypotheses to rigorous empirical testing, the importance of social and cultural factors in explaining variations in nutritional levels cannot be denied completely.

Figure 11: Per Capita Income and Calorie Supply in Selected Asian Countries

Note: The numbers refer to the countries for which data are presented in Table 23.
Coming to the question of child nutrition, the importance of non-income factors has already been demonstrated by some studies (e.g., the studies under a recent research project of the Asian Development Bank)27. While the level of maternal education can be an important explanatory variable, female participation in the labour force can also exert a significant influence on child nutrition. The latter is borne out by the experience of Grameen Bank borrowers in Bangladesh, where credit extended to women's economic activities is seen to have contributed to improvements in the nutritional status of poor households.28 Also, the fact that the prevalence of child malnutrition in South Asia is higher than in Sub-Saharan Africa should cast doubt on the direct link between income and child malnutrition. One has to look for factors other than income.
27 See in particular, Bhargava and Osmani (1997).

28 The experience of another NGO (BRAC) in Bangladesh shows that life-relevant education which includes child care practices can lead to improvement in the health of children.

References

Bhalla G S (1997) Structural Adjustment and the Agricultural Sector in India, in Chadha and Sharma (1997).

Bhargava A and Osmani S R (1997) Health and Nutrition in emerging Asia. Mimeo, Asian Development Bank, Manila.

Chadha G K and Alakh N Sharma (eds.) (1997): Growth, Employment and Poverty: Change and Continuity in Rural India. Vikas Publishing House, New Delhi.

Islam Rizwanul (1990): Rural Poverty, Growth and Macroeconomic Policies, International Labour Review, vol. 129, No. 6.

Khan A R (1997) Macroeconomic Policies and Poverty: An Analysis based on the Experience in Ten Asian Countries. Paper presented at the ILO Asian Regional Policy Workshop on Poverty Alleviation, 5-7 February 1997.

Osmani S R (1997) Poverty and Nutrition in South Asia. Abraham Horwitz lecture delivered at the Symposium on Nutrition and Poverty held on the occasion of UN ACC/SCN 24th Session, Kathmandu, 17-21 March 1997.

Sen A (1997) Structural Adjustment and Rural Poverty: Variables that Really Matter, in Chadha and Sharma (1997).

Szal, Richard and Erik Thorbecke (1986) Food, Nutrition and Employment. Mimeo, ILO, Geneva.

Tabatabai, Hamid (1989) Economic Indicators of Access to Food and Nutritional Status. UN/ACC/SCN Working Paper.

UNDP (1966) Human Development Report 1996. Oxford University Press.


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