HEALTH POLICY FOR THE DEVELOPING COUNTRIES

Investment in health constitutes an important component of investment in human capital. The state of health which is considered a stock, depreciates over time and at an increasing rate in later life. Investments in health would broadly include child care, nutrition, clothing, housing, medical services, and the use of one’s own time. “Healthy time” or “sickness-free time” contributes towards work, consumption and leisure activities.

The most important advance in population quality has been the increase in life span of people in low income countries. This reveals improvements in health. Since about 1950, life expectancy at birth has increased 10 percent or more in many LDCs. People of Western Europe and North America never attained so large an increase in life expectancy in so short a period. In India life expectancy at birth of males rose by 43 percent and that of females by 41 percent from 1951 to 1971.

Longer life spans provide additional incentives to acquire more education as investments in future earnings. The additional health capital and other forms of human capital tend to increase the productivity of the workers. Longer life spans result in more years of participation in the labour force and reduces “sick” time. Better health of workers in turn leads to more productivity per man hour at work.

Poverty is the major cause of disease in developing countries and more needs to be done than simple provision of medical facilities to improve health conditions. Reduction in poverty is to be seen as an overall objective of all general development and health policies in these countries. Health policies must be related much more to the environment and to the ecological, cultural and nutritional situation. Health programmes have been biased toward a small section of the urban population, which needs to be changed. Also, treatments should be widespread and ‘preventive’ rather than being ‘curative’.

Malnourishment is a major development problem. The interaction of malnourishment and infection has a far more serious effect on individuals than the combined effect of the two working independently. Consequently, the effects of nutrition actions and health programmes undertaken simultaneously are greater than the sum of their effects on the same populations would be if the actions were undertaken separately. Since integration of nutrition with health services is a particularly efficient way of using limited resources, improved nutrition should be considered an explicit objective in all relevant health work.

Substantial efforts are called forth on the part of governments and other development institutions towards addressing the health challenges being faced by the developing countries. Assistance agencies should emphasize food production, but with increased attention to those foods consumed by low-income groups and further support to projects that help to strengthen the purchasing power of the poor. They can also help government bodies fill gaps to their knowledge. Increased emphasis on nutrition is a logical extension of the effort to increase food production and consumption by those who need it. The food-health policy approach can complement and broaden other work of development-assistance agencies.

HEALTH AND PRODUCTIVITY: Investment in Health, Food and Nutrition

Human capital theory treats everyone’s state of health as capital, i.e. as a stock. Part of the quality of the initial stock is inherited and part is acquired. The stock depreciates over time and at an increasing rate in later life. Gross investment in human capital entails acquisition and maintenance costs. These investments include child care, nutrition, clothing, housing, medical services, and the use of one’s own time. The flow of services that health capital renders consists of “healthy time” or “sickness-free time”, which are inputs into work, consumption and leisure activities.

A healthy manpower is a great aspect for a developing economy as it leads to greater output per man (productivity). Poor health and undernourishment adversely affect the quality of manpower. In LDCs people are underfed and undernourished, resulting in poor quality of manpower. Deficiency in proteins and vitamins in people’s diet and lack of proper medical facilities are common. But at the same time improvements in health revealed by the longer life span of people in many low-income countries, have undoubtedly been the most important advance in population quality in these countries.

Since about 1950s, life expectancy at birth has increased 10 percent or more in many of these countries. People of Western Europe and North America never attained so large an increase in life expectancy in so short a period. In India, from 1951 to 1971, life expectancy at birth of males increased by 43 percent and that of females by 41 percent.

The favourable economic implications of these increases in life span are far reaching:
1. Longer life spans provide additional incentives to acquire more education as investments in future earnings.
2. Parents invest more in their children.
3. More on-the-job training becomes worthwhile.
4. The additional health capital tends to increase the productivity of the workers.
5. Longer life spans result in more years of participation in the labour force and bring out a reduction in “sick” time.
6. Better health and vitality of workers in turn lead to more productivity per man hour at work.

The best way to improve the quality of manpower in LDCs is to provide adequate food and better nutrition to people, better sanitary facilities and the extension of medical facilities which in turn will raise the efficiency and the productivity of the people. Such improved facilities raise the flow of earnings above what it would have been in the absence of the improvement in well-being in the following ways:
1. These return an absent worker to the active labour force,
2. Help lengthen his working life span,
3. Make him overcome a debility that is reducing his productive capacity,
4. Enable a child to return to school, improve his understanding and retention power,
5. Enable an adult to absorb more effectively in-service training.

Thus improvement in health can help to improve or maintain the productivity level of an active member of the labour force, or it can take the form of an investment – for example, helping to push up the expected lifetime earnings of a two-year-old child.

One measure of the benefits of a nutrition programme is in the medical costs saved through reduced demand for medical services. It is cheaper to prevent malnutrition than to cure it. Another potentially large nutrition benefit for developing countries is the reduction in productivity losses caused by the debility of a substantial portion of the labour force. Again, improved nutrition lengthens working years. This reduces the country’s dependency ratio, other things being equal. Lower dependency ratios increase per capita income.

In addition to direct productivity benefits, health programmes promise a number of economic benefits:
1. As the incidence of communicable diseases among the adequately nourished is lowered, the exposure of others to these diseases will be reduced.
2. The increased income of well-nourished workers (or well-nourished children when they enter the labour force) should improve the living standards of their dependents, thereby raising both their current consumption and their future productivity.
3. Mothers will improve performance on such economically important functions as the quality of care for the young when they are themselves in better health and nourishment.

Recognizing the increasing importance of skilled manpower and general labour quality for future national growth, investments in health of large numbers of malnourished children today can improve the quality of a significant fraction of the future labour force. Accordingly, health efforts should be so designed as to expand food supplies in order to benefit the poor, improving marketing system and agricultural price policies, change food preferences, improve health and environmental conditions – water, sanitation, immunization etc. The effects of nutrition actions and health programmes undertaken simultaneously are greater and the very poor, especially the rural poor should be the targets of these programmes. Substantial efforts are called forth on the part of governments and other development institutions towards this end.