Farming and Welfare Impacts of Prime-Age Adult Morbidity and Mortality Among Farm Households

1. Farming and Welfare Impacts of Prime-Age Adult Morbidity and Mortality Among Farm Households Suneetha Kadiyala November 12th, 2013

2. Health and Agriculture: The setting

3. Causes of mortality in LMICs Source: WHO, 2013

5. Over half the population in LMICs lives in rural areas

6. LMIC population is heavily dependent on agriculture Employment in agriculture, share of total employment (% 2005-2010) Source: FAO , 2013

7. Health and Agriculture: Frameworks

8. Illness Source: Adapted from Loevinsohn and Gillespie

9. Susceptibility to diseases Effect on Assets Illness Human, Financial, Social, Natural, Physical Effect on Institutions Community Based, Service Delivery, Participation Outcomes Agriculture production; food security; investments in livelihoods and human capital ; Nutrition Responses Individual, Household, Community

10. Source: Russell, 2004

11. Human capital Mortality, morbidity Loss of knowledge transfer Time diverted from production to caring Financial capital High expenses Sell assets Credit constraints Morbidity and mortality can affect the 5 capitals

12. Social capital Loss of role modeling Fewer incentives for collective action Exclusion due to stigma Physical capital Sale of equipment Property rights and dwelling Natural capital Land use Cropping patterns Natural resource management ….continued…

13. Health and Agriculture: Some stylized empirical findings • Poverty traps and HIV literature

14. Households incur substantial costs due to morbidity Direct costs refer to household expenditure linked with seeking treatment, including non-medical expenses such as transport or special foods. Indirect costs refer to the loss of household productive labour time for patients and caregivers. E.g. In Burkina Faso (Su et al. 2007) • The mean number of days of work lost for a sick person was 11 days • Mean days of work lost for a caretaker was 6 days Catastrophic costs: > 10% of household income Time to diagnosis, duration of illness and prevalence among economically active population affect costs

15. Households incur substantial costs due to morbidity Source: Russell, 2004

16. Morbidity/mortality has heterogeneous effects on agriculture production In Kenya, death of a working-age adult was: • Not associated with total land cultivated • But land under high-value crop production was reallocated to cereals • Loss of $120 in net revenue • The death of a household head reduced net crop output by 68% • A 28.5% decline in the value of farm equipment and 43% decline in value of livestock ;Approximately 35 % reduction in off-farm income • Temporal effects: 5-7 years after death of a male household head, decline in area cultivated cash crops. Similar studies in Zambia, Rwanda and Mozambique In Ghana, a percentage increase in the number of days ill during crop harvesting phase decreases the value of total agricultural production by about 2% Source: Yamano and Jayne 2004; Kirimi et al 2008; Donovan et al. 2005; Darko et al. 2013; Dorward and Mwale 2006

17. Morbidity/mortality has heterogeneous effects on agriculture production But in Uganda and Tanzania, long-term negative impacts due to HIV were not discernable Similar findings in a review of impact of malaria • But macro models show a significant impact on GDP growth rates No negative impact, but has overall development been stunted due to poverty trap? • In Zambia, mortality of prime-age adults as well as their chronic illness increases a household’s probability of being trapped in chronic poverty • Lower wage rates: 10 % lower wage rates due to disability in West Africa; Fall in wage rates of unskilled labour in Malawi • Lower earnings: over 17% lower earnings one year before termination due to AIDS related illness among tea pluckers in Kenya Source: Seeley et al 2010 ; Chima et al 2003; Chapoto et al 2011;Schultz and Tansel (1997); Dorward and Mwale 2006; Fox et al.2004

18. Health is the common key factor of descent into poverty Among households that fell into poverty in 20 villages of Western Kenya, 73 per cent cited ill health and high healthcare costs as the most important reason or descent Ill health and health-related expenses were associated with: • nearly 60 per cent of all descents recorded in Rajasthan, India • 74 per cent of all descents examined in Andhra Pradesh, India • 71 and 67 per cent of all descents investigated, respectively, in communities of Uganda and Peru In Gujarat, another Indian state, where Source: Krishna 2004; 2005, 2006

19. Illness affects human capital formation In Ethiopia, adult mortality among agrarian households • Reduced dietary diversity • Predicts child survival • Negatively affected linear growth among the poorest tertile Labour substitution has long-term consequences • In South Africa, prime-age adult mortality significantly increase both male and female adolescents’ labour force participation as they stop their schooling • In Malawi, adult mortality mortality lowers marriage age Kadiyala et al 2010; Kadiyala et al. 2011; Yamauchi et al. 2007

20. Some discussion points Overall, the research on the impact of morbidity and mortality on agriculture production, economic development and household welfare has slowed down Disconnects between macro simulations and micro studies Better way to measure full cost of morbidity and mortality needed, for which we need the LCIRAH mantra Focus on infectious diseases is essential, but not enough What is role of health policy and what is the role of agri-food policy? • Health policy could mitigate direct costs • Agri-food and health policies could prevent ill-health • But indirect costs are substantial