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

2. Health and Agriculture: The setting

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

5. 5 Over half the population in LMICs lives in rural areas Rural population Rural population growth (annual %) % of total 20002011 World53480.2 Low income76721.7 Middle income5851-0.1 Lower middle income66610.8 Upper middle income5140-1.5 Low & middle income61540.3 East Asia & Pacific6351-1.3 Europe & Central Asia42400 Latin America & Caribbean2521-0.2 Middle East & North Africa44411.1 South Asia73690.8 Sub-Saharan Africa68642

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

7. Health and Agriculture: Frameworks

8. Illness Source: Adapted from Loevinsohn and Gillespie

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

10. Source: Russell, 2004

11. 11 Morbidity and mortality can affect the 5 capitals 1. Human capital – Mortality, morbidity – Loss of knowledge transfer – Time diverted from production to caring 2. Financial capital – High expenses – Sell assets – Credit constraints

12. 12 ….continued… 3. Social capital – Loss of role modeling – Fewer incentives for collective action – Exclusion due to stigma 4. Physical capital – Sale of equipment – Property rights and dwelling 5. Natural capital – Land use – Cropping patterns – Natural resource management

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

14. 14  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 Households incur substantial costs due to morbidity

15. 15 Households incur substantial costs due to morbidity Source: Russell, 2004 CountryDirect costsIndirectTotal All Illnesses Burkina Faso (Sauerborn, 1995) $5.70 (3.7%)$12.53 (8.1%)$18.26 (11.8%) Nigeria (Onwujekwe, 2000) $4.54 (7.0%)$2.41 (3.7%)$6.95 (10.7%) Sri Lanka (Russell, 2001) $7.66 (6.5%)$5.21 (5.0%)$12.87 (11.5%) Tuberculosis Thailand (Kamolratanakul, 1999) $131 (8.6%)$53 (2.3%)$184 (10.9%) India (Rajeswari, 1999) $60 (13%)$117 (26%)$177 (40%) Zambia (Needham, 1998) $49 (8.3%)$28 (4.8%)$77 (13.1%)

16. 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. 17  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 Morbidity/mortality has heterogeneous effects on agriculture production 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. 18  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 Health is the common key factor of descent into poverty Source: Krishna 2004; 2005, 2006

19. 19  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 Illness affects human capital formation Kadiyala et al 2010; Kadiyala et al. 2011; Yamauchi et al. 2007

20. 20  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 Some discussion points