Income inequality and nutritional status for India’s women

Economic growth does not always improve nutrition for everyone. Diseases of poverty and wealth often co-exist in rapidly-developing economies. Data from Indian women show that income inequality increases the risks of both obesity and under-nutrition.

Researchers at Harvard School of Public Health, in the USA, and the University of Bristol, in the UK, analyse data from the 1998-1999 Indian National Family Health Survey, covering 77,220 women aged 15 to 49 years from 26 Indian states. They look at the impact of the state-wide Gini coefficient on body mass index (BMI). The Gini coefficient estimates inequality among incomes across a community or society by looking at differences in how much households spend. BMI is a measure of obesity (weight in kilograms divided by height in metres squared), the classifications of which are ‘underweight’ (BMI < 18.5), ‘normal weight’ (BMI 18.5-22.9), ‘pre-overweight’ or ‘at risk of being overweight’ (BMI 23-24.9), ‘overweight’ (BMI 25-29.9) and ‘obese’ (BMI ≥30). Their findings include the following.

• When the Gini increases by about three percent, the odds of being underweight or overweight both increase by 19 percent and the odds of being obese grow by 21 percent.
• People living in states with higher absolute levels of spending per capita have a greater risk of being pre-overweight, overweight, or obese, but have the same risk of under-nutrition.
• At the individual level, higher levels of education or standard of living cut the risk of being undernourished and increase the risk of being over-nourished.

The researchers conclude that the co-existence of under- and over-nutrition probably reflects the unequal sharing of food and other resources important to nutritional status. Poor people are even more likely to be underweight and rich people are even more likely to be overweight in a society with unequal resources. In addition, they point out the following.

• Income inequality is also a marker of social cohesion; unequal societies may have inefficient or less generous public distribution systems.
• The non-poor are more likely than the poor to use public systems designed to provide shelter, water, sanitation and sewerage, health care and food grains, suggesting that public distribution systems in many communities are poorly designed to meet the needs of the poor. For example, coverage of the Indian Integrated Child Development Scheme is highest in states with lowest levels of under-nutrition and those with high economic growth.
• Rather than reducing under-nutrition by ‘trickle-down’, economic growth seems to give greatest nutritional benefits to better-off sections of the population.

They recommend that policy-makers pushing overall economic growth should also try to ensure equity if they wish to optimise health outcomes in rapidly developing economies.

Source(s):
‘Income Inequality and the Double Burden of Under- and Over-nutrition in India’, Journal of Epidemiology and Community Health 61, pages 802-809, by S. V. Subramanian, I. Kawachi and G. Davey Smith, 2007

Funded by: National Institutes of Health

id21 Research Highlight: 21February 2009

Further Information:
S V Subramanian
Department of Society, Human Development and Health
Harvard School of Public Health
677 Huntington Avenue
Kresge 7th Floor
Boston
MA 02115-6096
USA

Contact the contributor: svsubram@hsph.harvard.edu

Department of Society, Human Development and Health, Harvard School of Public Health, Boston, USA

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