The change is not driven by declining incomes; by all accounts, real incomes are increasing. Yet, though Indians are richer, they eat so much less at each level of income that they eat less on average today than they used to. Nor is it because of rising food prices—between the early 1980s and 2005, food prices declined relative to the prices of other things, both in rural and urban India. Although food prices have increased again since 2005, the decline in calorie consumption happened precisely when the price of food was going down.
So the poor, even those whom the Food and Agriculture Organization would classify as hungry on the basis of what they eat, do not seem to want to eat much more even when they can. Indeed, they seem to be eating less. What could be going on?
The natural place to start to unravel the mystery is to assume that the poor must know what they are doing. After all, they are the ones who eat and work. If they could indeed be tremendously more productive, and earn much more by eating more, then they probably would when they had the chance. So could it be that eating more doesn’t actually make us particularly more productive, and as a result, there is no nutrition-based poverty trap?
One reason the poverty trap might not exist is that most people have enough to eat.
At least in terms of food availability, today we live in a world that is capable of feeding every person that lives on the planet. On the occasion of the World Food Summit in 1996, the FAO estimated that world food production in that year was enough to provide at least 2,700 calories per person per day.10 This is the result of centuries of innovation in food supply, thanks no doubt to great innovations in agricultural science, but attributable also to more mundane factors such as the adoption of the potato into the diet after the Spanish discovered it in Peru in the sixteenth century and imported it to Europe. One study finds that potatoes may have been responsible for 12 percent of the global increase in population between 1700 and 1900.11
Starvation exists in today’s world, but only as a result of the way the food gets shared among us. There is no absolute scarcity. It is true that if I eat a lot more than I need or, more plausibly, turn more of the corn into biofuels so that I can heat my pool, then there will be less for everybody else.12 But, despite this, it seems that most people, even most very poor people, earn enough money to be able to afford an adequate diet, simply because calories tend to be quite cheap, except in extreme situations. Using price data from the Philippines, we calculated the cost of the cheapest diet sufficient to give 2,400 calories, including 10 percent calories from protein and 15 percent calories from fat. It would cost only 21 cents at PPP, very affordable even for someone living on 99 cents a day. The catch is, it would involve eating only bananas and eggs.... But it seems that so long as people are prepared to eat bananas and eggs when they need to, we should find very few people stuck on the left part of the S—shaped curve, where they cannot earn enough to be functional.
This is consistent with evidence from Indian surveys in which people were asked whether they had enough to eat (i.e., whether “everyone in the household got two square meals a day” or whether everyone eats “enough food every day”). The percentage of people who consider that they do not have enough food has dropped dramatically over time: from 17 percent in 1983 to 2 percent in 2004. So, perhaps people eat less because they are less hungry.
And perhaps they are really less hungry, despite eating fewer calories. It could be that because of improvements in water and sanitation, they are leaking fewer calories in bouts of diarrhea and other ailments. Or maybe they are less hungry because of the decline of heavy physical work—with the availability of drinking water in the village, women do not need to carry heavy loads for long distances; improvements in transportation have reduced the need to travel on foot; in even the poorest village, flour is now milled by the village miller using a motorized mill, instead of women grinding it by hand. Using the average calorie requirements calculated by the Indian Council of Medical Research for people engaged in heavy, moderate, or light activity, Deaton and Dreze note that the decline in calorie consumption over the last twenty-five years could be entirely explained by a modest decrease in the number of people engaged in physically heavy work for a large part of the day.
If most people are at the point where they are not starving, it is possible that the productivity gains from consuming more calories are relatively modest for them. It would then be understandable if people chose to do something else with their money, or move away from eggs and bananas toward a more exciting diet. Many years ago, John Strauss was looking for a clear case to demonstrate the role of calories in productivity. He settled on self-employed farmers in Sierra Leone, because they really have to work hard.13 He found that the productivity of a worker on a farm increased at most by 4 percent when his calorie intake increased by 10 percent. Thus, even if people doubled their food consumption, their income would only increase by 40 percent. Furthermore, the shape of the relationship between calories and productivity was not an S—shape, but an inverted L—shape, as in Figure 2 in the previous chapter: The largest gains are obtained at low levels of food consumption. There is no steep jump in income once people start eating enough. This suggests that the very poor benefit more from eating extra calories than the less poor. This is precisely the type of situation where we would not see a poverty trap. So it is not because they don’t eat enough that most people stay poor.
This is not to say that the logic of the hunger-based poverty trap is flawed. The idea that better nutrition would propel someone on the path to prosperity was almost surely very important at some point in history, and it may still be important in some circumstances today. The Nobel Prize Laureate and economic historian Robert Fogel calculated that in Europe during the Renaissance and the Middle Ages, food production did not provide enough calories to sustain a full working population. This could explain why there were large numbers of beggars—they were literally incapable of any work.14 The pressure of just getting enough food to survive seems to have driven some people to take rather extreme steps: There was an epidemic of “witch” killing in Europe during the “little ice age” (from the mid-sixteenth century to 1800), when crop failures were common and fish was less abundant. Witches were most likely to be single women, particularly widows. The logic of the S—shape suggests that when resources are tight, it makes “economic sense” to sacrifice some people, so that the rest have enough food to be able to work and earn enough to survive.15
Evidence that poor families might occasionally be forced to make such horrific choices is not hard to find even in more recent times. During droughts in India in the 1960s, little girls in landless households were much more likely to die than boys, but boys’ and girls’ death rates were not very different when there was normal rainfall.16 Reminiscent of the witch hunt of the little ice age, Tanzania experiences a rash of “witch” killings whenever there is a drought—a convenient way to get rid of an unproductive mouth to feed at times where resources are very tight.17 Families, it seems, suddenly discover that an older woman living with them (usually a grandmother) is a witch, after which she gets chased away or killed by others in the village.
So it is not that the lack of food could not be a problem or isn’t a problem from time to time, but the world we live in today is for the most part too rich for it to be a big part of the story of the persistence of poverty. This is of course different during natural or man-made disasters, or in famines that kill and weaken millions. As Amartya Sen has shown, however, most recent famines have been caused not by lack of food availability but by institutional failures that led to poor distribution of the available food, or even hoarding and storage in the face of starvation elsewhere.18
Should we let it rest here, then? Can we assume that the poor, though they may be eating little, do eat as much as they need to?
ARE THE POOR REALLY EATING WELL, AND EATING ENOUGH?
It is hard to avoid the feeling that the story does not add up. Can it be true that the poorest individuals in Ind
ia are cutting back on food because they don’t need the calories, given that they live in families that consume around 1,400 calories per capita per day to start with? After all, 1,200 calories is the famous semi-starvation diet, recommended for those who want rapid weight loss; 1,400 does not seem too far from there. According to the Centers for Disease Control, the average American male consumed 2,475 calories per day in 2000.19
It is true that the poorest in India are also smaller, and if one is small enough, one doesn’t need as many calories. But doesn’t that just push the question back one level? Why are the poorest in India so small? Indeed, why are all South Asians so scrawny? The standard way to measure nourishment status is by the Body Mass Index (BMI), which is essentially a way to scale weight by height (i.e., adjusting for the fact that taller people are going to be heavier). The international cutoff for being malnourished is a BMI of 18.5, with 18.5 to 25 being the normal range, and people beyond 25 considered obese. By this measure, 33 percent of men and 36 percent of women in India were undernourished in 2004–2005, down from 49 percent for both in 1989. Among the eighty-three countries that have demographic and health survey data, only Eritrea has more undernourished adult women.20 Indian women, along with Nepalese and Bangladeshi women, are also among the shortest in the world.21
Is this something to be concerned about? Could this be something purely genetic about South Asians, like dark eyes or black hair, but irrelevant for their success in the world? After all, even the children of South Asian immigrants in the United Kingdom or the United States are smaller than Caucasian or black children. It turns out, however, that two generations of living in the West without intermarriage with other communities is enough to make the grandchildren of South Asian immigrants more or less the same height as other ethnicities. So although genetic makeup is certainly important at the individual level, the genetic differences in height between populations are believed to be minimal. If the children of first-generation mothers are still small, it is partly because women who were themselves malnourished in childhood tend to have smaller children.
Therefore, if South Asians are small, it is probably because they, and their parents, did not get as much nourishment as their counterparts in other countries. And indeed, everything suggests that children are very badly nourished in India. The usual measure of how well a child has been fed through the childhood years is height, compared to the international average height for that age. By this measure, the numbers for India from the National Family Health Survey (NFHS 3) are devastating. Roughly half the children under five are stunted, which means that they are far below the norm. One-fourth of them are severely stunted, representing extreme nutritional deprivation. The children are also extraordinarily underweight given their height: About one in five children under three is wasted, which means they fall below the international definition of severe malnourishment. What makes these facts more striking is that the stunting and wasting rates in sub-Saharan Africa, undoubtedly the poorest area of the world, are only about half those in India.
But once again, should we care? Is being small a problem, in and of itself? Well, there are the Olympic Games. India, a country with a billion inhabitants, has won an average of 0.92 medals per Olympics, over the course of twenty-two Olympic Games, putting it just below Trinidad and Tobago, at 0.93. To put these numbers in perspective, China has won 386 medals in eight games, at an average of 48.3, and there are seventy-nine countries that average better than India. Yet India has ten times as many people as all but six of those countries.
Of course India is poor, but not as poor as it used to be, and not nearly as poor as Cameroon, Ethiopia, Ghana, Haiti, Kenya, Mozambique, Nigeria, Tanzania, and Uganda, each of which, per head, has more than ten times India’s medal count. Indeed, no country that has fewer medals per Olympics than India is even one-tenth of its size, with two notable exceptions—Pakistan and Bangladesh. Bangladesh, in particular, is the only country of over 100 million people that has never won an Olympic medal. The next largest such country is Nepal.
There is clearly a pattern. One could perhaps blame the South Asian obsession with cricket—that colonial cousin of baseball that baffles most Americans—but if cricket is absorbing all the sporting talent of one-fourth of the world’s population, the results are really not that impressive. South Asians have never had the dominance over cricket that Australia, England, and even the tiny West Indies had in their heydays, despite their intense fealty to the sport and their massive size advantage—Bangladesh, for example, is bigger than England, South Africa, Australia, New Zealand, and the West Indies put together. Given that child malnutrition is one other area where South Asia really stands out, it seems plausible that these two facts—wasted children and Olympian failure—have something to do with each other.
The Olympics are not the only place where height plays a role. In poor countries and rich countries alike, taller people do earn more. It has long been debated whether this is because height really matters for productivity—it could be discrimination against shorter people, for example. But a recent paper by Anne Case and Chris Paxson made some progress in nailing down what explains this relationship. They show that in the United Kingdom and the United States, the effect of height is entirely accounted for by differences in IQ: When we compare people who have the same IQ, there is no relationship between height and earning.22 They interpret their findings as showing that what matters is good nutrition in early childhood: On average, adults who have been well nourished as children are both taller and smarter. And it is because they are smarter that they earn more. Of course, there are many not-so-tall people who are very bright (because they have reached the height they were meant to reach), but overall, tall people do better in life, because they are visibly more likely to have reached their genetic potential (both in height and in intelligence).
The study, when reported by Reuters under the not-so-subtle headline “Taller People Are Smarter—Study,” created a firestorm. Case and Paxson were deluged by hostile e-mails. “Shame on you!” scolded one man (4 feet 9 inches). “I find your hypothesis insulting, prejudicial, inflammatory and bigoted,” said another (5 feet 6 inches). “You have loaded a gun and pointed it at the vertically challenged man’s head” (no height given).23
But in fact, there is a lot of evidence for the general view that childhood malnutrition directly affects the ability of adults to function successfully in the world. In Kenya, children who were given deworming pills in school for two years went to school longer and earned, as young adults, 20 percent more than children in comparable schools who received deworming for just one year: Worms contribute to anemia and general malnutrition, essentially because they compete with the child for nutrients.24 A review study by some of the best experts on nutrition leaves little doubt that proper nutrition in childhood has far-reaching implications. They conclude: “Undernourished children are more likely to become short adults, to have lower educational achievement, and to give birth to smaller infants. Undernutrition is also associated with lower economic status in adulthood.”25
The impact of undernutrition on future life chances starts before birth. In 1995, the British Medical Journal coined the term “Barker Hypothesis” to refer to Dr. David Barker’s theory that conditions in utero have long-term impact on a child’s life chances.26 There is considerable support for the Barker Hypothesis: To cite just one example, in Tanzania, children who were born to mothers who received sufficient amounts of iodine during pregnancy (because of an intermittent government program of distributing iodine capsules to would-be mothers) completed between one-third and one-half year more schooling, compared to their younger and older siblings who were in utero when the mother was not getting these capsules.27 Although half a year of education might seem a small gain, it is a substantial increase, given that most of these children will complete only four or five years of schooling. In fact, based on their estimates, the study concludes that if every mother were to take iodine capsules, there would be a 7.5 perce
nt increase in the total educational attainment of children in Central and Southern Africa. This, in turn, could affect the child’s productivity throughout his or her life.
Although we saw that the impact of just increasing calories on productivity may not be very large per se, there are some ways to improve nutrition even for adults that will much more than pay for themselves. The one that we know most about is iron to treat anemia. In many Asian countries, including India and Indonesia, anemia is a major health problem. Six percent of men and 38 percent of women in Indonesia are anemic. The corresponding numbers in India are 24 percent and 56 percent. Anemia is associated with low aerobic capacity, general weakness and lethargy, and in some cases (especially for pregnant women) it can be life-threatening.
The Work and Iron Status Evaluation (WISE) study in Indonesia provided randomly chosen men and women in rural Indonesia with regular iron supplementation for several months, while the comparison group received a placebo.28 The study found that the iron supplements made the men able to work harder, and the resulting increase in their income was many times the cost of a yearly supply of iron-fortified fish sauce. A year’s supply of the fish sauce cost $7 USD PPP, and for a self-employed male, the yearly gain in earnings was $46 USD PPP—an excellent investment.
The puzzle is that people do not seem to want more food, and yet more food and especially more judiciously purchased food would probably make them, and almost certainly their children, significantly more successful in life. The key investments that would achieve this are not expensive. Most mothers could surely afford iodized salt, which is now standard in many parts of the world, or one dose of iodine every two years (at 51 cents per dose). In Kenya, when International Child Support, the NGO that was running the deworming program, asked the parents in some schools to pay a few cents for deworming their children, almost all of them refused, which deprived their children of hundreds of dollars of extra earning over their lifetime.29 As for food, households could easily get a lot more calories and other nutrients by spending less on expensive grains (like rice and wheat), sugar, and processed foods, and more on leafy vegetables and coarse grains.
Poor Economics Page 4