The households in the Udaipur survey are poor, even by the standards of rural Rajasthan. Their average per capita household expenditure is 470 rupees, and more than 40 percent of the people live in households below the official poverty line, compared with only 13 percent in rural Rajasthan in the latest official counts for 1999–2000. Only 46 percent of adult mates (age 14 and older) and 11 percent of adult females report themselves as literate. Of the 27 percent of adults with any education, three-quarters completed standard eight or less. The survey households have little in the way of household durable goods, and only 21 percent have electricity.
In terms of measures of health, 80 percent of adult women and 27 percent of the adult men have hemoglobin levels below 12 grams per deciliter; 5 percent of adult women and 1 percent of adult men have hemoglobin levels below 8 grams per deciliter. Using a standard cutoff for anemia (11 g/dl for women, and 13 g/dl for men), men are almost as likely (51 percent) to be anemic as women (56 percent) and older women are not less anemic than younger ones, suggesting that diet is a key factor. The average body mass index (BMI) is 17.8 among adult men, and 18.1 among adult women; 93 percent of adult men and 88 percent of adult women have a BMI less than 21, considered to be the cutoff for low nutrition in the United States (Robert Fogel, 1997
). Symptoms of disease are widespread, and adults self-report a wide range of symptoms: one-third reported cold symptoms in the last 30 days, and 12 percent say the condition was serious; 33 percent reported fever (14 percent, serious), 42 percent reported “body ache” (20 percent, serious), 23 percent reported fatigue (7 percent, serious), 14 percent problems with vision (3 percent, serious), 42 percent headaches (15 percent, serious), 33 percent back aches (10 percent, serious), 23 percent upper abdominal pain (9 percent, serious), and 11 percent chest pains (4 percent, serious); 11 percent had experienced weight loss (2 percent, serious). Few people reported difficulties with personal care, such as bathing, dressing, or eating, but many reported difficulty with the physical activities that are required to earn a living in agriculture. Thirty percent or more would have difficulty walking five kilometers, drawing water from a well, or working unaided in the fields; 18–20 percent have difficulty squatting or standing up from a sitting position.
Yet when asked to report their own health status, shown a ladder with 10 rungs, 62 percent place themselves on rungs 5–8 (more is better), and less than 7 percent place themselves on one of the bottom two rungs. Unsurprisingly, older people report worse health. Also, women at all ages consistently report worse health than men, which appears to be a worldwide phenomenon. Nor do our life-satisfaction measures show any great dissatisfaction with life: on a five-point scale, 46 percent take the middle value, and only 9 percent say their life makes them generally unhappy. Such results are similar to those for rich countries; for example, in the United States, more than a half of respondents report themselves as a three (quite happy) on a four-point scale, and 8.5 percent report themselves as unhappy or very unhappy. These people are presumably adapted to the sickness that they experience, in that they do not see themselves as particularly unhealthy or, perhaps in consequence, unhappy. Yet they are not adapted in the same way to their financial status, which was also self-reported on a ten-rung ladder. Here the modal response was the bottom rung, and more than 70 percent of people live in households that are self-reported as living on the bottom three rungs.
What about the relation between health and wealth? The standard measure of economic status in India is household total per capita expenditure (PCE), which we collected using an abbreviated consumption questionnaire previously used by the National Sample Survey in the 1999–2000 survey. In , we show self-reported health, number of symptoms reported in the last 30 days, BMI, the fraction of individuals with a hemoglobin count below 12, peak flow meter, and the fractions of individuals with high blood pressure and low blood pressure, broken down by third of the per capita income distribution. Although the pattern is not always consistent across the groups, individuals in the lower third of the per capita income distribution have, on average, a lower level of self-reported health, lower BMI, and lower lung capacity, and they are more likely to have a hemoglobin count below 12 than those in the upper third. Individuals in the upper third report the most symptoms over the last 30 days, perhaps because they are more aware of their own health status; there is a long tradition in the Indian and developing country literature of better-off people reporting more sickness (see e.g., Christopher Murray and Lincoln C. Chen, 1992
; Amartya K. Sen, 2002
SELECTED HEALTH INDICATIORS, BY POSITION IN THE PER CAPITA MONTHLY EXPENDITURE DISTRIBUTION
shows self-reported health as a function of age and gender, comparing the bottom three deciles with the top three deciles. Self-reported health is better in the higher deciles, though the effect is much stronger for men than for women, for whom there is little or no PCE gradient. The steeper gradient for men may be an indication that some of this relationship is driven by the effect of health on income, since we would observe such a relation if men earn more because they are stronger.
LOWESS PLOTS OF SELF-REPORTED HEALTH STATUS, By SEX AGE, AND PCE
We investigate this further in , in which the self-reported health status is regressed on age, age-squared, and measures of economic status. Our regressions show that, conditional on total household expenditure, neither health nor happiness was reduced by household size, so we report regressions using total household expenditure rather than per capita household expenditure. We also show the results of using the household’s own report of its financial status on a 10-point scale; this measure is typically a better predictor of health and happiness than are expenditure measures. We also constructed a dummy for each adult indicating whether that person had earnings from work and then regressed self-reported health status on each measure of economic status and its inter-action with the worker dummy. As anticipated, the slope of the regression of health on economic status is higher for earners, by about one-fifth for total household expenditure, and by a factor of 2 for the self-reported economic status measure. Column 2 shows the same regression with an indicator for having a hemoglobin level below 12 g/dl as the dependent variable. In both cases, we also find the inter-action between the income-earner dummy and household welfare status to be negative. These findings are consistent with the idea that at least some of the gradient comes from the effects of health on earnings, although they could also indicate that the nutrition and health inputs received by workers are more income-elastic than those of nonworkers. The last column of the table shows parallel regressions with happiness rather than health as the dependent variable. A concern with these subjective variables is that there is a personality-based (and reality-free) component that is common to both the happiness and the health measure, and which could be different for workers and nonworkers. But these regressions, unlike those for self-reported health status or anemia, show no effects of the interaction term; there appears to be some suggestive evidence of a feedback from health to earnings, but not from happiness to earnings.
HEALTH, HAPPINESS, AND ECONOMIC STATUS