HEALTH INTERACTION WITH FARM LABOR PRODUCTIVITY FINAL REPORT to the BILL & MELINDA GATES FOUNDATION INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE October 2010 This paper was prepared by: Kwadwo Asenso-Okyere Catherine Aragon Paul Thangata Kwaw S. Andam Table of Contents Executive Summary .......................................................................................................................1 1. Introduction ............................................................................................................................6 2. Agriculture and Disease .........................................................................................................7 3. Disease and Health..................................................................................................................8 4. Linkages between Agriculture and Health .........................................................................16 5. Linkages between Health and Nutrition, and Farm Labor Productivity ........................23 6. Conceptual Framework for Analyzing the Impact of Illness/Disease on Agriculture ...31 7. Effects and Outcomes of Ill-health on Agriculture............................................................34 8. Infectious and Parasitic Disease Projections ......................................................................53 9. Conclusions and Recommendations....................................................................................56 10. References ..............................................................................................................................62 i List of Tables Table 1. Life expectancy with and without AIDS in selected African countries, 2000 ........................ 10 Table 2. Leading infectious and parasitic disease causes of mortality (000s) for people aged 15 years and older in low-income countries, 2004 and 2030 ............................................................... 53 Table 3. Leading infectious and parasitic causes of disease burden (DALYs) for people aged 15 years and older in low income countries, 2004 and 2030 ................................................................ 54 List of Figures Figure 1. Framework for linkages between agriculture and health ....................................................... 17 Figure 2. Agriculture value added per worker by income group, 2000, and 2005 ............................... 24 Figure 3. Conceptual framework for the impact of illness/disease on agriculture ................................ 32 Figure 4. Projected agricultural labor force loss due to HIV and AIDS in the most affected countries of Africa, 2000 and 2020 ...................................................................................................... 55 List of Boxes Box 1: Zoonotic Diseases ..................................................................................................................... 15 Box 2: Pesticide Use and Farm Worker Health .................................................................................... 19 Box 3: Peri-Urban Agriculture and Malaria ......................................................................................... 20 Box 4: Integrated Agriculture Aquaculture (IAA) Project for HIV-affected households ..................... 28 Box 5: Impacts of Illness on Agricultural Productivity in Rural Kenya ............................................... 34 Box 6: HIV and AIDS and Absenteeism .............................................................................................. 35 Box 7: Child Labor ............................................................................................................................... 42 Box 8: Conservation Farming for Saving Labor ................................................................................... 44 Box 9: Home Gardens for Improving Household ................................................................................. 48 Box 10: Economic Burden of Illness to Households ............................................................................ 51 Box 11: Coping Strategies for Four States of Health ............................................................................ 53 ii Acknowledgments We are grateful to the Bill & Melinda Gates Foundation for the chance to undertake this interesting study. We thank colleagues in IFPRI who undertook technical and editorial review of earlier drafts of the paper. We also appreciate useful comments we received from staff of the Bill & Melinda Gates Foundation. All these reviews have improved the paper. We appreciate the assistance given by Daniel Ayalew Mekonnen in later drafts of the report. iii Executive Summary As part of the Advisory Services of the International Food Policy Research Institute (IFPRI), the Bill & Melinda Gates Foundation asked IFPRI to carry out a desk study to throw more light on the interaction between health and farm labor productivity. The study was deemed important because health issues are increasingly affecting labor productivity and decision making in the household. The gender dimensions of health and the ensuing household adjustments seem to affect females disproportionally. Although agriculture provides the food and fiber that people need, agricultural development and practice can exacerbate the incidence of disease through an interaction with disease vectors and parasites. When disease (regardless of whether it is a direct result of farming) afflicts farmers, their productivity is reduced and they remain in poverty with an unacceptable standard of living. Understanding the interactions between health and agricultural development, and designing effective policy instruments to manage those interactions to minimize harmful impacts, are becoming more relevant for development practitioners. This report provides an overview of what is currently known about the impact of health issues on farm level productivity, and how health impacts household decision making related to farming; and the impact of agriculture on the health of people. Health is defined as absence of disease and good nutrition contributes to it. A cursory look is taken at cardiovascular diseases and some infectious and parasitic diseases that cause serious ill health in developing countries. The coping mechanisms that households adopt to deal with health shocks are discussed. The approach used here is to follow two conceptual frameworks: (1) framework for understanding the two-way linkages between agriculture and health, and (2) framework for tracking the interaction of health and farm labor productivity by examining the pathway from the disease condition to its effects, outcomes on household decision making, and ultimately impacts on human livelihood. After a review of the literature to assess the state of knowledge on the subject with its ensuing discussion, conclusions and recommendations are made for further research, and policy actions and investments to tackle the issues raised. Three-quarters of the world’s poor people live in rural areas, and they depend largely on agriculture for livelihood. Parasitic and infectious diseases abound in the rural areas, partly due to issues associated with poverty and with farming activities. However, long term projections point to a reduction in the incidence and general prevalence of various diseases (especially HIV/AIDS, TB and malaria) due to individual, household, national, and global efforts to control them. Agriculture and health are generally linked by disease in a bidirectional manner: agricultural development projects may affect disease causation, and diseases may afflict farmers and negatively affect their productivity unless some adjustments are made in labor allocation to 1 the farm. Agricultural development affects health positively or negatively. Agriculture provides income that makes households resilient to health shocks, food to meet their nutrient and energy needs, and medicinal plants for treating ailments. On the other hand, agricultural development often leads to environmental change that has adverse effects on health (for example, irrigation dams or water storage receptacles create suitable conditions for the breeding of mosquitoes and therefore lead to increase incidence of malaria in the neighborhood). The use of agricultural inputs such as pesticides by untrained farm personnel often causes illness; improper food harvesting and storage practices allow mycotoxins toxic to humans and animals alike to flourish; lack of diet diversity and/or over-consumption of certain food items (oils, fats, etc) can lead to malnutrition which adversely affects health; some animal diseases also can infect humans, with grave consequences. Labor migration (including agricultural labor migration) can contribute to high incidence of HIV infections. Poor health brings hardships to households including debilitation, substantial monetary expenditures, loss of labor, and sometimes death. The health and nutrition status of adults affect the duration of labor force participation and consequently the welfare of the household including the development of children. In this report, the effects of ill health on farm households are discussed with respect to absenteeism due to morbidity, and eventual death; family time diverted to caring for the sick; and loss of savings, and household and farm assets as disease afflicts a household. The outcomes of these poor health impacts include loss of farming knowledge, reduction of land under cultivation, planting of less