Some studies use data from health facility records to create a disease-
oriented definition of the health status of a population, but in low-income
countries those using such facilities tend to be from higher-income households
and not even those with the worst health. Various surveys have asked whether
an individual has experienced illness or specific symptoms (such as fevers,
diarrhoea, or respiratory problems) during a prior reference period. Again such
surveys are difficult to interpret as the notion of an illness or symptom will
differ between respondents. Survey evidence generally finds that the poorest
people have better health status. In Ghana and the Côte d’Ivoire the likelihood
of adults reporting an illness is positively associated with education and per-
capita household expenditures. Reported morbidity is even much higher in the
US than in the poorest state of India, Bihar (Sen, 1998). In some circumstances
individuals may claim to suffer from an illness in order to become eligible for
health-related benefits. The number claiming Disability Benefit in the UK, for
example, increased from 1.1 million in the early 1990s to 3.2 million in 2012,
with no recorded increase in other aspects of ill health. Asking how many days
of normal activity were lost to ill health may reduce the impact of such errors.
Here the better educated whose opportunity cost of time is high will have less
incentive to miss work/school activities but the measure will be impacted by
fluctuations in employment and spells of unemployment due to economic
reasons.
Health status can also be measured by output, including anthropometric
measures such as height, weight and body mass index (BMI). The BMI is the
ratio of weight (in kilograms) to height (in meters) squared. A prime-age male
in the US has an average BMI of about 25. BMI is relatively easy and cheap to
collect through surveys that include fieldwork data on height, weight and
sometimes arm circumference. BMIs are considerably lower in poor countries,
av eraging between 21 and 23 in the Côte d’Ivoire for example. Values below
18 or above 30 have been associated with higher adult mortality (Strauss and
Thomas,1998). Undernourished babies tend to be born with low birth weight
which is then associated with a greater risk of coronary heart disease, strokes,
diabetes, and hypertension 50 or 60 years later (Smith, 1999; Cutler, 2006).
Improvements in maternal and child health inputs may only impact health
outcomes with a very long lag. Although it does not help us to measure the
impact of current health policy, current health status can be considered a
summary measure of health inputs over an individual’s entire life, providing a
more comprehensive measure of lifetime well-being than current income or
current capabilities.
Health and growth
Survey evidence finds that healthier workers (admittedly there is a problem
in defining and measuring a ‘healthy’worker) are physically and mentally
more energetic, more productive and earn higher wages. Rising longevity
may increase the incentives of individuals to acquire education and save for
132 Sources of Growth in the Modern World Economy since 1950