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16 JOHN HODDINOTT


Determinants of Health Status The setting within which households and individuals live affects health. The physi- cal setting—climate, access to water, the prevalence of communicable diseases, and health infrastructure—plays a major role in health status. So too does the social setting. Norms regarding what constitutes good health, the circumstances under which individuals should seek healthcare from modern or traditional sources, and how illnesses should be treated will all affect health status. Health is also affected by the allocation of individual and household resources. Assets in the form of the quality of housing and physical goods associated with water, sewerage, and waste disposal will affect health status. Knowledge of how health should be maintained, how illnesses can be identified, and how those illnesses can be treated will affect health. The allocation of time plays an important role in maintaining or improv- ing health. Health status is also affected by the consumption of goods that directly improve or worsen health. Nutritional status affects health—for example, severe vitamin-A deficiencies lead to blindness. The links between health status and agriculture are bidirectional. Choices


made in agricultural production affect health through three channels. First, manual work in agriculture is physically demanding and can directly damage health. Second, agricultural work exposes individuals to harmful pathogens, such as those found in water-borne diseases or those that come from zoonotic sources. Third, where agricultural production involves the use of chemical pesticides, exposure to these can be another threat to health.


Determinants of Nutritional Status Nutritional status results from the combination of time, physical assets, and knowl- edge of good nutritional practices, together with health status and the consumption of food. Food consumption, in terms of quantity, quality, and diversity, plays a major role in determining nutritional status and, as such, provides the most direct link between agriculture and nutrition. But it is not the only factor. There are physi- cal assets involved such as cooking pots and utensils. The nutritional status of very young children will be affected by the frequency of feeding—this is an example of how allocation of time (here, time devoted to childcare) affects individuals’ nutri- tional status. Social norms regarding foods and who “should” consume them, and knowledge of what are the right foods to consume and in what quantities also affect nutritional status. Because nutritional status depends on the capacity of the body to absorb nutrients, it is affected by other dimensions of an individual’s health status, such as the presence of healthy intestinal mucosa. Finally, the nutritional status of an individual within a household depends on how the amount of food and other inputs into nutrition are allocated across members.


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