E Dowler, University of Warwick, Coventry, UK
© 2005 Elsevier Ltd. All rights reserved.
In most societies there is an inverse relationship between socio-economic status and nutritional status, whether the former is measured as income, assets, or social class and the latter as food consumption or body dimensions. Socio-economic status is difficult to define consistently. The problems include how to define and measure basic subsistence, whether to examine the status of individuals or households, how to define and interpret social class differences, and how to understand differences in status between societies and in one society over time. People's circumstances often change, and sometimes the process of change may affect nutritional outcomes as well as the conditions themselves.
Basic subsistence usually means a level of living that enables people to survive and reproduce. Reproduction here means both physiological (women of childbearing age are menstruating and can conceive and carry children to term) and economic (a household has the means to feed, clothe, and house its members and take part in minimum social and economic exchange). Quantifying this basic level can be difficult: People disagree over the cutoff levels to define minimum energy or nutrient intakes for survival or reproduction, over the rates of child growth that are healthy, and over how much money or its equivalent is needed for a household to survive. Resolving these controversies depends partly on technical decisions and partly on agreed social value judgments. It also partly depends on who is making the decisions: experts in nutrition, health, or economics; social policy decision makers; or people living in the conditions concerned.
Disentangling what happens within the house-hold—who owns or has access to what assets and resources—is difficult. Even someone living alone may be entitled to resources or a share of production from another household. However, most surveys use household data on consumption or asset ownership and then divide these by the number of household members to estimate individual shares. This approach ignores differences within a household over the control and management of resources, and it assumes everything is shared equally. (What would 'equally' mean for nutrients? Everyone eating the same, or everyone eating what they need?)
Social class and status are affected by social and cultural conditions as well as economic conditions; most classifications try to incorporate all three factors. Some of the work described here uses proxy measures of socio-economic status as an alternative to income. These proxies can be single indicators, such as mother's educational level or head of household's occupation. Alternatively, they can be composite indices, often drawing on census data, that combine single indicators such as crowding, occupation, car access, housing tenure, or employment status into one index (e.g., the Carstairs Index in the United Kingdom). These composite indicators usually describe households' rather than individuals' socio-economic status.
Current social and economic changes that are associated with increasing socio-economic differentials in developed countries include the growth in unemployment or insecure employment, unstable family structures, homelessness, migrancy, and reductions in welfare provision. Similar factors are in force in developing countries, with the addition of economic structural adjustment, globalisation of production and trade, and the spread of HIV/AIDS, which affects production and earnings through the illness and death of economically active young adults.
There is debate about the relationship between socio-economic status, nutrition (food and growth), and work productivity. Some argue that undernutri-tion contributes to poverty at the household, and potentially national, level because an inadequate diet can reduce an individual's work capacity either through a direct effect of food or indirectly over time because the individual is small and/or thin. Reduced work capacity results in lower productivity and economic return, which in turn contribute to increasing poverty and malnutrition—a 'vicious circle.' These effects may be seen in an individual and his or her immediate household or as part of the reduction in human capital in malnourished populations across generations.
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