Is Food the Answer to Malnutrition? - The Oxford Topic of Food, Politics, and Society - page 414

leisure is indicative of significant trade-offs between the treatment of illness and house-
hold labor supply, and suggests the opportunity cost of travel to treatment centers plays
an important role in establishing visitation patterns. The fact that nonfood goods emerge
as a substitute for health care leads to the consideration of a tax on these goods as an
alternative health care financing mechanism. Such a tax could be used to cross-subsidize
the public provision of health services and reduce regressive user fees without providing
a disincentive to health-seeking behavior. Although the findings in this study provide
important baseline estimates of substitution effects existing between health care pro-
vider choice, food, nonfood goods, and leisure, more research is necessary to character-
ize these substitution patterns under varying socioeconomic conditions and to generate
consensus on the observed magnitudes of cross-price elasticities. This is particularly
important in considering the impact of a range of intervention programs that have dual
objectives, one of which is improving food and nutritional outcomes. One such example
is food for work schemes that have objectives including employment generation, infra-
structure creation and nutritional improvement (see Kotwal and Ramaswami, this vol-
ume). There are myriad complexities in terms of behavior responses to such programs
that will have uncertain and conflicting impacts on the health of particularly vulnerable
children and women. These range from potential changes in intrahousehold allocation,
because bargaining power may be altered in ways that depend on which members par-
ticipate in the scheme, to changes in allocative choices as a result of changes in labor
supply-altering energy output and, thus, relative needs of family members, to shifts in
time use and the price of leisure that may affect demand for health care and the nature of
infant care practices. A similar set of complexities apply to other interventions such as
conditional cash transfer programs, in which food is provided as a condition for activi-
ties ranging from girls attending school to receiving prenatal care.
Yet another related issue that emerges from the production function is that income
itself is not included; rather, the model includes consumption goods that are pur-
chased with earned and nonearned income. Nonetheless, reduced form results using
household-level data sets show a relatively modest short-term impact of income on nutri-
tional outcomes (Alderman, Hoogeveen, and Rossi 2006). This finding is mirrored in the
literature that finds that the impact of income on calorie consumption is quite modest,
as measured by the low-income elasticities of demand. For example, Bouis and Haddad
(1992) estimate that, in the Philippines, the elasticity is around 0.1, whereas Behrman and
Deolalikar (1990) suggest that it may be close to zero among poor villages in South India.
Subramanian and Deaton's (1996) estimates for India are at the high end of the spectrum,
being 0.5. In all cases, the food expenditure elasticities are much higher—perhaps on the
order of two times higher—because consumers alter the composition of their food pur-
chases as incomes increase. This latter process is, in part, a consequence of households
valuing dietary diversity, both for reasons of taste and variety. Thus, as incomes rise, even
when overall dietary requirements are not met, households switch into “higher quality”
foods and food groups, such as meat instead of cereals, or rice instead of cassava. Likewise,
there is a pattern of purchasing higher quality foods within relatively homogenous com-
modities, such as rice or meats. Indeed, this search for diversity and quality (measured