Soc, Sci. & Med.. Vol. 12C. pp. 117 to 125.

0162-7995 7S, lll5-11117S0200 0

© Pergamon Press Ltd. 1978 Printed in Great Britain

NUTRITION A N D LABOR P R O D U C T I V I T Y
BARRY M. POPKIN
Department of Nutrition, School of Public Health,
University of North Carolina, Chapel Hill, N.C. 27514, U.S.A.

Abstract--Improved nutritional status may have a significant positive impact on labor productivity.
Critical dimensions of productivity affected by nutrition include labor time and intensity of work.
The various hypotheses relating nutrition and productivity are reviewed. A study of labor-intensive
road construction workers in the Philippines is presented which corroborates many of these theoretical
relationships.

INTRODUCTION intake of a nutrient such as iron but still have iron

While we find a strong correlation between low labor
productivity, low incomes and under-nutrition in
both low and high income countries, social scientists
usually argue that the causality runs mainly in a di-
rection of poor nutrition resulting from low producti-
vity or low income [1]. Until recently there has been
little direct reason to believe adolescent or adult
nutrition may be a critical factor in explaining low
productivity or low income. Consequently, it has been
difficult to implement adult nutrition programs based
on their impact on production. Moreover, most nutri-
tion programs based on non-economic humanitarian
considerations are directed at women and children,
the population whose mortality, morbidity and physi-
cal and/or intellectual development are most affected
by poor nutritional status [2]. In this paper, the
major hypotheses which link poor adolescent and
adult nutritional status with low productivity are
presented. The key issue considered is whether invest-
ments in various productive endeavors, such as fac-
tories, plantations and rural development projects,
should include complementary nutritional invest-
ments.
The significance of this paper lies in the fact that
the active labor force in most low-income nations has
a poor diet and suffers from a high incidence of
chronic undernutrition [-3]. We will show that under
certain conditions enhanced nutritional status of the
10w-income labor force is associated with higher pro-
ductivity. It should be noted that most nutrition and
productivity studies have been conducted with salar-
ied populations who work in highly labor-intensive,
structured occupations. Our ability to generalize from
these studies to other key developing country occupa-
tion groups, such as rice farmers and urban factory
workers, is limited. It is indeed very difficult to separ-
ate motivational, organizational and technological
effects on production from nutritional effects.
The term nutrition as used here is quite different
from food intake. A person's nutritional status is the
condition of the body resulting from the intake,
absorption, and utilization of food over a period of
time. Diseases can affect any of these biological pro-
cesses as well as a person's food requirements. Food
intake is the critical nutritional input and this is the
reason why nutritional status is considered separately
from health. A person may have an adequate current
117
deficiency anemia because of the effect of hookworm
infestation, malaria or dietary inadequacy in an
earlier period. The role of health status in general
is not discussed as we feel poor nutritional status is
such a significant component of health that it deserves
separate consideration.
Poor nutritional status is often separated into mal-
nutrition and undernutrition. The former results from
a deficiency in the diet of one or more nutrients (e.g.
iron deficiency anemia) relative to a person's needs,
while the latter arises from an inadequate intake of
energy and protein. Both malnutrition and under-
nutrition affect work capacity or intensity. Reduced
body size caused by impaired growth may affect capa-
city, and energy or caloric intake can establish a ceil-
ing on effort [4]. Nutritional anemia decreases the
oxygen transporting capacity of the blood and can
affect the intensity of work. Iron supplementation can
improve physical capacity [5]. Other nutrient defi-
ciencies have been shown to be important, but under-
nutrition and anemia are the major problems empha-
sized in the studies of nutritionists and physiologists
[6].
Little has been written about the effect of nutrition
on work time, productivity and income. There are,
however, a variety of steps which link nutritional in-
puts and productivity or income. In particular, diet-
ary intake and disease affect nutritional status which
in turn affects physical capacity. Figure 1 lays out
the general steps needed to link the physiological
effects of malnutrition with labor productivity and in-
come [7]. This paper focuses on the relationship
between capacity and productivity or step three. We
assume from numerous past studies that our nutri-
tional status measures do relate to factors such as
physical capacity. To understand the impact of nutri-
tional status on labor productivity, we must examine
it in relation to a variety of other factors--technology,
physical capital, raw materials, and other inputs
which affect productivity. The final productivity-
income step is not considered here.
The article consists of three section. The first briefly
reviews the existing theories which discuss the linkage
between nutritional status and labor force producti-
vity. The second presents evidence from empirical
work which tests hypotheses emanating from these
theories. The last portion presents a discussion of the
implications of this evidence.
118 BARRY M. POr'KIN

Step I. Poor health, inadequate food

intake, other factors
Step L Decrease of nutritional
status of individual
Step 3. Work effort ceiling, poorer
physical fitness, higher
morbidity
Step 4. Loweredmarginal
product of labor
Fig. I. Conceptual linkages between nutritional status and productivity.
~ ,. ecreases nutritional status
of individual
imposes a ceiling upon
physical effort, lowers
physical fitness, increases
the incidence and severity
of morbidity
~ I lower work performance of
I
i the individual, decreased
_ _ J working time of individual
income of individual declines,
total net output declines for
entire population

CONCEPTUAL LINKAGESBETWEEN Their conceptualization is presented in Fig. 2. For

NUTRITIONAL STATUSAND most wage rates, the supply curve of the sick worker,
LABOR PRODUCTIVITY S~, lies to the left of the supply curve of the healthy
worker, Sh. At wage rate, OS, the sick person works
Nutritional status can affect productivity mainly SA days per year and the healthy person works SB
through its impact on the amount of productive labor days per year.
time, the intensity of work, and the productive value It would appear difficult to apply this model to
of the work activities selected. Less tangible effects the majority of rural workers in most low income
of nutrition such as the possibility of improved open- countries. For example, in the Philippines in farm
ness to new learning opportunities which enhance a households, the average male and female head of
person's productive potential when he is healthier are household engage in a multiplicity of market and
not considered. home production activities and it is difficult to predict
their reaction to an increase in their nutritional status
Productive labor time without understanding how such an improvement will
Clearly work at home or in the market can be pro- affect their relative productivity in each task, inter
ductive. Nutritional status can possibly impose a ceil- alia [12, 13]. Nutritional status changes may provide
ing on total work effort in a longer time period such a greater improvement in home than market produc-
as a lifetime or in a shorter period such as the seasons tivity. Moreover, there are circumstances in which the
of the year. Oshima hypothesized that limited energy non-working mother whose potential market produc-
can place a ceiling on prolonged physical effort of tivity is enhanced by nutritional or other improve-
farmers [8]. He pointed out that food consumption ments will not enter the labor market. This paper
(Ci) may be lower than energy expenditures (El) dur- does not attempt to investigate the intricacies of the
ing peak seasonal farming activities. The resulting impact of nutritional status on time allocation.
consumption deficit (Ci < Ei) must be compensated There are more limited short run labor supply hy-
by a level of activity lower than consumption potheses which can be developed. One concerns the
(Ci > Ei) in a separate season. This would explain, reduction of morbidity-related absenteeism, Nutri-
he felt, the lower level of multiple cropping in South tional status is a key determinant of human reaction
and Southeast Asia because it is essential for human to disease and consequently affects morbidity rates
survival that energy expenditures over a period of [14,]. Thus we might expect improved nutritional
time are either approximately balanced with con- status to increase work time through reduced mor-
sumption or less than consumption. bidity. In less structured employment studies, it is not
Research in the Philippines has partially supported clear how morbidity will affect work time. Further,
Oshima's hypothesis. One study of energy expendi- there is a large gray area of total work time effort
tures among rice farmers during a peak activity sea- related to activity levels which goes beyond this direct
son found Ei > Ci [9]. This seasonality constraint morbidity effect. Total active time would be expected
argument, however, is not backed up by one of a
leading group of Guatemalan physiologists. In a
study of agricultural workers in Guatemala, Viteri et s
al. have found that these workers maintain a balance
between energy consumption and expenditure FI0].
T T'
Of course, one difference may lie in greater seasonal
Wage per day or H'
variations in consumption and employment experi- marginal H
enced by the Asian farmers. p roductivity S S'
In the short run, nutritional status improvements oer clay
might be expected to be associated with an increase
in market labor supply or at least an increase in
active home production or leisure activities. The 0
approach formalized by Baldwin and Weisbrod person-days worked per year
argues that improved health will be associated with Fig. 2. Hypothetical labor supply and demand functions
an increased supply of labor at most wage rates [111. for a sick and healthy worker.
 Nutrition and labor productivity
to increase. Possibly, a less ambiguous hypothesis is
that nutritional status improvements will enhance the
percentage of market, non-market or even leisure time
in which the person is physically active [15]. As soon
as we try to predict how nutritional status will affect
the allocation of time between market and home ac-
tivities, our predictions become conditional on a wide
variety of relative productivity, technology, and pre-
ference relationships [16].
Statistical and data collection problems would cer-
tainly confront the researcher attempting to link
nutritional and productivity changes. Foremost is the
question of the source of the nutritional improvement
and the need to devise either a controlled experiment
with nutritional improvements or a recursive or
simultaneous model to capture the effect of output
on nutrition. Second is the need to collect refined
time, dietary, and nutritional status data for each
household member engaged in home and market pro-
duction. These data must be obtained along with the
other data traditionally used to develop production,
income and consumption functions.
Work intensity
The productivity or intensity of work in each hour
or short time period will also be improved as nutri-
tional status improves. If the demand for labor relates
to the marginal physical product of labor, nutritional
improvements will shift the value of marginal produc-
tivity of labor up from SS' to HH' in Fig. 2 where
HH' and SS' are the value of marginal products of
well-nourished and malnourished workers, respect-
ively [17]. Leibenstein and others have argued that
this higher marginal productivity of better nourished
workers may explain the existence of higher than
expected wage rates in situations where surplus labor
prevails. If the marginal productivity of each worker
is a function of his/her nutritional status, they argue
that it would be more profitable to pay labor higher
wages than would be normal under surplus labor con-
ditions to insure a greater work effort [18].
Job selection
• If higher paying jobs are more physically or men-
tally demanding, well-nourished workers would be
expected to select those tougher jobs [19]. Also, the
selection procedures of employers with the higher
paying and more demanding positions may be based
on nutritional or health considerations. Consequently
the tougher, better paying job (or task), may be
viewed as curve TT' in Fig. 2. It will be very difficult
to test this relationship, however, because of the
simultaneity between income level and workers' nutri-
tion. Either the higher paying employer may hire
better nourished workers or the more productive and
higher paying employment may allow the worker to
consume a better diet, live in a healthier environment
and enjoy other benefits which would improve his/her
nutritional status.
EMPIRICAL FINDINGS
This section reviews evidence which corroborates
some of the hypotheses presented above. The first
issue addressed is the establishment of the direction
of the nutritional impact. If a positive nutritional
119
status impact on labor time, work intensity or learn-
ing can be shown, the second issue to be determined
is the nutritional status range over which the returns
to changes in nutritional status are positive and if
there are increasing and decreasing productivity
returns over certain ranges of nutritional status. No
studies have examined the nutritional status-job
selection relationship.
Work intensity [20]
The author directed a study of labor-intensive road
construction workers in the Bicol region of the Philip-
pines, the project site of a joint Philippines Depart-
ment of Public Works and International Labor
Organization labor-intensive project for constructing
secondary and feeder roads. All workers in three
labor-intensive occupation groups were selected for
the study. Hemoglobin and other nutritional and
socioeconomic data were collected from 157 workers
who were involved in the three occupations of load-
ing, unloading and tamping dirt to build a secondary
road in a terrain dominated by a clay-like soil. The
loaders lifted dirt from an area near the road site
onto bullock carts; the carts brought the dirt to the
road where it was unloaded onto the site by the un-
loaders; and the tampers used a tamping instrument
to pack the soil onto the road site. Productivity data
were obtained by engineers who observed a worker
on two separate days and utilized various measures
of the volume of soil loaded, unloaded and tamped.
An adequate number of bullock carts and other work
gangs were made available so that each worker's out-
put was not limited by the outputs of the other occu-
pational groups. During the periods of work, the rest
and active working times of each worker were
observed. One weakness of the productivity data was
the inability to weigh the soil for moisture content.
Even though it rained on several days of data collec-
tion, we do not expect that this biased our nutrition
estimates.
Hemoglobin, weight, height and socio-economic
data were obtained in an interview of the workers
at a shelter established near the work site. The per-
centage of workers with low hemoglobin levels was
almost identical with that found among the Indone-
sian plantation workers. Fifty-eight percent of the
workers had hemoglobin concentrations lower than
13.0, the anemia cut-off point in the Indonesian
survey.
Output was measured in terms of cubic meters of
soil loaded, unloaded or tamped by the three groups.
All data have been converted to firm volumes of dirt,
and daily averages are reported here 1-21]. A change
in the type of payment system for workers took place
in the middle of this study. This led to a mass exodus
of workers and a discontinuation of the investigation
which had been planned as a double blind study with
a n iron supplementation intervention. Consequently,
complete productivity, nutritional and socioeconomic
data are available for only 38 workers. The defini-
tions, means, and standard deviations of the variables
used in the following analyses are presented in Tables
la and lb.
Anemia significantly affected the work output per
day in each occupational group (Table 2). Other fac-
tors affected labor productivity such as the worker's
120 BARRY M. POPKIN

Table l(a). Variables used in Filipino road construction worker study

Mean (Standard
Dependent variable value deviation) Definition

Firm soil output per 1.4 (0.9) Cubic meters per day of
day (cubic meters) firm soil loaded, unloaded or
tamped
Days of work missed over 0.7 (1.9) Based on construction
previous six weeks (days) site records of absenteeism of
workers
Average time worked (hours) 1.5 (1.0) Time and motion data on amount
of time in a day worker actively
worked
Percentage of time 0.21 (0.14) Active work time divided
worked (5~) by sum of active plus inactive
work time

Table l(b). Variables used in Filipino road construction worker study

Mean (Standard
Independent variables value deviation) Definition

Loader (0~1) 0.37 Dummy variable is one when

worker is a loader (otherwise = O)
Unloader (0-1) 0.45 - - Dummy variable is one when the
worker is an unloader (other-
wise = 0)
Worker age (years) 0.27 (12) Age in years of worker (proxy for
experience)
Household size (number) 8.2 (2.9) Size of household of worker (used
as a control for the motivation of
worker)
Rain index (0-1 index 0.45 (0.37) Index between 0 and 1. One is for
sunny weather on both days out-
put data were collected and 0 for
two days of total rain. This index
was calculated for each worker
Compensauon (0-1) 0.53 -- Workers who lived close to project
site provided two free days of
work per week and thus recieved
a lower daily cash salary. They are
coded 1 and those paid for all days
of work are coded 0
Hemoglobin (mg/100 ml) 12.4 (1.5) Hemoglobin value for each worker
Anemic (0-1) 0,58 - - Based on WHO criteria for ane-
mia. One equals person with he-
moglobin value less than 13
(O = otherwise)
Non-anemic ((~1) 0.42 -- One equals person with hemo-
globin value of 13 or above
(O = otherwise)
Low hemoglobin ((~I) 0.19 (1 = hemoglobin _< 11 g/100 ml)
(O = otherwise)
Middle hemoglobin (0-1) 0.39 - - (1 = hemoglobin > 11 and 13 <)
(O = otherwise)
High hemoglobin (0-1) 0.42 -- (1 = hemoglobin _> 13)(O = other-
wise)
H b Low (0: continuous) 6.6 (5.7) Variable equals person's hemo-
globin value if value is less than
13 (O = otherwise)

age, motivation level, wage rate, and weather on the
days output data were collected. Ordinary least
squares regressions were used to examine the partial
effect of hemoglobin concentration variations on pro-
ductivity. The road workers were paid the same basic
daily wage except that workers residing near the road
site were expected to contribute two full days of work
without pay. A dummy variable was used which
equals one for those paid less because they rived near
the site. A number of motivation variables were
considered. Household size, a variable uncorrelated
with worker nutritional status, was also used. Dummy
variables for two occupational groups are included.
The results are presented in Table 3. Using a
continuous hemoglobin variable, both additive and
multiplicative forms presented in Columns 1 and 2,
 Nutrition and labor productivity 121

Table 2. Relationship between the productivity and anemia status of Bicol road construction
workers (average daily output of firm soil in cubic meters)

Occupational group
Anemia Loaders Unloaders Tampers Total
status of output* outputt outputt output*
worker Average No. Average No. Average No. Average No.

Anemic 1.25 6 0.70 10 2.26 6 1.28 22

(Hb 12.9 < )
Non-anemic 1.96 8 0.75 7 3.65 1 1.54 16
(Hb >_ 13 g/100ml)
Total 1.66 14 0.72 17 2.46 7 1.39 38

* t-value significant at 0.05 level.

t t-value significant at 0.10 level.

Table 3. Regression: factors affecting worker productivity

Firm soil output Log firm soil Firm soil output Firm soil output
per day (m 3) output per day per day (m 3) per day (m 3)
(1) (2) (3) (4)
Constant 0.17 -3.86 1.75 1.18

Occupational grouping
Loader - 0 . 8 2 (2.45) -0.14(0.58) - 0 . 8 6 (2.44) - 0 . 9 0 (2.50)
Unloader - 1.92 (6.17) - 1.17(5.05) - 1.88 (5.87t - 1.90 (6.10)
Worker age 0.003(0.33) -- O.O04(0.421 O.003(0.31)
Log age -- 0.27(1.15) --
Household size 0.02 (0.36) -- 0.02 (0.38) 0.O1 (0.291
Log size -- -0.07(0.33) --
Rain index (rainy = O; sunny = 1) 0.69 (2.26) 0.76(3.40) O.61 (1.93) 0.70 (2.30)
Less compensation ( = O; better = I) - 0 . 3 2 (0.146) -0.33(1.96) -0.27 (1.19) -0.32 (1.40)
Hemoglobin 0.16 (2.06) -- --
Log hemoglobin -- 1.45(2.00) -- -
Hemoglobin middle -- -- 0.33 (0.991
(0)(1 i f > 11 to 13 <)
Hemoglobin high -- -- 0.71 (2.15)
(1) (1 if >_>_13)
HB low (O) (Hb value if 13<) -- -- -- 0.08 (0.501
HB high (0) (Hb value if > 13) -- -- -- 0.10 (0.78)
R2 0.64 0.66 0.65 0.64
~2 0.55 0.58 0.55 0.55
F 7.59 8.36 6.75 6.57

( n = 38) t-values in parentheses.

respectively, s h o w significant positive associations s h o w significantly different increases in productivity

between h e m o g l o b i n levels and productivity. T h e for t h o s e w o r k e r s with low and high h e m o g l o b i n
other relations are expected, for instance, better paid levels.
workers are m o r e p r o d u c t i v e a n d drier w e a t h e r
enhances w o r k e r productivity. Labor time
The range o f h e m o g l o b i n in w h i c h h e m o g l o b i n in- A m a j o r effect of p o o r nutritional status is the effect
creases are associated with increasing or d e c r e a s i n g o n labor time [22, 23]. The Filipino road c o n s t r u c t i o n
productivity r e t u r n s was examined. First, a p a r a b o l i c w o r k e r study f o u n d a significant association b e t w e e n
relationship was tested w h e r e b y : w o r k e r time a n d h e m o g l o b i n levels. H e m o g l o b i n level
Productivity = ao + a t H e m o g l o b i n increases are associated with significant increases in
the average time w o r k e d a n d decrease in the days
+ a 2 ( H e m o g l o b i n 2) + o t h e r factors.
missed. T h e s e results are presented in Table 4 a n d
This p r o d u c e d insignificant results w h i c h are n o t
reported. Second, the linearity of the h e m o g l o b i n Table 4. Relationship between hemoglobin level and days
values b e t w e e n 11 a n d 1 3 g / 1 0 0 m l and 13 o r m o r e of work over previous six weeks
g/100ml. O n l y the w o r k e r s with h e m o g l o b i n levels
Hemoglobin level
greater t h a n 13 h a d significantly greater p r o d u c t i v i t y
(g/100 ml) Days missed No. of cases
than the w o r k e r s with h e m o g l o b i n levels less t h a n
11 ( C o l u m n s 3, Table 3). Third, two c o n t i n u o u s 13.9 _< 0.74* 127
hemoglobin variables r e p r e s e n t i n g h e m o g l o b i n ranges _>14.0 0.07 30
less t h a n 13 and greater t h a n or equal to 13 were
used. T h e s e results p r e s e n t e d in C o l u m n 4 d o n o t * t-values significant at 0.05 level.
122 BARRY M. POPKIN

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 Nutrition and labor productivity
Columns 1 and 5 of Table 5. Over a six week period,
workers with a hemoglobin level about 14g/100ml
had 0.67 more days of work than those with lower
hemoglobin levels. Multivariate analysis shows a sig-
nificant positive hemoglobin association with time
worked per day (Table 5, Column 1).
A second time relationship is the hypothesis that
increased nutritional status will lead to increases in
the percentage of active time [24]. Time and motion
studies were conducted in the Filipino road construc-
tion worker study. The rest and work activities of
each construction worker, recorded on two separate
days were used to develop a percentage of active work
time dependent variable. The results presented in
Column 2 of Table 5 indicate a significant positive
association between hemoglobin levels and the per-
centage of active work time.
Additional detailed analyses carried out on the
work time results from the Filipino road construction
worker study, examined the issue of returns to hemo-
globin increases. In Column 3 of Table 5 workers
with high hemoglobin levels are shown to work a
greater percentage of time than did workers with
lower hemoglobin levels. The same formulation was
used with days missed in the previous six weeks as
the dependent variable (Column 6, Table 5), and no
significant difference was found for workers with the
different hemoglobin levels. Finally proof of a poten-
tially large range over which increasing returns to
hemoglobin increases may exist are presented in
Column 4, Table 5. Increases of hemoglobin levels
in the 13 g/100ml and above group are associated
with a larger impact on the percentage of active work
time than hemoglobin increases among the more
anemic group.
DISCUSSION
This paper has presented studies which indicate
that reduced energy supply and hemoglobin levels
may have an important cost in terms of physical
performance. These studies have begun to provide the
linkages between nutritional status changes and
actual performance needed to demonstrate the nutri-
tional inputs, and should be viewed as a complemen-
tary productive investment in a wide variety of
developmental activities.
There are a number of critical research needs which
will have to be explored in the future if nutritional
investments in other productive activities are to be
programmed at a much more precise level. One is
the need to understand the levels of nutritional status
over which positive productivity gains can be
obtained with nutritional inputs. Such information is
needed for both a more precise definition of the target
population and the amount of nutritional supplemen-
tation or other health inputs required.
Second is the need to expand the research to two
important segments of the work force--the factory
worker, and farmers and farm laborers. There are
some anecdotal and poorly controlled studies which
indicate potential positive nutritional supplemen-
tation impacts on skilled factory workers [25]. Mini-
mal research has been done among the farm popula-
tion [26]. Given the complex time allocation issues
and wide variety of activities engaged in by most
123
peasant farmers, it is questionable whether cross-sec-
tional studies can provide answers to the nutritional
status-productivity linkages among these households.
Aside from the individual opportunities in a variety
of productive activities, there are a wide range of in-
tra-household time allocation possibilities which com-
plete this relationship. There are also the econometric
problems of estimating relationships in which nutri-
tional status both affects and is affected by the pro-
ductivity of time.
Overall, jobs which require great manual precision
or strength, those which are group-managed with
controlled numbers such as rubber and tea plan-
tations, and those with peak seasonal labor shortages
appear to offer potential for more careful consider-
ation of nutritional investments which are comple-
mentary to other investments. This is especially true
for the cheaper nutritional investments such as iron
supplementation. Energy supplements may be crucial
in enhancing work output, but energy supple-
mentation programs may require more complex and
costly delivery systems. There are also negative
aspects to be considered, notably the potential
employment displacement in labor surplus situations.
Finally, we must realize that we are discussing
investments which maximize the returns to scarce
capital investments in productive endeavors. If nutri-
tional and health investments are found to be part
of this package, they should be included as productive
investments. Given the relatively greater physiological
needs of preschool children and women of child-bear-
ing age, the nutrition and public health sectors will
not be likely to use their limited resources on less
needy school children and adults.
Acknowledgements--The author wishes to thank the
Rockefeller Foundation for providing financial support for
the final phases of this research. Earlier support came, also,
from the Bicol River Basin Development Program. Much
of the research upon which the article is based comes from
Filipino work completed while the author was Visiting As-
sociate Professor, School of Economics, University of the
Philippines and member of the special field staff of the
Social Science Division, Rockefeller Foundation. The
author acknowledges the assistance of Luz Dullin and
Susan de Jesus in part of the research and his colleagues
at the U.P. School of Economics. He also thanks Peter
Heywood and Michael Latham for ideas they have shared
with him. Bruce Johnston and Samir S. Basta are thanked
for their helpful comments on earlier drafts.
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124 BARRY M. POPKIN
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(Edited by Scrimshaw N. S. and Behar M.) pp. 67-76.
Plenum Press, New York, 1976.
4. Viteri F. E. Considerations on the effect of nutrition
on the body composition and physical working capa-
city of young Guatemalan adults. In Amino Acid Forti-
fication of Protein Foods (Edited by Scrimshaw N. S.
and Altschul A. M.) pp. 350-375. M.I.T. Press, Cam-
bridge, 1971. Heywood P. Malnutrition and producti-
vity in Jamaican sugar cane cutters. Unpublished
Ph.D. dissertation, Cornell University, Ithaca, New
York, 1974.
5. Karyadi D. and Basta S. Nutrition and health of In-
donesian construction workers: endurance and ane-
mia. Staff Working Paper No. 152, International Bank
for Reconstruction and Development, Washington,
D.C., 1973.
6. Viteri F. E., op cir. and Heywood P., op cir. Weight
for height is a commonly used index of energy stores
used as an indicator of energy capacity. Hemoglobin
concentration in the blood is the most frequently used
measure of anemia.
7. There is a strong empirical basis for the linkages in
steps 1 and 2. Exceptionally careful studies in Guate-
mala have prolonged considerable insights into the
relationship between food intake, energy expenditures,
and weight and other body composition changes. See,
for example, Viteri, op cir. For a careful review of
studies in this area, see Heywood, op cir. The structure
of these relationships could be estimated; however,
most analyses estimate the reduced-form equations
which relate health or nutrition to productivity.
8. Oshima H. T. Food consumption, nutrition, and
economic development in Asian countries. Econ. Def.
Cultural Change 15, 385, 1967.
9. Florentino R. Nutrition in relation to work producti-
vity. Presented at the Philippines Association of Nutri-
tion Forum, Nutrition in Development, University of
the Philippines at Los Banos, 6-7 January 1975. The
results cited in Florentino's paper come from Guzman
P. E. et al. A study of the energy expenditure, dietary
intake, and pattern of daily activity among various
occupation groups, in Laguna rice farmers. Philipp. J.
Sci. 103, 1974.
10. Viteri F. E.. Torun B., Galica J. C. and Herrara E.
Determining energy costs of agricultural activities by
respirometer and energy balance techniques. Am. J.
clin. Nutr. 24, 1418, 1971.
I1. Baldwin R. E. and Weisbrod B. A. Disease and labor
productivity. Econ. Det,. Cultural Change 22, 414, 1974.
12. See Binswanger H., Evenson R. E. and White B. (Eds.).
Household Studies. Agricultural Development Council,
Singapore, 1978, for a collection of papers presenting
time studies for the Philippines, Bangladesh and In-
donesia. For example, Boulier showed that the average
father in a family with farming as the primary source
of income spent 22 hr farming, almost 16 hr in wage
work, almost 10 hr in poultry/livestock work and over
4 hr in other income producing activities for a total
of 52.13 hr of market work per week. In addition, the
average father spent over 3 hr on home production
activities. The mother in these farm households distri-
buted her market time more evenly and contributed
significantly more of her time to home production.
Boulier B. L. Children and household economic ac-
tivity in Laguna, Philippines. Binswanger et al., op cit.
13. Gronau R. Leisure, home production and work the
theory of the allocation of time revisited. J. polit. Econ.
77, 1099, 1977.
14. For a discussion of the nutritional status-morbidity
relationship, refer to Scrimshaw N. S., Taylor C. E.
and Gordon J. E. Interactions of nutrition and infec-
tion. World Health Organization Monograph Series
No. 57, World Health Organization, Geneva, 1965.
15. Viteri, 1971, op cit., discusses this relationship.
16. Gronau, op cir.
17. Baldwin and Weisbrod, op cir.
18. Leibenstein H. The theory of underemployment in
backward economies. J. polit. Econ. 65, 91, 1957.
Rogers G. B. Nutritionally based wage determination
in the low-income labour market. Oxford Economic
Papers, pp. 61 81, Oxford University Press, London.
1975. These wage-productivity theorists have not
established that a higher net revenue or lower average
cost is actually obtained by landlords who would f01-
low this practice. There are a wide variety of insti-
tutional considerations which could lead to this same
phenomenon.
19. Baldwin and Weisbrod, op cir.
20. Studies conducted in Indonesia, Guatemala and South
Asia corroborate the general findings reported below.
An Indonesian study of anemia and rubber plantation
worker productivity, found a significant nutritional
affect, both in cross-sectional analyses and studies 0[
the effects of iron supplementations. Basta S. S. and
Churchill A. Iron deficiency anemia and the producti-
vity of adult males in Indonesia. International Bank
for Reconstruction and Development Staff Working
Paper No. 175, Washington, D.C., 1974. These authors
noted that malnourished workers were placed in lower
productivity areas. This corroborates the job selection
hypothesis of Baldwin and Weisbrod.
Two carefully conducted studies have b e e n carried
out in Guatemala. Both focused on energy intake among
populations with normal hemoglobin levels (non-
anemic). Agricultural laborers in the Guatemalan high-
lands, supplemented for three years, showed a superior
working capacity, but their actual work output was
not studied. For these results see Viteri F. E. Consider-
ations on the effect of nutrition on the body composi-
tion and physical working capacity of young Guatema-
lan adults. In Amino Acid Fortification of Protein Foods
(Edited by Scrimshaw N. S. and Altschul A. M.) p.
350-375. M.I.T. Press, Cambridge, 1971, and Viteri F.
E., Torun B., Galica J. C. and Herrara E. Determining
energy costs of agricultural activities by respirometer
and energy balance techniques. Am. J. clin. Nutr. 24,
1418, 1971.
The second Guatemalan study provided energy sup-
plements for one group of sugar cane workers and pla-
cebos to a second group. Published reports from this
study showed that the energy supplementation raised
the net caloric intake of these workers by about
400kcal/day to 3200kcal/day; however later results
contradict these findings and appear to show no
change in either net dietary intake or worker producti-
vity. The dietary, biological and socioeconomic con-
trols in this study are sophisticated, and the lack of
a positive is being studied in detail. For the prelimi-
nary report on this study, see Maarten D. C., Immink
F. E., Viteri F. E. and Torun B. Calorie supplemen-
tation, working capacity and productivity in sugar
cane cutters. Presented at 10th International Congress
of Nutrition, Kyoto, Japan, 1975.
One of the interesting South Asian studies was
Satyanarayana K., Rao D. H., Rao D. V. and
Swaninathan M. C. Nutritional working efficiency in
coalminers. Indian J. reed. Res. 60, 1800, 1972. In this
study, no productivity gains were associated with
calorie supplements as there was a major coal car con-
straint which prevented worker weight gains from
being translated into productivity. A study in Sri
Lanka did show a significant relationship between
anemia and daily tea productivity of female workers.
Gardner G. W., Edgerton V. R., Barnard R. J. and
 Nutrition and labor productivity
Senewiratne B. Physical working capacity and iron
deficiency anemia. Presented at 10th International
Congress of Nutrition, Kyoto, Japan, 1975.
It has not been possible for this author to judge the
methodology of this study from the published reports
and conversations with the authors involved in the
studies.
21. A more detailed report on the data collection and a
descriptive statistical analysis of these data is found in
Dullin L. E. Health and nutrition and labor producti-
vity: the case of Bicol Road workers. The productivity
of these workers was recently observed by Taiwanese
engineers. In Taiwan similar workers have a producti-
vity over 4000/0 higher than these Bicol workers. The
Taiwanese engineers noted that much of this difference
must relate to the heavy clay-like soil found in the
Bicol area.
22. We do not discuss the extensive literature linking mal-
nutrition and mortality nor the effects of malnutrition
on blindness~ This author was involved in a study of
vitamin A deficiency, one of the four leading causes
of blindness. In this study, a survey of blindness a m o n g
35,000 persons determined that one out of every 662
children aged I-5 were blinded from factors associated
with vitamin A deficiency. The economic benefits of
not being blinded were signficant. For example for a
preschool boy in an urban squatter area, a present
value of $405 would accure to him if his blindness
was prevented and he attained a mean education level
for children in this area. See Popkin B., Solon F. S.,
Fernandez T. and L a t h a m M. C. Benefit-cost analysis
in the nutrition area: a project in the Philippines.
(Forthcoming).
23. The Indonesian study described earlier reported a sig-
nificant decline in infectious diseases and absenteeism
in the iron treatment group. Basra and Churchill, op
cit.
24. Time and motion studies conducted in G u a t e m a l a
showed that the supplemented peasants engaged in
both relatively more active work and leisure activities
than the unsupplemented peasants. That is a greater
125
percentage of both their market and leisure time was
spent in physically active tasks. Viteri felt that even
under situations where both groups were highly moti-
vated to be active, the unsupplemented group had
limited energy reserves and was forced to rest more.
Viteri F. E. Considerations on the effect of nutrition
on the body composition and physical working capa-
city of young G u a t e m a l a n adults. In Amino Acid Forti-
fication of Protein Foods (Edited by Scrimshaw N. S.
and Altschul A. M.) pp. 350-375. M.I.T. Press, Cam-
bridge, 1971.
A study of road construction workers in Kenya found
that the time to complete certain tasks was signifi-
cantly correlated with weight for height and hemo-
globin levels. Latham M. C. and Brooks M. The rela-
tionship of nutrition and health to worker productivity
in Kenya. Report to the International Bank of Recon-
struction and Development, Cornell University, Ithaca,
New York, 1977.
25. Keller W. O. and Kraut H. A. Work and nutrition.
In World Review of Nutrition and Dietetics (Edited by
Bourne G. H.) Vol. 3, 1962. United Nations Food
and Agricultural Organization. Nutrition and Working
Efficiency, U N F A O , Rome, 1962.
26. In one recent study, Capule examined with both ordi-
nary least squares and two stage least squares frame-
works, the nutrition and rice farmer productivity rela-
tionship. Her model looked at the interaction between
nutritional status and labor time and its impact on
farm output and found no significant nutritional effect.
This was the case in both the OLS and TSLS formula-
tions. In the latter approach, rice output and food con-
sumption of the household were the two endogenous
variables. The deficiencies in the nutritional data and
limitations in the size of the sample may have led to
these poor results. Or it may be that the theoretical
problems associated with an analysis of this relation-
ship which were mentioned in the text must be exam-
ined. Capule C. A note on education, extension and
nutritional status as determinants of production effi-
ciency. In Binswanger et al., op cit.