HUMAN RESOURCE DEVELOPMENT AND PRODUCTIVITY :

T H E ROLE OF NUTRITION

by : Barry M. Popkin*)

W h i l e w efind a strong correlation between l o w labor productivity,

low income a n d undernutrition i n b o t h l o wa n d high income countries,
social scientists usually feel t h e causality r u n s m a i n l y i n a d i r e c t i o n
where poor nutrition results f r o m l o w productivity o r l o w income. U n t i l
recently there h a s been little reason t o believe n u t r i t i o n m a y be a
critical factor i n explaining l o w productivity o r l o w income. Consequent-
ly i t h a s been difficult t o i m p l e m e n t a d u l t n u t r i t i o n programs based o n
their i m p a c t o n p r o d u c t i o n . M o r e o v e r m o s t n u t r i t i o n programs based o n
noneconomic h u m a n i t a r i a n considerations a r e directed a t w o m e n a n d
children. F o r some time, physiologists have k n o w n t h a t a person's w o r k
capacity is related t o his/her n u t r i t i o n status b u t controlled careful
studies o f this relationship under n o r m a l w o r k i n g conditions have been
sparse.') I n this paper, t h e m a j o r hypotheses w h i c h link t h e e x p l a n a t i o n
of l o w p r o d u c t i v i t y o r l o w i n c o m e t o n u t r i t i o n a l f a c t o r s a r e presented.
I h e n t h e recent studies w h i c h shed l i g h t o n some aspects o f t h e n u t r i -
tion-productivity relationship a r e presented a n d t h egaps i n o u r k n o w -
ledge a r e clarified.
V/e w i l l s h o w t h a t u n d e r c e r t a i n c o n d i t i o n s , e n h a n c e d n u t r i t i o n a l
status o f t h el o w income labor force i s associated w i t h higher productivity.
A t t h e same t i m e m o s t o f t h e studies have been conducted w i t h captive
plantation populations w h o w o r k i n labor-intensive occupations. O u t
ability t ogeneralize f r o m these studies r o other key rural o r urban occupa-
t i o n a l groups such as rice f a r m e r s o r f a c t o r y w o r k e r s i s still l i m i t e d . I n
F i g u r e 1 , t h e various steps required f o rn u t r i t i o n t o affect o u t p u t a r e
described. T h i s paper acknowledges t h e fact t h a t n u t r i t i o n i s t s have est-
ablished t h e linkages o f steps 1 a n d 2 a n d concentrates o n step 3 . Step
4 i s a c o n t r o v e r s i a l issue w h i c h w i l l n o t b e covered here. E a c h step i s
essential i f a total nutrition-productivitv-income linkage i s t o be establish-
ed.

*) The author wishes to thank Mr. Hidayat and Professor Edita T a n , University
of the Philippines, School of Economics, for reading an earlier version of this
article.
') Heywood provides an excellent review of these articles. Peter F. Heywood.
" Malnutrition and Productivity in Jamaican Sugar Cane Cutters," Unpublished
Phd dissertation. Ithaca, New York, Cornell University. 1974.

EKI, V O L . XXIV N O . 3, SEPT.. 1976 275

Figure 1 . Conceptual Linkage Between Nutritional and Productivity.

Step 1 . Poor Health

decrease nutritional
Inadequate food intake
status of individual
other factors

impose a ceiling upon

Step 2. decrease physical effort
nutritional status • lowers physical fitness
of individual increases incidence and
. severity of morbidity

Step 3. work effort ceiling lowered work performance

poorer physical fitness of the individual
higher morbidity decreased time for working
of individual

Step 4. lowered income of individual

marginal product declines
of labor total net output declines
for entire population

T h e t e r m n u t r i t i o n as used here i s quite different f r o m f o o d i n t a k e .

A person's n u t r i t i o n a l status i s the condition o f the body resulting f r o m
the .intake, absorption a n d utilization o f food over a period o f time.
Diseases can affect any o f these processes o r also a person's f o o d require-
-ments. Food intake i s t h e critical n u t r i t i o n a l i n p u t b u ta person m a y
have a n adequate short r u n intake o f a n u t r i e n t such as i r o n b u t still
have i r o n deficiency a n e m i a because o f the effect o f h o o k w o m o r m a l a r i a
or a longer t e r m dietary inadequacy. T h e role o f health status i n general
is n o t discussed as w e feel p o o r n u t r i t i o n a l status i s such a significant
c o m p o n e n t o f health t h a t i t deserves separate consideration. P o o r n u t r i -
tional status is often separated i n t o m a l n u t r i t i o n and undernutrition. T h e
f o r m e r results f r o m a deficiency i n t h e diet o f one o r m o r e nutrients
relative t o a person's needs w h i l e the latter arises f r o m a n i n t a k e o f a n
.adequate a m o u n t o f food. T h e physiological adaptation t o m a l n u t r i t i o n
conditions such as a n e m i a and u n d e r n u t r i t i o n are related t ow o r k capacity.
B o t h conditions are discussed i n this paper.
T h e difference between w o r k capacity a n d productivity m u s t b e
•clarified. " W o r k capacity relates t o physical fitness, a n d i n particular, t o

.276 EKI, V O L . XXIV N O . 3, SEPT., 1976

 m a x i m u m aerobic power.-) Lowered w o r k capacity could theoretically
affect the intensity and d u r a t i o n o f w o r k . A l o n g w i t h the n u t r i t i o n effect,
an analysis o f actual w o r k performance o r productivity m u s t consider
n u m e r o u s other variables w h i c h affect t o t a l o u t p u t such as t h e m o t i v a -
tional, technological, and organizational factors and resource inputs. T o
understand the impact o f nutritional parameters o n output w e must a p -
preciate that labor is o n i y o n e o f t h e m a n y inputs i n a n y production
function. F u r t h e r m o r e t h elabor component c a n be separated i n t o labor
t i m e and labor intensity factors and t h e n u t r i t i o n a l status o f a person
Of g r o u p o f w o r k e r s m a y affect b o t h factors. T h e n e x t s e c t i o n w i l l c o n s i d e i
s o m e o f 'the k e y a r g u m e n t s l i n k i n g n u t r i t i o n a l status t o o u t p u t a n d
discuss a generalized m o d e l w h i c h captures m o s t o f these effects. W e
focus o n step 3 o f figure 1 . : | ,

Conceptual Linkage Between Nutritional Status A n d Labor Productivity

N u t r i t i o n a l status could affect directly t h e a m o u n t o f labor t i m e ,
the intensity w i t h w h i c h o n ew o r k s and t h eproductive potential o f t h e
task selected. I t c a nindirectly affect productivity b y reducing t h e m p t i v -
a t i o n o f persons o r their receptivity t o n e w ideas and their a b i l i t y t o
combine their resource inputs i n a n effective m a n n e r .
The time argument h a s t w o components - t h e endurance factor o r
i n a b i l i t y o f t h e body t o expend m o r e calories t h a n i t c o n s u m e s over a
longer period o f t i m e and t h e effect o f poor n u t r i t i o n a l status o n t h e
incidence and severity o f m o r b i d i t y rates. O s h i m a h a s argued t h e f o r m e r
p o i n t m o s t effectively.''') H e h a s p o i n t e d o u t t h a t t h e f o o d i n t a k e ( C i )
o r A s i a n s i s less t h a n t h e i r r e q u i r e m e n t s ( R i ) . M o r e o v e r t h e e s t i m a t e d
requirements, R i , m a y b e t o ol o w because t h e U . N . F . A . O . requirements
are based o n t h e size a n d a c t i v i t y levels o f t h e populace. Since t h e size
a n d a c t i v i t y levels o f a n y p o p u l a t i o n reflect a d a p t i o n t o a .given l e v e l
of f o o d intake, w e have this relationship :

Ci < R i (1)
Ri = f (Ci) (2)

where C i = the food consumption o f person i and R i = dietary require-

m e n t s o f person i .T h e result o f the R i — C i c o n s u m p t i o n gap, O s h i m a
argues, m u s t be a constraint o n w o r k effort.

Heywood. ibid.
Harry T . Oshima. "Food Consumption. Nutrition and Economic Ocvelopment
in Asian Countries." Economic Development and Cuilural Change I S . July 1167:
385-397.
•

EKI. V O L . -XXIV N O . 3. SEPT.. 1976 277

 T h i s is explained m o r e clearly b y adding t h e parameter E i . t h e actual
energy expenditures o f person i .O s h i m a argues t h a t i f energy expenditures
ate greater t h a n food c o n s u m p t i o n i n o n e season, this g a p m u s t b e r e -
covered i n a second season. T h i s w o u l d explain t h e l o w level o f m u l t i p l e
cropping i n populations w i t h l o w food intakes. This is shown i nFigure 2
w h e r e curve E i . the energy expenditures o f the person i . is m u c h higher d u r i n g
the peak p l o w i n g / p l a n t i n g a n d harvesting periods. T h e c o n s u m p t i o n level
C i is l o w e r t h a n E i d u r i n g t h e rice season, especially t h e peak a c t i v i t y
periods such as t h e harvest season. I f t h e E i - C i g a p is n o t counter-
balanced b y a C i - E i gap d u r i n g t h e offseason, t h e farmer w o u l d become
m o r e malnourished a n d might finally die.

Figure 2. Hypothetical Rebtionship Between Energy E.xpenditure a n d

Food Consumption.
. ci X .

El

K C a l per day
of energy
I n t a k e of
energy expen-
diture

0 End . 365
Begin rice
rice crop
crop 115-150 days

Time I n days

Oshima's a r g u m e n t h a s been backed u p partially b y research i n t h e

PiliJippines. I n a study o f t h e energy expenditure a n d c o n s u m p t i o n pat-
t e r n s o f n i n e rice f a r m e r s , eight o f t h e m h a d energy expenditures E i

278 EKI. V O L . XXIV N O . 3, SEPT.. 1976

greater t h a n c o n s u m p t i o n , C i . ' ) T h i s p o i n t i s controversial a n d s o m e
physiologists present a picture o f a greater E i adaptation t o C i . For
example, "agricultural workers i n t h e highlands o f Guatemala m a i n t a i n
a very efficient balance b e t w e e n energy i n t a k e and output."-''') O s h i m a ' s
seasonal catchup m e c h a n i s m w o u l d n o t o p e r a t e i f t h e E i - C i gap w e r e
kept very s m a l l o n a day t o day basis. I f t h el a t t e r i s correct, the lack
of m u l t i p l e c r o p p i n g m i g h t b e e x p l a i n e d b y a g r o n o m i c f a c t o r s such a s
the l o n g g r o w i n g season o f the t r a d i t i o n a l rice varieties a n d socioeconomic
or s t r u c t u r a l factors such a s t h e lack o f e c o n o m i c incentives, l a n d t e n u r e ,
credit, e t c .
T h e sickness o r m o r b i d i t y factor h a s been s u m m a r i z e d b y B a l d w i n
and W e i s b r o d . ' ) T h e y feel that p o o r h e a l t h w i l l b e associated w i t h a
reduced supply o f labor a t all wage rates. I n figure 3 , t h e supply curve
of t h esick w o r k e r , S s , i s d r a w n t o t h e l e f t o f t h es u p p l y curve o f t h e
h e a l t h y w o r k e r . S h . A t w a g e rate. O S . t h e sick person w o r k s S A days
per year and t h e healthy person. S B days p e r year. Caloric deficiencies
have been s h o w n t o affect the t o t a l t i m e available i n physical endurance
tests i n a laboratory.') Moreover, n u t r i t i o n a l status is a n i m p o r t a n t
d e t e r m i n a n t o f h u m a n reaction t o disease.") F o r these reasons, w e
w o u i d feel t h e Ss a n d S h cun-es c o u l d reflect t h e l a b o r s u p p l y curves
for persons w i t h p o o r and good n u t r i t i o n a l status, respectively.
T h e intensity o f w o r k effort over a very l i m i t e d period will also
affect productivity. T h i s was a n essential link i n t h e w a g e - p r o d u c t i v i t y

See the studies of Horentino and de Guzman.

Fiorentino. Rodolfo. "Nutrition in Relation to Work Pro^iuctivity" presenied at
tlie Philippine Association of Nutrition Forum "Nutrition in National Develop-
ment" University of the Philippines at Los Banos. January 6-7. 1975.
Guzman. P . E . de et al. " A Study of the Energy Expenditure. Dietary Intake
and Pattern of Daily Activity Among Various Occupational Groups. I . I.aguna
Rice Farmers."
Philippine Journal of Science, 103. 1974.
D From Viteri and Torun. "Ingestion caiorica y trabajo fisico de ohrerors agri-
colas en Guatemala. Efecto de la suplementacion alimenlaria y su lugar en
los programas de salud, Bol Ofic. Sanit. Pnnanier. 78. 1975: 58-74 as quoted
in Immink. M . D . C . . Viteri. F . E . . and Torun. B. "Caloric Supplementation. Work-
ing Capacity and Productivity in Guatemalan Sugar Cane Cutters." presented
at Xth International Congress of Nutrition. Kyoto. Japan. August. 1975: !.
,;) Baldwin. Robert E . & Burton A. Weisbrod "Disease and Labor Productivity."
Economic Deveiopmcitl a n d C u l t u r a l C h a n g e . 2 2 . April 1974: 414-435.
Heywood. op. cit.. p. 5 i .
D Scrimshaw. N . S., Taylor. C . E. & J. E. Gordon, in : I n t e r a c t i o n s of N u t r i t i o n
a n d I n j e c l i o n . Geneva: Worid Heaitli Or.gani/alioa Monograpii Scries No. 57.
15h5. +

EKI. VOL. XXIV N O . 3. SEPT.. I97(- 279

argument developed b y Leibenstein and others t o explain t h e existence
o f a h i g h w a g e r a t e d u r i n g s u r p l u s l a b o r conditions.®) L e i b e n s t e i n a r g u e d
that i f the marginal productivity o f labor were a function o f w o r k effort
and w o r k effort, i n turn a function o f n u t r i t i o n a l status, i t m i g h t be
profitable t o pay labor a wage rate greater t h a n one w o u l d prescribe t o
the value o f labor's marginal product under surplus labor conditions.
I n figure 3 w ecan view S S ' and H H ' as the marginal productivity curve
for sick a n d h e a l t h y w o r k e r s , respectively.'")
Figure 3. Hypothetical Labor Supply and D e m a n d Functions for a Sick
and Health Worker.

Wage per day or

/ 'H / •

marginal producti- T -T
vity per day H c/ /D H
S /B S

persons.daya per year

B a l d w i n and W e i s b r o d argue t h a t p o o r l y n o u r i s h e d persons m a y also

w o r k a t j o b s o r tasks w h i c h pay less a n d a r e p h y s i c a l l y less d e m a n d i n g .
T h i s w o u l d m e a n t h a t the p o t e n t i a l m a r g i n a l p r o d u c t i v i t y o f jobs select-
ed b y better nourished persons w i l l b e higher t h a n t h e jobs o f persons
w i t h l o w n u t r i t i o n a l status. O f course t h e selection process m a y begin
w i t h t h e employer. A higher p a y i n g e m p l o y e r m a y b e able t o select
the better nourished workers. T h e tougher a n d higher paying task is
s h o w n as curve T T ' i n figure 3.

") For a discussion of this issue, see Leibenstein. Harvey, '"The Theory of Under-
employment in Backward Economics," T h e J o u r n a l of P o l i t i c a l E c o n o m y 65.
April 1957: 91-103.
Rogers. G . B.. "Nutritionally Based Wage Determination in Low-Income Labour
Market." O x f o r d E c o n o m i c P a p e r s 2 7 March. 1975: 61-81.
1") This graph is derived from Baldwin and Weisbrod. op. cit.

280 EKI. V O L . XXIV N O . 3, S E T T . . 1976

 F o u r t h i s t h e e d u c a t i o n - m o t i v a t i o n effect. P o o r n u t r i t i o n a l s t a l l s '
can provoke poor j u d g m e n t , irritability, moodiness, and i n a t t e n t i o n . T h e i e ;
behavior changes could affect one's receptivity l o n e w ideas. H u n g i r
w i n c h results f r o m insufficient f o o d intake t o meet one's i m m e d i a t e !
energy needs s h o u l d also b e i n c l u d e d . " ) F o r these a n do t h e r reason:,
poor n u t r i t i o n a l status w i l l affect a person's ability t o learn.'-) Educa- i
t i o n a l status, i n t u r n , h a s been s h o w n t o have a direct effect o n t h :
efficiency w i t h w h i c h a person combines available inputs, ceteris paribus,
a n d t h ea b i l i t y o f a person t o reallocate available resources. W e l c h h a ;
described the i m p a c t o f education t h r o u g h these separate efficiency and
a l l o c a t i o n effects o n f a r m e r p r o d u c t i v i t y . " ) E x a m p l e s o f this effect m a M
include errors o f p l a n t i n g d e p t h a n d t i m i n g , pesticide, a n d fertilizer
application and t i m i n g w h i c h relate t o education.")
T h i s case f o r o b t a i n i n g p r o d u c t i v i t y increases f r o m n u t r i t i o n a l i m -
p r o v e m e n t s is n o t based entirely o n t h e premise o f labor shortages;
nevertheless, t h e critical question i n a t t e m p t i n g t o q u a n t i f y some o f
these effects i s t h e p r o b l e m o f surplus labor. C o u n t r i e s such as I n d o -
nesia and the Philippines have substantial u r b a n and rural u n d e r e m p l o y m e n t
a n d u n e m p l o y m e n t levels. O t h e r s argue t h a t these a r e seasonal labor
constraints; the m a r g i n a l product o f each w o r k e r i s never zero; functions
performed b yone poorly nourished w o r k e r can n o t be corrected b y adding
e x t r a w o r k e r s ; o r o u t p u t o f t h e m a l n o u r i s h e d w o r k e r w i l l b e o f poore.-
q u a l i t y e v e n i f h i s / h e r t a s k s a r e v e r y limited.'®) O f c o u r s e , f o r c e r t a i n
stiiplus labor groups w i t h l o w skill levels such as landless f a r m w o r k e r s ,
nutritional status is not a limiting condition and improved w o r k e r quality
w i l l have n o effect u n t i l changes a r e made i n t h e structural conditions

I'J Read. Merrill S. "Malnutrition. Hunger, and Behavior" J o u r n a l of t h e A m e r i c a n

D i e t e t i c A s s o c i a t i o n 6 3 . October 1973: 386-391.
See two articles by Popkin. Popkin. Barry M. "Economic Benefits from the
Elimination of Hunger in America." P u b l i c P o l i c y X X . Winter 1972. 133-153.
Popkin. Barry M. and R. Lidman. "Economics as an Aid to Nutritional Change,"
A m e r i c a n J o u r n a l of C i i n i c a i N u t r i t i o n 25. March 1972: 331-344.
I") Weicii. Finis. "Education in Production" J o u r n a l of P o l i t i c a l E c o n o m y 78 January/
February. 1970: 35-39.
Berg. Alan with Robert Muscat. T h e N u t r i t i o n E a c t o r : I t s R o l e i n National
Development. Washington. D . C . : The Brookings Institution. 1973.
1') Mellor. John W . T h e E c o n o m i c s of A g r i c u l t u r a l D e v e l o p m e n t Ithaca. N . Y.:
Cornell University Press. 1970.
Berg and Muscat, op. cit.. pp. 20-21.
Sulistyo shows that the marginal productivity of labor in East Java is low
out not equal to zero.
Sulistyo. C r e a t i n g E m p l o y m e n t O p p o r t u n i t i e s i n t h e R u r a l A r e a s of E a s t Java.
Unpublished PhD Dissertation. (Boulder. Col. University of Colorado). 1975.

EKI. VOL. XXIV N O . 3. SEPT.. 1976 281

 t h e y face. O v e r a l l , i t i s easier t o see h o w t i g h t l y paced j o b s such as
f a c t o r y a n d s e m i - s k i l l e d w o r k (e.g., b r i c k layers) w h i c h r e q u i r e great
manual precision o r strength and group-managed labor intensive activitei
such as p l a n t a t i o n o r road construction w o r k m i g h t gain m o r e f r o m
i m p r o v e m e n t s i n the labor force's n u t r i t i o n a l status. I t i s interesting t o
note that the only occupations i n w h i c h intensive nutrition-productivity
investigations have been conducted a r e these m^jre captive occupationaj
groupings. T h e f o l l o w i n g section reviews some o f these studies.

Empirical Findings o nthe Nutrition and Productivity Linkage

Several well-designed studies have s h o w n t h a t enhanced calorie and
i r o n i n t a k e s are associated significantly w i t h increased w o r k o u t p u t a m o n g
persons w h o have either l o w energy stores o r a n e m i a . Studies conducted
in Indonesia, Guatemala, t h ePhilippines and South Asia a r e reviewed.
A d d i t i o n a l findings of several o f these studies indicate t h a t b o t h w o r k i n t e n -
sity and w o r k t i m e m a y b e increased. N o n e o f these studies have developed
relevant delivery systems w h i c h w o u l d provide n u t r i t i o n a l inputs o n a
c o n t i n u o q s basis w i t h a n e t beneficial effect. Each project h a d a s i t s
objective a desire t o establish t h e n u t r i t i o n - p r o d u c t i v i t y l i n k a g e u n d e r
actual production conditions. T h u s they a t t e m p t t o establish the linkage
described i n step 3 i n Figure 1 . W o r k i n t e n s i t y refers t o p r o d u c t i v i t y
of a person over a short t i m e span.

a. I n t e n s i t y o f w o r k l\
Indonesia
T w o studies were conducted b y persons f r o m the N a t i o n a l Institute
of N u t r i t i o n Bogor a n d t h e W o r l d Bank ( I B R D ) . " ) I n the first, t h e
health and n u t r i t i o n a l status and productivity o f 5 7 1 civil construction
workers were studied. F r o m this w o r k i t was determined that anemia
w a s a severe p r o b l e m . These results w e r e used t o p l a n a n i r o n i n t e r -
vention study a m o n g 3 0 0 rubber plantation latex tappers and weeders.
A double blind iron treatment o r placebo was administered over a 6 0 -
day period. A t t h e end, productivity o f the anemic tapper treatment
group' increased t o the level o f the n o n a n e m i c tapper group. T h e y estimat-
ed that the iron treatment group had a productivity 1 5 % higher than

;>«) Basra, S. S. and A. Churchill, Iron Deficiency Anemia and the Productivity of
Adult Males in Indonesia. Staff Working Paper No. 175, (International Bank
for Reconstruction and Development, Washington), 1974.
Karyadi, Darwin and Samir Basra, "Nutrition and Health of Indonesian Cons
truction Workers : Endurance and Anemia" Staff Working Paper No. 152. I n
ternational Bank for Reconstruction and Development, April 1973.

282 EKI, V O L . XXIV N O . 3, SEPT., 1976

 ihe placebo g r o u p a t the end o f the i n t e r v e n t i o n p r o g r a m . .Alter treaiineJi':'
oi the weeders n o significant differences were f o u n d between the a n e m c i
piacebo groups because of increases i n the i r o n status o f the placebo iron a n i l
a n e m i c c o n t r o l g r o u p . T h e s e increases i n i r o n s t a t u s o f the placebo g r o u p mav-|
h a v e r e l a t e d t o t h e 5 - 7 % s a l a r y s u p p l e m e n t d i s t r i b u t e d t o e a c h w o r k e •.
U s i n g o n l y p r e and post a n e m i a status as a basis o f comparison, the/
f o u n d t h e a n e m i c w o r k e r s h a d a p r o d u c t i v i t y level 2 0 % less t h a n i h ;
nonanemic workers.
T h e s e r e s u l t s a r e h i g h l y e n c o u r a g i n g b u t w e m u s t b e catitioi:.+
interpreting them. First, 6 5 o f t h e3 0 0 workers dropped our during t h e
s t u d y a n d w e a r e n o t g i v e n statistics o n t h e representativeness o f th-.
r e m a m i n g sample. Second, there w a s a p o s i t i v e i r o n t r e a t m e n t effcc;
.among the n o n a n e m i c latex w o r k e r s and the n e t t r e a t m e n t m i n u s piacelic
effect f o r t h e anemic, n o n a n e m i c a n d t o t a l latex w o r k e r samples a r
i n s i g n i f i c a n t . " ) T h i r d , effects n o t c o n t r o l l e d i n t h i s analy.sis i n c l u d e t h e
seasonality o f latex yield i n t h e rubber trees a n d t h e assignments o f
tappers t o higher y i e l d i n g areas based o n t h e i r m o r b i d i t y and n u t r i t i o n a l
s t a t u s . " ) T h i s seasonal latex yield effect m a y explain t h e yield increase
of the n o n a n e m i c t r e a t m e n t group. I t also m a y explain the fact t h a t i r o n
s u p p l e m e n t a t i o n d i d n o t result i n a significant latex o u t p u t effect.

Guateinula
V i t e r i and others feel they have good evidence t h a t t h e reduction
o f a n e m i a and t h e a d d i t i o n o f calories w i l l enhance w o r k i n g efficiency.
T h e y f o u n d poor peasants spend nii t h ecalories they ingest and felt a
caloric increase w o u l d m a k e possible a n increase i n physical activity. I n
one controlled study, they f o u n d that t h e calorie supplemented group
w o r k e d m o r e intensely (finished their tasks quicker) t h a n t h e control
g r o u p . " ) A l s o , they f o u n d the n o n w o r k active leisure t i m e o f t h e caioric
supplemented group were significantly greater t h a n t h e control group.
T h e n o n - s u p p l e m e n t e d c o n t r o l g r o u p required a b o u t I I . 8 h o u r s o f sleep

An excellent discussion of certain statistical issues in this Indonesian Study is.

found in.
Nasoetion. Andi H a k i m . "Spurious Correlation as a Result of Constraints in
Randomization" presented at A / D / C seminar and Workshop on Problems of
Field Data Collection in Rural Areas. Singapore. 1974.
") Viteri. 1971.
Viteri. Fernando E . "Considerations on the effect of Nutrition on the Bo(%
Composition and Physical Working Capacity of Young Guatemalan Adults" in
N.S. Scrimshaw and A . M . Altachul, A m i n o A c i d F o r l i f i c a t i o n of P r o t e i n F o o d s .
Cambridge: The M I T Press. 1971: 350-375.

EKI. V O L . .XXIV N O . 3. SEPT., 1976

p l u s rest as contrasted w i t h o n l y 8 h o u r s o f sleep a n drest f o r t h e supple-
mented group.
S o m e l i m i t a t i o n s i n t h e G u a t e m a l a research design have been p o i n t -
ed o u t . " ) T h e groups w e r e classified b y socioeconomic status rather t h a n
by t h e nutritional status o f t h e individual. Using this additional i n f o r m a -
t i o n m a y have enhanced t h eresults. H e y w o o d also p o i n t s o u t t h a t t h e
energy expenditures o f these peasants were studied over o n l y a 3 - 6 d a y
period — a period w h i c h m a y be t o o short t o draw valid conclusions
w h e n so m a n y other experimental effects m a y have existed. I n G u a t e m a l a ,
V i t e r i h a s also s h o w n t h a t t h e r e d u c t i o n o f a n e m i a increased a l a b o r a t o r y
measure o f w o r k capacity ( t h e H a r v a r d Step Test w a s used). T h e i r best
results came t w o m o n t h after iron therapy w a s initiated.
Recently the Guatemala group completed a n intervention study a m o n g
sugarcane v/orkers. I n that project their p r e l i m i n a r y results indicated t h a t
sugarcane cutters o n higher energy intake increase their v;ork a n d energy
o u t p u t . T h e high calorie intakes resulted f r o m calorie supplements p r o -
v i d e d t o t h e t r e a t m e n t group.®") T h e r e s u l t s o f t h i s s t u d y a r e s i g n i f i c a n t
in that there were good controls o n most non-nutritional a n dproductivity
•factors a n d d e t a i l e d l i n k a g e s b e t w e e n n u t r i t i o n a l a n d p r o d u c t i v i t y
factors existed. T h e i r results a r ebased o n t h e differential productivity o f
the treatment a n d control group. T h e latter w a s given a placebo drink.
O n e unexplained factor w a s that p r o d u c t i v i t y increased steadily b u t t h e
energy expenditure gapbetween t h etreatment a n d control groups were
significantly different after 5 m o n t h s b u t n o tafter 1 0 months.

PhiUppines
A recent cross-sectional investigation o f t h e relationship between
anemia a n d road construction w o r k e r productivity w a s conducted i n t h e
B i c o i r e g i o n o f t h e Philippines.®') N u t r i t i o n a l a n d s o c i o e c o n o m i c data
w a s collected f o r 1 5 7 w o r k e r s o n a labor intensive g o v e r n m e n t project.
T h e final product was a s t u r d y soil r o a d b u i l t above n o r m a l f l o o d levels.
T h e l e v e l o f a n e m i a w a s c o m p a r a b l e w i t h t h a t f o u n d i n I n d o n e s i a as
a b o u t 5 5 % o f t h e 1 5 7 w o r k e r s h a d a n e m i a according t o t h e m o s t recent
W H O classification. T h e workers studied were soil loaders, unloaders,
a n d tampers. O u t p u t , n u t r i t i o n a l a n d socioeconomic data were collected

Heywood, op. cit., pp. 44-45 , 62-63.

20) Immink et al, op. cit. '
21) The following discussion conies from Popkin, de Jesus and Dullin.
Popkin, Barry M., Luz Dullin and Susan J . de Jesus, "The Effect of Anemia
on Road Construction Worker Productivity" report submitted to the Department
of Public Works Philippines, February, 1 9 7 6 .

284 EKI. VOL. XXrV NO. 3, SEPT., 1976

 over a t w o - d a y period f o ro n l y 3 8 o f tliese w o r k e r s before some major-
c h a n g e s i n t h e i r w a g e p a y m e n t s y s t e m l e d t o a m a s s e x o d u s o f w o r k e •»
f r o m t h e project site. T h e relationship b e t w e e n a n e m i a a n d p r o d u c t i v i y
is g i v e n i n T a b l e 1 f o r these 3 8 w o r k e r s . T h e a n e m i c w o r k e r s i n
three occupations h a d l o w e r o u t p u t levels.

T a b l e 1. Relationsliip Between T h eProductivity A n d A n e m i a Status C f

Bicol Road Construction W o r k e r s ' )
(Average Daily O u t p u t )

Occupational Group
Anemia
Status o f Loaders Unloaders Tampers Total
Worker Output Output Output Output
Ave. No. Ave. No. Ave. No. Ave. No.

Anemic U25 6 .70 10 2.26 6 1.28 22

Non-anemic 1.96 8 .75 7 3.65 1 1.54 • 16
Total 1.66 14 .72 17 2.46 7 1.39 38

') Output is measured in cubic meters of firm soil.

A n e m i a is n o t t h e o n l y factor w h i c h affects w o r k e r p r o d u c t i v i t y .
A m u l t i v a r i a t e analysis is used t o d e t e r m i n e t h e pure a n e m i a effect.
O t h e r factors w h i c h could affect road w o r k e r productivity include t h e
worker's age. education, m o t i v a t i o n level, wage rate, occupation, equip-
m e n t provided a n dweather conditions. M u l t i v a r i a t e regression analysis
allows u s t o u n d e r s t a n d w h a t effect, i f any, a change i n a n e m i a o r a n y
other health o r nutritional parameter w o u l d have i f t h eother factors d o
n o t change.
Average p r o d u c t i v i t y i n cubic meters o f f i r m soil w a s t h e dependent
variable. T h erelationships used a l l o w us t o explain a large percentage o f
the v a r i a t i o n o f productivity. I n regression 1 . t h evariation explained is
7 0 % ( T a b l e 2 ) . T h e m o s t i m p o r t a n t factor, h o w e v e r , is t h e d i r e c t i o n a n d
effect o f each o f t h e various parameters, especially t h e h e a l t h / n u t r i t i o n a l
ones. I n regression 2 , over 6 8 percent o f t h e v a r i a t i o n i n p r o d u c t i v i t y is
explained. T h e t w o regressions a r e presented t o provide t w o different w a y s

EKI, V O L . XXIV N O . 3. SEPT.. 1976 285

Table 2 . Regression : Factors Associated With Road Worker Productivity
Dependent Variable: ' ) f i r m soil output/day - " •
m e a n value 1.544 c u . m .
Independent Variables Regression 1 . Regression 2
X
Unnqfanr 1.46 1.81
\>lHi lo XOtll x
a i n u t r i t i o n a l status i
1 ) a n e m i a s e v e r e (0-1)®) -.515*** • • ' 'i —

( h e m o g l o b i n less t h a n 10.9 g/100 m l ) (1.319)

2) n o sign o f a n e m i a (0-1) : .412*** —
(hemoglobin above 12.9 g/100 m l ) (1.571)
3) a n e m i a W H O (0-1) — -.52**
(2.04)
32 worker's age .004 •; . 0 0 2
(y'^ y e a r s ) (.401) (.21)
as w o r K c r s e d u c a t i o n ' .016 .013
t (.187) (.16)
35 nousenolu size / 0.19 003
(.429) (.08)
Sir, compensation") .232 ** .271 *
/nil (1.581) /t o ^\
(1.86)
a? (r 0a-i1n) i n d e x ( r a i n y = 0 , s u n n y = 1 ) .702**
//-V ,1 -1 \
(1.620) (1.94)
as o( 0c -c tuhpraut i o1n)a l groupings®)
loader (0-1) -.402 -.485**
(1.092) (1.32)
Unloader (0-1) -1.891* -1.96*
(5.704) "(5.93)
R® .70 • .68
F-ratio 7.30 7.80
N u m b e r o f Cases 38 38

T-values are presented i n parentheses

Statistical significance
* = 1 % level
** = 5 % level '
*** = 10% l e v e l ... •
1) For the loaders, the output is in loose cu. meter since the dummy occupation
variable allowed not to change the intercept of this parameter.
2) For each dummy (0-1) variable, presence of this category and 0 = otherwise.
For anemia group, a third dummy for the 11-12.9 hemoglohin group was deleted,
similarly the tampers were left out of the occupational group.

286 EKI. V O L . X X I V N O . 3. SEPT., 1976

 of s h o w i n g the anemia effect - a n effect w h i c h is significant and lark
i n b o t h cases.
I n regression 1 , the presence o f very severe a n e m i a i n a road w o r k e r i
is a s s o c i a t e d w i t h a s i g n i f i c a n t d r o p i n a v e r a g e p r o d u c t i v i t y r e l a t i v e t o a
w o r k e r w i t h h e m o g l o b i n i n t h e 1 1 - 1 2 . 9 r a n g e . * ) A t t h e s a m e t i m e higli',
h e m o g l o b i n levels a r e associated w i t h a significant increase i n produci -
iviiy. A weight/height o r undernutrition parameter produced a small an i
insignificant impact on productivity; consequently, i t was o m i t t e d f r o m this J
analysis. Inclusion o f this weight/height parameter did n o t greatly affect
the other regression coefficients so its exclusion should n o t affect the i r |
ter'pretation o f the results.
O t h e r interesting effects include t h e compensation factor. W o r k e r ! ;
w h o were paid for each day o f w o r k had about a 1 5 % higher daily outpui
t h a n the w o r k e r s w h o w e r e expected t o w o r k t w o days for free. T h i s p a j
scheme m a y provide a potentially i m p o r t a n t w o r k disincentive.
A n o t h e r factor expected t o be very i m p o r t a n t was the rain o r weathei
parameter. S u n n y and dry weather was associated w i t h a higher increase
in output. Since this index only roughly allows u s t o control for the effects
of weather, w e c a nnot accurately estimate h o w m u c h more productive
w o r k e r s are d u r i n g s u n n y w e a t h e r .
I n regression 2 . t h e t w o anemia variables were taken o u t and a n
a n e m i a d u m m y variable for the W H O classification o f anemia was used.
I n regression 2 , t h e a n e m i a effect w a s s i g n i f i c a n t . * * ) I n b o t h cases w e f i n d
t h a t a n e m i a is associated w i t h a rather large reduction i n productivity.
Regression 1 provides u s w i t h a different insight b y showing that high
h e m o g l o b i n is associated w i t h a higher level o r productivity relative t o
the m i d d l e level o f h e m o g l o b i n w h i l e very l o w h e m o g l o b i n levels lead t o
a significant r e d u c t i o n i n o u t p u t relative t o the m i d d l e h e m o g l o b i n levels.
F r o m these regressions w e can predict the p r o d u c t i v i t y level o f anemic
a n d n o n a n e m i c w o r k e r s i n d i f f e r e n t o c c u p a t i o n s w h o possess all o f t h e
same o t h e r ch-aractcristics. T h e results presented i n T a b l e 3 indicate t h a t
the productivity o f the nonanemic worker was 2 3 t o 1 6 2 percent greater
than that o f the anemic workers.

'J It is expected that these cliects of anemia will he felt not only directly on
productivity but indirectly through its effects on many other parameters. Tliis
effect may be captured witli interaction terms or a structural congrucncy test
but we felt our sample size was too small for such an analysis.
") The other relationships did not change in sign although iliey do change in
size which may indicate some degree of linear dependence between the anemia
and other independent variables.

EKI. V O L . XXIV N O . 3. SEPT.. 1976 287

 Table 3. Estimated Output For Average Worker With And Without
Anemia
(cubic meters of output per day)

WFIO Classification loader Unloader Tamper

Anemia • 1.79 .32 2.28 .

No Anemia 2.31 .84 2.80
no Anemia
Ratio : 1.29 2.62 1.23
Anemia

N u m b e r o f Cases = 38.
1) These predicted values are based on regression 2, table 2. The average worker
has the following characteristics: 26 years old, grade 5 education level, S
dependents, and lives neat the project site.

One o f the criticisms o f the Indonesian study apply more strongly t o

the Filipino one. T h e exodus o f 119 o f the 157 workers f r o m w h o m other
data w a s collected could lead t o a very unrepresentative sample. T h e de-
parted group did n o t appear t o have different productivity data than the
workers w h o remained b u t this representativeness factor m u s t b e viewed
f r o m a broader f r a m e w o r k . O u t p u t per w o r k is a f u n c t i o n o f various a t -
titudinal as well as resource i n p u t factors. There m a y have been a system-
atic difference between the attitudes o f the r e m a i n i n g sample and those
w h o left w h i c h m i g h t have effected these n u t r i t i o n - p r o d u c t i v i t y linkages
in a systematic way.

South India
Sn Lanka
A s t u d y a m o n g f e m a l e tea pickers f r o m the K a n d y area o f S r i L a n k a ,
f o u n d a h i g h p r e v a l e n c e o f s e v e r e anemia.®®) T h e y f o u n d t h e a b i l i t y t o
sustain w o r k w a s h i g h l y related t o h e m o g l o b i n levels. P r e l i m i n a r y results
indicate t h a t a t a h e m o g l o b i n level o f 6 g/100 m l , t h e w o m e n picked
a b o u t 2 1 p o u n d s o f tea per day. A t a level o f 1 0 g/100 m l , t h e t e a p r o d -
u c t i o n increased t o 3 1 pounds p e rday and as the level approached t h e
high point, they picked about 3 7 pounds per day.
In India, a 500 calorie daily supplement t o coal m i n e w o r k e r s whose
sole task w a s s h o v e l i n g coal tubs s h o w e d n o results because o f a capital

22) Gardner, G.W., Edgerton, V.R.. Barnard, E . ) . and Senewiratne, B. "Physical

Working Capacity and Iron Deficiency A n e m i a " presented at X t h Internationa)
Congress of Nutrition. Kyoto, )apan, August, 1975. ,

288 EKI. V O L . XXIV N O . 3, SEPT., 1976

 constraint.®®) T h e a u t h o r s f o u n d t h a t t h e w e i g h t o f t h e w o r k e r s i n c r e a i e d
but the lack o f additional coal tubs prevented any increase i nproductivi
A s e p a r a t e s t u d y i n N o r t h e r n I n d i a o n t h e e f f e c t o f t h e h e a l t h a id
nutritional status o f road construction workers o n productivity failed t p
p r o v i d e a n y c o n c l u s i v e n u t r i t i o n - p r o d u c t i v i t y effect.®') U s i n g c r o s s - s e c t i c
al t e c h n i q u e s , d e t a i l e d n u t r i t i o n a l a n d b i o c h e m i c a l i n d i c e s w e r e c o l l e c t e d
on 1 9 8 road construction workers. Productivity measures were based m
a standardized test i n w h i c h w o r k e r s carried sacks o f sand u p a n i s meteij
rise - a p r o d u c t i v i t y m e a s u r e w i c h avoided t h e experience factor. W e i g h t d : f - i
ferences w e r e o n e o f t h e f e w significant variables w h i c h explained t i p
d i f f e r e n c e b e t w e e n t h e h i g h a n d l o w o u t p u t o b s e r v e d a n d i t i s possible',
that a n intervention study m a y have produced m o r e conclusive result.
T h e l a b o r e r s c o u l d b e s e p a r a t e d i n t o a l o c a l i n e x p e r i e n c e d a n d a n i m p o r :-
ed experienced group. F o r t h e local group, a biochemical measure p f
i r o n levels w a s correlated positively w i t h o u t p u t .

b. W o r k time
A higher absentee rate a n d incidence o f disabling accidents • a n 1
decreased w o r k i n g t i m e m a y be associated w i t h poorer n u t r i t i o n a l s t a t u i .
JTherci a r e ! i f e w t s t u d i e s ; w h i c h , analyze these; relationships.L'On&vproject
the^-'-"--'-'--'-*--'----'''-^^-'^'^*-*-^^^''-^---"-----'^^^^^

...''"¥he^'^
a n d productivity.®^)'''^Anemic w o r k e r s w e r e a b s e n t m o r e o f t e n " t h a n non-
anemic workers. This is s h o w n i n Table 4 according t o both the W H O
and t h e m o r e detailed I C N N D anemia classifications i n Table 4 . They
also f o u n d t h a t t h e a n e m i c loaders a n d u n l o a d e r s s p e n t less a c t u a l time

Satyanarayana, K . . D . Hanunantha Rao, D . Vasudeva Rao & M. C . Swaninalhan

"Nutritional Working Efficiency in Coalminers," Indian Journal of Medical
Research 60. December. 1972: lSOO-1806.
Transport Research Division, "Effects of Health and Nutrition Status of Road
Construction Workers in Northern India on Productivity" Technical Memorandum
No. 4, Transportation and Urban Projects Dept., IBRD January, 1975.
=5) Popkin, 1972 Op. cit.
21!) Basra and Churchill, op. cit.
27) Popkin, Dullin and De Jesus, op. cit.

EKI, V O L . X X I V N O . 3. SEPT.. 1976 289

T a b l e 4. Relationship Between Hemoglobin Level A n d Days Of Work
Missed Over Previous M o n t h D u eT o Illness.
A. I C N N D Classification
Hemoglobin Group Mean Days Missed N o . o f Cases

L o w (Severe A n e m i a ) 0.8 47
Deficient 0.7 80
Acceptable • 0.1 24 •
High 0.0 6
Total 0.6 157
B. Classification
Hemoglobin Group Mean Days Missed - N o . o f Cases
Without Anemia 0.5 71
With Anemia 0.7 86
Total 0.6 157

w o r k m g w h i l e they were o n t h ej o b site t h a n d i d t h e n o n a n e m i c w o r k e r s .

I n T a b l e 5 w e s h o w t h a t t h e a n e m i c u n l o a d e r s w o r k e d less, rested m o r e
a n d required m o r e t i m e t o u n l o a d each sledge filled w i t h soil. T h e anemic
l o a d e r s also w o r k e d less t i m e a n d rested m o r e ; h o w e v e r , t h e i r a v e r a g e
t i m e p e r t a s k w a s less b u t t h i s w a s a s s o c i a t e d w i t h a s m a l l e r o u t p u t
level p e r task. •
( •
Table 5. Relationship Between A n e m i a Status A n d Activity Analysis.

Time Working Time n o tworking Task Time

Workers ( i n hours) (in hours) ( i n mins.)
average average average

Loaders
Anemic 1.47 5.65 1.29
Non-Anemic 2.66 4.40 2.34
Unloaders .
Anemic 1.27 5.81 _ 2.70
Non-anemic 1.77 5.35 2.42

N u m b e r o f Cases = 3 8 .

290 EKI. V O L . X X I V N O . 3, SEPT., 1976

Summary
The studies reviewed help us to fill in the step 3 linkage in figur :
1 . The Guatemala intervention pilot project established the Jihkagi:
between caloric increases which release the work effort ceiling and in-
creased work performance. The Indonesian, Guatemalan and Filipin)
anemia studies established the linkage between a reduction in anemia
and increased work perforrhance and working time. Each of these studit s
was conducted under working conditions which are quite close to norma .
Experiments have not been conducted in populations where contros
exist on the labor work routine in terms of hours worked and/or tie
number and composition of the workers; thus the surplus labor question
has been bypassed. One of the key unanswered questions we face n
this area relates to the role of increased nutritional status among farmer.":
and others in surplus labor situations such as the found in Central Javi.

E K I , V O L X X I V N O . 3, SEPT.. 1976 291