Income Inequality Associated with Double Disease Burden of Overnourishment and Undernourishment in India

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Effect seen even after adjusting for numerous variables

It has been known that countries with rapidly developing
economies may experience a double-disease burden that results from
undernutrition and overnutrition. People living in poverty experience
diseases that result from a lack of resources, while affluent
individuals may suffer from diseases that result from an abundance of

Researchers at the Harvard School of Public Health (HSPH) and the
University of Bristol have examined the extent to which income
inequality is predictive of this double nutritional burden in India.
They found that people living in Indian states with high levels of
income inequality experienced a greater risk of both under- and
overnutrition, even after adjusting for various demographic, economic,
and behavioral variables.

The researchers found that for every three percent widening in a
state’s income inequality between the most affluent and the most poor,
the risk for being underweight increased by 19 percent and the risk for
being obese increased by 21 percent.

“Put simply, here’s one macro-economic determinant that affects the
health of the poor, via making them undernourished, and the rich, via
making them overnourished, simultaneously,” said lead author S V
, associate professor in the HSPH Department of Society,
Human Development, and Health

The study was published in advance online on August 20, 2007, in The
Journal of Epidemiology and Community Health

The researchers analyzed a nationally representative database of 77,220
Indian women between the ages of 15 and 49 years, using body mass index
as an indicator of under- and overnutrition. The women lived in 26
states in India. Income inequalities among the states were measured by
differences in per capita consumption.

In an additional finding, higher per capita consumption expenditure at
the state-level, which is a marker of economic development, was
associated with an increased risk of obesity. Yet, no association was
observed between higher state per capita consumption expenditure and
reduced risk for undernutrition, suggesting that economic development
does not have a guaranteed connection to alleviating disease among the
impoverished, noted Subramanian.

The authors suggest that economic inequality and the resulting
increased risk for under- and overnutrition does not reflect a lack or
overabundance of resources. Rather, they emphasize the role of the
distribution of these resources.

“Arguably, states with a high level of income inequality tend to not
only facilitate opportunities for over-consumption, but may also lead
to system-level inefficiencies and corruption that in turn fail to
provide adequate nutrition for those who need it,” asserted Subramanian.

To address this double-disease burden and to optimize health outcomes,
the authors propose implementing strategies such as ensuring access to
adequately nutritional food by the poor and disseminating information
about the adverse impacts of obesity within the general population and
especially among the affluent.

S V Subramanian is supported by the National Institutes of Health Career Development Award.
Other authors on the study were Ichiro Kawachi of the HSPH Department
of Society, Human Development, and Health, and George Davey Smith of
the University of Bristol.