Health Disparities and Market Integration
Economic development comes with both risks and benefits. Rapid market integration鈥攊ncreasing participation in markets due to a transition from subsistence to cash agriculture, migration for labor, or an influx of tourism鈥攃an result in an increase in socio-economic inequality (as some households benefit more than others, and some possibly not at all, from participation in markets), as well as higher disease rates and greater disparities in health.
It is well known that economic development dramatically affects health in complex ways, and that health trends and disparities established in the initial period of market integration are often difficult to reverse. Nonetheless, how market integration affects health at the onset of economic development remains poorly understood.
绿帽社 faculty member Katherine Wander is part of a collaboration across multiple universities to describe the early phases of rapid market integration among two populations traditionally reliant on subsistence agriculture, to understand how this process affects inequality, health, and health disparities.
The Mosuo farmers are an ethnic minority living in the Hengduan Mountains in Yunnan and Sichuan Provinces of Southwest China. Some Mosuo have capitalized on the tourism industry around Lugu Lake, and an increasing minority of families are gaining much of their income from tourism. The construction in 2015 of an airport near the main tourist area is increasing the impact of tourism. Large disparities in household income have already accompanied the transition away from agricultural subsistence among communities closest to Lugu Lake and most reliant on tourism.
Matlab, Bangladesh villagers are ethnic Bengalis whose primary economy consists of farming and fishing, supplemented by day labor, small business, and remittances from family members. A small but increasing number of men are engaged in full-time wage labor, which often means migrating long distances and living outside of Matlab. Increasing access to labor markets and decreasing per capita land availability have motivated families to decrease reliance on subsistence agriculture since the 1980s. Such changes have led to much larger economic disparities in the last two decades, as well as rising food insecurity. Bangladesh still suffers from high rates of malnutrition, tuberculosis, and diarrheal disease, and early signs indicate the emergence of chronic diseases, such as cardiovascular disease and diabetes, in Matlab, as well.
In both field sites, we are collecting information about nutritional and health outcomes (including under- and over-nutrition, iron deficiency, anemia, insulin resistance, and inflammation) across communities and households that vary in their degree of participation in markets. These outcomes are particularly appropriate for detecting early, often sub-clinical declines in health during the process of rapid market integration.
We will use the information on nutritional and health outcomes in combination with socio-demographic data to further assess how material wealth, education, and social networks affect health outcomes and disparities during market integration. This study aims to provide a holistic understanding of how market integration affects health, via inequality in wealth, education, and social networks. This understanding may offer clues for how to counter the health disparities produced by market integration.