751 



the relationship between health (plus education) and agricultural 

 productivity was "more vigorous"' than that of labor and fertilizer, 

 the more usual indices of changed agricultural productivity.^*^ 

 In summary : 



There does emerge clearly the evidence of an output response 

 in the rural parts of poor lands when acti\dty in the health 

 field changes, and this in a society and economy where 

 popular arguments notwithstanding — labor is a relatively 

 under-utilized resource. The health influence may thus not 

 ODerate simply tlirough more man-hours * * *; it is rather, or 

 also, a consequence of attitude shifts on the part of the 

 laborer.^^^ 



Output per person in Africa, Asia, and Latin America has 

 increased in recent decades even as population growth reached 

 record rates of expansion * * *. On the record, therefore, 

 economic progress has begun even as population growth 

 expanded.^®" 



Malenbaum considers health benefits so obvious that there is little 

 effort to quantify them. When that effort is made a whole spectrum of 

 social and economic indicators (in 115 countries) showed that health 

 variables tended to be the most highly correlated with all measures of 

 progress.^®^ He states further that the use of statistics which lump 

 urban and rural data together tends to conceal rather than reveal 

 the benefits of health service to poor people in poor nations. Cost/ 

 benefit statistics in such countries must be worked up below the 

 national level because national statistics obscure too many important 

 subnational or regional differences : 



Preliminary statistical analysis of changes in health and in 

 health programs in poor areas, where labor is the dominant 

 factor of production, suggests a positive effect of health inputs 

 on subsequent output. There is an economic rationale for such 

 a relationship in poor lands, through changes in the \dgor and 

 motivation of the self-employed workers who are predominant 

 in the labor force. Such a positive role also fits new doctrines 

 of growth, in which quality of factor inputs receives greater 

 weight than quantity of labor or capital. There exists a need 

 for such additional statistical analyses, and especially in small 

 areas (villages, counties, districts), where outputs and pro- 

 duction processes are more homogeneous than in nations as a 

 whole.i»2 



The Complex Issue of Health and Overpopulation 



The most provocative dilerama of all faces those who would try to 

 show by analysis that, on a short-term basis at least, the saving of lives 

 which increases population also produces a net economic gain in today's 

 low-income, non-developed lands. There is a gain in production, includ- 

 ing food, but there is also reduction in morbidity rates which increases 



188 Wilfred Malenbaum. "Progre» in Health: What Index of Progress?" The Annals of 

 the American Academy of Political and Social Science. (January 1971), pages 109-113. 

 i8» Ibid., page 114. 

 i^o Ibid., page 110. 

 i°i Ibid., page 110. 

 »=' Ibid., page 113. 



