Can estate sector workers break away from poor health and poverty?

While Sri Lanka’s overall health indicators are on track to achieve the 2015 Millennium Development Goals (MDGs), malnutrition continues to be a serious concern in the country. Certain population groups fare worse than others. Priyanka Jayawardena discusses the causes of undernutrition in one of the least developed sectors of the country, the estate sector based on her recent study.

People in Sri Lanka’s estate sector are one of the most marginalized groups in the country. Because the majority of them descended from indentured labour brought from India in the early 1900s and they were not granted citizenship status. They lived for decades without state provision of social services. Large inequalities exist in their access to and the utilization of health services. Estate workers are largely dependent on the estate’s management for their basic needs – housing, health and education.

Families working on estates are among the country’s poorest in terms of nutrition. About 30 percent of children under the age of five are underweight, nearly one in three babies has low birth weight and one-third of women of reproductive age are malnourished (see Figure 1). This is a serious issue as it leads to a possible ‘vicious cycle’. The intergenerational cycle of malnutrition (see Figure 2), as established in Jayawardena (2012), is deeply embedded in the estate sector. A recent study by the author identified what factors influenced estate sector child and maternal malnutrition – important empirical insights in addressing the intergenerational cycle of malnutrition in the estate sector.

Debilitating poverty prevails

In the estate sector, households’ socioeconomic status is considerably lower than in the rural and urban sectors. Almost 61 percent of its households fall into the poorest category, while in the urban and rural sectors this was at 8 percent and 20 percent, respectively (see Figure 3). Households’ poor socio-economic status affects the health and welfare of people in the estate sector adversely. For example, as revealed in Jayawardena, (2012), a child belonging to the ‘poorest’ socio-economic quintile is three times more likely to be underweight than a child in the richest quintile.

Eating smart

A significant reason for child and maternal malnutrition in the estate sector was intake of the ‘wrong’ kind of foods, specifically those lacking in protein. Consumption of nutritious food was much lower among children and mothers in the estate sector. In terms of food consumption by children aged one to three years, the estate sector demonstrates the lowest levels of consumption of protein-rich food (meat, fish, poultry, eggs and cereals), when compared to urban and rural areas (see Figure 4). Similarly, mothers in the estate sector consumed fewer protein-rich foods when compared to their peers in the other two sectors. Consumption of other essential nutrients, such as fruits and vegetables that are rich in vitamin A, were much lower among the estate sector children than the country average.

Estate sector alcoholism

The study revealed that regular alcohol consumption in the estate sector significantly increased the prevalence of malnourished women. Alcohol consumption was extensively higher among estate sector people. According to DHS 2006/07 data, 40 percent of the estate sector families were regular users of alcohol; whereas in the other two sectors it affected around 17 percent of families (see Figure 5). Although the estate sector recorded the highest poverty levels (11.4 percent of people compared to 8.9 percent at national level), they spend Rs.1,216 per month on alcohol, tobacco, etc., which is roughly double that of the average household-level spend on alcohol in the rest of the country (Rs.665).

Educated women hold the key

Evidence suggests that women are critical in ensuring good nutrition for the family and household food security. Women have the greatest potential to make decisions that positively affect children’s health, how household income is spent, the quantity and quality of food and in health-seeking behaviour. In the estate sector, the level of women’s education is much lower than in urban and rural areas. The study’s findings reveal that the education and knowledge of women have a strong impact on their nutritional status, as well as on the nutrition of her children. Poor education makes it difficult for women to take full advantage of the awareness raising campaigns on family health and hygiene practices offered in their localities, either by the government health service or by the estate management.

Addressing a critical concern

The causes of malnutrition are clearly multi-faceted and so actions to reduce it require interventions at different stages of the life cycle. It also requires that nutrition considerations are incorporated into all sectoral policies. Sustainable nutritional interventions should be aimed at enhancing food security at the household and community levels as well as at schools in the estate sector. Nutrition education programmes should be strengthened to inculcate better consumption habits – what foods to select, how to prepare and feed children and the hygienic and nutritional value of food. Strong national programmes on nutrition counselling and programmes that promote positive health practices and curb negative ones like alcoholism programmes can be useful in improving awareness among women in the country’s estate sector, and break the cycle of poverty and poor health. (Courtesy Talking Economics)

(Priyanka Jayawardena is a Research Officer and holds a BSc

(Honours) in Statistics from the University of Colombo. She is currently reading for a Master’s in Economics

at the University of Colombo)