Exploring Models of Economic Inequality and the Impact on Mental and Physical Health Outcomes in Rural Eastern Province, Zambia

Abstract

Structural adjustment measures adopted during the early 1990s considerably altered the rural landscape throughout Zambia. Households responded and continue to respond in a variety of ways, although many do so under highly inequitable terms. Poverty rates, food insecurity, and income inequality all remain unacceptably high in Zambia, particularly in rural areas. Using a biocultural and livelihoods approach, this alternate "publication in scholarly journals" format dissertation examines some of the complexities that condition livelihoods and differentially shape biologies in rural Zambia today. Three main problems are explored: 1) the relationship between food insecurity and adult mental health; 2) piecework (casual labor) as a coping strategy and indicator of household vulnerability to food insecurity; and 3) the association between relative deprivation and adult physical health. Research for the dissertation took place in a rural area in Eastern Province, Zambia in 2009. The research employed a mixed methodology, collecting qualitative and household-level survey data during the rainy and dry seasons. Various statistical analyses were utilized in the three papers appended to the dissertation. The results were further explored using the findings from the qualitative data. In paper one, a positive relationship between food insecurity and poor mental health was found. Food insecurity during the dry season had a greater effect on mental health than in the rainy season. In paper two, the results demonstrate the importance of piecework labor as a coping strategy and the need to adopt a multi-period lens to robustly assess whether participation in piecework reflects a household's vulnerability to food insecurity. In the third paper, a negative association was established between relative deprivation and adult nutritional status. Together, the results from the dissertation provide clear evidence that both the material and relative circumstances of people play important roles in patterning variation in mental and physical health outcomes in rural Zambia.