Analysing the drivers of dietary diversity, diet quality and household food security in developing Asia: Evidence from urban Vietnam and rural Bangladesh

This thesis explores the drivers influencing dietary diversity, diet quality and overall food security, using different approaches for urban and rural households in emerging Asia. The first empirical study investigates the possible mechanisms through which modern food environments may affect Vietnamese households’ dietary diversity and diet quality. The analysis uses primary data collected in 2016 and 2017 from 1,700 households in urban Hanoi and Ho Chi Minh City, as part of the Vietnam Urban Food Consumption and Expenditure Study. To measure household diet quality, Household Dietary Diversity Scores (HDDS), and consumption frequencies of micronutrients (vitamin A and heme iron) and a macronutrient (protein), are calculated using seven-day food recall data. A Poisson regression model is estimated using a two-step control function approach to address the potential endogeneity of key explanatory variable, modern market food expenditure shares. Higher modern market food expenditure shares are significantly associated with consumption of heme iron, however, no significant relationship is found for consumption of vitamin A and protein. Results from system of equations show that modern market food expenditure shares are significantly associated with diet quality through indirect linkages with HDDS. The second study investigates the relationship between ‘western’ foods consumed away-from-home, and the diet quality of 4,997 individuals in Vietnam. Diet quality is measured using 24-hour food diaries which include information on food consumed both at-home and away-from-home. Dependent variables explored are individual daily caloric intake and percent of total calories from the consumption of carbohydrates, fat and protein. After testing for potential endogeneity of the key independent variable, individuals’ daily calorie shares from western food-away-from-home (western FAFH), we find that western FAFH has a significant association with high calorie intake. Our results for macronutrient shares show that western FAFH is associated with a higher intake of fat. The third study examines the relationship between farm households’ food security status, and health and economic shocks using a nationally representative sample of 3,448 rural farm households from a secondary dataset, the 2012 Bangladesh Integrated Household Survey. A consolidated Food Security Index (FSI) is calculated using a suite of food security indicators: food consumption score, food expenditure share and livelihood coping strategies to capture rural farm households’ food consumption, as well as their economic vulnerability. Empirical results from an ordered probit model controlling for village-level unobservables suggest that both health and economic shocks are significantly associated with FSI. Further results show that marginal and small farming households are more vulnerable to food insecurity when health and/or economic shocks impact their households. The results from the two analyses using Vietnam data suggest that policy makers need to be aware of the potential impact of increasingly ‘obesogenic food environments’ on consumer food consumption behaviour and diet quality. Finally, the results of the third analysis using rural data from Bangladeshi farming households, highlights the need for policy makers to consider the unique needs of farming households, the most vulnerable group, when designing food security interventions to address shocks or to eliminate food insecurity among rural populations.Thesis (Ph.D.) -- University of Adelaide, Centre for Global Food and Resources, 201

Globalization and gender gap in Indonesia.

This thesis contributes to the growing literature of economic development by analyzing the effects of exposure to globalization on gender gap in labour market participation in Indonesia. I combine the individual-level data of three waves (1997, 2000 and 2007) of Indonesian Family Life Survey (IFLS), with the provincial level data on exports and imports and also use data on population size of all cities in Indonesia by calculating geodesic distance between these cities and the individual’s residence. I construct the province-level Population Gravity Index (PGI) score for each individual based on the idea that cities with larger populations exert more force (or gravity) of globalization, but this force weakens as an individual is located in more remote areas. I interact the individual’s PGI score with provincial exports and imports and sum over all provinces to construct two explanatory variables .export exposure (XEX) and import exposure (IEX). The dependent variables are related to intensive and extensive measures of employment outcomes. I estimate the effects of export and import exposure on probability of paid work for females and males aged from 20 to 65 years controlling for household fixed effects and province- year fixed effects. I find significant results for gender specific effects in labour force participation in Indonesia. The main findings of the thesis provide evidence that women’s work participation is positively responsive to import exposure, and negatively to export exposure. However, I find no significant effects for males working less for pay with export exposure. This means exposure to exporting activities increases household income by increasing income earned by males, and this positive household income effect, in turn, discourages women’s participation in paid work. Therefore, labour supply of men is inelastic in response to export exposure and import exposure. Meanwhile, to be consistent with the income effect, I also look at the probability of paid work in a particular sector. The result shows that females likely to work less both in agriculture and manufacturing sector with an export exposure. To get a closer view of working population’s income status, I observe various employment outcomes by work status. The result is also consistent with the income effect story as I find significant evidence that females prefer to do housework than any other jobs in response to export exposure. This result is also consistent with the income effect story that exposure to exporting activities increases household income by increasing income earned by males, and this positive household income effect discourages women’s participation in paid labour market exhibiting a pronounced gender gap in labour force participation in Indonesia.Thesis (M.Phil.) -- University of Adelaide, School of Economics, 201

Export Exposure and Gender Specific Work Participation in Indonesia

The paper examines if exports have unequal influence on the work decisions of men and women using household panel data from the Indonesian Family Life Survey. We construct a novel measure – the export exposure index – which allows us to estimate the relationship between exports and the work decisions of individuals even after controlling for household and province-year fixed effects. Our regression analysis shows that an increase in exports does not have a statistically significant effect on men, but encourages women to allocate time away from paid employment towards unpaid house or family work. These results are consistent with our simple theoretical model which predicts that the relative increase in spousal income (following an increase in export exposure) strengthens females' comparative advantage in unpaid housework and allows them to devote more time to home production.48 p

Does food market modernisation lead to improved dietary diversity and diet quality for urban Vietnamese households?

This study investigates the possible mechanisms through which modern food markets may affect Vietnamese households’ dietary diversity and diet quality using data from a survey of 1,700 urban households with seven-day food recall. We calculate Household Dietary Diversity Scores to measure dietary diversity, and use consumption frequencies of micronutrients (vitamin A and heme iron) and a macronutrient (protein) to create a household measure of diet quality. We estimate a Poisson regression model using a two-step control function approach to address the potential endogeneity of our key explanatory variable, modern market food expenditure shares. Higher modern market food expenditure share is positively and significantly associated with consumption frequency of heme iron, but there are no significant associations with consumption of vitamin A and protein. We further explore indirect linkages between food expenditure shares and dietary diversity, which in turn, may be linked to household diet quality. Results from a system of equations show that the food expenditure share variable has no significant relationship with dietary diversity, but dietary diversity is positively and significantly associated with diet quality. Our results indicate that alone, policies which encourage ‘food market modernisation’ are not enough to improve diet quality in urban Vietnam

Establishing and evaluating a quality improvement collaborative to address hospital to home transitions for older people

Introduction: Hospital use increases with age. Older people and their families have reported poor experiences of care at the time of discharge home from hospital. As part of a larger project, we established and evaluated a quality improvement collaborative to address hospital to home transitions for older people. Methods: We convened an expert panel of 34 stakeholders to identify modifiable issues in the hospital-home transition period. We established a collaborative involving health professionals across a range of agencies working to common goals. Teams were supported by a network manager, three learning sessions and quality improvement methodology to address their identified area for improvement. We used mixed methods to evaluate whether the establishment of the quality improvement collaborative built networks, built capacity in the health professionals and improved the quality of care for older people. Evaluation methods included interviews, surveys, network mapping and case studies. Results: Nine teams (n=41 participants) formed the collaborative and attended all meetings. Mapping showed an increase in networks between participants and organisations at the conclusion of the collaborative. Interview data showed that building relationships across services was one of the most important parts of the collaborative. Survey results revealed that most (77%) believed their quality improvement skills had developed through participation. Advice and regular meetings to progress project work were considered important in ensuring teams stayed focused. In terms of improving the quality of care, some participants indicated that they achieved the stated aims of their project better than expected (21%), most (41%) felt they achieved their aim as expected, 26% got close to their aim and the rest did not know the outcome (13%). Conclusions: Establishing a quality improvement collaborative was a positive activity in terms of building a network across organisations and progressing quality improvement projects which aimed to achieve the same overall goal.</p