Income, age and obesity: South Asia’s advantages in the COVID-19 pandemic · Global Voices
Ian Inkster

Image by soumen82hazra, under license from Pixabay
Since the beginning of the pandemic of COVID-19, all major media, but especially those of the Western nations, have postulated accelerating disaster for South Asia. Poverty, lack of public medical facilities, lower levels of adult literacy, and lesser amounts of medical expertise would, it was assumed, work strongly against the ability of South Asia to weather the COVID-19 storm. In fact, as several of my earlier columns on Global Voices argued, this was, indeed, not the case at all.
From early weeks it seemed that South Asia was already benefitting from key income and age distribution features. Columns B, C and D of Table 1 below clearly show the associated data on incomes and age structures in South Asia, to which is added the two heaviest affected high-COVID Western nations and, as a data check, the large and significant middle-income systems of Iran and Turkey and estimates for the world overall.
Very clear are the ultra-low Covidity levels in South Asia as measured by cases per million and deaths per million in Column A. All South Asian Covidity is significantly lower than the world averages, much lower than the middling-income nations Iran and Turkey, and a world apart from the high-income exemplars U.S.A. and Britain—the U.S. cases rate is over 10 times that of India, its mortality 15 times that of India. It is possible that there are as yet undiscovered explanations here, but the seeming arbiter of Table 1 is the combination of income and age distributions (B-D). Lower per capita real incomes, as measured by purchasing power parity estimates that adjust for cost-of-living differences and yield the most accurate perspectives on real spending power, give rise to much lower Covidity levels.
The main reason for this correlation is that low incomes mean a high proportion of youngsters in the population (the low median age) and a tiny proportion of folk over 65 years. So, the cruelly low per capita income of Afghanistan is associated with the lowest COVID-19 cases data on the table and very low mortality. It also yields an extremely low median age (a high number of young people) and a very small proportion of older people. The characteristics of COVID-19 in all its variants today is that it generally travels around the young without serious illness but hones in on the old, commonly causing death, often associated with severe respiratory problems.
Knowing nothing else, we might be sensible in arguing that income and age differences are determining differences in Covidity levels. Iran and Turkey confirm this, their higher incomes giving higher Covidity, a slightly older population, but retaining a small proportion of older people over 65 years. They lie in an intermediate position. But the rich nations demonstrate the high extreme: exceptionally high COVID-19 levels, high incomes, fewer young people, more older folk.
On this basis we might expect that, however horrible the impacts of the epidemic are in many South Asian cities and villages, it remains likely that the final estimates for the pandemic will leave South Asia far less damaged in health and economy than previously hazarded and more ready to take some advantage of economic growth elements engendered by what will emerge as the faster economic recovery of East Asia.
There is as yet no other such underlying force at work explaining what at first seems counterintuitive—large poor nations surviving the pandemic better than rich Western countries. There is the possibility that varieties in policy or in “objective” factors such as degrees of air pollution, crowded frontiers or uncontrollable borders might also be at work in the same direction as income and age, but these are not yet obvious in any research work.
My own earlier findings for South Asia and elsewhere are that different COVID policy packages work to differentiate like-for-like; that is, superior policies in Japan or Germany might well have reduced Covidity more than did policies in say the U.S.A. or Britain, or within South Asia there might be some policies working better in one place that are absent in another. Until we know that population density, air pollution, climate or any such factors operate as systematically in this pandemic as do income and age, then such possibilities remain hypothetical.
However, with particular regard to South Asia, it is worth noticing another variable that tends to vary with age and income and might well be conditioning the overall Covidity results. This is the variations in levels of obesity between nations and, to an extent, between everyday cultures of nourishment and health. Thus, Column E of Table 1 shows extremely high levels of obesity in the richer nations of the U.S.A., U.K., Iran and Turkey. Higher income means higher Covidity and greater obesity.
An important paper by East Asian academics published in the major journal “Metabolism” in December 2020, illustrated that high obesity was strongly associated with high Covidity cases, serious illnesses and mortality. The paper was published on September 28 and has since been followed up by a great amount of scientific research and critical surveys.
Using standard body mass indexes in conjunction with estimates of accumulated visceral adipose tissue as the measure of obesity, examining some 45,650 participants from 33 studies, the gist of the summary findings seems to be that significant correlation exists between high obesity and serious COVID infection from hospitalisation through ICU admissions, IMV treatment, to death. It would seem to be increasingly clear that obesity increases the large number of COVID victims who progress to very serious conditions such as pneumonia and respiratory failure. It is—by deduction—more likely to impact mortality rates than cases per se, but this remains empirically unclear.
Evidently, South Asia again benefits. The World Health Organization (WHO) estimates that on average worldwide obesity is around 13 per cent, and Column E shows this to be very significantly above obesity levels for all major South Asian nations. Startlingly, the move to higher incomes in Iran and Turkey has given a more than proportional rise in obesity to reach the levels of rich nations such as the U.K. and U.S.A. in our table. It might be that if the extension of the pandemic is linked to the evolution of new varieties of the virus, then low obesity levels might help in future protection from the worst illnesses of the pandemic, reducing in particular serious illness and mortality.
Finally, given that for Iran and Turkey the rise in incomes during the present generation (growing each at around 5 per cent GDP per annum since 2013) is associated with higher Covidity but has altered age distributions only modestly, while seemingly exerting a massive effect on obesity levels, it could be that in certain national situations the obesity effects of income outride the age distribution effects of income in the generation of Covidity levels.
None of this is to deny the disastrous effects of the pandemic in South Asia. But it is to give hope that the obvious and insidious and unforgiving impacts of poverty and lack of public medical facilities might continue to be offset by processes related in a measurable association through income, age and diets and lifestyles.