Health trade-offs of rural structural transformation: evidence from longitudinal data in Bangladesh

OBJECTIVES/BACKGROUND: This study examines the relationship between occupational transitions out of agriculture and functional health outcomes among rural adults in Bangladesh, with a focus on gender differences and variation by duration of exposure to non-agricultural work. METHODS: Data come from three waves (2011-2012, 2015 and 2018-2019) of a nationally representative panel of rural households. The analytic sample includes 4648 adults aged 15 and older observed in all three waves. Functional health outcomes (difficulty standing up from a seated position, walking 5 km and carrying a load of ~18.5 kg) were self-reported. Occupational transition was defined at the individual level as a shift from agriculture to non-agricultural work. Propensity scores were estimated using machine learning estimators. Gender-disaggregated and exposure-duration-stratified estimates are also reported. RESULTS: Exiting agriculture was associated with a modest but meaningful increase in reported functional health limitations. Among all individuals who transitioned to non-agricultural work, the probability of reporting difficulty standing, walking or carrying a load increased by 1.9-2.8 percentage points (pp). These effects were concentrated among women, who experienced statistically significant increases in all outcomes (2.5-3.2 pp), while effects for men were small and not statistically distinguishable from zero. Stratified analyses by timing of exit show that adverse effects for women persist across early and late exiters, with walking difficulties increasing in intensity, underscoring the durability of these health impacts. CONCLUSIONS: While structural transformation is widely associated with socioeconomic gains, this study highlights potential physical health burdens that may emerge alongside these broader benefits. In Bangladesh, transitions out of agriculture were linked to increased functional limitations, particularly among women. These findings suggest that the overall welfare gains from rural labour transitions may be tempered by under-recognised costs to physical functioning. Policies supporting structural change should incorporate occupational health safeguards and gender-responsive measures to ensure that development benefits are more equitably realised.