[MUSIC] >> The people, if you adopt the capabilities approach, don't really regard it as a way of, you know, explaining why some countries do better than others at improving well-being. It's, it's more of a way of sort of, conceptualizing and evaluating well-being and it's, it's often contrasted to two other types of approaches. One focused on resources. >> Mm-hm. >> And one focused on preferences or the satisfaction of preferences, or to put it more simply, happiness. >> Mm-hm. >> So these are all different ideas of what you want to maximize say in the life of a poor person to improve everybody's well being. So, one hypothesis, you improve their freedom. >> Mm-hm. >> That's a capabilities approach. >> [UNKNOWN] associated with this approach right? >> Absolutely I think the book that you've assigned isn't it called Development as Freedom? >> Yeah, yeah. >> It's, it's not development causes freedom or development is caused by freedom. It's Development as Freedom. So there is, you know it's a logical relationship as much as a conceptual where there's sort of an intrinsic connection there. >> Mm-hmm. >> And you know a resource based approach would basically say that you know, the goal of, of development is to make sure that everybody has a minimal amount of like food, clothing, shelter, and so on. That was like the basic needs approach from the 1980s. From the capabilities approach, that's really inadequate, because the problem is that even if you have these resources, people differ quite a bit in their ability to translate those resources into well-being. And for example, a, a person with a certain type of disability might have a much harder time Translating you know an adequate amount of, of food, say, into an adequate amount of nourishment, or like a you know, a, a person who has, you know, a chronic disease might not be able to utilize the food in the proper way. >> Yeah. >> So you know, if you're focusing on development I think the thing to focus on is people's capabilities and what sort of capabilities freedom, freedom to choose. >> Mm-hm. >> Not just freedom to choose haphazardly, but freedom to choose thoughtfully, reasoned choice, what >> Reasoned choice, yeah. >> What Aristotle called practical reason. >> Mm-hm. >> That's the thing you want to maximize. Another approach is that, you know, what you really want to maximize is people's ability to satisfy the preferences that they already hold. >> Mm-hm. >> Or for example, to set, make themselves Happier. >> Mm-hm. >> But from a capabilities perspective, you know, happiness is greatly overrated. [LAUGH] You know, before about 1600 or so, we were all here to love and serve God, and not to make ourselves happy. And the whole idea of being happy is actually a fairly Recent invention. And you know, if you think of it, I guess there's the old saying that you know, Socrates dissatisfied is better than a pig satisfied. >> Yeah, yeah. so, you know, the idea there is that, as Karl Marx once said in his economic and philosophical manuscripts, suffering humanly considered is an enjoyment of the self for man. >> Mm-hm. >> So in other words, even in emotions that we would consider to make us unhappy, like you know, grief, sorrow, guilt >> Mm-hm >> These are human, truly human emotions. So from the capabilities approach, what you want to do is maximize the extent to which people can lead, fully human, in other words, a thoughtfully chosen life, which is not necessarily a happy life. And. >> And. Yeah. Yes. When they say happiness, they really mean satisfied. >> Yeah. >> They mean, like, that, that you get your preferences satisfied. And not, not happiness in the, in the classical sense which have something to do with reason. Like >> Right. >> You weren't really happy if you sat around like a pig all day. >> Right. >> Stuffing your face or playing video games. >> Yeah. >> You were satisfied or you, you were not moved to do other things. But that didn't count as real happiness. It sounds like this notion of happiness has a lot to do with education. In another words it's, a reasoned and purposefulness and so that having the opportunity to reflect on your own choices and to be aware of choices that you might not, or preferences that you might not know you had, all right, so Edu, is education a, a significant element in this capabilities of frame work? >> Yeah, absolutely. Education is a root to freedom. In all, all kinds of different ways. So education is, is very important. Education doesn't necessarily make you happier. But it. >> You're telling me. After all these years of school, I'm still not happier. [LAUGH] >> Well, it's definitely makes you, it enriches your life, in the extent that, you know, it, it shows you that you know, the purpose of life is not merely to play video games and eat a lot of good food. So but, you know, let's, let's face it. Like, among capabilities, some are more important than others. >> Sure. Right. >> And the capability to survive physically is, is quite fundamental. >> Absolutely. >> Because, to live the life We have reason to choose we have to be alive. >> That's right. And in order to be educated, you need a certain level of health. >> Exactly. >> Right? To be able to think and reflect. >> Yeah. There's all kinds of research out there that shows that feeding little kids a decent breakfast, you know, greatly improves their school performance. >> So, when you weave education and the capabilities approach more generally into thinking about The health, and, and, and, and the kind of global, health challenges we have, it, it makes us seem like so, it, because it even more daunting test, more expensive test. >> Uh-huh. >> But, I know in the book you argue that's not necessary the case that, that is not always the, they're are expensive solutions but they're not necessarily the, the, the best ones. >> Sure that, that's absolutely the case and. On the education front, if you take as the outcome that you're interested in, the reduction of premature mortality, or say, the reduction of infant or child mortality. statistically, it's fairly easy to show, both at the household level, at the cross-national level, that female education is much more important than male education. >> Mm-hm. Both help to reduce premature mortality, but educating girls is much more important than educating boys, so that's actually unfortunately the opposite of the situation in many developing countries where the girls have a much larger educational deficit. >> Right. >> Than the, than the boys do. Although as you know in the United States the, the opposite is true, and it's the boys who are more educationally challenged than the girls, but providing people with a basic education as Evon Illidge pointed out long ago, does not require a cyclotron. >> Right. >> So it just requires you know, some good teachers, and paper and pencil, and. >> Yeah. >> A few books, and, and you're, you're ready to go. >> And time. >> Yeah and time, absolutely, so. That's one of the things that really improves health a lot that is cheap. But if you look at, you know some things that improve health are extremely cheap. Health education costs virtually nothing. >> Right. >> Child immunization is very inexpensive. Things like providing nutritional supplements, or oral re-hydration therapy for children with diarrhea. >> Mm-hm. >> That's very cheap. Other stuff that's very helpful is a little more expensive. Things like providing safe water, adequate sanitation, family planning services. Certain types of education is a little more expensive, but You know even the total amount, if you add up the total amount of money that all these interventions cost, and compare it to the total amount of money spent on, that governments spend on things in many developing countries like. Topping off middle class pensions, providing university educations, subsi, subsidizing gasoline for people's automobiles. >> Right. >> If you put those together, those are all vastly more expensive than the sum title, total of the other interventions. But you know, the governments do these a lot more than they do the other interventions. >> Right. >> So that the trick is to get, you know, the, the money to move from the regressive policies to the progressive ones. >> Now, I mean, cynically asking this question [LAUGH], is that because The person who want cheap gasoline votes and the child who dies doesn't vote. In other words even the very poor whose children are dying, they are less likely to play a roll in politics than the person who wants to drive and they get subsidized gas or subsidized crops or I mean is there a Is, does, is democracy, in a, in some, cynical sense, undermine this, effort at global health? >> Well, there, The relation between democracy, thought of as free and fair elections. >> Mm-hm. >> Basic human and civil rights, and effective authority to the people who get elected. >> Mm-hm. >> Has a complex relation to other outcomes that we value. Cause democracy certainly has intrinsic value. >> Right. >> As well as instrumental value, but you know, it has a vextralation to outcomes like rapid economic growth, or low infant mortality. It's not always a congenial relation. And you know, for example if you survey people like in the United States you find that they often prefer curative health services to preventative health services. >> Right. >> So if politicians do what majorities want, they're going to be enacting policies that are sort of inimical to people's health. >> Right. >> In other countries. I mean, I looked at some surveys places like Indonesia and Thailand. >> Right. >> Back in the early 70s, people were much more interested, at least the survey respondents were much more interested in income generation Then they were in health facilities. That may of been anemical to their health. So if, you know, governments are doing what majorities prefer, you know, they will do things that are not conducive of public health. But if you look across nationally there is a fairly robust and positive relation Between more democracy and better health. [BLANK_AUDIO] >> In this course, we're, we're looking at some real extremes, so last week, we talked about extreme poverty and some of the things different groups are doing to combat extreme poverty. and, you know, this week there's, there's some focus in my remarks on some of the most dramatic health challenges we have, from, from diarrheal disease to HIV/AIDS, to especially the diseases that cause high infant mortality and or, or, or radically premature death. And I wondered if you know, from your experience, cross nationally, looking at different kinds of political regimes and different geographic areas. Are there a couple of things that stood out for you, that are sophisticated but not necessarily ultra expensive ways to deal with these extreme health issues. >> Well, I think, I mean, one example that really sticks out in my mind is from our own country. In my book, Wealth Health and Democracy in East Asia and Latin America, I looked at four countries, four Latin American, four in East Asia But I grew up in the United States, and the United States is always on my mind. What lessons can the United States learn from >> Yeah >> Places like, you know, Chile or South Korea. And I remember reading an article in the New York Times that I later investigated a little more closely about Sharky County Mississippi. >> huh. It's in the Mississippi delta and in the Mississippi in general, from 1980 to 19, was it, no 1990 to 2005. >> Mm-hm. >> The infant mortality rate for non-whites Actually went up. It went up from 15 per 1000 to about 17 per 1000. This is the infant mortality rate for non whites in Mississippi. Which is the poorest state in the United States. 17 per 100 is a pretty high infant mortality rate. For example, the infant mortality rate in 2012 in Brazil, according to World Bank is 13 per 1000. Considerably lower than the infant mortality rate for non whites in Mississippi in 2005. But there was one county in Mississippi, Sharkey County, in the Mississippi Delta Where one inspired physician collaborated with a place called the Cary Christian Center which subsisted exclusively on private donations, and this physician in conjunction with three members of the Cary Christian Center who were You know, elderly women, for the most part developed a scheme whereby they would find out everybody in the county who was pregnant and then go visit them once a month, bring them in a bus, to have classes, prenatal classes for expectant mothers, postnatal classes for new mothers, And from 1990 to 2005 while the infant mortality rate for Mississippi as a whole went up from 15 to 17 per 1000, the infant mortality rate in Sharkey County fell from at least 15 per 1000, I don't know what it was in 1990 to five per 1000. >> Wow. >> So that's less than One third of the rate in the state as a whole, even though Sharkey County is much poorer than in the state as a whole. And this intervention costs basically nothing. The ladies working with the physician they didn't have any medical training whatsoever. It's all a matter of finding out where the people who need help are Doing some very expensive interventions to >> Yeah >> Help them and just, and just organizing things. >> Organizing education, right? >> Yeah >> I mean those are, fascinating. Well that really leads me to the last question I have is, you know the name of this course is how to change the world, and, and, > > You know many of the students watching our videos and doing the reading are eager to get involved with organizations or do something that will not eradicate extreme poverty or get rid of these, these, terrible diseases but would make some positive difference in that regard, like your example just now. >> Yeah. >> I wonder if you have other thoughts for our students, ways in which they can get more involved to. Make a positive difference around issues of of health and disease. >> Well one thing people can do is that, if they live in a country which is not democratic or even not optimally democratic, would be to, you know, try to establish, consolidate, or deepen democracy in some way or another. So, you know, from the capabilities perspective. You know, develop is freedom. >> Yes >> But, to some extent I think freedom does cause development, you know, thought of as in part being able to lead a long and healthy life. >> Right >> So, I think that democracy is one root that everybody has the capacity to You know, to, to enhance. And, apart from that, people should do whatever they personally are trained to do. >> Yeah. >> I'm, I'm a college professor. I'm a Political Scientist, so... What I do is to try to analyze why some countries enact good health policies and why other countries don't. >> Right. >> And extract lessons for institution building and political pressure and policy design which is consistent with that understanding. But many other people, you know, who are not political. >> Right. >> Science professors. They can train themselves to be front line health providers, doctors, nurses, radiologists, lay health personal. They can you know, go into the bio medical field or engineering. They can start business that Create medical devices or pharmaceuticals that can help people. >> Mm hm. >> If you have money you can give money to good causes like partners. >> Yeah, Partners in Health. >> Partners in Health, yeah. >> Or doctors Without borders, other wonderful institutions like that who are helping to make people healthier in the poorest countries of the world. But yeah, in general I think that the one that that everybody can do is to... You know, make, try to make their politicians more responsive. >> Raise awareness and, and, and educate ourselves. >> Yeah. One of my favorite lines from Developments of Freedom is from the chapter on democracy where Amartya Sen writes, you know, democracy does not operate on human development like quinine works on malaria. I mean you've got, if it's up to democracy only creates opportunities. It's up to citizens and politicians of the opportunities that... Democracy creates. So I think it's up to all of us to use the freedoms that democracy permits if we're fortunate enough to live. >> Hm. >> In a democratic country to push our politicians to enact policies that will you know, improve the, the well being of the less fortunate members of our societies. >> Yep. Well I think classes like this that Raise awareness about those conditions and about interventions that could be helpful in that regard. I, I hope there's a step in that direction, for the listeners and, and, and for us, as teachers, I mean as we, as we work with students here with Wesleyan and now around the globe. >> Yes, I think that's you know, absolutely a lot of things start With education and I guess you know, education in a sense is freedom as well. >> Alright, that's something I very much believe, and thanks so much for talking with me today. >> Thank you.
