Development As Freedom
This week at our Meeker County Public Health staff meeting, we watched Episode 6 of a series called “Unnatural Causes…Is Inequality Making Us Sick?” (www.unnaturalcauses.org). This particular episode is called “ Collateral Damage”, which describes the past and present affects of the U.S. detonation of 67 nuclear devices in and around the Marshall Islands between 1946 and 1958. The impact of these tests on the Marshallese people was profound - in terms of social, political, geographical, economic determinants of their health and wellbeing. As a public health professional, research and interaction with our clients demonstrates how socio-economic status can play a very vital role in an individual’s capacity to “contribute” to society.
The opportunity to view and study this documentary tied nicely with the reading for this week, “Development as Freedom” (1999) by Amartya Sen. Upon doing some further research, I discovered that Sen is an economist/philosopher who won the Nobel Prize in 1998 for his “social choice theory”: poverty stemming from the lack of capabilities to function resulting from what he terms as “unfreedoms” in society. According to Sen, it is most important that people develop in a manner that allows them to “do and be” – to contribute and feel valued.
The freedoms that Sen describes in the reading are: 1) political (free speech, elections), 2) economic (opportunity for work, trade, production), 3) social opportunities (health and education), 4) transparency guarantees and 5) protective security. Sen suggests that development has more to do with enhancing quality of our lives and improving our freedoms, rather than economic development or prosperity. With this notion, I whole-heartedly agree. However, it is my feedback that Sen did a poor job of defining and describing “transparency and protective security” in this reading.
So, let’s consider some “unfreedoms”. Per the reading, Sen describes these as social determinants to health: reduced access to health care and poor sanitary conditions/unclean water. In the case study of the Marshallese, inhabitants were moved off their home islands because of the U.S. military influx, thus their lands, culture, and traditional ways of life were destroyed. Being displaced from their home island caused rapid urbanization, a crowded living environment and poor hygiene. This resulted in increased incidence of tuberculosis (population proximity, poor hygiene) and diabetes (change in eating habits, lack of access to healthy foods).
Sen also describes the lack of opportunity to contribute to “trade or production” (economic independence) as an “unfreedom”. In the case of the Marshallese, the lives and traditions of the Islanders were disrupted when the United States occupied their nation and used their outer islands for extensive nuclear testing after World War II. Many Marshallese crowded to the island of Ebeye hoping to get a job at the U.S. base on nearby Kwajalein. According to the U.S. State Department in 2006, there are 25,706 people of working age in the Marshall Islands, yet only 39% are employed and 61% are unemployed or inactive.
In summary, the Marshallese case study demonstrates how, without choice, each of their five "freedoms" were distrupted, thus determing their social, health and economic consequences.
My question to the readers of this blog is 1) In what current situation(s) have you observed globalization and/or urbanization impacting poverty, hope and health? 2) In the current financial crisis, do you think Sen’s theory that the quality of our lives and improving our freedoms are more important than economic development or prosperity? How does the recent $800 billion economic recovery bill help or hinder your argument?
Looking forward to a great discussion!