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Hunger and Public Action$

Jean Drèze and Amartya Sen

Print publication date: 1991

Print ISBN-13: 9780198283652

Published to Oxford Scholarship Online: November 2003

DOI: 10.1093/0198283652.001.0001

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The Economy, the State and the Public

The Economy, the State and the Public

(p.257) 13 The Economy, the State and the Public
Hunger and Public Action

Jean Drèze (Contributor Webpage)

Amartya Sen (Contributor Webpage)

Oxford University Press

Abstract and Keywords

Many of the arguments of the book are summarized, with a special emphasis on the role of public action (in a broad sense) to alleviate hunger. Early warning systems and employment provision plans are mentioned for famine prevention. The authors suggest endemic deprivation can be eliminated by looking at basic health care and elementary education in addition to food provision. The last part draws on the influence of food price fluctuations and international cooperation and conflict for public action.

Keywords:   basic health, early warning system, elementary education, employment provision, endemic deprivation, famine prevention, food prices, hunger, international cooperation, public action

13.1 Against the Current?

This is a book about what public action can do to eradicate hunger in the modern world. A question that would occur to many people is this. Is this not a hopeless time to write in defence of public action? The world has, in recent years, moved decisively towards unhesitating admiration of private enterprise and towards eulogizing and advocating reliance on the market mechanism. Socialist economies—from China to the USSR and East Europe—are busy de‐socializing. Capitalist economies with a tradition of ‘welfare state’ policies—from the UK and the USA to Australia—have been absorbed in ‘rolling back the frontiers of the state’, with a good bit of privatization of public enterprise. The ‘heroes’ at this moment are the private ownership economies with high growth rates—not only old successes such as Japan, but also the new ‘trail blazers’—South Korea, Hong Kong, Singapore. What chance is there of getting much of a hearing at this time for an argument in favour of more public action? And, more importantly, how can we possibly defend such a case, given the empirical regularities that are taken to have emerged in the recent decades?

There is indeed some sense in seeing the developments in the modern world in these terms. But there is also a good deal of nonsense mixed with that sense. We have had the occasion, in earlier parts of this book, to discuss fairly extensively the enormously positive role of public action in the success stories in the modern world. This applies inter alia to the outstanding and decisive contribution made by constructive public action in eradicating famines (see Part II), as well as in eliminating endemic undernutrition and deprivation (see Part III).

In the field of famine prevention, the decisive role of public action is illustrated not only by the elimination of famines in India since independence, but also by the unsung and underappreciated achievements of many African countries (see Chapters 5 and 8). These experiences firmly demonstrate how easy it is to exterminate famines if public support (e.g., in the form of employment creation) is well planned on a regular basis to protect the entitlements of vulnerable groups. Ensuring that the concerned governments take early and effective steps to prevent a threatening famine is itself a matter of public action. It is also clear that the eradication of famines need not await a major breakthrough in raising the per‐capita availability of food, or in radically (p.258) reducing its variance (even though these goals are important in themselves and can be—and must be—promoted in the long run by well‐organized public policy). Public action can decisively eliminate famines now, without waiting for some distant future.

Regarding the elimination of regular, persistent deprivation (as opposed to the eradication of intermittent famines), the analysis presented here has indicated the positive contribution that can be made by public provisioning (especially of education and health services) and more generally by public support (including such different policies as epidemiological control, employment generation and income support for the vulnerable). Expectations based on general reasoning are, in fact, confirmed by the empirical experiences of different countries.

Public support in these different forms has played a major part in combating endemic deprivation not only in economies that are commonly seen as ‘interventionist’ (e.g., China, Costa Rica, Jamaica, Sri Lanka), but also in the market‐oriented economies with high growth (e.g., Hong Kong, Singapore, South Korea); on this see Chapters 10–12. Indeed, the contrast between what was called ‘growth‐mediated security’ (as in, say, South Korea) and ‘unaimed opulence’ (as in, say, Brazil) relates closely to the extensive and well‐planned use of public support in the former cases, in contrast with the latter (see Chapter 10). When it comes to enhancing basic human capabilities and, in particular, beating persistent hunger and deprivation, the role played by public support—including public delivery of health care and basic education —is hard to replace.

The crucial role of public support in diverse economic environments is well illustrated by the intertemporal variations in the experience of China. The radical transformation in the health and nutritional status of the Chinese population (visible inter alia in a sharp increase in life expectancy, a dramatic decline of infectious and parasitic diseases, and improved anthropometric indicators) took place before the reforms of 1979, at a time of relatively moderate growth of GNP but enormously effective public involvement in the promotion of living conditions. The post‐reform period has seen an impressive acceleration in the growth of GNP and private incomes, but also a crisis of public provisioning (especially of health services), and an increase in mortality. Much more is involved in increasing human capabilities—and in preventing their decline—than the stimulation of economic growth through revamping private incentives and market profits.

We have also discussed how the crucial role of public support in removing endemic deprivation is visible not only in the achievements and failures of developing countries today, but also in the historical experiences of the rich and industrialized countries. This is well illustrated by the sharp increases in longevity in Britain during the decades of the world wars, which were periods of rapid expansion of public support in the form of public food distribution, employment generation and health care provisioning (not unconnected with the (p.259) war efforts).1 There is nothing particularly ad hoc in the findings regarding the contribution of public support to human lives in the developing countries today.

Public action is not, of course, just a question of public delivery and state initiative. It is also, in a very big way, a matter of participation by the public in the process of social change. As we have discussed, public participation can have powerful positive roles in both ‘collaborative’ and ‘adversarial’ ways vis‐à‐vis governmental policy. The collaboration of the public is an indispensable ingredient of public health campaigns, literacy drives, land reforms, famine relief operations, and other endeavours that call for cooperative efforts for their successful completion. On the other hand, for the initiation of these endeavours and for the government to act appropriately, adversarial pressures from the public demanding such action can be quite crucial. For this adversarial function, major contributions can be made by political activism, journalistic pressures and informed public criticism. Both types of public participation —collaborative and adversarial—are important for the conquest of famines and endemic deprivation.

To emphasize the vital role of public action in eliminating hunger in the modern world must not be taken as a general denial of the importance of incentives, nor indeed of the particular role played by the specific incentives provided by the market mechanism. Incentives are, in fact, central to the logic of public action. But the incentives that must be considered are not only those that offer profits in the market, but also those that motivate governments to implement well‐planned public policies, induce families to reject intrahousehold discrimination, encourage political parties and the news media to make reasoned demands, and inspire the public at large to cooperate, criticize and coordinate.2 This complex set of social incentives can hardly be reduced to the narrow—though often important—role of markets and profits.3

This is indeed a good time to keep in view the crucial role that public action—in various forms—can play in eradicating hunger in the modern world. The empirical experiences of different countries point to certain systematic connections, and it is important not to lose sight of them in the scramble to be more ‘private’—more exclusively ‘market‐based’—than the next country. We have to recognize the functions of public action and the rewards they can bring. The cost of overlooking them can be very high—in terms of unnecessary misery, morbidity and mortality.

(p.260) 13.2 Famines and Undernutrition

The two forms of calamity related to hunger with which this book is concerned are (1) famines, and (2) endemic undernutrition and deprivation. The distinction between the intermittent and explosive occurrence of famines and the quieter and persistent phenomenon of regular undernutrition is important both from the point of view of diagnosis (they have different features and often quite dissimilar causal antecedents) and that of action (they call for substantially distinctive policies and activities).

In the earlier chapters we have had the occasion to discuss the shared conceptual background and interconnected causal circumstances of the two phenomena (Part I: Chapters 1–4). We have also examined and assessed the specific demands on strategies and actions imposed respectively by famines (Part II: Chapters 5–8) and by endemic deprivation (Part III: Chapters 9–12). The distinction relates closely to the different demands of what we have respectively called ‘entitlement protection’ and ‘entitlement promotion’.4 The task of entitlement protection is largely a matter of making sure that vulnerable groups do not face a collapse of their ability to command food and related necessities. Possible threats can arise not only from production failures—of non‐food commodities as well as food—but also from worsening opportunities of acquiring the basic necessities (e.g. through unemployment, collapse of real wages, worsening of terms of trade). The concentration here has to be on preventing sharp declines in the economic circumstances of those who live close to the borderline of starvation. In contrast with the largely conservative task of entitlement protection, the exercise of entitlement promotion is, in many respects, more radical. In this case the concentration has to be on expanding the general command that people—particularly the more deprived sections of the population—have over basic necessities.

Of the two phenomena, famine clearly is much more visible and easier to diagnose. It is also a good deal easier to eradicate than regular undernutrition. Indeed, it is remarkable that famines continue to occur in the modern world despite the relative ease with which they can be totally eliminated through public action. The possibility of such termination has been amply illustrated by the experiences of many countries that have successfully achieved the transition.5

To make the eradication of famines more universal, some of the common tactics of anti‐famine policy would have to be replaced by strategies that take fuller account of the economic and social realities in the famine‐prone countries. (p.261) We have tried to clarify the nature of these required strategies (Part II), and we shall make a few further remarks on them in the next section.

Endemic undernutrition is a less obvious—less ‘loud’—phenomenon than famine. Though it kills many more people in the long run than famines do, it does not get the kind of dramatic media attention that famines generate. But even in terms of sheer mortality, many times more people are killed slowly by regular undernourishment and deprivation than by the rarer and more confined occurrence of famine. Endemic deprivation is also a more complex social condition, involving deep‐rooted economic and social deficiencies. Eliminating it is a much more difficult task than preventing famines. But it has been achieved to varying extents by many different developing countries, and there are lessons in these experiences.

The objectives of public action against endemic hunger have to go well beyond the enhancement of food intake. Human well‐being relates to the lives that people can live—their ‘capabilities’—rather than only to the commodities they can command. In the context of hunger, we are concerned with the ability that people have to lead a life without undernourishment, and not with the quantities of their food intake as such (on this see Chapter 3).

Even as far as entitlements are concerned (i.e. the command over commodities that people have), the relevant characterization must take note of all the commodities that can significantly influence a person's ability to lead a life without undernourishment. This would typically include not only food, but also health care and medical attention, since parasitic and other diseases contribute substantially to undernourishment as well as ill health. The list of important commodities must also include such items as clean water, living space and sanitation.

In fact, capabilities depend not only on the commodities consumed, but also on their utilization, as was discussed in Chapter 1. Variations in utilization (i.e. in the conversion of commodities into capabilities) can arise from the biological and social characteristics of persons, e.g., a pregnant woman may need more nutrients to achieve the same level of nourishment as another person. These variations can be important for policy planning, and entitlement analysis—focused as it always is on commodities as opposed to capabilities—cannot be a fully adequate basis for assessment of public action. Even when the utilization rates are not much influencible by policy, the fact of varying utilization rates has to be taken into account, particularly for assessing distributions of commodity entitlements (e.g. between women and men).6

But quite often rates of utilization may well be influencible by public action and policy. For example, if lack of information and knowledge about nutrition and health, or blind acceptance of injurious practices and traditions, reduces the capabilities that a person can get from a given entitlement to food and health care, then an expansion of education can—quite possibly—much (p.262) enhance the person's nutritional capabilities. In this case, the entitlement to—and the actual use of—educational opportunities must also be included among the relevant focal points for policy. Education is not only of direct importance to living (e.g., in broadening a person's horizon of perception and thought), it can also influence the conversion of other entitlements into human abilities (e.g., the conversion of incomes into nutritional capabilities).

In fact, the expansion of basic education in general, and of female education in particular, can have several distinct roles in reducing endemic undernourishment.7 Some of the influences of educational expansion may operate through affecting the person's entitlement to food and health care, e.g., by making the person more employable (and thus raising her income), or by making her more influential in demanding public provisioning of these basic essentials (through informed criticism of public policy and more articulate demands). The influence of education may also work through increasing the person's ability to use the available opportunities and entitlements (including the public services offered, e.g., through more extensive and better informed utilization of health services).8 Finally, educational expansion can also lead to a less prejudiced intrahousehold distribution of food and health care. For example, greater female literacy tends to increase the bargaining power of women within the household and can reduce anti‐female bias in nutritional division.9

In assessing the policies and programmes that have been used in different countries to promote entitlements and to expand basic capabilities of the people, we identified some common elements in the effective strategies, but also noted some genuine plurality of possible approaches (see Part III). We shall comment briefly on the similarities and pluralities in section 13.4 of this chapter.

13.3 Famine Prevention

In Chapters 5 to 8 of this book we have examined various aspects of anti‐famine strategies. While there is much to learn from the informal security systems that have existed for a long time in famine‐prone countries, it is also clear that an adequate system of famine prevention has to go well beyond strengthening these traditional security systems. For example, sometimes informal insurance arrangements based on community‐centred mutual support can be of great use (p.263) (as has indeed been found on different occasions in the past), but in other cases such arrangements can help very little since the economic viability of the entire community may be simultaneously undermined leaving little room for mutual support. The entitlements of the vulnerable groups may be threatened in many different ways, and the preventive system has to cover all the likely sources.

In the recent literature on famine prevention, much attention has been paid to formal systems of ‘early warning’ of famine threats. The advantages of getting such warnings are clear enough, but nevertheless we have not found the refinement of formal ‘early warning systems’ to be a crucial requirement of an effective anti‐famine strategy. Countries that have been remarkably successful in preventing famines through timely public action typically have not made much use of such formal systems. This applies to countries as diverse as India, Botswana, Cape Verde and Zimbabwe.

Indeed, most often the warnings of imminent dangers have tended to come from general reports of floods or droughts or economic dislocations and from newspaper coverage of early hardship and visible hunger. In countries with relatively pluralist political systems, open channels of protest have also helped to direct forcefully the attention of the authorities to the need for preventive action without delay. Varieties of administrative, journalistic and political communications have served the ‘early warning’ role in the absence of elaborate systems of famine prediction or of formal procedures of ‘early warning’.

Of course, informal ways of anticipating famine threats can sometimes mislead. But so can formal systems of ‘early warning’, which are often based on some rather simple model (explicitly invoked or implicitly presumed), paying attention to a few variables and ignoring many others. There is undoubtedly scope for improving famine warning systems based on economic analysis.10 But there is little chance that a formal model can be developed that would be practically usable (with all the necessary data inputs being marshallable with the required speed) and that would take adequate note of all the variables that may possibly be relevant in the wide variety of cases that can, in fact, arise. The supplementation of formal economic models by more informal systems of communication and analysis is, to a great extent, inescapable.

In fact, most cases of neglected famine threats reflect not so much a lack of knowledge that could have been remedied only with formal systems of prediction, but negligence or smugness or callousness on the part of the non‐responding authorities. In this context it is important to note that such informal systems of warning as newspaper reports and public protests carry not only information that the authorities can use, but also elements of pressure that may make it politically compelling to respond to these danger signals and do something about them urgently. It is, we have argued, no accident that the (p.264) countries that have been most successful in famine prevention in the recent past have typically had rather pluralistic politics with open channels of communication and criticism. A relatively free newspaper system may be the most effective ‘early warning’ system a famine‐prone country can rely on.

The issue of early warning is closely linked to that of preparedness. There is great advantage in being able to rely on ongoing famine prevention systems that do not have to be devised as and when a particular threat arises. Contingency plans indicating what to do and when to do it can make the exercise of famine prevention a great deal more reliable. Aside from avoiding the confusions that are typical of suddenly devised ad hoc response, a general system of this kind also has the advantage of integrating different programmes of action in which many agents may be involved but which do call for coordination at the national level.

As far as policies for entitlement protection are concerned, in Chapters 6 to 8 we had the opportunity to assess various methods that have been tried. Since most of the particular findings were put together in the concluding sections of these chapters, we need not cover that specific ground again. However, it is perhaps worth mentioning that we have argued in favour of strategies of entitlement protection based on employment creation, particularly in the form of public works programmes. This strategy is an efficient counter‐measure to the loss of entitlements resulting from one of many possible changes (such as loss of employment or income or output due to droughts or floods) which may induce starvation of the affected group of people. This policy is also in line with the fact that, in most sub‐Saharan African countries, seeking wage labour has become, these days, one of the chief survival strategies for vulnerable populations in times of crisis. Further, public employment is also a particularly effective solution to the ‘selection problem’, i.e., identifying whom to assist (discussed in Chapter 7).

The other major advantage of a strategy of employment provision (discussed in Chapter 6) is that it offers the possibility of greater reliance on ‘cash support’ (as opposed to the direct provision of food, cooked or uncooked). Indeed the payment of cash wages in exchange for labour may be the only practicable form of large‐scale cash support in famine situations. Given the urgency of relief in a situation of famine threat, the advantages of being able to avoid the delays involved in moving and distributing food through bureaucratic channels can be quite crucial. By combining (1) public intervention (through cash wage payments—rather than leaving potential famine victims unaided), and (2) selective use of markets (in allowing food to be moved by the normal channels of trade—in response to the newly generated demand), it is possible to avoid both the inefficiency of bureaucratic food distribution and the unreliability of depending only on market‐generated entitlements. It is the combination of different institutional arrangements that seems to provide, in many cases, the most reliable means of preventing famines effectively.

The possibility of using the market mechanism to supplement public (p.265) intervention should not, however, be interpreted to imply that there is, then, no need for a substantial public stock of food grains. Public holding of food stocks can be crucial, even when the main burden of entitlement protection is carried by income generation programmes, and even when food movements and trade are largely left in private hands.

As was discussed in Chapter 6, public food stocks can help famine prevention in a variety of ways. First, they may be important to prevent collusive actions by traders in response to the enhanced demand for food resulting from income generation programmes. The ‘threat’ of breaking artificially generated price increases through releasing public stocks of food in the market can be very effective in preventing traders' collusion. Second, public food stocks can also prevent price rises due to panic and overestimation of future increases in food prices. This can be important even if there is no collusion on the part of traders.11 Third, while we have argued that entitlement protection measures need not necessarily await an improvement of food availability through the public distribution system, the process of famine prevention can, of course, be very substantially helped by the release of food in the market—exercising a downward pressure on rising prices. Public stocks of food can be particularly important for market stabilization given the delays that are typically involved in importing food.

Famine prevention strategies are often designed on the assumption that it is crucial to achieve a strong influence on the intra‐family distribution of food (e.g., in favour of young or undernourished children). We have argued that, in practice, the information and control needed for such discrimination are typically hard to obtain. There may, in fact, be good grounds for seeking the cooperation of the family unit in situations of famine vulnerability, rather than threatening its cohesiveness through divisive distribution practices.12 This view relates partly to the incentive problems associated with attempts to influence the distribution of food within the family (see Chapter 7), and partly (p.266) to the evidence of preferential treatment of young children in the early stages of a famine in many societies (Chapter 5).

As far as gender discrimination is concerned, we have found ample evidence of the enormity of the problem of chronic female disadvantage in nutrition and health in many parts of the world (Chapter 4). This problem is, however, distinctly less acute in sub‐Saharan Africa—where most famines tend to take place these days—than in, say, South Asia or China or West Asia. Also, there is little evidence that gender discrimination plays a major additional role in the causation of famine mortality in particular, despite its importance in the determination of mortality in general (see section 4.4). The need to counter gender inequality—important in general—would not, therefore, seem to undermine, in the specific context of famines, the case for greater reliance on prevention strategies which concentrate on the regeneration of household incomes (e.g., through employment provision) rather than on individual support (e.g., through feeding). In fact, given the very high rates of female participation in public works programmes observed in most parts of the developing world, and the importance of female employment for the reduction of intra‐family inequalities, gender considerations would seem to add strength to the case for employment‐based famine prevention strategies.

The provision of employment cannot, of course, be an answer to all the different aspects of the famine prevention problem. For one thing, the choice of selection mechanism requires enough versatility to take note of the diversity of potential famine victims. In particular, additional provision must always be made for those (usually in relatively small numbers) who can neither work nor rely on the support of able‐bodied relatives. However, the inability to work is a relatively easily observable condition, which can form the basis of administrative selection for ‘unconditional relief’. Direct distribution of cash or food on the basis of fairly unambiguous selection criteria has indeed been found eminently practicable in many countries (see the case studies of Chapter 8).

It must also be remembered that the strategy of employment provision operates mainly through private incomes. While a good case can be made for regarding income generation as the most urgent and basic task in a situation of famine vulnerability, the survival of vulnerable groups also depends substantially on adequate access to a number of crucial public goods and services, including especially clean water, health care and sanitation. A comprehensive strategy of entitlement protection requires paying adequate attention to these public provisions.

13.4 Eliminating Endemic Deprivation

As was mentioned earlier, the elimination of regular hunger and undernutrition is a much harder task than the eradication of famines. The phenomenon of endemic deprivation is more pervasive; it affects many times the number of people who are threatened by famines. It is also more resistant to change, (p.267) since it requires widespread promotion—on a long‐term basis—of entitlements beyond well‐established levels, and not just protecting established entitlements from short‐term declines (as in the case of famine prevention).

Nevertheless, it is not hard to see what is needed for the elimination of endemic undernutrition and deprivation. People earn their means of living through employment and production, and they use these means to achieve certain functionings which make up their living. Entitlements and the corresponding capabilities can be promoted by the expansion of private incomes on a widespread basis, including all the deprived sections of the population. They can also be promoted by extensive public provisioning of the basic essentials for good living such as health care, education and food. Indeed, participatory growth and public provisioning are among the chief architects of the elimination of endemic deprivation—illustrated amply by historical experiences across the world. The basic challenge of ‘social security’ (in the broad sense in which we have used this term) is to combine these instruments of action to guarantee adequate living standards to all.

The problem of undernutrition cannot be divorced from that of morbidity and ill health—both because undernourishment makes one prone to illness and also because a good deal of the observed undernourishment in the world is due to the effect of parasitic and other diseases which make the absorption and retention of nourishment that much more difficult. Thus—as was discussed earlier—the entitlements that have to be promoted for eliminating persistent undernutrition are not merely of food, but also of health care, medical attention and epidemiological environment (just as the entitlements to be promoted for eliminating preventable morbidity include food as well as medical care).

Further, as we discussed earlier, basic education too has a major role in the eradication of both undernourishment and preventable morbidity. This is not merely because education helps in the use of one's personal means to buy food and medicine in a more informed way, but also because widespread elementary education leads to greater utilization of public health services. It can also generate more effective political demand that such services be provided. Furthermore, an educated public can more easily participate in national economic growth—partly through the expansion of remunerative employment—making the fruits of growth more widely shared. All this is in addition to the part that education directly plays in making human lives more worthwhile through broadening one's horizon of thought and experience.

The essential entitlements to be promoted for eliminating endemic deprivation and undernutrition, thus, include basic health care and elementary education in addition to food as such. They also include other necessities such as clean water, living space and basic sanitation. Many countries have achieved great success over the last few decades in widespread promotion of these essential entitlements and the corresponding capabilities to function. In terms of a simple criterion of the promotion of elementary capabilities (specifically, (p.268) the reduction of infant and child mortality), ten countries were identified in Chapter 10 as having produced the fastest transformation since 1960. All of them have impressive records of gearing public policy towards guaranteeing widespread access to these basic ingredients of living.

However, there are also interesting diversities in their experiences. We have distinguished between two broad strategies for promoting basic social security for all. One strategy—called ‘growth‐mediated security’—has taken the form of fast growth of real national income per head and the use of the fruits of this growth to enhance the living conditions on a wide basis. Countries in this category among the identified ten include both newly industrializing countries such as South Korea, Hong Kong and Singapore, and also countries that have benefited from the rise in oil prices, in particular Kuwait and United Arab Emirates. All these countries have not only achieved much higher real income per head, they have used the fruits of that growth to expand the basic entitlements to food, health care and elementary education for all (see Chapter 10). Indeed, despite the role of private enterprise in these economies, in all cases the state has played a major part in promoting social security by bringing the basic ingredients of living within the reach of all the citizens—either through direct provisioning or through ensuring a participatory form of economic growth.

The other strategy, which has been called ‘support‐led security’, has taken the form of promoting—through direct public support—entitlements to education, health care and food, without waiting for the national income per head to rise to a high level through general economic growth. Countries in this category among the ten include not only China and Cuba, but also Costa Rica, Chile and Jamaica.13 The experiences of these countries (on which see Chapters 11 and 12) bring out the possibility of avoiding a longish ‘wait’ in the elimination of hunger and acute deprivation by immediate use of extensive public support.

In seeing the range of possibilities that are open to different developing countries, it is important to examine both the common elements and the contrasting features of the experiences of successful countries. The strategies of support‐led security and growth‐mediated security have the common feature of marshalling public action to involve diverse sections of the population in the process of social and economic transformation. In particular, countries in both groups have made extensive use of public provisioning (p.269) (especially in health care, basic education and food distribution) to enhance living conditions.

The experience of each group here contrasts with that of countries which have grown fast—in terms of GNP or real income per head—without using the fruits of growth to bring the essential ingredients of living within the reach of most people. In this respect the contrast between, say, Kuwait or South Korea or Singapore, on the one hand, and Brazil or Oman, on the other, is very sharp indeed. While the latter countries too have experienced fast economic growth, they have failed to ensure widespread public participation in the process of expansion of private incomes, and have not used extensive public support programmes to guarantee basic entitlements to the vulnerable sections of the population. For example, the fruits of growth have been used for public provisioning of education and health care in Kuwait, South Korea and Singapore in a way that simply has not happened in, say, Brazil or Oman.

The experiences of what we called ‘unaimed opulence’, of which Brazil provides a good illustration, show that growth as such is not a dependable strategy for enhancing elementary well‐being and capability. If it is to serve as a solid basis for promoting living conditions, growth must take a participatory form (e.g., with widespread creation of remunerative employment), and a substantial part of the resources made available by economic growth has to be devoted to the expansion of public provisioning. Since the participatory nature of the growth process, particularly in the form of widespread access to remunerative employment, is itself dependent on certain preconditions that can be influenced by public provisioning (e.g., of elementary education), the role of public provisioning in distinguishing between ‘unaimed opulence’ and ‘growth‐mediated security’ is quite central.

The use of public support in general—and of public provisioning in particular—is, thus, a common element in the experiences of growth‐mediated security and support‐led security, and the main difference is one of timing and sequencing. In the case of China or Cuba or Sri Lanka or Costa Rica, the countries concerned have not waited to get rich before embarking on ambitious programmes of public support. In the case of Kuwait, opulence has come first, but the gains from wealth have been transformed into better living conditions mainly through generous public provisioning. In South Korea, the expansion of private incomes played a relatively larger part, but public support—especially in the promotion of education, skills and employment—was crucial in ensuring participatory growth.14 There are clearly different (p.270) time patterns of social and economic change in the two broad strategies identified here, but also a commonality of the use of state involvement and public action in particular fields that are directly relevant for enhancing the basic capabilities of the population.

In promoting the elementary capabilities of living without undernourishment, escapable morbidity and preventable mortality, major contributions are made by the entitlements that people enjoy to food, health services, medical attention, good epidemiological environment and basic education. In the promotion of guaranteed entitlements to these essentials, public provisioning can play an important part. In fact, in most countries in the world, public provisioning is—for good economic and social reasons—a standard part of the delivery system of many of these vital ingredients of basic living. This applies even to the richer—more industrialized—countries in the world, and, as was discussed in Chapter 10, the history of longevity expansion in these countries has commonly involved crucial contributions of direct public provisioning. What the experiences of the countries with ‘support‐led security’ bring out is the possibility of making these vital ingredients of quality of life widely available even when the country is still quite poor.

We have discussed earlier (in Chapter 12) the apparently perplexing question as to how this type of public provisioning could possibly be affordable by poor countries. One simple point to note is that some of the epidemiological transformations in health care, e.g., the elimination of infectious vectors, are remarkably economic in terms of resource use, and a great deal can be achieved in reducing preventable morbidity and premature mortality through fairly simple and inexpensive public policy. The same applies to the promotion of literacy and basic education.

A more complex aspect of this issue is the relevance of relative prices in the determination of real costs. Both elementary education and health care are extremely labour‐intensive in their provisioning, and one of the characteristics of a poor economy is the cheapness of labour—and of training labour for elementary education and basic medical services. Thus, the poorer economies not only have less money to spend on providing these services, they also need less money for making these provisions. The handicap of national poverty is, therefore, to some extent reduced through the cheapness of labour costs as far as these public services are concerned, provided the country orientates its public policy to generate enough training of the appropriate kind. The bite of the financial constraints can also be substantially reduced by giving priority to basic services and to the needs of the most deprived people.15

13.5 Food Production, Distribution and Prices

The recognition of the role of direct public support in enhancing capabilities does not, of course, deny the importance of aggregate production. Indeed, (p.271) public provisioning should not be seen simply as a distributive device, even though it may be aimed at bringing basic ingredients of living within the reach of all. When elementary education or basic health services are provided more widely, the total production of these commodities is also expanded, so that the process is one of enlargement of production as well as of equitable distribution. It is not so much that the same bundle of commodities is more equally distributed as a result of this process, but that larger aggregate outputs of education and health services are produced, and it is from this enhanced production that the new recipients get their own share.16

This is not to deny that there can be, in particular cases, a conflict between aggregative and distributive considerations in policy making. A number of such conflicts were discussed earlier on in this book in the context of specific policies. In the particular context of food policy as such a conflict that has received some attention recently is that between the productive influences of high food prices vis‐à‐vis their possibly regressive distributional effects.17 That low food prices tend to depress production incentives is certainly correct, and it has been argued with some force that this has been one of the factors behind the food production crisis in sub‐Saharan Africa. While there are clearly many other aspects of the African food production problem (as was discussed in Chapters 2 and 9), low food prices can be seen as being among the contributory factors.

There is not much difficulty in accepting fairly readily that higher food prices can lead to a larger volume of food output being produced, but it would be a mistake to assume that, whenever that is the case, good public policy would require a considerable raising of food prices. We have to be concerned not only with the total volume of food produced, but also—indeed primarily—with the food consumption of the different sections of the population. Higher food prices, even as they increase the total food output, may reduce drastically the ability of the poor to buy food, and thus a larger volume of aggregate food output might actually go with a reduced consumption of the most vulnerable people. There is a real issue of conflict involved between the positive production incentives and the reduced affordability associated with (p.272) high food prices. Which way the balance of advantages would lie is not just a matter of being either a hard‐nosed ‘productionist’ or a soft‐hearted ‘distributionist’, but also of knowing precisely how the different groups of consumers would be affected by the new equilibrium with higher food prices.18

In this book we have not tried to argue in general for ‘high’ or ‘low’ food prices. These are instrumental issues and can be resolved only in terms of the relevant features of each case, taking into account the production effects as well as distributional impact.19 That itself amounts to a denial of such often‐advocated policies as total reliance on ‘getting prices right’. This is not only because the ‘rightness’ of prices depends ultimately on our overall objectives (including the assessment of social welfare) and must not be seen simply as a matter of what the market mechanism would have determined, but also because there is so much more to a sound food strategy than just fiddling with food prices.20 Other issues include policy matters (e.g., technology, environmental improvement) related to the production of food and also of crucial non‐food commodities (e.g., other outputs that generate income, or the supply of commodities such as health and education). The solution of the food problem requires a great deal more than getting food prices ‘right’.

We have also emphasized the links between the economic and the political aspects of the food problem. Even in the context of the general diagnosis that the food production crisis in, say, sub‐Saharan Africa arises partly from having unduly low food prices, the question can be asked as to why this is the direction in which food prices tend to ‘err’ in so many different countries. It would be amazing if the answer had nothing to do with the relative political powers enjoyed by the different classes and groups, e.g., the contrasting interests of food‐growing peasants and the food‐buying urban élite. Whether we see this in terms of the hold of a handful of administrators with interests of their own, or in line with what has been called a general ‘urban bias’ in development policies, or in terms of some other political analysis, it would be naïve to concentrate on ‘getting prices right’ without also addressing the underlying political factors that lead to these price biases.21

(p.273) Discussion of food problems in Africa and elsewhere has often suffered from a systematic narrowing of vision to a few variables, overlooking the reach and relevance of many other factors. This can be seriously misleading for public policy. We have discussed earlier on in this book how the nature of the problem of hunger—both famines and endemic deprivation—calls for a broader political economic analysis taking note of the variety of influences that have a bearing on the commodity commands and basic capabilities that people enjoy. The case for such a broader focus—rejecting a cramped analysis—should not be interpreted as being something equally simplistic, though on the ‘opposite’ side, e.g., being ‘anti‐price‐policy’ or ‘anti‐production’. Production and prices belong to the analysis, but do so along with other concerns.

13.6 International Cooperation and Conflict

The agents of change in conquering hunger can come from inside or outside the country in question. It may be thought that the focus of this book has been primarily on forces that operate from inside. This would be fair comment. We have indeed mainly concentrated on what can be done through public action within the country to eradicate hunger. This should not be taken to imply that we believe that international help cannot be of any great use in combating hunger. We do believe that both famine prevention and the eradication of endemic undernutrition call for leadership and coordination coming from inside rather than outside the country, but that does not imply that international help cannot supplement these efforts effectively.22 Nor that international conflicts of interest do not hinder an adequate solution of the problem of hunger in the modern world.23

Some of the policies we have discussed will undoubtedly call for international reform and coordination. Environmental protection is an obvious example. This type of international effort will be increasingly important in the future. There is also a good case for making sure that the countries battered by famines or undernutrition do not have to face severely restricted world markets, e.g., markets in the rich countries from which their goods are systematically excluded. The need for confronting and eliminating collusion and manipulation in food markets can also be important. Further, there is need for international cooperation in dealing with the excessive burden of debt that is borne by some of the poorest countries, especially in sub‐Saharan Africa.24 (p.274) These and many other areas of possible international cooperation are of obvious importance.

There has recently been a great deal of debate about the pros and cons of aid in general and of food aid in particular. This is not the occasion to attempt a general assessment of that complex and tangled problem.25 There is indeed a need to ‘de‐escalate’ the issue. It is not hard to find cases in which aid will help, e.g., by providing timely relief, by permitting a larger investment for the benefit of living standards. Nor is it difficult to find other cases in which much harm does follow from aid, e.g., through economic or political dependency, or through the spread of corruption. It is hard to believe that aid can emerge as being just generally good or generally bad. Like all other policies and institutions, aid too has to be assessed by balancing its positive and negative consequences in the respective contexts.

It may, however, be worth commenting briefly on a particular argument that has often been used to argue generally against food aid as such. It has been pointed out that food aid tends to depress food prices and thus reduces the incentive to produce more food. There is some truth in this way of looking at the problem, but it can scarcely be seen as a decisive rebuttal of the case for food aid. First, production is, as was discussed earlier, only one part of the overall picture of entitlement determination, and has to be supplemented by distributive considerations, which can be especially important when the use of food aid is geared to giving relief to the needy. Second, food production is only one part of total production, and the ability of people to command food will depend also on the effects on the production of other goods which generate employment and income; it is quite inadequate to look only at the incentive effects on food output. Third, what the impact of food aid will be on food prices is not a fact of nature but a matter of policy. It is not particularly complex to make sure, if it is so desired, that food aid does not lower the food prices that producers receive. Indeed, the element of income‐gain involved in receiving food aid makes it also possible to have a consumer subsidy that makes the prices that producers receive exceed the prices the consumers have to pay. In general the effects of food aid on prices will depend on what is done with it. The tendency to believe that it must—of necessity—adversely affect incentives is far from correct.

While aid is often seen as the central ‘international’ aspect of the problem of world hunger, it is possible to argue that an international issue that is no less important is that of war and peace. The problem of hunger is made much worse by the war‐torn nature of the world. Many of the great famines in the world have been associated with actual wars—varying from armed conflicts in Biafra and Eritrea to the ‘killing fields’ of Kampuchea. Wars increase a country's (p.275) vulnerability to famines in many different ways: (1) through the destruction of crops, (2) by destroying resources including land and the environment, (3) by deflecting resources from economic development and welfare programmes to military expenditure, (4) by disrupting trade, commerce and economic activity, (5) by making the provision of organized relief for the hungry much harder, (6) by causing population displacements and generating masses of destitute refugees, and (7) through the suppression of the freedom of the press and civil rights, and by making the country less tolerant of protest and pluralism.

Sub‐Saharan Africa in particular has been especially torn by strife and warfare, with terrible consequences on hunger and deprivation. Angola, Chad, Ethiopia, Mozambique, Somalia, Sudan, and many other countries have been transformed to a greater or lesser extent into veritable battlefields. Quite a few of these wars have been directly or indirectly associated with global conflicts and the cold war, with the African governments falling in line with one international side or another. The big powers have also been remarkably tolerant of regimes on their respective sides despite persistent violations of the very principles of democracy and socialism on behalf of which the big powers allegedly wage their respective battles. It is a story in which there is little honour—either locally, or in the distant capitals from which many international conflicts have been pursued with such vigour and lethal arms pushed with such energetic cunning. It is arguable that one of the biggest contributions that the big powers can make to the solution of the problem of world hunger is to refrain from exacerbating armed conflicts in the ‘third world’.

The disastrous effects of wars (and war preparations) on the problem of human well‐being and hunger sharply contrast with the success that some of the poorer countries have achieved by giving low priority to military expenditure. Costa Rica which abolished its army in 1949 is the most obvious example. The saving of resources involved has certainly helped to channel economic efforts to the improvement of living standards.

The international aspects of world hunger are indeed extensive. In addition to the much‐debated issues of aid, trade and debt, they include problems of international coordination involved in environmental protection and—less palpably but most surely—the problems of war and peace, which can have such a crucial influence on the successes and failures of different countries in eradicating famines and endemic hunger. Once again the need is to take an adequately broad view of the causal antecedents of starvation and undernutrition. That general theme has, of course, been a recurrent one in this book.

13.7 Public Action and the Public

The persistence of widespread hunger is one of the most appalling features of the modern world. The fact that so many people continue to die each year from famines, and that many millions more go on perishing from persistent (p.276) deprivation on a regular basis, is a calamity to which the world has, somewhat incredibly, got coolly accustomed. It does not seem to engender the kind of shock and disquiet that might be reasonable to expect given the enormity of the tragedy. Indeed, the subject often generates either cynicism (‘not a lot can be done about it’), or complacent irresponsibility (‘don't blame me—it is not a problem for which I am answerable’).

Perhaps this is what one should expect with a resilient and continuing calamity of this kind. But it is not at all easy to see why we do not owe each other even the minimal amounts of positive sympathy and solidarity that would make it hard for us to cultivate irresponsible complacency.26 While we shall not wait for an answer to that ethical question, we must address the issue of cynical pessimism (i.e., the belief that ‘not a lot can be done’). There is, in fact, little reason for presuming that the terrible problems of hunger and starvation in the world cannot be changed by human action. Much of this book has been concerned with exploring and clarifying what can be done and how.

As we have discussed, the eradication of famines is a fairly straightforward task, and there is not much difficulty in achieving it given systematic preparedness and the will to act quickly to protect or recreate threatened entitlements (Part II). Indeed, the successes achieved in different Asian and African countries in eliminating famines seem eminently repeatable in others. While the problem of endemic undernutrition and deprivation is harder to deal with, here too the possible lines of policy are clear enough and well illustrated by particular strategies that have already been used in one form or another (Part III). There is little room for cynical pessimism or for paralysing scepticism.

The types of public action needed in different contexts have been discussed earlier on in the book, and there is no need here—in this final section—to go once again into these questions. But it is worth emphasizing that throughout this book, we have seen public action as something involving a great deal more than activities of the state. This is partly because the public can do a great deal for itself even without governmental assistance, but also because the nature of government policy can depend very extensively on the nature of public activism, including articulated demands and criticisms. The connections are easy to identify in many contexts, e.g., the role of adversarial politics and of an active press in forcing the hands of the government to act rapidly enough to abort threatening famines (see Chapter 5). In other contexts, the precise part played by public activism may be harder to identify exactly, even though the influence may be understood to be generally quite strong. For example, the social impact of women's political movements and economic organizations —and more generally of informed discussion and criticism of women's relative deprivation—can be recognized to be quite substantial even when it is (p.277) hard to specify the exact details of the process of influence (see Chapters 4 and 11).

It is also worth noting, in general, that effective action is not only a matter of informed analysis, but also one of determination and will. The idea of the ‘political will’ has often been invoked in social analysis. That concept, however, is hard to make very precise, and the tendency to treat it as a ‘black box’ for ‘completing’ incomplete explanations has been viewed—rightly —with some suspicion. There are, in fact, many problems in trying to specify the exact process through which a ‘political will’ is supposed to operate, and there are certainly many connections here that are hard to observe. But, at the same time, it would be a mistake to leave no room whatever in our social analysis for the general influence of firm commitment, uncompromising resolve and dedicated action by the political leadership, and to take no account of the way in which an inspired leadership can generate effective social response.

Indeed, without bringing in the class of concepts that are associated with the general idea of political will and determination, it is difficult to provide an adequate analysis of the process through which, say, a country like China achieved a remarkably rapid improvement in longevity and general health even without a massive increase in GNP per head or in aggregate economic opulence. This success was based on a politically inspired and forcefully led transformation of the access to basic ingredients of living enjoyed by the Chinese population, and we have discussed some of the ways in which that transformation took a concrete shape (see Chapter 11). While there are technical issues here concerning institutional structure, financing arrangements and relative costs, underlying all this was the force provided by a politically committed leadership determined to achieve a radical transformation.

However, it must also be acknowledged that dogmatic commitment and inflexible resolve on the part of the leadership can sometimes be associated with a negative—rather than a constructive—role in combating hunger and deprivation. For example, the same China that achieved so much success through determined public action in transforming health conditions, also carried out—with misplaced confidence—a disastrous set of public policies leading to the largest famine in this century in 1958–61 in the wake of the so‐called Great Leap Forward (see Chapter 11). Despite their destructive consequences, these wrong‐headed policies could not be modified by the pressure of public criticism both because the leadership was uncompromising and overconfident and because the system did not encourage—or indeed allow—such criticism.27

(p.278) Aside from this issue of political commitment, we have had several occasions to note the positive role that political pluralism can play in the eradication of hunger and deprivation. The contribution of political pluralism relates to the importance of adversarial politics and social criticism in influencing state action in the direction of greater sensitivity to the well‐being of the population. The power of public pressure is not, of course, confined to pluralist political systems, and indeed we have discussed how even fairly authoritarian political regimes may have strong incentive to respond to popular demands (as in South Korea or Chile). But it is clear that the scope for effective public influence on the activities of the state tends to be greater in political systems that make room for opposition and criticism. We have discussed, for instance, how the accountability of the Indian government to the electorate (combined with a relatively free press) has made the prevention of famines a political compulsion, in a way that has not applied in China (or in sub‐Saharan Africa). We have also noted the crucial role played by participatory politics in the development of public support systems in countries such as Costa Rica, Sri Lanka and Jamaica.

This is not to say that the political systems of these countries are in any way ‘exemplary’ as far as pluralism and participation are concerned. The demands of different classes typically do not receive equal attention because of the strong links between economic inequality and the distribution of political power. Ultimately, genuine political participation involves a great deal more than the elementary political rights that are recognised in these countries. Also, formal political rights may fall far short of providing a sound basis for political participation when large sections of the public are deprived of the means of effectively exercising these rights and of articulating their demands. We have noted, for instance, how the extraordinary persistence of mass illiteracy in India has contributed to the neglect of many social problems, and has tended to prevent chronic deprivation from becoming a politically sensitive issue in the way that famine has become.28 But these qualifications, however real and important, do not detract from the general connection that can be observed between the scope for pluralist politics and the role of public activism.

The distinction between the ‘collaborative’ and ‘adversarial’ roles of the public has some relevance to this dichotomy between the advantages of political commitment vis‐à‐vis those of political pluralism. While a leadership committed to radical social change can often inspire more public collaboration, having a committed leadership is not adequate for—and may even be hostile to—the exercise of the adversarial role of the public. Since both the roles have value in combating deprivation, it is natural to look for the possibility of combining the advantages of committed leadership with those of pluralist tolerance. Whether such combinations are possible, especially in the circumstances (p.279) that rule in most developing countries, remains a challenging question.29 There is no reason, in principle, why a political system that allows, encourages and helps the public to be active (both adversarially as well as collaboratively) cannot also lead to governments that provide bold initiatives and inspiring leadership. But it is obvious that in practice the actual possibilities are much constrained by social, political and economic circumstances, and the ‘ideal combinations’ are hard to realize, as the history of the world has shown again and again.

In these concluding comments, we have taken the liberty of raising some very broad questions, drawing on—but going beyond—the analyses presented earlier in the book. Some of these questions are easier to raise than they are to answer. But it is nevertheless important to ask these bigger questions even when the answers are far from clear. While much of this book has been concerned with issues of diagnosis and policy that admit of relatively clear‐cut answers (and these we have tried to present sharply enough), it would be misleading not to point to the broader—and ‘grander’—questions that lie close to the fields of our inquiry and which can profoundly influence the nature of these fields.

It is important, in this concluding section, to re‐emphasize our focus on public participation—collaborative and adversarial—in eradicating famines, undernutrition and deprivation. It is, as we have tried to argue and illustrate, essential to see the public not merely as ‘the patient’ whose well‐being commands attention, but also as ‘the agent’ whose actions can transform society. Taking note of that dual role is central to understanding the challenge of public action against hunger. (p.280)


(1) On this and related experiences, see Chapter 10. Some contemporary developments point to similar lessons to these historical experiences. For instance, the resilient persistence of hunger and deprivation in some sections of the population even in the richest countries of the world (e.g., the USA) seems to have a clear connection with the neglect of public support (see Harvard School of Public Health 1985, 1987). This is an important issue for further exploration in analysing the survival of undernutrition and preventable morbidity (and the persistence of inequalities in health and longevity between different classes and regions) within the rich countries of North America and Europe (see, e.g., Townsend and Davidson 1982).

(2) See Chapters 4, 5–8, 10–12.

(3) We have also discussed the importance of combining and connecting state action and market response in strategies to combat hunger (see particularly Chapters 6 and 7).

(4) See Chapter 1 on the respective definitions and characterizations, including that of the notion of ‘entitlements’ itself. In this concluding chapter, as in the earlier ones, several specific concepts and categories are freely used without redefinition, since they have been explicitly discussed and explained in the first chapter of this book.

(5) As was mentioned earlier, this applies not only to the often‐discussed case of India, but also to many success stories from sub‐Saharan Africa, e.g., in Botswana, Cape Verde, Zimbabwe (on these and other experiences, see Chapter 8).

(6) On this see Sen (1984a, 1985a, 1987c).

(7) The positive connection between female education and the elimination of undernutrition has been investigated in a number of recent studies; see, e.g., Caldwell (1979), Behrman and Wolfe (1984, 1987), Cornia (1984), Ware (1984), Jain (1985), Mosley (1985a), Cleland and van Ginneken (1987), Levine (1988), Senauer and Garcia (1988), Thomas et al. (1988a, 1988b).

(8) For example, there is considerable evidence that the high level of basic education, especially female literacy, in Kerala leads to a better search for and exploitation of available medical services compared with the rest of India (see Nag 1985, 1989, and Caldwell 1986). This reinforces Kerala's advantage in having more public health services on offer. On Kerala's experience, see Chapter 11.

(9) On this issue, see Chapter 4, and also Chapter 11.

(10) On different lines of possible improvement, see e.g. Cutler (1985b), Desai (1986), Borton and York (1987), Autier (1988), Walker (1988), Autier et al. (1989), Swift (forthcoming).

(11) See Ravallion (1987a) on the process through which a market can ‘overshoot’ in anticipating price increases even without much collusion by traders. See also his analysis of the overreaction of food markets in the Bangladesh famine of 1974. Those food markets undoubtedly suffered from the general knowledge that there was relatively little food in public stock held by the government in Bangladesh. The suspension of US food aid to Bangladesh in the crucial period also added to the helplessness of the government to break the price rise through its own stock. The US government resumed its food aid only after Bangladesh accepted its demand that it should stop exporting jute to Cuba—by which time the famine was nearly over (on this see Rothschild 1976, McHenry and Bird 1977, Sobhan 1979, 1986). The lessons of that experience certainly underline further the advantages of holding a sizeable public stock of food grains as a general precautionary strategy.

(12) This point refers specifically to famine situations, and is not meant to indicate any general scepticism regarding the merits of nutritional intervention through individual feeding. In fact, rather different issues are raised in assessing such intervention in the context of chronic hunger and endemic undernutrition. See Chapters 3 and 6, and also Berg (1973, 1981, 1987a, 1987b), Gwatkin et al. (1980), Austin and Zeitlin (1981), Beaton and Ghasseimi (1982), Underwood (1983), Sen and Sengupta (1983), Pinstrup‐Andersen and Biswas (1985), Godfrey (1986a, 1986b), Field (1987), Kumar and Stewart (1987), Norgan (1988), among others.

(13) One country that has achieved no less than any of these five in terms of support‐led security is Sri Lanka. But in its case the main expansion took place prior to 1960, and it is thus not included in the list of top performers in the 1960–85 comparison. On this and on the assessment of Sri Lanka's policies, see Chapter 12. Another interesting experience is that of the state of Kerala in India which has also achieved extraordinary success in support‐led security. Kerala is not included in the list of top performing countries since it is not a country but only a state in a federal country (even though in population size it is much larger than several of the countries actually included in the list, such as Hong Kong, Singapore, Kuwait and United Arab Emirates). For an analysis of Kerala's experience, see Chapter 11.

(14) Another major factor in this success story of private enterprise has been Korea's fairly comprehensive land reforms, which took place early and contributed greatly to the sharing of the fruits of economic growth. Further, the role of the state in that country's planned economic expansion based on guided private enterprise is also important to study (e.g., the part played by state planning in industrial expansion, in a way not altogether dissimilar to what had happened in Japan earlier). As was discussed in Chapter 10, the Korean ‘miracle’ must not be seen in terms of an imaginary policy of laissez faire, since that has not been a feature of that country's route to success.

(15) See Chapters 11 and 12.

(16) Indeed, even the greater use of available health services as a result of the expanded education of the population (discussed earlier) must be seen as an enhancement of actual production of these services, since more of these services are then produced and used. Unfortunately, the usual estimations of the ‘output’ of public health services often does not record this basic fact. One reason for this is the tendency to measure the output generated by public provisioning in some mechanical way, e.g., in terms of the volume of public expenditure itself, or in units of theoretically available capacities rather than the actual volume of services used by the public.

(17) It is a common belief that the problem of regressive distributional effects of high food prices does not apply in much of sub‐Saharan Africa, where most of the poor are thought to be peasant farmers who would benefit from an increase in the ordinary level of food prices. Recent empirical studies, however, suggest that in many African countries the number of poor who depend on market purchases of food for their survival is in fact large (and rapidly growing). On this see, among other contributions, Iliffe (1987), von Braun (1988), Weber et al. (1988), Liedholm and Kilby (1989).

(18) Dharm Narain (1988) in particular has clarified a number of issues involved in this conflict. On his contributions and their general bearing on economic policy, see also Mellor and Desai (1985). On different aspects of ‘food price dilemmas’ in developing countries, see Timmer (1984, 1986), Pinstrup‐Andersen (1985b), Ghai and Smith (1986), Kanbur (1986a), Lipton (1987a), Streeten (1987), Besley and Kanbur (1988), Mellor and Ahmed (1988), Ray (1988a, 1988b), among others.

(19) These effects would, of course, depend inter alia on the particular way in which it is proposed to influence food prices (e.g. through devaluation, imports, indirect taxes, food price subsidies).

(20) For analyses of the relationship between general development problems and food strategies, see Valdés (1981), K. Basu (1984), Swaminathan (1986), Boyce (1987), Gittinger et al. (1987), Mellor et al. (1987), Pinstrup‐Andersen (1987, 1988b), Rukuni and Eicher (1987), Eicher (1988a), Lipton (1988a). Many of the underlying issues have been investigated by various authors in the papers included in Drèze and Sen (forthcoming).

(21) On various political aspects of these economic relations, see among others Bauer (1954), Lipton (1977), Mitra (1977), Byres (1979), Bates (1981, 1983, 1986), Sobhan (1986), Hopkins (1988), Streeten (1989).

(22) We have discussed in the context of famine prevention the helpful part that international agencies can play in strengthening and supplementing national efforts. But we have also discussed the advantages of the leadership of famine prevention being in the hands of national governments, with public participation (see Chapters 6–8).

(23) Various aspects of the bearing of international interest conflicts on the problem of hunger have been investigated by George (1976, 1984, 1988), Lappé and Collins (1979, 1980), Byron (1982), Twose (1984), Parikh (1986), among others.

(24) On the scope for ‘cooperative debt relief’, with special reference to Africa, see Jacques Drèze et al. (1989).

(25) For a general analysis of the contribution of aid, see Cassen et al. (1986). For a strong defence of food aid, see Dawson (1985), Singer et al. (1987); see also Clay and Singer (1985). On the other side, see Jackson and Eade (1982), Bauer (1984), Griffin (1987).

(26) This book is not directly concerned with exploring ethical issues as such, and we shall resist going into the question as to what we owe each other as human beings. On the ethical issues raised by the hunger and suffering of people at a distance from us, see Onora O'Neill's (1987) powerful and far‐reaching analysis. See also Sen (1982d, 1985a, 1988e).

(27) Similarly, the reduction of communal health services in rural China and the imposition of the ‘one child’ policy and related measures of compulsory birth control, which accompanied the reforms of 1979, were carried out with remarkably little public discussion and opportunity of social criticism, despite the dangers of serious adverse effects on mortality rates (especially on infant mortality).

(28) The Indian state of Kerala is an exception to this pattern, and we have discussed how the longstanding achievements of this state in the field of education have borne fruit in the form of a more effective and broad‐based system of public support than exists in the rest of India.

(29) This is a question that has come even more to the forefront with the recent demands for democratic rights in China and Eastern Europe.