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Social Security in Developing Countries$

Ehtisham Ahmad, Jean Drèze, John Hills, and Amartya Sen

Print publication date: 1991

Print ISBN-13: 9780198233008

Published to Oxford Scholarship Online: September 2011

DOI: 10.1093/acprof:oso/9780198233008.001.0001

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Public Action for Social Security: Foundations and Strategy

Public Action for Social Security: Foundations and Strategy

Chapter:
(p.2) (p.3) 1 Public Action for Social Security: Foundations and Strategy*
Source:
Social Security in Developing Countries
Author(s):

Jean Drèze (Contributor Webpage)

Amartya Sen (Contributor Webpage)

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780198233008.003.0001

Abstract and Keywords

This chapter discusses the nature of well being and deprivation, and tries to characterize the focus variables underlying the analysis of social security. It deals with the normative foundations of the problem and asks the question: what is the object of the exercise? The chapter examines whether the desired results can be achieved through normal economic and social processes without needing to devise systems of social security as such. It also discusses a central problem of protective social security, namely, the prevention of famines through public action. The chapter focuses its attention to the prevention of chronic deprivation and determines how promotional social-security programmes can combat regular and persistent hunger and hardship. It examines the nature of public action, and the role of the public in public action is analysed. The chapter also discusses the problem of integration of State activities with those of the public in general and of non-governmental institutions in particular.

Keywords:   well being, deprivation, social security, social processes, famines, public action, social-security programmes, State, non-governmental institutions

1. Introduction

‘As you all know,’ said Hecate, the mistress of the witches in Macbeth, ‘security is the mortals’ chiefest enemy.’ His exaggerated sense of security certainly did not help Macbeth, but the ’chiefest enemy’ that the majority of humanity face is the almost total absence of security in their fragile and precarious existence. The lives of billions of people are not merely nasty, brutish, and short, they are also full of uncertain horrors. An epidemic can wipe out a community, a famine can decimate a nation, unemployment can plunge masses into extreme deprivation, and insecurity in general plagues a large part of mankind with savage persistence.

It is this general fragility, on top of chronic and predictable deprivations, that makes the need for social security so strong and palpable. That recognition is part of the background of this chapter, but not the whole of it. The case for public action in this field requires us to go beyond the negative diagnosis of what isn’t there, to the positive identification of what can, in fact, be achieved through a programme of social security. The motivation here is to investigate what the problems are, why some special actions are needed, what forms such actions should take, and in general how we should think about devising public action for social security.

It is useful to distinguish at the outset between two different aspects of social security—what we may call respectively ‘protection’ and ‘promotion’. The former is concerned with preventing a decline in living standards in general and in the basic conditions of living in particular. The problem of protection is paramount in the context of famine prevention, and also in dealing with other kinds of sudden economic crises and sharp recessions.

This contrasts with the objective of enhancing the normal living conditions and dealing with regular and often persistent deprivation. This promotional aspect of social security is, in a sense, more ambitious, in wanting to eradicate (p.4) problems that have survived thousands of years. The strategic issues involved in promotional social security may differ very considerably, as we shall see, from those in protective social security.

It may be useful to make three clarificatory remarks to prevent misunderstanding of the distinction and in particular of the terms chosen. First, while both ‘promotion’ and ‘protection’ have superficially a somewhat paternalistic ring, the terms refer in fact to the objects of the exercise, rather than to the agency that may bring about those objects. As we shall argue, public action for social security is neither just a matter of State activity, nor an issue of charity, nor even one of kindly redistribution. The activism of the public, the unity and the solidarity of the concerned population, and the participation of all those who are involved are important features of public action for social security. There is no assignment of any paternalistic role to the State—or to any other body—in clarifying the plurality of the objectives involved.

Second, the contrast between protection and promotion arises in different contexts in our analysis. For example, we may be concerned with the distinction in the context of the generation of incomes, and we may then distinguish between the promotion of incomes (changing persistently low incomes) and the protection of incomes (preventing sharp declines). The distinction may apply, similarly, in the context of entitlements, living standards, and so on. There will then be a need to differentiate between entitlement promotion and entitlement protection, between the promotion of living standards and the protection of those standards, and so forth. The protection-promotion distinction has to be integrated with other discriminations that will be used in this chapter.

Third, while the objectives of protection and promotion are distinct, the pursuits of these objectives are not, of course, independent of each other. Nor is the importance of one independent of the achievement of the other. For example, success with the promotional objectives may make protection easier (for example, individual insurance may be less difficult when one’s normal level of prosperity is higher). It can also make protection less intensely crucial (for example, a decline from a higher standard of living may cause hardship but not the kind of starvation and extreme deprivation that a fall from a lower-more precarious—level would entail). There are other interdependences between the two aspects of social security and their respective pursuits. It is perhaps as important to note the interdependences as it is to clarify the distinction.

The plan of this chapter is something like this. In Section 2, we discuss the nature of well-being and deprivation and try to characterize the focus variables underlying the analysis of social security. This section deals with the normative foundations of the problem, and asks the question: what is the object of the exercise? In Section 3, we examine whether the desired results can be achieved through normal economic and social processes, without needing to devise (p.5) systems of social security as such. Why do we specifically need social security? The next section discusses a central problem of protective social security, namely, the prevention of famines through public action. What can be done to make communities safe from famines? In Section 5, the attention is shifted to the prevention of chronic deprivation. How can promotional social-security programmes combat regular and persistent hunger and hardship?

In Section 6, the nature of public action for social security is examined, and the role of the public in public action is analysed. We also discuss the problem of integration of State activities with those of the public in general and of nongovernmental institutions in particular. Some concluding remarks are made in Section 7.

2. Well-Being, Deprivation, and Security

The basic idea of social security is to use social means to prevent deprivation, and vulnerability to deprivation. What counts as deprivation is, of course, a matter of valuation, and the values involved can be characterized in different ways.

2.1. Utility versus Objective Deprivation

The utilitarian notion of value, which is invoked explicitly or by implication in much of welfare economics, ultimately sees value only in individual utility, itself defined in terms of some mental condition, such as pleasure, happiness, desire-fulfilment. This subjectivist perspective has been extensively used, but it can be very misleading, since it may fail to reflect a person’s real deprivation. A thoroughly deprived person, leading a very tough life, might not appear to be badly off in terms of the mental metric of utility, if the hardship is accepted with non-grumbling resignation. In situations of long-standing deprivation, the victims do not go on sighing all the time, and very often make great efforts to take pleasure in small mercies and to cut down personal desires to modest— ‘realistic’—proportions. A person’s deprivation, then, may not at all show up in the metrics of pleasure, desire-fulfilment, and so on, even though he or she may not have the ability to be adequately nourished, comfortably clothed, minimally educated, and so on.1

This issue, aside from its foundational relevance, may have some immediate bearing on practical public policy. Smugness about continued deprivation and vulnerability is often made to look justified on grounds of lack of strong public demand and forcefully expressed desire for removing these impediments. For example, the persistence of massive illiteracy in India, especially among (p.6) women (the proportion of the literate among all Indian women above 5 years of age is still only around 28 per cent according to the last census), is often ‘rationalized’ in terms of the absence of a clamouring demand (especially among rural women) for elementary education. At a more removed—but still fairly immediate—level, similar arguments are used about the quiet tolerance of endemic undernutrition in many parts of the world, including India. These demand-centred arguments tend to hide the enormity of actual social deprivations.

2.2. Commodities, Incomes, and Quality of Life

An alternative approach is to focus on a person’s ‘real income’, or command over essential commodities. This concrete perspective need not be subjectivist in the way utilitarian valuation is, since it is not exclusively dependent on the mental metrics of utility. Indeed, this type of ‘non-psychological’ accounting has been enormously influential in the recent literature on economic development, largely through the use of the ‘basic needs’ approach, which concentrates on the requirement to provide some specified minimal amounts of necessary goods (such as food, clothing, shelter) to all.2

The approach has, however, the disadvantage that commodities—and therefore income and wealth—are means to well-being, rather than constituent elements of it. In fact, the conversion of commodities into personal achievements may vary greatly between one person and another, and also between communities. For example, the calorie requirement for being well-nourished varies greatly with metabolic rates, body size, sex, pregnancy, age, parasitic ailments, climatic conditions, and so on, and an interpersonal comparison of deprivation or of poverty cannot be adequately performed just in terms of comparing commodity commands.3

Focusing only on incomes for analysing poverty and deprivation—as is frequently done—is problematic on two counts. The value of income lies in its use for commanding commodities, and therefore the variability in the relation between commodities and the quality of life applies also to that between incomes and the quality of life. But on top of that there are additional problems in the conversion of incomes into commodities. There are variations in the power of income to establish command over goods and services, because of market limitations in such forms as imperfect competition, presence of externalities, and the unavailability of certain goods in particular markets (for example, the (p.7) absence of educational services on offer in the rural markets of many developing economies). Therefore the problem of conversion of commodities into living standards is compounded by the problem of conversion of incomes into commodities.4

2.3. Living Standards and Capabilities

If neither the subjectivist utilitarian view, nor the means-oriented (commodity or income) view, is adequate, we need some other focus variable for analysing quality of life in general, and deprivation and poverty in particular. One approach, which has been explored recently, focuses on the capability to perform certain basic functionings.5 The foundations of the approach go back, in a particular form, to Aristotle. Aristotle examined the problem of ‘political distribution’ in terms of his analysis of ‘the good of human beings’, and this he linked with his investigation of ‘the function of man’ and his exploration of ‘life in the sense of activity’.6 The Aristotelian theory is, of course, a very specific one, and involves elements (such as objectivity of valuation, a particular reading of human nature, and so on) that may or may not be compelling to all of us. But the argument for seeing the quality of life in terms of valued activities (and the ability to choose these activities) has much broader relevance and application.7

If life is seen as a set of ‘doings and beings’ that are valuable, the exercise of assessing the quality of life takes the form of evaluating these functionings and the capability to function. This valuational exercise need not be performed by simply counting pleasures or desires (as in the utility-based accounting), or by focusing on commodities or incomes instead of doings and beings (as in the commodity-based accounting). The task is that of evaluation of the importance of the various functionings in human life, going beyond what Marx called (p.8) ‘commodity fetishism’.8 The functionings themselves have to be examined, and the capability of the person to achieve them has to be appropriately valued. The evaluation is a reflective activity, and not a matter of identifying valuation with some mental metric or other, such as pleasure or desire.9

2.4. Poverty and Deprivation

The approach of focusing on capabilities and functionings can be used in a variety of evaluative problems.10 In the case of studying poverty, it is the failure to have the capability to achieve minimal levels of certain basic functionings that would occupy the centre of the stage. The capabilities to be adequately nourished, to be comfortably clothed, to avoid escapable morbidity and preventable mortality, and so on, become the appropriate focus variables. This general approach yields a policy perspective that takes us well beyond an income-centred or a commodity-centred analysis, and also forces us to abandon smugness based on socially conditioned, unreflected acceptance of traditional inequities, deprivations, and vulnerabilities. The practical import of this reflective foundation, built on evaluating human functionings and capabilities, becomes clear as strategic problems in devising social-security programmes are seriously considered.11

Seeing poverty as capability failure may, at first sight, appear to be quite a departure from the traditional idea of poverty, which is typically associated with a shortage of income. The poor are taken to be those whose incomes fall below a certain specified level, namely, the so-called ‘poverty line’, and there is an extensive literature on (1) how the poverty line may be fixed, and (2) how the conditions of the different people below the poverty line may be put together to provide an aggregate measure of poverty.12 However, the motivation underlying (p.9) the concern with deprivation of income is indeed the likely impact of income shortage on the lives that people can lead. The income view of poverty is derivative, related to the effects of income on people’s basic capabilities to lead minimally acceptable lives. The ultimate concern of poverty analysis has to be with the deprivation of living conditions, for example, lack of nourishment (rather than of the income to buy nutrients), exposure to preventable diseases (rather than inability to buy medicine), and so on.

The concentration on income in the poverty literature, while ultimately justifiable only derivatively, happens to be quite helpful, up to a point, for the analysis of policy issues, since the shortage of real income (appropriately defined) is one of the most visible and crucial factors restricting the basic capabilities of many people. It is because of the recognition of this important fact that the very idea of poverty has got associated with a shortfall of income rather than with a failure to have the ability to achieve certain basic functionings (such as being adequately nourished, minimally sheltered, and so on). That causal connection is an important one to keep constantly in view, and in particular contexts—such as famine prevention—the creation of income may indeed be the crucial policy instrument to use.

But it is precisely because income shortage and poverty seem so inseparably tied that we ought to be careful about those cases in which the ties are qualified by other factors which may also have significant policy relevance. First of all, the deprivation of particular members of a family may have a close but somewhat variable relation with total family income, since the intrahousehold distribution may itself vary. No analysis seriously concerned with poverty can leave the matter of, say, child poverty merely to the size of the family income available to support the children, ignoring altogether how that family income is, in fact, used to support the lives that the members of the family—children and adults—can lead. Similarly, no serious poverty analysis can fail to take note of the important needs of women, related to social as well as biological factors, including of course pregnancy. There are also other parameters of age and ability, of health and disease, and so on that must be considered in determining the relationship between income and the capability to lead adequate lives.

While in devising policy strategies note must obviously be taken of the crucial and far-reaching role of income in providing the means of minimally acceptable living conditions, the subtler aspects of policy choice may well be lost unless we also see the importance of income as being ultimately derivative and contingent. Once an adequately comprehensive view of poverty and deprivation has been taken, it is possible to make good use of the diagnosis of income shortage and of the instrumental importance of income creation without losing sight of the ends in the anxiety about the means.

(p.10) 3. Why Social Security?

The basic problems that call for social-security programmes are of two different general types. There is, first of all, the problem of widespread, persistent deprivation, and there is also the issue of fragility of individual security.

3.1. Persistent Deprivation

Much of humanity has come to terms with systematic denials of decent living conditions, and experiences failures of elementary capabilities. The overall picture is one of extreme deprivation across the world. The ‘under-5 mortality rate’, which is 13 per thousand in the USA, 11 in the UK, 9 in Switzerland and Japan, and 7 in Finland and Sweden, is more than 50 in eighty countries in the world, more than 100 in sixty countries, and more than 200 in twenty-three countries (among those for which data have been processed by UNICEF 1988). These are average figures, including the rich and the poor, the urban and the rural, and mortality rates for the rural poor would far exceed even these astonishingly high figures.

While life expectancy at birth is more than 75 years in many of the countries of Europe and North America, the corresponding figure is below 60 years for most poor countries, below 50 years for a great many of them, and even below 40 years for some.13 Similarly, the incidence of avoidable mortality is incomparably higher in many of the poorer developing countries than in the richer nations of the world. The failure of actual basic capabilities, compared with what is potentially possible, is remarkably widespread and intense.

3.2. Vulnerability and Fragile Living Conditions

In addition to the problem of persistent deprivation, there is also the issue of vulnerability. The average experience of the poorer populations understates the precarious nature of their existence, since a certain proportion of them undergo severe—and often sudden—dispossession, and the threat of such a thing happening is ever-present in the lives of many more. The decline may result from changes in personal circumstances (such as illness or death of earning members of the family), or from fluctations in the social surroundings (such as a crop failure, a general recession, or a civil war).

There are two different, but interrelated, problems raised by this feature of human existence. There is, first, the problem of how to counter the effects of the decline in the lives of those who experience it. And there is, second, the (p.11) problem of how to increase the security in the lives of all, so that people do not live in constant fear of a calamity visiting them. The phenomenon of sudden decline affects the interests not only of those who succumb to it, but also those of others who are made to live diminished lives as a result of the ever-present threat (even though they may, in the event, not succumb to it).

3.3. Opulence, Public Support, and Capability Expansion

How can we deal with these problems of (1) persistent deprivation, and (2) fragility of individual security, involving irregular declines and persistent vulnerability? What, in particular, is the role of social security in encountering these challenges?

The latter question can be put in a different—and somewhat negative—way also. Why can’t these problems be dealt with through standard channels of economic growth and social progress? It could be argued that the rich economies avoid most of these problems simply because of the average level of their opulence. That surely is the way to go? Or, at least, the need for taking the social-security route has to be established by showing the inadequacy of the more non-interventionist, traditional path.

In fact, the basic premisses of this ‘negative’ view are themselves far from sound. Improvements in living standards in the rich economies have often been the direct result of social intervention rather than of simple economic growth. The expansion of such basic capabilities as the ability to live long and to avoid preventable mortality has typically gone hand in hand with the development of public support in the domains of health, employment, education, and even food in some important cases. The thesis that the rich countries have achieved high levels of basic capabilities simply because they are rich is, to say the least, an oversimplification.

The point can be illustrated by looking at the time pattern of expansion of longevity in Britain and in Japan. Table 1.1 presents the increase in life (p.12) expectancy at birth in England and Wales in each of the first six decades of this century (starting with a life-expectancy figure that was no higher than that of most developing countries today). Note that while the increase in life expectancy has been between one to four years in each decade, there were two decades in which the increase was remarkably greater (around seven years approximately). These were the decades of the two world wars, with dramatic increases in many forms of public support including public employment, food rationing, and health care provisions.14 The decade of the 1940s, which recorded the highest increase in British life expectancy during the century, was a decade of enormous expansion of public employment, extensive and equitable food rationing, and the birth of the National Health Service (introduced just after the war).

Table 1.1. Increase in life expectancy in England and Wales per decade (years)

Decades

Male

Female

1901–11

4.1

4.0

1911–21

6.6

6.5

1921–31

2.3

2.4

1931–40

1.2

1.5

1940–51

6.5

7.0

1951–60

2.4

3.2

Source:

Based on data presented in Preston et al. (1972: 240–71);. See also Winter (1986); and Sen (1987a).

The Japanese figures come in less regular intervals, but a similar picture emerges of accelerating increase in life expectancy during the decade of the Second World War and post-war reconstruction (see Table 1.2). This was, again, a period of rapid expansion of public support.15 These are suggestive (p.13) facts, even though any detailed analysis of cause-effect relations would have to take into account other associated factors (such as the significantly increased tempo of medical innovation during the wars). No matter how exactly the credit for expansion of longevity during the war and post-war years is divided, it is extremely unlikely that the role of public support and social intervention could be shown to be inconsequential. There is more to the expansion of life expectancy than the simple story of economic growth and increased average opulence.

Table 1.2. Increase in life expectancy in Japan (months);

Period

Male

Female

Total

Per year

Total

Per year

1908–40

55.2

1.73

87.6

2.74

1940–51

136.8

12.44

144.0

13.09

1951–64

100.8

7.75

123.6

9.51

Source: Based on data provided in Preston et al. (1972:420–39);.

3.4. Distribution, Provisioning, and the Quality of Life

The association between the average prosperity of a nation (given by such indicators as GNP per head) and the basic capabilities enjoyed by its population is substantially weakened by a number of distinct factors: (1) inequalities in the distribution of incomes; (2) variations over time of incomes of any person; and (3) the dissonance between personal incomes and individual capabilities.

The first issue has been much discussed in the development literature. There can be remarkable disparities in the sharing of the fruits of economic growth. Even the presumption that there must be substantial ‘trickle down’ effects has been contradicted by the actual experience of a number of countries.16 Enhancing the average income level is, thus, an undependable route to the promotion of living standards. Average income is also a capricious variable for protecting entitlements of the population, since different occupation groups can go to the wall and perish even when average income rises, and indeed several major famines have occurred in overall boom situations. The need for social security thus remains strong even when a country is successful in its attempt to generate economic growth.

The second problem concerns variations of income over time even for a given person. A person’s earnings may change not merely with age (with little income when one is very old or very young), but also with business fluctuations, international slumps, crop failures, agricultural seasonality, and so on. The time pattern of earnings may not at all match the time pattern of needs. Indeed, sometimes the needs are maximal precisely when incomes tend to be minimal (for example, when a person is seriously ill). This intertemporal mismatch would not matter greatly if capital markets were ‘perfect’, allowing adjustment of expenditure to needs even without altering the pattern of earnings. The (p.14) problem of unexpected fluctuations could similarly be encountered if insurance markets were versatile and efficient. But capital markets and insurance markets are frequently non-existent or feeble (especially in developing countries). Social security has a special role in these circumstances.17

The roots of the third problem have already been discussed in earlier sections of this paper. The conversion of commodity holdings into personal capabilities depends on a number of contingent circumstances (for example, the relation between nourishment and food intake can vary greatly with age, sex, pregnancy, climate, and many other factors). Furthermore, often the vital commodities needed for the protection or promotion of living conditions (such as public-health provisions) cannot easily be individually owned, and the public sector may well be able to deliver them more efficiently than the market. Thus, the relation between individual income and individual capabilities is weakened not merely by the influence of variables other than commodities (as was discussed earlier), but also by the importance of delivery mechanisms (this issue will be further examined in Section 5).

The last point indicates that the unreliability of GNP as a guide to living conditions must not be seen merely as a problem of distributional inequality of the aggregate GNP. The problem of the delivery mechanism and the related questions of converting incomes into capabilities require us to go well beyond the usual concern with income distribution as a supplement to the GNP and other aggregate measures.18

These factors put together indicate why economic growth alone cannot be relied upon to deal either with the promotion or with the protection of living standards. The strategy of public action for social security has to take adequate note of the problems that limit what aggregate expansion can do in enhancing living conditions. In the next section we turn to an acute problem of protection of entitlements and living standards, namely, the conquest of famines, and in Section 5 we move on to the more diverse problem of promotion of living standards to combat the persistent deprivation that has been the lot of much of humanity for much of history. Which way should the strategy of public action for social security take us in facing these momentous challenges?

(p.15) 4. Famine Prevention

Starvation is clearly among the most acute forms of deprivation, and famine prevention must, therefore, be—explicitly or implicitly—one of the most elementary functions of social-security systems. At the same time, the social-security perspective itself can, as we shall see, throw fresh light on famine prevention issues. While exploring these interconnections, much of our attention will focus on sub-Saharan Africa. This is natural enough, since famine vulnerability afflicts this part of the world more than any other.

4.1. Famines and Public Action

In the short term, preventing famines is essentially an entitlement protection exercise. In the long term, much more is involved, including entitlement promotion, aimed at a durable elimination of vulnerability—through greater general prosperity, economic diversification, and so on. But even within a long-term perspective, the task of setting up reliable entitlement protection systems remains a central one. Indeed, in most cases it would be very naïve to expect that efforts at eliminating vulnerability could be so successful as to allow a country to dispense with distinct and specialized entitlement protection mechanisms.19 While entitlement protection does not subsume all aspects of famine prevention, it is undoubtedly the most vital part of the problem.

Any particular exercise of entitlement protection is intrinsically a short-term one. But it should not be confused with the popular notion of ‘famine relief’ which conjures up the picture of a battle already half lost and focuses the attention on emergency operations narrowly aimed at containing large-scale mortality. The task of devising planned, coherent, effective, and durable entitlement protection mechanisms is a much broader one. Entitlement crises have many repercussions on the rural economy and on the well-being of affected populations, and a comprehensive strategy for dealing with the scourge of famine must seek to ensure not only that human beings have secure lives but also that they have secure livelihoods.

(p.16) This is not just a question of immediate well-being, but also one of development prospects. Consider, for instance, the so-called ‘food crisis in Africa’.20 The current débâcle of agricultural production in much of sub-Saharan Africa has, not without reason, been held partly responsible for this region’s continued vulnerability to famine. But it is also legitimate to wonder how farmers who are condemned every so often to use up their productive capital in a desperate struggle for survival can possibly be expected to save, innovate, and prosper. Improved entitlement protection systems in Africa would not only save lives, but also contribute to preserving and rejuvenating the economy of this continent. The alleged dilemma between ‘relief’ and ‘development’ is a much exaggerated one, and much greater attention has to be paid to the positive links between famine prevention and development prospects.

Seeing famine prevention as an entitlement protection problem draws our attention to the plurality of available strategies for dealing with it. Just as entitlements can be threatened in a number of different ways (which may or may not involve a decline in the overall availability of food), there are also typically a number of feasible routes for restoring them. Importing food and handing it over to the destitute is one of the most obvious options. The overwhelming preoccupation of the journalistic and institutional literature on famine prevention in Africa has been with the logistics of food aid, reflecting the resilient popularity of this approach.21 But there is a good case for taking a broader view of the possible forms of intervention, and indeed the historical experience of famine prevention in different parts of the world actually reveals an impressive variety of approaches to the protection of food entitlements.

At a general level, a reliable system of famine prevention can be seen to consist essentially of two distinct elements. The first is a mechanism to ensure that an early decision to act is taken by the responsible authorities in the event of a crisis. This part of the system has, inevitably, an important political dimension. The second indispensable element of a famine prevention system is of a more administrative nature, and involves an intelligent and well-planned intervention procedure, ensuring that the political decision to act translates into effective action for the protection of entitlements. In the remainder of this section we shall investigate both aspects of the problem of famine prevention.

(p.17) 4.2. Early Warning and Early Response

Effective entitlement protection calls, inter alia, for early and decided action in the event of a crisis. The advantages of early intervention are of course well recognized, even from the narrow point of view of saving human lives. Extraordinary difficulties are encountered with containing mortality once large-scale population displacements have been allowed to begin. The penalties of reluctant or apathetic response to a crisis are dramatically visible in the disastrous human toll of unrelieved famines, such as the Bengal famine of 1943 and the Chinese famines of 1959–61.22

The blame for delayed action is often put on inadequately detailed information about the existence, or the exact character, of a crisis. There has, in fact, recently been a surge of interest and involvement in so-called ‘early warning systems’.23 However, it would be hard to see a central part played by formal early warning techniques in the recent experiences of successful famine prevention, whether in India, Botswana, Zimbabwe, or Cape Verde.24

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 pluralistic political systems (such as India and Botswana), 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.25But there is little chance that a formal model can be developed that would be practically usable (with all the necessary data inputs being obtainable at the required speed) and that would take adequate note of all the variables that may well be relevant in the wide variety of cases that can possibly (p.18) arise. The supplementation of formal economic models by more informal systems of communication and analysis is, to a great extent, inescapable.

It would, moreover, be a mistake to see the problem of early warning only in terms of the gathering and analysis of information. The informational exercise has to be seen in the broader context of the need to trigger early and resolute action on the part of the concerned authorities. Indeed, most cases of unmet famine threats reflect not so much a lack of knowledge that could have been remedied with more reliable systems of prediction, but negligence or smugness or callousness on the part of the non-responding authorities.26 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 no accident that the countries that have been most successful in famine prevention in the recent past have typically had relatively pluralistic politics with open channels of communication and criticism.

Official tolerance of political pluralism and public pressure in many African countries is, at the moment, quite limited. The opposition is often muzzled. Newspapers are rarely independent or free. The armed forces frequently suppress popular protest. Further, to claim that there are clear signs of change in the direction of participatory politics and open journalism in Africa as a whole would be undoubtedly premature. However, there is now perhaps a greater awareness of the problem and of the need for change. The long-term value of creative dissatisfaction should not be underestimated.27

4.3. Cash Support and Employment Provision

As was discussed earlier, an effective system of famine prevention requires not only a mechanism to ensure early response in the event of a crisis, but also a sound procedure of entitlement protection. One factor which has frequently accounted for belated and somewhat unsuccessful famine prevention efforts is the dependence of entitlement protection measures on the timely arrival of food aid, and generally on the complicated logistics associated with the direct delivery of food to potential famine victims. The greater use of ‘cash support’ to protect the entitlements of vulnerable groups is an important option to consider in remedying this problem.

Cash support is not a new idea. It has, in fact, a rich history covering many (p.19) parts of the world.28 But the suggestion that it has a contribution to make to famine prevention strategies in Africa today is often met with resilient suspicion. This suspicion cannot reasonably arise from the belief that the conversion of cash into food might prove impossible in a famine situation. Indeed, a plethora of recent sudies have shown that the acquisition of cash (for subsequent conversion into food through the market) is now one of the most important survival strategies of vulnerable populations in famine-prone countries.29 But there is a deeper problem. If it is clear enough that cash can almost always help an individual to acquire food and avoid starvation, it is less obvious that cash support can improve collective security. After all, one person’s ability to command food through cash support may adversely affect other people’s entitlements—for example, by exerting an upward pressure on prices. The merits of cash support do, therefore, require careful scrutiny.

Assessing the likely impact of entitlement protection measures backed by cash rather than by food involves a careful consideration of market responses.30 Indeed, an immediate effect of cash-based entitlement protection is to exert an upward pressure on food prices (since the effective demand for food increases), and this in turn can have complicated repercussions on the allocation of food in the economy. Needless to say, this increase of prices has altogether different implications from the sort of inflationary pressure that might result from, say, speculative hoarding or a boom in the urban economy. In this instance, the increase of prices has its origin in the greater purchasing power of the needy and is part of the process of improving (rather than undermining) their command over food. In order to assess the precise impact of a cash-based entitlement protection strategy on the allocation of food in the economy, one must examine carefully the effects it is likely to have, via the price mechanism, on (1) the net aggregate amount of food consumed in the region under consideration, and (2) the distribution of consumption between different sections of the population.

Price increases are likely to lead to an improvement in the availability of food in the affected region through changes in production, trade, and storage. The potential for reducing the forces of famine by inducing interregional food movements towards severely affected regions through the channel of private trade is particularly important to consider.

(p.20) In the common international perception, connected largely with the nature of media reports, African famines are often seen in terms of acute and more or less uniform ‘shortages’ of food everywhere in the affected country or countries. This is, however, largely a myth, and in fact the scope for interregional food movements to alleviate the intensity of distress is often considerable. Large variations in food output between different regions are common in Africa, and frequently a marketable surplus does remain in or near the famine-affected territory. There is also considerable evidence that private trade in Africa is alive to economic opportunities when it is allowed to operate without bureaucratic restrictions. Of course, sharp contrasts exist between different countries in these respects, and it may well be that in some places a major reliance on the operation of private food trade to respond to the demands generated by cash support would be problematic. There are, however, no serious grounds for general pessimism in this respect.31

Despite the possibly important effects of cash support on the total supply of food in the affected region, it is very likely that the increase in food availability will fall short of the increase in the consumption of those receiving cash support. Indeed, the same price rise which has an expanding effect on supply will also have a contracting effect on the demand for food of those who do not receive cash support but now face higher prices. To that extent, a redistribution of consumption towards the protected groups will take place.

The prospect of dealing with the threat of famine partly by inducing a redistribution process operating within affected areas strikes terror in the heart of many observers. They see this as a failure to respond to the ‘real problem’ of ‘shortage’, and as an attempt ‘to transfer food from one victim to another’. It must be remembered, however, that large inequalities are a pervasive feature of most famine-prone societies. There is, moreover, considerable evidence that the consumption patterns of even relatively privileged households are quite responsive to price changes in situations of economic adversity.32 The scope for redistribution from these groups to the most vulnerable may therefore be far from negligible. When direct delivery of food through the public relief system is hampered or slowed down by administrative and logistic difficulties, redistribution through selective cash support may be a crucial option.

The success of the redistributive strategy, however, depends to a great extent on the ability of the relief system to provide preferential support to the entire vulnerable population. If substantial numbers of vulnerable people are excluded from entitlement protection measures but have to take the consequences of price increases, the overall vulnerability of the population could conceivably be exacerbated rather than diminished by the relief system.33 An (p.21) important question therefore concerns the need to cover all the major vulnerable groups, while continuing to exclude the more privileged in order to preserve the redistributive bias on which the success of the strategy of cash support depends.

In this respect, much can be said in favour of a strategy of open-ended employment provision. The element of ‘self-selection’ involved in this strategy makes it possible to carry out comparatively large transfers to vulnerable households, while at the same time imparting a strong redistributive bias to the entitlement protection process.

In fact, often the only effective and politically acceptable method of providing large-scale cash support is precisely that of employment provision with cash wages. The case for this strategy receives added strength from a number of other advantageous features of employment-based entitlement protection. These include: (1) being compatible with intervention at an early stage of a subsistence crisis (when affected people are looking hard for alternative sources of income but do not yet suffer from severe nutritional deprivation); (2) obviating the necessity of movements of entire families to feeding camps; (3) at the same time, obviating the necessity of taking food to every village (as in a system of decentralized distribution), to the extent that the work-seeking adult population is mobile; (4) inducing positive market responses in the form of an upward pressure on local wages; (5) providing women (who are, very often, a majority of the work-force on public-works programmes) with an independent source of income and thereby increasing their bargaining power within the household.34

Cash support and employment provision have strong and mutually reinforcing advantages, which have been well illustrated in a number of recent experiences of famine prevention, both in Africa and in South Asia.35 These advantages deserve greater recognition, even though it is also important not to fall into the trap of assuming the existence of a universally attractive model of public intervention in famine situations.

(p.22) 5. Confronting Deprivation

We noted earlier (in Section 3) the possible dissonance between the average opulence of a country and the basic capabilities of its population. Despite this possible dissonance, there are good grounds for expecting a positive general association between the two. This is partly because the increased private incomes associated with greater general affluence do indeed offer the opportunity to obtain command over a number of commodities which are crucially important to basic capabilities, such as nutritious food, sound shelter, and adequate fuel. But, in addition, greater opulence provides resources for extending public support in areas such as health, education, employment, food distribution, and social insurance. While some of the best things in life may not be purchasable in the market, and while the command over them may depend to a great extent on public provisions made by the State, it is also true that what the State can provide may, in turn, be much facilitated by greater general opulence.

5.1. Alternative Strategies: Growth-Mediated Security and Support-Led Security

Given the distinct, though interconnected, roles played by overall opulence and public support in enhancing capabilities, it is possible in principle to distinguish two contrasting approaches to the removal of precarious living conditions. One approach is to promote economic growth and take the best possible advantage of the potentialities released by greater general affluence, including not only an expansion of private incomes but also an improved basis for public support. This may be called the strategy of ‘growth-mediated security’. Another alternative is to resort directly to wide-ranging public support in domains such as employment provision, income redistribution, health care, education, and social assistance in order to remove destitution without waiting for a transformation in the level of general affluence. Here success may have to be based on a discriminating use of national resources, the efficiency of public services, and a redistributive bias in their delivery. This may be called the strategy of ‘support-led security’.

The possibility of success through either approach is credible enough in principle. But there have been, in fact, serious detractors questioning the viability of each of these avenues of action. The merits of the respective strategies have to be assessed against the actual experiences of different countries in the world. Intercountry comparisons of performance may, of course, be quite misleading, but they do provide a preliminary and suggestive bias for noting certain elementary relationships and possibilities.

We shall examine briefly the comparative performance of different countries (p.23) in terms of one particular indicator, namely the observed percentage reduction in combined infant and child mortality (hereafter ‘under-5 mortality’) between 1960 and 1985.36 The ten best performers among the developing countries according to this criterion are the following: Hong Kong, United Arab Emirates, Chile, Kuwait, Costa Rica, Cuba, China, Singapore, Jamaica, and South Korea.37 The actual figures are presented in Table 1.3.

Table 1.3. Proportionate reduction in under-5 mortality rates: the top ten countries (1960–1985)

Country

% reduction in U5MR (1960–85)

% growth rate of GNP/capita (1965–85)

GNP per head in US$ (1985)

Level of U5MR (1985)

Hong Kong

83

6.1

6 230

11

Chile

82

−0.2

1 430

26

United Arab Emirates

82

n.a.

19 270

43

Costa Rica

81

1.4

1 300

23

Kuwait

80

−0.3

14 480

25

Cuba

78

n.a.

n.a.

19

Singapore

76

7.6

7 420

12

China

75

4.8

310

50

Jamaica

72

−0.7

940

25

South Korea

71

6.6

2 150

35

Note: Excluded from the comparison are the countries of Eastern and Western Europe, Japan, New Zealand, Australia, USA, USSR, and Canada.

Sources: UNICEF (1987: Table 1); World Bank (1987: Table 1).

On the basis of the information contained in Table 1.3, and of what is known about the experiences of the countries involved, it is possible to divide these ten countries into two distinct groups. Growth-mediated security has clearly been an important part of the experiences of Hong Kong, Singapore, South Korea, Kuwait, and the United Arab Emirates. These countries have experienced outstandingly high rates of economic growth between 1960 and 1985, and their remarkable success in reducing under-5 mortality has been much helped by their rising opulence.38 Thus, a half of the ten highest performers in terms of (p.24) percentage reduction of under-5 mortality seem to have resorted to a strategy of growth-mediated security, of one sort or another.

On the other hand, the other five countries (namely, Chile, Costa Rica, Cuba, China, and Jamaica) have had quite different experiences. Their growth rates have been comparatively low. Moreover, as we shall see shortly, these countries stand out sharply in having achieved far lower mortality rates than most other countries at a comparable income level. The basis of their success does not seem to rest primarily in rapid income growth, and suggests the possibility of support-led security.39

There is, in fact, considerable evidence that direct public support has indeed been the driving force behind the success of each of these five countries.40 We shall return to this question in Section 5.3.

5.2. Economic Growth and Public Support: Interconnections and Contrasts

The distinction made in the preceding section between growth-mediated security and support-led security reflects an important strategic aspect of public action, but it can also be easily misunderstood. A few remarks may help in clarifying the precise nature of the contrast.

First, the distinction involved is definitely not a question of activism versus disengagement on the part of the State. The governments of the countries which have pursued a strategy of growth-mediated security have, in fact, often been extremely active both in bringing about economic growth and in disseminating its fruits. The constructive role of the State in these countries has in varying extents included: (1) promoting economic growth through skilful planning; (2) facilitating wide participation of the population in the process of economic expansion, particularly through the promotion of skills and education and the maintenance of full employment; and (3) utilizing a substantial part of the resources generated by rapid growth for extensive public provisioning of basic necessities. This applies even to countries such as South Korea or Singapore, which are often presented as examples of the fecundity of ‘laissez-faire’, but whose experiences are in fact rich illustrations of the diverse roles that State activism can play within a strategy of growth-mediated security.41

(p.25) Second, the contrast we have pursued is also not a simple one of market versus State provisioning. The masses can gain a share in general opulence not only through the increase of private incomes, but also through wide-ranging public provisioning. A striking example is provided by Kuwait, where rapid growth has created the material basis for what is clearly one of the most munificent ‘Welfare States’ in the world.42 The general notion that one of the important fruits of economic growth can be to facilitate public support is also visible from other successful experiences of growth-mediated security. These experiences contrast sharply with those of countries such as Brazil where there has been little effort to combine rapid growth with social provisioning, and where, as a result, living conditions remain shockingly poor for a large part of the population.43

Third, the distinction made in the last section has little to do with the dilemma that has sometimes been construed between the pursuit of ‘growth’ and the fulfilment of ‘basic needs’. A strategy of ‘growth-mediated’ security is not at all the same thing as the pursuit of economic growth tout court, or what might be called ‘unaimed opulence’. The former need not conflict with the satisfaction of basic needs—indeed it is an approach to their satisfaction. Conversely, support-led security does not imply surrendering the goal of economic growth. In fact, sometimes improvements in the quality of human life (for example, through better health and education) also enhance the productivity of the labour-force. And economic growth can be crucial to the sustainability of a strategy based on generous public support. The interconnections and contrasts between the two strategies are more extensive and more complex than would be captured in a simple dichotomy between growth and basic needs.

The real source of the contrast lies in the fact that the countries that have made substantial use of the strategy of support-led security have not waited to grow rich before resorting to large-scale public support to guarantee certain basic capabilities. The contrast is a real one, but it should not obscure the complementarities that exist between economic growth and public support— and in particular, the prominent role played by public support in the strategies of growth-mediated as well as support-led security.

Despite these complementarities, dilemmas can arise in seeking a balance between the two strategies. Both growth-oriented measures and support-oriented measures make substantial claims on public resources as well as on public administrative capabilities. There are choices to be made in public policy-making, and nothing is gained in obscuring the conflicts involved.

(p.26) 5.3. The Strategy of Support-Led Security

In Section 5.1 we noted how a number of countries (including China, Costa Rica, Jamaica, Chile, and Cuba) have achieved outstanding success in reducing under-5 mortality rates in spite of unremarkable rates of growth of GNP per head. We have also suggested that these experiences can be seen as illustrative of a strategy of ‘support-led security’, which consists of embarking on ambitious programmes of public support at an early stage of development.

The causal links between public efforts and social achievements in these as well as other countries have received a good deal of attention in the recent development literature.44 The investigations have taken different forms. One group of studies has been concerned with examining similarities in the nature of public support efforts in different countries (each with good records in mortality reduction and other achievements), and the commonalities involved in their respective efforts have been assessed, especially in contrast with the experience of other countries.45 A second group of studies has been concerned with interregional comparisons within single countries, comparing the achievements of regions which have greater or lesser involvement in public support.46A third set of studies has presented intertemporal comparisons within single countries of public efforts and social achievements.47 A fourth set of studies has examined the direct impact of public support measures, such as health and nutrition programmes, at the micro level.48 The causal links between public support provisions and social achievements have been clearly brought out in different ways in these diverse empirical investigations.

Public support can take various forms, such as public health services, educational facilities, food subsidies, employment programmes, land redistribution, income supplementation, and social assistance, and the respective country experiences have involved various combinations of these measures. While there are significant contrasts in the relative importance of these different forms of public support in the different country experiences, the (p.27) basic commonality of instruments is quite striking (especially in view of the great diversity of the political and economic regimes).49 Underlying all this is something of a shared approach, involving a public commitment to provide direct support to raise the quality of life, especially of the deprived sections of the respective populations.

The empirical investigations cited earlier also throw some useful light on the resource requirements (and affordability) of the kind of public support measures that have been found crucial to the strategy of support-led security. Scepticism regarding the feasibility of large-scale public provisioning in a poor country often arises precisely from the belief that these measures are inordinately ‘expensive’. Several experiences of support-led security (particularly those that have succeeded in spite of a low GNP per capita, as in China, Sri Lanka, and Kerala) suggest that this diagnosis is, at least to some extent, misleading.

Indeed, the costs of social-security programmes in these countries have been in general astonishingly small. This applies, in particular, to public provisioning of health care and education. It has been estimated, for instance, that in China the percentage of GDP allocated to public expenditures on health has been only around 2 per cent. Moreover, only about 5 per cent of total health expenditure has tended to go to preventive health care, which has been one of the major influences behind the fast retreat of infectious and parasitic diseases.50 There are similarly striking figures for other experiences of support-led success.51

The relatively inexpensive nature of public provisions in the domains of health and education in developing countries is partly a reflection of the low level of wages. Aside from this, several considerations would tend to reduce the real burden of public support in these countries. First, financial costs are not always a good reflection of social costs, and in particular a good case can often be made for regarding the social costs of labour in labour-surplus economies as being lower than the market wage.52 Second, the opportunities for raising revenue are not independent of the existence of a social-security system. For instance, the scope for resorting to exacting indirect taxation may be much (p.28) larger when vulnerable groups are protected from possibly severe deprivation. Third, there is an element of investment in public provisioning (for example, through the relation between health, nutrition, education, and productivity). This reduces the diversion from investment opportunities that is apparently involved in a programme of public support.

Resource constraints should not be overlooked, but it would be a mistake to regard these constraints as the most important obstacle to be overcome in attempts to provide social security through direct public support in developing countries. The distinction of China, Kerala, Sri Lanka, or other countries with a distinguished record of support-led security does not lie in the size of financial allocations to particular public provisions. Their real success seems to be based on creating the political, social, and economic conditions under which ambitious programmes of public support are undertaken with determination and effectiveness, and can be oriented towards the deprived sections of the population.

It is not enormously surprising that efforts to provide extensive public support are rewarded by sustained results, and that public sowing facilitates social reaping.53 Perhaps what is more remarkable is the fact that the connections studied here are so frequently overlooked in drawing up blueprints for economic development. The temptation to see the improvement of the quality of life simply as a consequence of the increase in GNP per head is evidently quite strong, and the influence of that point of view has been quite pervasive in policy-making and policy-advising in recent years. It is in the specific context of that simple growth-centred view that the empirical connections between public support measures and the quality of life deserve particular emphasis.

6. The Nature of Public Action

Before closing this chapter we must address some general issues regarding the strategy of public action for social security. These issues are implicit in many of the discussions that we have already presented, but there is a case for addressing them separately and explicitly.

Public action must not be confused with State action only. Public action includes not merely what is done for the public by the State, but also what is done by the public for itself. We have to recognize inter alia the role of nongovernmental organizations in providing social security (particularly in times (p.29) of distress), and the part that social, political, and humanitarian institutions can play in protecting and promoting living conditions.

Among the actions that can be undertaken by the public, the political role of pressuring the government to act is a particularly important one. As was discussed earlier, there is considerable evidence, for instance, that early action in preventing famines has often been precipitated by newspaper reports of early cases of starvation and by pressure from political and social organizations demanding action.54 Public involvement and activism may have the role both of drawing the attention of the government to problems that may otherwise be neglected and of forcing the hands of the government by making it politically impossible—at least unwise—for it to ignore impending threats.

While this informational and adversarial role of action by the public operates through the government, there are other non-governmental, public activities that directly contribute to the support of entitlements and living conditions of the vulnerable population. The problem of integration of governmental and non-governmental activities is an important one in a programme of public action for social security.55

There is also an important problem of integrating State actions in supporting living conditions with what emerges from the market mechanism. While it is true that the need for State action partly arises from the failure of the market to provide adequate protection and promotion of living conditions, it does not follow that State action for social security must dispense altogether with reliance on the market. In so far as the market mechanism contributes to economic expansion, provides effective means of matching supplies to demands, and yields widespread entitlement generation (particularly through employment creation), it can be a very significant ally in providing social security through public action.

A purist strategy—relying only on the market or only on State action—can be awfully short of logistic means. The need to consider the plurality of levers and a heterogeneous set of mechanisms is hard to escape in the pursuit of social security. In the context of discussing famine prevention, we had the occasion to discuss both the possible failure of the market mechanism to provide adequate guarantee of entitlements and the possibly helpful role of markets in meeting demands generated by public relief programmes (Section 4). Similarly, in discussing the elimination of systematic and persistent deprivations and the promotion of living standards in general, we had the opportunity to discuss the part that economic growth—even when promoted by market-related processes —can play provided that the fruits of growth are sensibly used for the purpose of social security (Section 5).

(p.30) In this context we have to guard against two rather disparate and contrary dangers. One is to ignore the part that the market mechanism can play in generating growth and efficiency (despite its various limitations as an allocative device), with the State trying to do it all itself through administrative devices. The other is to be over-impressed by what the market mechanism can do and to place our reliance entirely on it, neglecting those things that the government can effectively undertake (including various policies for the promotion of health and education).

The Chinese success during the pre-reform period (that is, prior to 1979) in enhancing the quality of life, despite its low GNP per head, illustrates the important role that the State can play in the direct promotion of social security. But it also shows how easily inefficiencies can be bred and how the engine of economic growth can be rigidly constrained by an over-reliance on administration and a severe neglect of the market. The remarkably fast economic expansion (particularly in agriculture) since the reforms, including the reinstatement of many markets and market-type institutions, brings out the part that the market can creatively play. And yet, there is evidence that there has been some set-back in the sharp decline of mortality rates and related features of the quality of life since the reforms of 1979, and that this may be connected with some withdrawal from public provisioning (especially communal health delivery in the rural areas).56 In emphasizing the problem of integration, our aim is to warn against both types of problems (namely, over-reliance on as well as neglect of markets).57

7. Public Action For Social Security

This chapter has been concerned with foundational as well as strategic issues involved in public action for social security. We began by distinguishing between two different but interrelated challenges, namely, the protection of living standards from serious declines (for example, by preventing famines), and the promotion of these standards to permanently higher levels (for example, by eliminating endemic hunger, chronic hardship, and rampant morbidity). Social security is concerned with both these challenges (Section 1).

(p.31) Second, a foundational issue concerning the whole idea of social security is the choice of ‘evaluative space’, that is, the variables in terms of which the success or failure of social security is to be judged. We have argued in favour of using a suitably adapted version of an old evaluative tradition (associated with the works of Aristotle, Smith, and Marx, among others) which focuses on the capability that people have—based on their individual as well as social characteristics—to achieve valuable functionings (doings and beings). This provides a useful way of interpreting the standard of living and the positive freedom to achieve valued living conditions. This focus contrasts with purely subjective criteria such as utility-based accounting (used in mainstream welfare economics), and also with various criteria that focus only on means that are useful in living a good life (such as real incomes, entitlements, Rawlsian ‘primary goods’, Dworkinian ‘resources’) rather than on the nature of that life and the freedom to lead a less deprived life. The means are, of course, helpful in achieving ends, and thus the strategy of social security must pay attention to them, but ultimately the successes and failures of social security would have to be judged in terms of what it does to the lives that people are able to lead (Section 2).

Third, another foundational issue concerns the question as to why we need a separate and explicit policy for social security, rather than expecting that it will be taken care of by general economic growth and overall expansion. The popular belief that it is through economic growth as such that the rich countries of today have overcome their own inheritance of massive deprivation can be shown to be a gross oversimplification, and conscious public efforts to enhance living conditions have played a substantial part in that achievement. Even among the poorer countries today, some have achieved a great deal more than others through deliberately planning social security and expanding public support. Any reliance on GNP per head either as a means of protection, or as a vehicle of promotion, can be extremely treacherous, partly because of distributional inequalities but also because of the limitations of private markets in generating good living conditions (Section 3).

Fourth, as far as the protective aspect of social security is concerned, we analysed the phenomenon of famines and experiences in controlling and eradicating them. The prevention of famines has to be sought in entitlement protection rather than only in the marshalling and distribution of food. Public action has to be geared to the variety of economic and social influences that determine the ability of people (particularly vulnerable groups) to command and use food. The study of actual experiences of famine prevention in different countries brings out particularly the importance of both (1) an administrative system that is systematically aimed at recreating lost entitlements (when these are disrupted by droughts, floods, wars, economic slumps, or whatever), and (2) a political system that can act as the prime mover in getting the administrative system to work as and when it is required.

(p.32) Various specific lessons were also discussed, including (1) the advantages of cash support as a method of quickly recreating lost entitlements (without waiting for prior food movements through bureaucratic channels); (2) the crucial role of employment creation in a comprehensive anti-famine strategy; (3) the power of informal communication channels and political activism in precipitating early action, in comparison with formal ‘early warning’ techniques; and (4) the need to see famine prevention as a matter not just of containing excess mortality, but also of minimizing hardship, avoiding loss of capital and productive resources through distress disposal, and preventing a lasting disruption of economic and social systems (Section 4).

Fifth, we then shifted our attention from the urgent imperatives of entitlement protection to the more general problem of the promotion of living standards. In this context, we discussed the effectiveness of different kinds of policies, and distinguished in particular between two general approaches, which we respectively called ‘growth-mediated security’ and ‘support-led security’. A comparison of the contrasting performances of different countries brings out the plurality of routes through which living standards have been promoted, in some cases involving the achievement of elevated GNP per head (as in Hong Kong, Singapore, South Korea, the United Arab Emirates, Kuwait) and in others without remarkable increase in GNP per head (as in China, Costa Rica, Cuba, Chile, Jamaica, Sri Lanka). The experience of the latter group of countries brings out the possibility of not waiting for GNP expansion before achieving substantial breakthroughs in guaranteeing minimal living standards to all. This strategy of ‘support-led security’ involves public action in a particularly crucial and indispensable way.

On the other hand, the experience of the former group suggests that growth too can be an engine of promotion of social secuirty, if the fruits of growth are skilfully used for social objectives. It is, in fact, the misuse of the opportunities provided by enhanced opulence that has been the cause of the most severe disappointments with the route of economic growth (for example, in Brazil). Here too there is a positive role for public action in ensuring productive use of the fruits of growth in enhancing living conditions and in achieving social security (Section 5).

Finally, we discussed some general issues regarding the nature of public action for social security (Section 6). It is particularly necessary to distinguish between actions undertaken for the public and by the public. The former are, of course, important in achieving social security, but can be both incomplete (requiring integration with efforts of the public in general and nongovernmental institutions in particular), and in need of a political push (requiring an informed and active role of public pressure groups). In both these respects, public action for social security has to be seen in a much wider perspective than that of State action only.

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Notes:

(*) Several sections of this chapter draw substantially on our recent book Hunger and Public Action (Drèze and Sen 1989). We are most grateful to John Hills and Nicholas Stern for helpful comments on an earlier draft, and to Asad Ahmad, Peter Lanjouw and Shantanu Mitra for research assistance.

(1) On this subject, see Sen (1985b).

(2) See Streeten et al. (1981).

(3) The variability of the relation between commodities possessed and personal states is discussed in Sen (1980, 1985b). The ‘basic needs’ literature, which has played an enormously important and creative part in development economics, has also increasingly focused its evaluative attention on living conditions (being nourished, being disease-free, etc.) rather than on needs defined in terms of command over essential commodities as such (food, health services, etc.). See Streeten (1984) and Stewart (1985, 1988).

(4) See Sen et al. (1987), with the 1985 Tanner Lectures at Cambridge by Amartya Sen (1987b), and comments by Muellbauer (1987), Kanbur (1987), Hart (1987), Williams (1987), and Hawthorn (1987). See also Schokkaert and van Ootegem (1989).

(5) See Sen (1982,1985 a, b).

(6) Aristotle (1980: bk 1, pp. 12–14). Note that Aristotle’s term ‘eudaimonia’, which is often misleadingly translated simply as ‘happiness’, stands for fulfilment of life in a way that goes well beyond the utilitarian perspective. Though pleasure may well result from fulfilment, that is a consequence rather than the cause of valuing that fulfilment. For an examination of the Aristotelian approach and its relation to recent works on functionings and capabilites, see Nussbaum (1988).

(7) Among the classical political economists, both Adam Smith and Karl Marx explicitly discussed the importance of functionings and the capability to function as determinants of well-being; see Smith (1776: particularly 351–2) and Marx (1844). Marx’s approach to the question was closely related to the Aristotelian analysis (and indeed was apparently directly influenced by it, on which see de Sainte Croix 1981, and Nussbaum 1988). One part of the Marxian reformulation of the foundations of political economy is clearly related to the importance of seeing the success of human life in terms of fulfilling the needed human activities. Marx (1844) put it thus: ‘It will be seen how in place of the wealth and poverty of political economy come the rich human being and rich human need. The rich human being is simultaneously the human being in need of a totality of human life-activities—the man in whom his own realization exists as an inner necessity, as need.’

(8) Marx (1887: chap. 1, sec. 4, pp. 41–55). See also Marx (1844).

(9) It is sometimes presumed that to depart from a person’s own pleasures or desires as the measuring rod is to introduce paternalism into the evaluative exercise. This view overlooks the important fact that having pleasure and desiring are not themselves valuational activities, even though the latter (desire) can often result from valuing something, and the former (pleasure) can often result from getting what one values. A person’s utility must not be confused with his or her own valuations, and thus tying the evaluative exercise to the person’s own utility is quite different from judging a person’s success in terms of the person’s own valuation. On these and related issues, see Sen (1985a).

(10) See Sen (1980, 1982, 1985a,b, 1987b); Culyer (1985); A. Williams (1985); Helm (1986); Kakwani (1986); Brannen and Wilson (1987); Hart (1987); Hawthorn (1987); Hossain (1987); Kanbur (1987); Muellbauer (1987); Osmani (1987); B. Williams (1987); Griffin and Knight (1988). See also the related literature on social indicators and general development goals, e.g., Adelman and Morris (1973); Sen (1973); Adelman (1975); Griffin and Khan (1978); Morris (1979); Streeten (1981, 1984); Stewart (1985); Dasgupta (1986); Lall and Stewart (1986).

(11) See, for instance, Drèze and Sen (1989) on the implications of the capability approach for public action aimed at removing nutritional and related deprivations.

(12) Some of the conceptual problems in the identification and aggregation of poverty, with suggested solutions, are discussed in Sen (1976a, 1981a); Atkinson (1983); Foster (1984). Foster in particular provides an extensive critical review of the literature.

(13) UNICEF (1988).

(14) See Winter (1986) for an illuminating analysis of the effects of the First World War on public distribution and public involvement, and their impact on living conditions in Britain. The experience of the Second World War is discussed in great detail by Titmuss (1950: chap. 25), who examined the evidence indicating a strong relationship between the surprisingly good health conditions of the British population during the war (including a rapid improvement of the health status of children) and the extensive reach of public support measures in that period. As Titmuss put it, ‘by the end of the Second World War the Government had, through the agency of newly established or existing services, assumed and developed a measure of direct concern for the health and well-being of the population which, by contrast with the role of Government in the nineteen-thirties, was little short of remarkable’ (p. 506). According to Titmuss, the most influential part of social policy during the war related to employment provision and food rationing. This conclusion is strongly corroborated by Hammond’s detailed study of the ‘revolution in the attitude of the British State towards the feeding of its citizens’ which took place after 1941 (Hammond 1951). On these issues, see also Marrack (1947); McKeown and Lowe (1966:131–4); McNeill (1976:286–7); Szreter (1988).

(15) In Japan, it seems that the years of most rapid expansion of longevity were those immediately following the Second World War. Indeed, according to census estimates, the expectation of life for males leaped from 50 in 1947 to 60 in 1950–2, and that for females from 54 to 63 (unpublished figures from the Ministry of Health and Welfare). We are grateful to Akiko Hashimoto for helpful discussions on the empirical evidence relating to this observation. On the demographic transition in Japan, and its relation to public support, see Taeuber (1958); Shigematsu and Yanagawa (1985); and Morio and Takahashi (1986).

(16) The problem of unequal sharing of economic expansion was extensively discussed by Griffin and Khan (1977, 1978). There have been in recent years several empirical studies on the sharing issue, and while sharing has been, evidently, more equal in some cases than others, altogether ‘trickle down’ is clearly an unreliable means of reducing poverty.

(17) On this general question, see Chap. 2 below.

(18) To illustrate the point, the Indian State of Kerala has one of the lower GNP per head among the different Indian States, but has remarkable achievements in generating a high quality of life (e.g., a life expectancy in the upper 60s—far above that of any other Indian State). If the crude aggregate measures of GNP per head are corrected by taking note of distributional inequalities, Kerala’s relative position does not go up very much, and it still remains one of the poorest Indian states in terms of distribution-adjusted real incomes (on this see Sen 1976b, and Bhattacharya et al. 1988). It is in the public delivery of health, food, and education that we have to seek an answer to Kerala’s achievements in living standards. On Kerala’s experience of public support, see the literature cited in Sec. 5.3 below.

(19) The entitlements that need to be protected in a famine situation naturally relate, to a large extent, to food itself. Indeed, the initiation of famine mortality typically follows enfeeblement caused by hunger as well as other destitution-related phenomena such as population displacements. However, given the prominent role often played by water contamination and epidemic diseases in the propagation of famine mortality, measures also have to be taken to guarantee adequate access to basic health care and safe water supply. Many empirical studies have shown that simple measures for the protection of entitlements to staple food and basic public services can lead to a dramatic reduction of excess mortality in famine situations. For some examples (historical as well as contemporary) see Valaoras (1946); Ramalingaswani et al. (1971); Berg (1973); Krishnamachari et al. (1974); Binns (1976); Smout (1978); Will (1980); Kiljunen (1984); Otten (1986); Drèze (1988); and de Waal (1989) among others.

(20) For analyses of the main issues involved, see Berry (1984); IDS Bulletin (1985); Rose (1985); Eicher (1986, 1988); FAO (1986); Whitehead (1986); Mahieu and Nour (1987); Mellor et al. (1987); Rukuni and Eicher (1987); Platteau (1988); Drèze (1989).

(21) International agencies, it must be said, bear some responsibility for the perpetuation of archaic intervention strategies. For instance, the persistent reluctance of the international donor community to undertake multi-year food aid commitments, or to allow the ‘monetization’ of food aid, have been an important factor of rigidity in famine prevention policies.

(22) On the inadequate nature of government response in these events, and the political factors involved, see Sen (1981a, 1983); Peng (1987); Brennan (1988).

(23) One study finds the current situation of duplication and heterogeneity of independent efforts to be quite ‘surrealistic’ (CILSS 1986: 67). That study, which is not meant to be exhaustive, identifies no fewer than 39 different early-warning systems in the Sahel alone, of which 14 are engaged in primary data collection and 25 ‘recycle’ information collected by ‘more or less competing agencies’ (p. 69).

(24) On this see Drèze and Sen (1989: chap. 8).

(25) 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).

(26) This applies, inter alia, to the famines in Bengal in 1943 and in China in 1959–61, mentioned earlier. In the case of the African famines of 1983–5, too, it has been observed that ‘early warnings were given in almost all instances’ (World Food Programme 1986: 4).

(27) On the role of the press and adversarial politics in the context of African famines, and the emerging signs of change in some countries, see Yao and Kone (1986); Mitter (1988); Reddy (1988); Drèze (1989).

(28) Cash, relief has a long history both in India (Loveday 1914; Drèze 1988) and in China (Mallory 1926; Will 1980; Li 1987), and has also been an important feature of famine prevention in a number of African countries more recently, including Botswana (Hay et al. 1986), Cape Verde (van Binsbergen 1986), Tanzania (Mwaluko 1962), and Ethiopia (Kumar 1985; Padmini 1985).

(29) See Drèze and Sen (1989: chap. 5), and the literature cited there.

(30) Our concern here is with the wisdom of cash-based entitlement protection measures that are carried out without a corresponding amount of food being released on the market by the relief system. This ‘cash injection’ issue has to be distinguished from what one might call the ‘cash medium’ issue, which is concerned with comparing the merits of giving food directly with those of giving cash with a corresponding amount of food being released on the market. See Drèze and Sen (1989: chap. 6), for further discussion of this distinction, and of the cash medium issue itself.

(31) For further discussion of this issue, and of the evidence, see Drèze and Sen (1989: chap. 6).

(32) The evidence is discussed in Drèze and Sen (1989: chap. 5).

(33) It should, however, be mentioned that some of the excluded groups could gain from derived benefits obtained from the income support provided to other groups. For instance, a reduction of distress livestock sales on the part of those who receive support could substantially benefit vulnerable livestock owners outside the relief system by arresting an impending collapse of livestock prices. The increased purchasing power of those who do receive support can also have helpful ‘multiplier effects’, e.g., through their purchases of labour services from other vulnerable groups.

(34) For further discussion of these and other advantages of employment provision as a strategy of entitlement protection, see Drèze and Sen (1989: chaps. 6, 7).

(35) See Drèze (1988, 1989); and Drèze and Sen (1989: chap. 8), for case-studies of famine prevention in India, Botswana, and Cape Verde. Of course, the provision of employment has to be supplemented by measures of unconditional relief for those who are not able to work and cannot rely on the support of able-bodied dependants. Such measures have been part of the entitlement protection systems of each of these three countries. Also, highlighting the contribution that cash support and employment provision can make to the protection of entitlements should not be seen as dismissing the role of food supply management. The latter can be important too, but it need not be tied to income generation measures, as in systems of direct feeding or ‘food-for-work’.

(36) The information on under-5 mortality rate (U5MR) for 130 countries, on which this exercise, is based, appears in table 1 of UNICEF (1987). The nature of the U5MR index is explained in UNICEF (1987: 126). This index must not, of course, be interpreted as an overall indicator of the quality of life, but it clearly relates to a very important aspect of it.

(37) North Korea was excluded from the initial list because we learned from the statistical agencies involved that the figures for North Korea were not independently obtained but simply assumed to be the same as those for South Korea.

(38) The first three of these countries have been among the five fastest-growing countries during the period under consideration (World Bank 1987: table 1). The last two (Kuwait and the United Arab Emirates) have not experienced high growth rates of GNP over that period in terms of conventional measures, but this is mainly because the phenomenal increase in their incomes that has in fact taken place as a result of changes in relative prices (in this case involving oil) is not well captured in the growth rate of the real quantity index of GNP per capita (see World Bank 1984 b).

(39) The Chinese growth rate appearing in Table 1.3 is quite impressive, and might be seen as suggesting that the basis of China’s success may well lie as much in economic growth as in direct public support. It can be shown, however, that (1) China’s growth rate during the period of interest has been much exaggerated, and (2) economic growth has followed rather than preceded the wide-ranging measures of public support which must be seen as the main source of China’s success. On this question, see Drèze and Sen (1989: chap. 11).

(40) See the case-studies in Drèze and Sen (1989: chaps. 11, 12), and the literature cited there.

(41) See the case-studies in Drèze and Sen (1989: chap. 10).

(42) On the extensive nature of public provisioning in Kuwait, see Ismael (1982), who describes this country as ‘a total service society with almost every human need from the cradle to the grave serviced by institutional arrangement’ (p. 105). It should be mentioned, however, that the welfare state in Kuwait discriminates sharply between Kuwaiti citizens and non-Kuwaiti residents.

(43) On this experience of ‘unaimed opulence’ in Brazil, see Sachs (1986).

(44) In addition to the 5 countries mentioned above, two further experiences of successful support-led security deserve special mention here: those of Sri Lanka, and of the State of Kerala in India. In the case of Sri Lanka, the main expansion took place prior to 1960, and this country is thus not included in the list of top performers for 1960–85 in Sec. 5. 1. Kerala, on the other hand, did not appear in this list because it is not a country but only a State in a federal country (India). On these two experiences of support-led security, see Isenman (1980); Halstead et al. (1985); Basu (1986); Caldwell (1986); Anand and Kanbur (1987); Kumar (1987); Sen (1987a); Drèze and Sen (1989), among others. See also Chap. 7 below.

(45) See e.g. Sen (1981b); Flegg (1982); Halstead et al (1985); Stewart (1985); Caldwell (1986).

(46) See e.g. Castaneda (1984, 1985), Jain (1985), Nag (1985), Prescott and Jamison (1985), Morrison and Waxier (1986), Kumar (1987), Mata and Rosero (1987).

(47) See e.g. Castaneda (1984, 1985) on Chile, Anand and Kanbur (1987) on Sri Lanka, and Mata and Rosero (1987) on Costa Rica.

(48) See e.g. Gwatkin et al. (1980); Harbert and Scandizzo (1982); Garcia and Pinstrup-Andersen (1987); Berg (1987); Mata and Rosero (1987).

(49) See the case studies presented in Drèze and Sen (1989: chaps. 11, 12).

(50) Bumgarner (1989). On this general question, see also World Bank (1984a) and Jamison.

(51) The percentage of GDP allocated to public expenditures on health in Sri Lanka in 1981 was barely 1 % (Perera 1985: table 8). The corresponding figure for Cuba was around 2.7% (Muniz et al. 1984: tables 6.1 and 6.6). In Kerala, per capita government expenditure on health is not much greater than in the rest of India (Nag 1985: table 16). For further evidence and discussion of the scope of low-cost public provisions in the domain of health, with special reference to China, Costa Rica, Kerala and Sri Lanka, see various contributions in Halstead et al. (1985), and also Caldwell (1986).

(52) On the distinction between financial costs and social costs, see Drèze and Stern (1987), and the literature reviewed there.

(53) Hunger and deprivation are, to a large extent, social conditions that cannot be seen only in isolated individual terms. There are strong interdependences and so-called ‘externalities’ involved in health (e.g. through the spread of diseases), education (e.g. through influencing each other), and nutrition (e.g. through food habits being dependent on social customs). The importance of social intervention in ensuring adequate entitlements to ‘public goods’, and in dealing with externalities generally, has been well recognized for a long time in economics (see Samuelson 1955; and Arrow 1963).

(54) See Sec. 4.2. See also Sen (1983); Ram (1986); Drèze (1988); Drèze and Sen (1989); Reddy (1988).

(55) For further discussion of this issue, with special reference to sub-Saharan Africa, see Chap. 9 below.

(56) See Sen (1987 a, 1988); Hussain and Stern (1988); and Drèze and Sen (1989: chap. 11). Some of the reported increases in mortality rates have other explanations (e.g., changes in reporting bias, changing age composition of the population) but some part of the increased mortality rates does seem to be both (1) real, and (2) related to declining arrangements of public provisioning.

(57) The Chinese experience is, in fact, a storehouse of important lessons for social-security planning. In drawing attention to the problems faced, we must not, of course, ignore the basic fact that public action in China has achieved remarkable results in improving various aspects of the Chinese quality of life to levels that are totally unusual in countries with comparably low per-capita income. On this see particularly Riskin (1987), and also Chap. 6 below.