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Key Text Social Rights and Economics: Claims to Health Care and Education in Developing Countries

Author: V Gauri
Date: 2003
Size: 13 pages (194 KB)

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Summary

What are the foundations and uses of social rights in development? What are the differences and similarities between the rights approach to health care and education, and the economic approach? This article published in World Development analyses both approaches and their policy consequences, and looks at the questions economics poses for rights approaches. It argues that there is considerable overlap between the two and that the differences are not irreconcilable.

There are two approaches to establishing social rights: The first emphasises human agency, arguing that in a fully human life people make important decisions, and that ignorance and disease impairs the ability to choose. The second emphasises human dignity and the fact that health and education are valued in societies, and therefore that being denied them means exclusion from society. In contrast, economics emphasises education and health because they are positively related to household productivity and economic growth. In this view, the overriding factor in determining the means of delivery is efficiency.

The two approaches have important similarities in their approaches to healthcare, as well as some reconcilable differences:

From the rights perspective, participation, empowerment, transparency and participation in service delivery are important for health care and education quality. They are also constitutive of the social respect that is essential for self-esteem.
From the economic perspective, these aspects of service delivery are also important, but to mitigate problems of collective action and asymmetric information, which lead to inefficiencies.
There are three important differences in policy. First, the rights approach sees the actual process of service delivery as important: it should support self-esteem.
The economics approach, instead, prioritises effectiveness and views these processes instrumentally. This could, in principle, support authoritarian styles if they were effective, but in reality the thrust of micro-economic theory is to expand choice.
Second, the rights approach disaggregates data among women and minorities to look for evidence of inequity. The economic approach disaggregates by income level, as useful behavioural assumptions can be made on this basis.
Third, the rights approach takes into account adaptive preferences such as the habit of deprived individuals to lower their aspirations. Economics does not easily accommodate individuals who do not maximise their welfare.

In addition, economics poses two difficult questions for the rights approach, and there are also important implications for development policy:

The first problem is that the rights approach has no explicit metric for making tradeoffs between different priorities. Although the methods economics offers for making allocations are problematic, they are clear and calculable.
The second problem is that the rights approach could lead to behaviour-distorting subsidies, and does not take this into account. These distortions could undermine the right that policies are trying to protect.
However, the economics approach can also neglect the fact that making something a right can result in large and desirable changes in behaviour.
The analysis shows that reforms that strengthen the bargaining positions of service users both enhance service delivery and have intrinsic value, in that they enhance self-respect.
It also highlights the problem of the tendency of the deprived to lower their expectations. Initiatives to enhance information and participation could augment peoples' 'capacity to aspire'.
Finally, it shows that both approaches can miss the behavioural effect of interventions. The identification of unforeseen consequences of policy change is critical for research and practice.

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Source: Gauri, V. 2003 ‘Social Rights and Economics: Claims to Health Care and Education in Developing Countries’, World Development, vol. 32 no. 3 pp. 465-477
Author: The World Bank, http://www.worldbank.org