We have briefly discussed the recent development paradigm that the global emphasis on income and economic growth is essentially a top down conceptualisation of human development (Kleine, 2009).
In an effort to make it bottom up, Amartya Sen has argued in his book ‘Development as Freedom’ that development should be understood and analysed based on how people wish to live a life that they have reasons to value (Sen, 1999a). This is a departure from the previous way of thinking that development means being well-off (economic development) to meaning wellbeing. This makes the viewpoint more people centric. Thus, efforts to expand people’s freedom to choose the life they value and remove related hindrances, is collectively called development. Sen concludes that freedom cannot be about economic factors (freedom to enter into the marketplace) and political factors (freedom to vote) only; rather, true freedom should also consider liberty to access social services, i.e. healthcare, sanitation and nutrition etc.
(Miletzki & Broten, 2017; Sen, 1999a; 1999b). Having explained that, Sen also discusses the potential hindrances which he called ‘unfreedoms.’ According to Sen:
‘Development requires the removal of major sources of unfreedom: poverty as well as tyranny, poor economic opportunities as well as systematic social deprivation, neglect of public facilities as well as intolerance or overactivity of repressive states’ (Miletzki & Broten, 2017, p. 34; Sen, 1999a).
Sen later extended his argument around freedom beyond the economic angle to elaborate an evaluation approach to assess the level of development in a society. His book ‘Development as Freedom’
is the collection of lectures at the World Bank where he explains that wellbeing is a cumulative outcome of people’s capabilities and agency, which can be critical in assessing the progress and state of development in a society. It is popularly known as the Capability Approach (CA) (Miletzki & Broten, 2017;
Sen, 1999a). It has become very popular in a short period of time because of its use in explaining the pathway of how resource(s) can enable an individual (or the community) to achieve a goal that they may value. Sen explains that ‘various things a person may value doing or being’ are called functionings and ‘the alternative combinations of functionings that are feasible for one to achieve’ are called capabilities. In many cases, functionings can be an already achieved element of an someone’s wellbeing (i.e. levels of health, education etc.). And the ability to be able to do what one values or has reason to value is called agency (Sen, 1999a; Sen, 1985, p. 203) (Faith, 2016; Roberts, 2015). For instance, Mr. X wants to go from one place to another for any purpose, without any difficulties. According to Sen’s philosophy, this is a state of wellbeing for Mr. X as he values this as a personal freedom; within the traditional economic approach, this is called utility. One way to achieve this can be by riding a bicycle. Considering bicycle as a resource, Mr. X must learn to ride a bicycle and then he will achieve his personal freedom to go from one place to another. According to CA, the ability to ride bicycle is called a functionings and the ways to learn how to ride are called capabilities.
CA also recognises that personal (or group) functionings do not always refer to the capabilities or opportunities that are at an individual or group’s disposal. Sen explains this using the example of two starving people. One person is starving because of religious reasons (religious fast), having the capability of being fed or buying food whenever he chooses to, and the second person is starving due to poverty and lacks the capability of being nourished. In the US context, Sen describes that getting admitted to a university does not mean that opportunities are the same for all students, because of racial and/or ethnic differences. And when it comes to agency-related freedom, it is also important to understand that the ability to act towards a wellbeing goal can be influenced by one’s individual, social or demographic
characteristics (human agency) as well as by broader factors such as policy, political state, organisational provisions and views etc. (external agency) (Miletzki & Broten, 2017; Roberts, 2015; Sen, 1999a; Sen, 1985, p. 203) (Roberts, 2015).
It is also important to understand that capabilities and rights are not identical, but rather interdependent; capabilities enable people to practise their rights (Sen, 2005). By challenging the conventional utilitarian approach to conceptualising development, CA helps us to consider people’s backgrounds and experiences and how they relates to their decisions and expectations (Nussbaum, 2000).
Thus, because of its broad dimension, CA primarily being an evaluation approach, it has been widely used in policy and academia as a normative framework. Examples include the UN’s adoption of HDI instead of Gross Domestic Products (GDP) calculations and the UK’s Equality Measurement Framework by the Equality and Human Rights Commission etc. (Faith, 2016; Miletzki & Broten, 2017;
Sen, 1999a; Sen, 1999b). However, there are considerable criticisms of CA, as well.
Although CA was primarily developed as an evaluation approach, it is heavily dependent on the pluralism of reason to value and considers the individual as the unit of analysis. Thus, it is very difficult to apply CA as a quantitative evaluation method. This is due to two central arguments of CA: a. the most important functioning is very subjective, and thus may vary among people and b. quantitative measures look for generalisation while CA is inherently focused on an individual’s preferences and practices.
Because of these challenges, CA is often characterized as too broad and vague to be evaluated. As a result it is very hard to operationalise CA (Alexander, 2008; Roemer, 1998; Sugden, 1993). Others have found CA to be very difficult to operationalise as well (Comim, Qizilbash, & Alkire, 2008; Deneulin & Shahani, 2009; Qizilbash & Clark, 2005; Zheng, 2009). However, being broad and vague also makes CA useful for exploring development concepts from a human perspective. While the operationalisation is difficult from a quantitative paradigm, it can be an ideal approach for more complex methods like system and qualitative research (Robeyns, 2000, p. 29). Considering this as a strength of using CA, it can be the ideal theoretical foundation for a bottom up approach to understanding the equity implications of eHealth in addressing access related health disparity.
Another criticism suggests that CA emphasises wellbeing, whilst failing to discuss agency with equal importance; i.e. how agency is created, what its constituents are etc. (Roberts, 2015; Robeyns, 2003;
Zheng & Stahl, 2011). Sen explains agency as the ability to be able to do what one values or has reason to value. Rather than discussing the constituents or how it is developed, Sen has viewed agency as human and external (as mentioned above). In relation to this, Sen mentions conversion factors, which represent the relationship between resources and functionings; the degree to which one can transform a resource into a functioning (Nambiar, 2013; Sen, 1992). While in many ways both agency and conversion factors are the same, the latter is more inclusive of explaining the alternate pathways to achieve a specific functioning and wellbeing in relation to resources, capabilities, functionings and wellbeing. Or in other words, conversion factors are the critical form of agency which can be used in a more measurable way to understand the
‘unfreedoms’ which restrict a person or a group from reaching a state of happiness/wellbeing using available resources.
Based on the discussion above, CA is a complex philosophical underpinning for understanding the impact of development initiatives from a community’s perspective. We have already discussed that this complexity makes it difficult to operationalise. In the next section, I will discuss a framework that has made an attempt to operationalise CA, called the Choice Framework. It demonstrates the use of CA to understand people’s use of ICT.