Health Inequalities and social welfare through the lens of Senian capability approach: the Palestinian case

Background: Recent decades have witnessed a rising interest in the capability framework – put forth by the Nobel Laureate Amartya Sen (1992) – as an alternative approach to the measurement of individual’s well-being. Accordingly, Sen defines the capability of individual to leading a healthy life of normal length and to avoid premature mortality as essential capability to well-being. With the exception of few attempts, the literature on capability has, however, remained largely theoretical. This paper seeks to present an empirical application of a recent methodology and in doing so offers practical insights on how capability can be measured/ operationalized over four basic attributes (health, knowledge, social cohesion and living conditions) using the particular context of the Palestinian territories.

Methods and Materials: Capability is conceptuialised as a latent variable and measured using a full generalized structural equation modelling (GSEM) technique. The GSEM enables to account for the unobservable and multidimensional nature characterizing the concept of capability (using multiple indicators for each latent variable) and to capture the mutual influence amongst the basic capabilities under investigation as well as the interactions and causal factors determining their levels. Estimation results are, then, used to derive normalized capability (scores) indices (CI) at the individual level, and to analyze their empirical distributions. The methodology is applied to data taken from the Palestinian Family Survey (PFS-2010). The PFS-2010 is a nationally representative multi-stage stratified cluster sample covering a total of 15,355 households residing in the two Palestinian territories, the West Bank and the Gaza Strip.

Empirical Findings: while highlighting the major role played by the supply-side factors such as the availability of primary and secondary care facilities, number of schools and classrooms, cultural centres and activities, our results (although preliminary at this stage- analysis in progress) show high interdependence between individual’s health capabilities and the other capabilities related to knowledge, social cohesion and living conditions. Our preliminary results also confirm the importance of some (exogenous) demand-side factors in the conversion of capabilities into achievements; mainly male individuals living in urban areas appear to be more capable to convert their basic capabilities into achievements.

 

Conclusions: Analyzing inequality in welfare in this sort of way appears to be promising, since it offers a distinctive angle and useful information on how to think about justice – at least in an economic sense. An important empirical conclusion of our investigation is that when the capability in one attribute (health) is highly mutually dependent on capabilities in other attributes (knowledge and living conditions), the CI constructed at the individual level tend to reflect to a large extent inequality in these attributes. This has important policy implications since it indicates that it is not only health inequalities per se that matter, but also the associations between health and other dimensions of well-being. Thus, reducing inequalities in welfare seems to be also a matter of reducing these associations through appropriate health related policies than only redistributing wealth. Future research ought to address the multidimensionality character by including inequalities in other spheres of well-being.