In complaining about the closure of a local Sure Start club for being too “middle class”, Rachel Sylvester says: “services only for the poor will end up as poor services.”
This is a longstanding claim. And it’s true; poor areas tend to have worse schools and health care (pdf) - to take just two important public services - than wealthier areas.
But why? This, I suspect, is an area where Amartya Sen’s “capabilities” approach might help. Services for the poor are poor services because the poor are less capable of gaming the welfare state for their own ends.
In part, this is a simple problem of material resources. The poor have fewer opportunities than the likes of Ms Sylvester to write newspaper articles to advance the idea that public policy should cater to their own selfish interests.
However, I suspect too that the lack of capabilities is a lack of mental resources; the poor are bound by a latter day version of Blake’s mind forg’d manacles. They are less able or willing to make demands upon educational authorities or doctors, and more easily fobbed off if they do.
From this perspective, a capabilities-based policy would focus upon helping the worst-off to organize better, to make more demands upon services providers.
Herein, though, lies an issue.
One reason why the poor complain as little as they do about poor public services is that their preferences and expectations have adapted downwards to their circumstances, so they are content with their lot*.
A capability approach would try to correct this attitude. It would try to raise the expectations of the worst-off, so they campaigned, individually or collectively, for better public services.
Doing this would, however, increase discontent; one virtue of adaptive preferences is that they help us cope with a bad situation. In this sense, there’s a trade-off between improving capabilities, and increasing happiness, at least in the short-run.
* This is not to say that downwardly-adpative preferences are universal. Some of the poor (especially perhaps the younger ones?) have excessively high expectations. But this is just another, albeit very different, example of how the worst-off's low capabilities arise from their own mentality rather than from a lack of material resources .
This is a longstanding claim. And it’s true; poor areas tend to have worse schools and health care (pdf) - to take just two important public services - than wealthier areas.
But why? This, I suspect, is an area where Amartya Sen’s “capabilities” approach might help. Services for the poor are poor services because the poor are less capable of gaming the welfare state for their own ends.
In part, this is a simple problem of material resources. The poor have fewer opportunities than the likes of Ms Sylvester to write newspaper articles to advance the idea that public policy should cater to their own selfish interests.
However, I suspect too that the lack of capabilities is a lack of mental resources; the poor are bound by a latter day version of Blake’s mind forg’d manacles. They are less able or willing to make demands upon educational authorities or doctors, and more easily fobbed off if they do.
From this perspective, a capabilities-based policy would focus upon helping the worst-off to organize better, to make more demands upon services providers.
Herein, though, lies an issue.
One reason why the poor complain as little as they do about poor public services is that their preferences and expectations have adapted downwards to their circumstances, so they are content with their lot*.
A capability approach would try to correct this attitude. It would try to raise the expectations of the worst-off, so they campaigned, individually or collectively, for better public services.
Doing this would, however, increase discontent; one virtue of adaptive preferences is that they help us cope with a bad situation. In this sense, there’s a trade-off between improving capabilities, and increasing happiness, at least in the short-run.
* This is not to say that downwardly-adpative preferences are universal. Some of the poor (especially perhaps the younger ones?) have excessively high expectations. But this is just another, albeit very different, example of how the worst-off's low capabilities arise from their own mentality rather than from a lack of material resources .
Interesting point, Chris. There are also geographical anomalies to consider. There was a report recently on the chances of cancer survival in different boroughs and counties in England. Kensington & Chelsea came out top, whereas Herefordshire, my girlfriend's home county, came bottom. While headline comparisons were not pretty, but the data couldn't take account of the geographic differences beteen the two places. Routine trips to a GP are harder in a sparsely populated rural county, when compared with a wealthy, densely populated Royal Borough that has plenty of private health insurance and a world class hospital. Geographic trends also seems to influence the provision of services in other ways. Westminster council is by no means a paragon of virtue, but going on personal experience, they are certainly one of the most efficient jurisdictions I've ever lived in. Partly, this is its enormous tax base, but equally the number of senior experienced professionals who serve as councillors - former directors of IBM, NHS managers etc - must influence how competently it manages its services.
Posted by: Julian | March 16, 2010 at 04:11 PM
Very interesting take on capabilities in public service provision. As you point out though, pecuniary status is not the only determining factor wrt capabilities.
Encouraging those who experience poor public services to agitate for better is only likely to be effective if said agitation leads to improvements - i.e. if the public services are locally accountable. Example - commuters reliant on a train service can campaign till their blue in the face for punctuality/reliability/fair fares etc, but unless there's an obligation on the service provider to listen then all the raised expectations in the world won't alter the service (replace trains for schools/hospitals/roads/police as appropriate).
Any thoughts on the appropriation of the capabilities approach (or an approximation thereof) by the likes of James Purnell, who I'm sure I don't have to remind you designed our current 'workfare' system of benefits...?
Posted by: Prateekbuch | March 16, 2010 at 04:59 PM
"They (the poor) are less able or willing to make demands upon educational authorities or doctors, and more easily fobbed off if they do"
That must be why almost a third of Glasgow's population are 'on the sick'.
http://www.timesonline.co.uk/tol/news/uk/scotland/article3647272.ece
Posted by: Laban | March 16, 2010 at 08:11 PM
I can't help thinking about the letter to The Times today from GPs complaining about the whinging slightly unwell. The GPs may have a few valid points but they sound as if they are only interested in patients with something interesting wrong with them. So if you are eloquent you'll see the doctor, if not you'll see the nurse.
Posted by: charlieman | March 16, 2010 at 08:16 PM
charlieman - how does 'interesting' become 'eloquent'. A vague sniffle is a vague sniffle even if owned by shakespeare.
A lot of people who go to emergency units have colds and sore throats. ? eloquent.
Often it is the ambience sought .
Posted by: john malpas | March 17, 2010 at 06:59 AM
John Malpas: GPs employ gate keepers (euphemistically called receptionists) who determine who sees the doctor and when. The eloquent will express their symptoms in such a way that the gate keeper will provide access for them. Others are compelled to wait until their symptoms have been assessed by a nurse before they are permitted an expert hearing.
I agree that a lot of people clutter up A&E with trivial complaints. Many may be fools but rational others may be driven to illogical behaviour because the GP surgery fails them.
"Often it is the ambience sought .": Which is why so many alternative therapies are successful. The conundrum is how to deliver talking therapy that helps a patient without consuming GP time, that at the same time can discover serious ailments.
Posted by: charlieman | March 17, 2010 at 08:13 PM
Comment from a psychologist friend...
"Yeah, I think that there might be some truth in this. But also, well in the case of psychology services anyways, there are some areas which have historically received poor service to the extent where 'no-one watches what you do', and this has actually meant that psychologists are more able to use other, less evidence based (but anecdotally) more useful models of therapy - for example, Newham, which has been neglected for years, has a very sucessful family therapy service as opposed to the bog standard CBT approach."
Posted by: Nick | March 18, 2010 at 11:16 AM