Free Development as Freedom by Amartya Sen

expenditure on health as explanatory variables on their own, the connection between GNP per head and life expectancy appears (in the Anand-Ravallion analysis) to vanish altogether.
    It is important to emphasize that this result, if vindicated by other empirical studies as well, would not show that life expectancy is not enhanced by the growth of GNP per head, but it would indicate that the connection tends to work particularly
through
public expenditure on health care, and
through
the success of poverty removal. The basic point is that the impact of economic growth depends much on how the
fruits
of economic growth are used. This also helps to explain why some economies, such as South Korea and Taiwan, have been able to raise life expectancy so rapidly through economic growth.
    The achievements of the East Asian economies have come under critical scrutiny—and some fire—in recent years, partly because of the nature and severity of what is called “the Asian economic crisis.” That crisis is indeed serious, and points to particular failures of economies that were earlier seen—mistakenly—as being comprehensively successful. I shall have the opportunity of considering the special problems and specific failures involved in the Asian economic crisis (particularly in chapters 6 and 7 ). But it would be an error not to see the great achievements of the East Asian and Southeast Asian economies over several decades, which have transformed the livesand longevities of people in the countries involved. The problems that these countries now face (and have potentially harbored for a long time), which demand attention (including the overall need for political freedoms and open participation as well as for protective security), should not induce us to ignore these countries’ achievements in the fields in which they have done remarkably well.
    For a variety of historical reasons, including a focus on basic education and basic health care, and early completion of effective land reforms, widespread economic participation was easier to achieve in many of the East Asian and Southeast Asian economies in a way it has not been possible in, say, Brazil or India or Pakistan, where the creation of social opportunities has been much slower and that slowness has acted as a barrier to economic development. 8 The expansion of social opportunities has served to facilitate high-employment economic development and has also created favorable circumstances for reduction of mortality rates and for expansion of life expectancy. The contrast is sharp with some other high-growth countries—such as Brazil—which have had almost comparable growth of GNP per head, but also have quite a history of severe social inequality, unemployment and neglect of public health care. The longevity achievements of these other high-growth economies have moved more slowly.
    There are two interesting—and interrelated—contrasts here:
    1) for
high economic growth economies
, the contrast between:
    1.1) those
with
great success in raising the length and quality of life (such as South Korea and Taiwan), and
    1.2) those
without
comparable success in these other fields (such as Brazil);
    2) for
economies with high success in raising the length and quality of life
, the contrast between:
    2.1) those
with
great success in high economic growth (such as South Korea and Taiwan), and
    2.2) those
without
much success in achieving high economic growth (such as Sri Lanka,
pre-reform
China, the Indian state of Kerala).
    I have already commented on the first contrast (between, say, South Korea and Brazil), but the second contrast too deserves policyattention. In our book
Hunger and Public Action
, Jean Drèze and I have distinguished between two types of success in the rapid reduction of mortality, which we called respectively “growth-mediated” and “support-led” processes. 9 The former process works
through
fast economic growth, and its success depends on the growth process being