Free Development as Freedom by Amartya Sen Page A

wide-based and economically broad (strong employment orientation has much to do with this), and also on utilization of the enhanced economic prosperity to expand the relevant social services, including health care, education and social security. In contrast with the growth-mediated mechanism, the support-led process does not operate through fast economic growth, but works through a program of skillful social support of health care, education and other relevant social arrangements. This process is well exemplified by the experiences of economies such as Sri Lanka, pre-reform China, Costa Rica or Kerala, which have had very rapid reductions in mortality rates and enhancement of living conditions, without much economic growth.
PUBLIC PROVISIONING, LOW INCOMES AND RELATIVE COSTS
    The support-led process does not wait for dramatic increases in per capita levels of real income, and it works through priority being given to providing social services (particularly health care and basic education) that reduce mortality and enhance the quality of life. Some examples of this relationship are shown in figure 2.1 , which presents the GNP per head and life expectancy at birth of six countries (China, Sri Lanka, Namibia, Brazil, South Africa and Gabon) and one sizable state (Kerala) with thirty million people, within a country (India). 10 Despite their very low levels of income, the people of Kerala, or China, or Sri Lanka enjoy enormously higher levels of life expectancy than do much richer populations of Brazil, South Africa and Namibia, not to mention Gabon. Even the
direction
of the inequality points opposite when we compare Kerala, China and Sri Lanka, on one side, with Brazil, South Africa, Namibia and Gabon, on the other. Since life expectancy variations relate to a variety of social opportunities that are central to development (including epidemiological policies, health care, educational facilities and so on), an income-centered view is in serious need of supplementation, in order to have a fuller understanding of the process of development. 11 These contrasts are of considerable policy relevance, and bring out the importance of the support-led process. 12
    FIGURE 2.1:
GNP per Capita (U.S. Dollars) and Life Expectancy at Birth, 1994

    Sources:
Country data, 1994, World Bank,
World Development Report 1996;
Kerala data, Life expectancy, 1989–1993, Sample Registration System cited in Government of India (1997), Department of Education,
Women in India: A Statistical Profile;
Domestic product per capita, 1992–1993, Government of India (1997), Ministry of Finance,
Economic Survey 1996–1997
.
    Surprise may well be expressed about the possibility of financing support-led processes in poor countries, since resources are surely needed to expand public services, including health care and education. In fact, the need for resources is frequently presented as an argument for
postponing
socially important investments until a country is already richer. Where (as the famous rhetorical question goes) are the poor countries going to find the means for “supporting” these services? This is indeed a good question, but it also has a good answer, which lies very considerably in the economics of relative costs. Theviability of this support-led process is dependent on the fact that the relevant social services (such as health care and basic education) are very
labor intensive
, and thus are relatively inexpensive in poor—and low-wage—economies. A poor economy may
have
less money to spend on health care and education, but it also
needs
less money to spend to provide the same services, which would cost much more in the richer countries. Relative prices and costs are important parameters in determining what a country can afford. Given an appropriate social commitment, the need to take note of the variability of relative costs is particularly important for social services in health and education. 13
    It is obvious that the growth-mediated process