3 Conceptual framework
3.2 Capability Approach
In this thesis, the Capability Approach by Amartya Sen is used as a lens to sort out and make sense of our data.
The central argument in the book Development as Freedom, by Amartya Sen, is that the international community needs to stop viewing development as something that can be measured in income or commodities. Instead, development should be measured according to the freedom people have to choose the lives they have reason to value.
The concepts we use from the capability approach allows us to analyze the barriers for people in Mitchells Plain to achieve a diabetes-friendly lifestyle.
In this chapter, we will introduce the capability approach. It contains different concepts that we have used to analyze and get an overview of our data. Still, the capability approach is a comprehensive development theory that contains many aspects which we are not able to cover in this thesis. We have chosen to focus on the concepts that we use in our analysis: Functionings, capabilities and conversion factors.
These concepts helps us address what people are able to do and be, and to reflect upon the phenomna of «having diabetes in Mitchells Plain» from a patient perspective.
The philosophy behind the capability approach
Amartya Sen sees development as providing individuals with the possibility to pursue choices they value (Sen, 1999). The capability approach puts the human in the center, and argue that development should not be measured by objective targets, such as poverty levels or education levels, but on whether the individuals have the capabilities to pursue the lives they value. This perspective puts its emphasis on the freedom to choose, rather than the achieved outcomes an individual experience (Robeyns, 2005, p. 96).
For example, a person should have the capability to be well-nourished (have access to food, income to buy nourishing foods, etc). However, if the person finds value in a religion, and believes that fasting is part of practicing that religion, the person should have the opportunity to do so. Thereof the freedom to choose. In other words, the capability to achieve the function of “being well-nourished” should be available for the person. If the individual is prohibited from having the capability to be well-nourished, or to practice his religion, the person would be deemed capability-deprived according to Amartya Sen (Mukherjee, 2016; Sen, 1999).
24 3.2.1 Explaining the capability approach
Here capability approach is explained through the terms, capability, functionings and conversion factors.
Functionings and capabilities
There are different things a person can value doing or being, for example working, resting, being respected, being healthy, being part of a community. These are called functionings (Robeyns, 2005, p. 95). A functioning is something that can be achieved, and the sum of the valuable functionings a person achieves contribute to give life value (Robeyns, 2005, p. 95).
In Sens framework capabilities refer to the set of valuable functionings an individual has effective access to. It has a broader focus than that of functionings because capabilities highlight the freedom to exercise choice in regard to the functionings he wishes to achieve. The freedom to choose endows the person with the ‘freedom to lead one type of life or another’(Sen, 1999, p. 40). Thus, functionings are states of being and doing that an individual has reason to value, and capabilities decide if a person has effective access to achieve any given functioning.
Part of Sen’s critique is of the intrinsic value that is given to resources such as money or technology. He argues that it does not make sense to measure development according to the number of people with access to, for instance, mobile phones or bikes.
Instead, Sen emphasizes the importance of distinguishing between a resource, and capabilities and functionings on the other hand (Robeyns, 2005, p. 98).
One example is the value of having resource in form of a bicycle. In the capability approach, a bicycle is not valuable to us because of the bike in itself. The bike does not hold intrinsic value, but the value is derived from its potential to help us achieve the functioning of mobility. As such, a resource function as means to achieve a functioning. In turn, the capability to convert a resource, and use it as a means to achieve a functioning is influenced by conversion factors (Robeyns, 2005, p. 99).
To illustrate, a cooking book with diabetes-friendly recipes can be a good resource to achieve the functioning of having a diabetes-friendly diet. However, for the book to be valuable for a person, the person must be able to convert the resource into a valuable function. The person must be able to read, have access to an environment for cooking the recipes, have enough money to afford the groceries in the recipes and the recipes must not contradict their religious beliefs.
25
In figure 2 below, we illustrate the relation between resources, conversion factors, capabilities and achieved functionings. In the figure, we see that the potential of converting the neighborhood park in to the achieved functioning of “doing exercise”first depends on the three conversion factors, and secondly depends on the individual choice to do so.
Figure 2 - Relation between resources, conversion factors, capabilities and achieved functionings
Conversion factors
Conversion factors are important because they highlight the factors that constrain the capability achievement of individuals (Nambiar, 2013). Sen divide conversion factors into three groups: Personal, social and environmental.
The personal conversion factor regards individual characteristics like gender, literacy, intelligence, disabilities, knowledge etc. If a person has never learned how to ride a bike, this would function as a barrier use the resource of a bicycle to increase mobility.
Similarly, having an amputated leg, or impaired sight renders the bike a useless resource (Robeyns, 2005, p. 99). The social conversion factor regards conditions influenced by norms, policies, cultural issues, gender roles, power and hierarchies, etc.
For example, if women are not allowed to ride bicycles, social norms would influence her use of the resources (Robeyns, 2005, p. 99). The environmental conversion factor regards circumstances afforded by the immediate environemt. Examples are infrastructure, geographical, housing, access to clean water etc. If there are no roads for bicycling, or no safe places to store the bike, the environment function as a barrier to utilize it as a resource to achieve mobility(Robeyns, 2005, p. 99).
The conversion factors help us understand how resources and services can be accessed, and potentially be helpful for the person, but different factors influence how able the person is to utilize this potential (Mukherjee, 2016).
26 3.2.2 Capabilitiy approach in ICT research
Richard Heeks (2006, 2010) argue that ICT (Information And Communication Technology) research has a tendency to put too much emphasis on the value of technology in itself, and calls for an increased focus on whether or not people actually derive value from implementing technology. Andersson, Grönlund and Wicander supports this notion, and argue that the capability approach has promising traits as a tool to evaluate the potential impact of an ICT intervention (2012).
3.2.3 Our use of the Capability Framework
The capability approach represents an (at the time) novel approach to development and has been extensively used in the context of human development. Here ‘poverty’
is understood as deprivation in the capability to live a good life, and ‘development’ is understood as capability expansion. It is a comprehensive approach meant to shape how we understand and measure development, and the concept of "freedom" is essential in this approach.
In his book Development as Freedom, Amartya Sen spends the first two chapters mapping out the concepts and building blocks that the approach builds on (that of capabilities, functionings, agency and conversion factors). The remaining chapters are spent making the case for abolishing "un-freedoms" such as poverty, famine and lack of political freedom while framing these as things that constrain peoples’ general capabilities. These concepts are discussed in the vast part of his book (chapters 3-12), where Sen goes through the concepts that are needed to be "in place" for the individuals to achieve freedom. The themes that are covered are (1) political freedoms (democracy), (2) economic facilities (3) social opportunities, (4) transparency guarantees and (5) Protective security. The discussions on these themes are high-level, with a primary goal of shifting the reader's view of development to that of viewing it as "freedom."
Hence, "Development as Freedom" provides us with 1) a set of concepts that constitute the building blocks of the capability approach; and 2a) a reframing of development as having freedom to live the lives people value, and 2b) an outline of the overarching structures that need to be in place not to inhibit those freedoms.
While acknowledging that the capability approach primarily is a development theory, and this is not a development thesis, we find parts of his framework useful to understand the barriers that prohibits people in Mitchells Plain from living a
diabetes-27
friendly lifestyle. We will not examine the bigger overarching themes (point 2a and 2b above) that Amartya Sens discusses in Development as Freedom, but instead use the building blocks of the capability approach to examine the aspects of a person’s capabilities to achieve the functioning of living a diabetes-friendly lifestyle.We believe the capability approach can be useful to analyze the barriers people face, through the three conversion factors, in achieving diabetes-self management in Mitchells Plain.