CHAPTER 12
Pillars of development: health, education and mobility
Health, education and mobility (HEM) services are crucial ingredients of a good quality of life. They are in-between material and immaterial quality of life aspects and in-between between private and public goods. They feature prominently in development aspirations and people spend much money on them.
- Fertility, morbidity and mortality rates determine the health situation of a population. Most countries go through a health transition, in which welfare- and lifestyle-related diseases slowly replace infectious diseases as most important causes of death. Different conceptions of health reflect the different ways of organizing health systems and health care and services, notably the role and effectiveness of the state;.
- In education, a transition towards higher levels of (formal) schooling develops in most countries as part of the move towards Modernity. Governments support this with a variety of goals and instruments. Here, too, there are different conceptions of ‘good’ education and the role of private education is one of the organizational issues;
- Migration and urbanization are happening since ancient times. The rapid increase in mobility stems from the combination of transport technology and fossil fuel availability. The resulting infrastructures facilitate and stimulate a further growth in travelling by car and airplane: although in affluent countries there are signs of saturation, low-income countries are expected to catch up. Both in number of kilometers travelled and in the mode used (the modal split: walking, cycling, private car, bus, train, airplane a.o.), countries show sizeable differences;
- HEM-services are core elements of Western-style Modernity and are widely aspired for and expected throughout the (rest of the) world. A more sustainable fulfilment of these needs and desires is necessary. The prospects are in many places good: novel less intrusive medical and educational services, expansion of public/bicycle transport and infrastructure and penetration of electric vehicles and others. Their successful introduction depends on actions and policies directed towards state and market provision of public goods and an orientation on technological developments and behavioural changes. Their design and operation should be inspired by ethical ideals of solidarity and dignity in order to be accepted and implemented.
Test your understanding of this chapter by reviewing the study questions below.
Answer:
Public goods (PG) have the characteristic that they non-rivalrous and non-excludable. Individual health and education are thus, in a sense, not PG; in a narrow context they can be considered private ‘goods’.
However, the provision of my (individual) health and education is intricately connected to other people: doctors, nurses, hospitals, teachers, schools and so on (an important consideration in virtue ethics). If collective health and education systems are in place, these ‘goods’ are in general non-rivalrous (unless there is insufficient capacity and resulting crowding) and non-excludable (if a society operates on collective contracts about their provision). If there are no means or intentions to support a collective health or education system, they can become ‘club goods’: those who can afford hire a doctor or a teacher.
Answer:
The probability to die is highest at (very) young age and at high(er) age. Hence, the curve has a U-shape with a less steep right-hand part.
Answer:
The Healthy (or Health-Adjusted) Life Expectancy (HLE) is defined as the number of years that a person can expect to live in full or good health. Life Expectancy (LE) minus HLE is an estimate of the number of years an (average) person lives in limited or bad health. There is a rough correlation between these variables (LE minus HLE) and Health Expenditures (HE) per year per person. This can be interpreted as an indicator of the effectiveness of health expenditures.
Answer:
A possible CLD is sketched below. Good governance implies a positive feedback loop in which public schools provide adequate education (left loop). If such governance is absent or thwarted, the available budget and teacher quality start to deteriorate, which induces more (rich) parents to opt for private schools for their children. Private schools will get more funding for investments and teachers, which adds more stress on the available government budget even if private schools are largely financed by high entrance fees. Thus a second dynamic takes over (right loop, dashed). Of course, the real world exhibits more complex dynamics. A similar dynamics operates around privatization of health services.
Answer:
The modal split is a characteristic of mobility is the distribution of kilometers travelled for each transport mode: walking, cycling, private car, bus, train, airplane a.o.
Answer:
A usual argument in favour of state provision is what economists call a natural monopoly. This occurs in (sectoral or industrial) activities which have high entry costs and barriers, primarily by large (material, financial or knowledge) infrastructure. It often coincides with strong economies of scale. In such situations, competition by rivals is not possible or not desirable. Where to draw the boundary around ‘natural’ and ‘unnatural’ monopoly or oligopoly is at least partly an ideological choice, because the costs and benefits of e.g. privatization are difficult to assess (see section 19.2.1).
Another argument is social-political. HEM-services are essential for people’s well-being (some even argue that housing, water and energy services are to be included too). This implies that one cannot let their supply be determined by the amount of money that can be spent by those who use them or are in need of them. This is a crucial aspect of the welfare state and explains the increasing role of the state in the economy (see Figure 10.4).
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