Paul Andrew Bourne, Dip. Edu; B.Sc. (Hons)
Adam Smith and other classical theorists examined determinants of development and their influence on peoples’ well-being, effectively giving birth to the theoretical construal of development as an economic phenomenon. They inferred that development was a function of economic indicators: such as, economic growth; stable prices; good budgetary management, and proper fiscal and monetary management. Those classical economists’ conceptualization of development was an axiom, and this epistemology was the zeitgeist, which some scholars fashion as ontology.
The classical school of thought sees economic growth as the creation to build the country’s Gross Domestic Product (GDP) within a specified time, usually twelve months. From that perspective, development is the transformation of the foundation within an economy. The transformation of any modern society has its own record as to its achievement and utilizing as well as its limitation of resources (Bourne, 2005).
The dominant perspective represents the classicalists’ viewpoint and fashions even today’s developmentalists’ stance. Nevertheless, Todaro (2000) emphasized that development since the 1970s has been reconceptualized to include “reduction or the elimination of poverty”, and “inequality and unemployment” (pp. 14). He further cited that development should be “a multidimensional process involving major changes in social structures, popular attributes and national institutions, as well as the acceleration of economic growth, the reduction of inequality, and the eradication of poverty.” This new conceptualization formulates all modern perspective on development. Todaro (2000) definition of development includes not only the traditionalists’ perspective on the theorizing but expanded it to encapsulate social structures and governance. He added that development include three core values, “sustenance”, “self-esteem” and “freedom.” Marks (1986) a sociologist concurs with Professor Todaro (2000) that “social change includes development, underdevelopment and underdevelopment.
Development implies some positive progress in a society’s condition whereas underdevelopment implies decline or stagnation” (Marks, 1986, pp. 180). It is on this basis that development will be used for this research. Development will not be analyze within any economic perspective as this is already well established and so development herein will be social.
Sustainable development was defined by the World Commission on Environment and Development as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs.” Development in this context refers to societal as well as economic development. Sustainable development, therefore, encompasses human welfare, economic growth, stability, environmental protection, and conservation. It seeks to meet the needs of the present while conserving resources for future generations.
The issue of development continues to plague man’s vast intellect. As there is no singulate consensus on the matter but a plethora of discourse and more theorizing. The European Union, in a newsletter of the delegation of the European Commission in Jamaica, pens the words that “development that meets the needs of the present without compromising the ability of the future generations to meet their own needs’ is sustainable development. This phenomenal construct, concurs with the World Commission on Environment and Development, is not perceived by business pundits as warranting a consorted attention, which would demand particular type governance for social and economic management of a country’s resources. Many experts in forwarding a theorizing on sustainable development fail to edifice positions that entail investment on health care.
Dossier (2002, p.4), Head of the EC Delegation in Jamaica, cites that a “health population is necessary to economic growth and sustainable development”; this perspective subsumed the value of expenditure on this determinant of development. A few people recognize the contribution of health to development, which indicates the worth they place on the human capital in the function of development. “Good governance is necessary if policy is to meet needs and expectations (Dossier, 2002, p.4), which places significance on government’s involvement in the process but this does not dwindle a holistic partnership between the former and the private sector in an effort concretize a development goal. Increasing demands of people on government, and the continuous deterioration of the economic base of developing countries, the private sector needs to forward a systematic move that will address some the inadequacies of the government.
One of the ‘Millennium Development Goal of halving the number of people living in extreme poverty in 2015’ is “to combat the spread of communicable diseases and increase investment in health care” (Dossier, 2002, p.4), and this should be noted that those words were spoken by an external agency. Despite the intentions of external developmental agencies a limited action of developing countries’ governments, governance in those topologies lacks social development focus. Social development does not only benefit the recipient but the society and the private sector hence, improvement in the quality of health care will not only advance better lives for the people but profitability of private companies. With the increasing spread of HIV/AIDS, malaria and other major diseases, more people will be request time off, this will translate into reduced production times and so production will be adversely affected. Therefore, access to excellence health care is an advantage for the business hegemony and the ‘laboured’ class.
The involvement of the private sector in health care is to be a policy responsibility, which again is a vital determinant for development. This body of professionals and pundits will use a different technique in responding and demand better governance for all. The government’s ill actions highlight the rationale for private sector governance in public sector management as these directly affect their entities. Bourne (2005) argues, “Cost is yet another factor discouraging utilization of mental health services. Minorities are less likely than hegemonic class to have private health insurance and other provisions, and this factor has a miniscule influence on ‘quality’ health even though the ‘laboured’ class is confronted with other pressing needs.
The private sector has been private concerning the dictates of governance in developing economies but any continuation of this doctrine will only further cripple their potential and capacity, and longevity. With the economic realities of Third World countries, private entrepreneurs if they fail to forge a plan of action for social development, deviance form the ‘laboured’ class may become their worst foe. Studies have shown that unhealthy workers provide an additional cost and this erodes company’s profitability unless the entity is able to pass on those costs to the consumer. Globalization and liberalization with the context of international competition is a reality that Third World entities are to discount in their decision-making policy, and this will limit the extend to which they are able to increase product costing. Hence, companies are to be cognizant their involvement in social capacity building, and one that is vital for their personal development is health expenditure.
PIOJ (1995, p.29) in its ‘National Plan of Action: On population and development’ summarizes an aspect of Jamaica’s health situation when they pen the words that “Moreover, segments of our population continue to lack access to clean water and sanitation facilities, are forced to live in congested conditions and lack adequate institution.” This reality is becoming increasingly burdensome to the ‘laboured’ class, while they observed the bourgeoisie class with bitterness and much hate. The ‘laboured’ class is the ‘work’ horses for countless private businesses and so the latter group must contextualize this when profits are reported and lifestyles are displayed. The proletariats progressively have to accept ‘poor’ health facilities and other social conditions coupled with the inept autocratic governance of the political administrators, this impact on the people’s conceptualization of their social world and may form an epistemology that this anti the social order.
“Individuals, families and groups in the population can be said to be in poverty when they lack the resources to obtain the type of diet, participate in the activities and have the living conditions and amenities which are customary, or at least widely encouraged or approved, in the societies to which they belong. Their resources are so seriously below those commanded by the average individual or family that they are in effect, excluded from ordinary living patterns, customs and activities.”
(Townsend 1979, p.31)
Townsend’s outlook was a synthesis of Jamaican poor and their socio-economic realities. Prior to the SAP in the 1980s, when many people in Jamaica were below the poverty line, now (post 1980s); the situation has even worsen significantly to the position where many people are merely living, and may be termed as subsistence existence.
King (2001) in Social and Economic Studies wrote that, “The budgetary allocations to the health sector also have implications for social equity.” It is clear from Dr. King’s postulation that government spending on health care influences the quality of life of peoples within a country. This determinant of the quality of life is not limited to health but spans education, defence, political system and governance. King (2001) forwarded that position that, “One fifth of the education [Jamaica] budget is being used on tertiary education, which does not benefit the lowest quintile.” Although King’s finding was as stated, the actuality is that the quality of life of peoples who attain tertiary educational institutions and by extension the society benefits there from. It appears that Dr. King is incognizant of the multiplier effect of single dollar spent on educating one university graduate. Milton Freidman (1955) in an article titled The Role of Government in Education posited that:
“A stable and democratic society is impossible without widespread acceptance of some common set of values and without a minimum degree of literacy and knowledge on the part of most citizens. Education contributes to both. In consequence, the gain from the education of a child accrues not only to the child or to his parents but to other members of the society; the education of my child contributes to other people's welfare by promoting a stable and democratic society. Yet it is not feasible to identify the particular individuals (or families) benefited or the money value of the benefit and so to charge for the services rendered. There is therefore a significant "neighborhood effect."
Friedman’s (1955) position, therefore, contradicts Dr. King’s (2001) stance. If democracy is highly improbable with a minimum degree of literacy, then public spending on education in and of itself is a factor of improvements in the quality of peoples’ lives, and this same can be forwarded on expenditure on health care. This position concurs with noble prizewinner Professor Michael Todaro’s (2000) three (3) objectives of development. Dr. Friedman in his article “The Role of Government in Education” argued that the value of educating a child does not end with the individual but extends to the society a factor Dr. King failed to “ingredientized” in his position forwarded earlier.
Professor Todaro credited Adam Smith for being the first development economists (Michael Todaro, 2000). He wrote that, “his Wealth of Nations [Adam Smith], published in 1776, was the first treatise on economic development, the systematic study of the problems and processes of economic development in Africa, Asia, and Latin America.” Although Friedman lauded Smith for his pioneer work he cited that “I disagree with this viewpoint” (Todaro, 2000: p. 7). He [Todaro], although an economist, believed that development spans a plethora of other factors beyond the traditionalists view on the subject. The distinguished modern economist cited that, “there are non-economic variables, values, attitudes and institutions” (Todaro, 2000: pp. 13).
One author forwards a slant that “GOVERNMENTS have long recognized the importance of primary and secondary education and preventive health care in improving the welfare of the poor. Not only do improvements in education and health directly affect the well-being of the poor, they also promise greater productivity and expanding income opportunities. Countries that have succeeded in providing universal education and reducing infant mortality rates have been shown to have higher economic growth rates” (Vinaya Swaroop, 1996). Swaroop is senior economist in the Public Economics Division of the World Bank's Policy Research Department and the excerpt was taken from "The Public Sector in the Caribbean: Issues and Reform Options," Policy Research Working Paper 1609 (Washington: World Bank).”
Swaroop’s perspective is the premise for a rationale of expenditure on health care. Such theorizing highlights reasons for the critical analysis of social development, and it beneficiaries. The present beneficiaries of government-subsidized education and health programme are not the ‘laboured’ class; and, in many countries, the quality of education and health care has failed to improve because of a misallocation of resources (Swaroop, 1996). With the move afoot by the public sector to expend financial resources on basic health care and education, this is promogated by Swaroop as the benefits are general in comparison to tertiary care and education that is highly limited. This programme requires financial resources constrict the assistance of non-governmental agents as the public sector in an effort to execute the intended idea.
“A healthier, more educated and higher skilled population is the surest route to higher productivity and better standards of living.” So says “Decent Work,” the Report of the Director-General to the 1999 International Labour Conference. Yet how can we have Decent Work without a healthy workforce? The ILO has long focused considerable attention on improving occupational health – on and off the job. The rising overall cost of health care in recent decades has not only affected individuals, but is creating financial problems for social security systems and threatens to crowd out other expenditures, notably on income replacement benefits. The World Labour Report 2000 shows how governments can work to guarantee access for all to health care and protect individuals from the detrimental effects of poor health on income security” (International Labour Organization)
My thesis is a co-partnership between the private and the public sector for expenditure on basic health care. The rationale for this position is subsumed in disparity in health care for the rich and the poor. This position is embedded in ILO’s ideational that states, “Despite major advances in the fields of medicine and healthcare services over the past decades, a significant health gap between rich and poor remains. As populations grow, so apparently do inequities. Today, despite the wealth-creating effects of globalization, the poor continue to shoulder a particularly disproportionate social burden in terms of inequitable access to decent healthcare, rising costs and higher rates of morbidity and mortality” a social reality that the I confront daily. The proclivities of the hegemonic class and the private sector is to withdraw themselves from social concerns but in order to display to the ‘laboured’ class that they are genuinely disquiet about their existence, they need to extend finances in social programmes in particular health care. This is two-fold as ameliorating the social realities of the ‘laboured’ class foster better social co-operation between the groups, and it is a panacea.