The Ethics of Human Rights (77): The Case Against the Sale of Human Organs, Ctd.

Take a look at the following conflicting facts:

1.

There are currently 113,198 [U.S.] patients on the United Network for Organ Sharing wait list for organ transplants. With only 28,535 transplant surgeries performed in the United States last year, it is clear that actions need to be taken to increase the supply of available organs. Around 7,000 Americans die each year while waiting for a suitable transplant (source).

2.

In a study of India’s kidney market, 86 percent of donors had major health issues after their surgery. … The same study of kidney sales in India revealed that 79 percent of sellers regretted their decision to donate an organ and a shocking 71 percent of sellers were married women. Because poor women in India have little power, they can be easily forced by their husbands to sell their organs. (source).

Good health and survival are human rights. Those of us who have objections to unregulated markets in human organs have to show that markets fail, on balance, to further human rights protection and that alternative systems of organ provision perform at least as well as organ markets in terms of human health and survival. It’s important to note here that the comparison of the cases for and against organ sales will have to take the human rights of all – buyers as well as sellers – into consideration, and will also have to factor in all human rights and not just the rights to health and survival if the case against organ markets can show that other human rights may suffer if markets are implemented.

The typical argument against organ sales – and, by extension, against other types of commodification and other instances of the “imperialism” of the market – consists of three parts:

• some “things” are degraded or corrupted if turned into commodities
• if some “things” are traded for money then the profit motive may crowd out other types of motivation, and those other types of motivation are often morally valuable
• organ markets are typically coercive given the fact that poor people will be coerced by economic necessity to sell their organs.

The first point has been stated most clearly by Michael Sandel:

[M]arkets don’t only allocate goods; they express and promote certain attitudes toward the goods being exchanged. Paying kids to read books might get them to read more, but might also teach them to regard reading as a chore rather than a source of intrinsic satisfaction. Hiring foreign mercenaries to fight our wars might spare the lives of our citizens, but might also corrupt the meaning of citizenship. Economists often assume that markets are inert, that they do not affect the goods being exchanged. But this is untrue. Markets leave their mark. … We don’t allow children to be bought and sold, no matter how difficult the process of adoption can be or how willing impatient prospective parents might be. Even if the prospective buyers would treat the child responsibly, we worry that a market in children would express and promote the wrong way of valuing them. Children are properly regarded not as consumer goods but as beings worthy of love and care. Or consider the rights and obligations of citizenship. If you are called to jury duty, you can’t hire a substitute to take your place. Nor do we allow citizens to sell their votes, even though others might be eager to buy them. Why not? Because we believe that civic duties are not private property but public responsibilities. To outsource them is to demean them, to value them in the wrong way. (source)

Market values can indeed change how we look at things. If a human body is viewed as an organ mine, then ultimately this can destroy the dignity of the body, of the human person and of life itself. There is an inescapable incompatibility between the view that something has a financial exchange value and that the same thing has dignity. The horror of slavery wasn’t merely defined by the pain, the oppression and the lack of freedom suffered by slaves, but also by the fact that slaves were viewed as commodities rather than human beings. And although it’s unfair to compare organ trade to slavery, the same commodification and financial market logic underlies both. Commodification of the human person, whether as a whole or in part, is a failure to treat human beings with dignity and respect. Human beings shouldn’t be used as tools, instruments or resources.

Not even if it means saving people’s lives? Yes, not even if it means saving people’s lives, on the condition that there are other feasible ways of saving people’s lives. And there are. The fact that current rates of donation are not always and everywhere sufficient to meet the growing demand does not imply that all possible donation schemes are insufficient. Rather than giving up completely on donation just because current schemes don’t always work well we should focus on improving it, especially given the serious drawbacks of the market system that is hastily and sometimes lazily proposed by some.

I do understand the tendency of some to look for market solutions, especially given the success of markets in other areas of life. But there’s no good reason to assume that all social relationships should be financial ones.

The second objection to organ sales is that market values crowd out non-market values worth caring about such as altruism and solidarity. Not only is this intuitively persuasive – if people get money for things it’s likely that they’ll stop giving it away for free, and that giving in general will become rare when market values invade every part of life – but there’s also some evidence. This paper argues that donation rates would decline in a market, with detrimental consequences for social relationships. And this paper also finds evidence of crowding out.

I’ve dealt with the third objection – the coercion objection – in an older post.

The Ethics of Human Rights (70): A Human Right to Non-Existence?

Can people have a human right not to exist? This potential right has to be distinguished from the right to die or the right to end your life. In fact, what I’m talking about here is a right not to be born. Can a potential or prospective person have a right that forces her potential parents not to act in such a way that she comes into existence?

It’s common to hear people claim that, in some circumstances, it’s in a person’s interest for her parents to not act in such a way that leads to her conception and birth. And when there’s an interest there’s possibly a right as well. The specific circumstances people often refer to are, for example, the likelihood of genetic defects in the parents that would lead to a life of suffering for the potential child. Indeed, it’s uncontroversial that we can cause harm to a child by bringing about her existence, and when there is harm, there’s often also a right to be protected against such harm.

Less common these days is for people to argue that those who are “burdened” in non-genetic ways – such as the poor – should also not procreate owing to the risk that their children would find themselves leading similarly dismal lives.

So, if prospective parents are in a position to know or to be told that their potential children will lead a life not worth living because of genetic reasons, should they respect the so-called right to non-existence of these potential children? This right – if it exists – imposes a duty on prospective parents not to beget miserable children.

(A short parenthesis: suppose there is such a right not to exist, does that right not imply the existence of the “mirror-right”, namely a right of prospective children to exist when their lives will be very rewarding? In other words, do people have a duty to procreate in some circumstances? Most human rights imply their mirror-right: the right to free association implies the right to leave associations or to not associate at all; the right to free speech implies the right to remain silent; freedom of religion implies freedom from religion etc.

However, the presence of a mirror-right doesn’t always seem to be a necessary corollary of a right. The right to a free trial or the right to be free from discrimination don’t seem to imply any mirror-rights. If we assume, temporarily, that there is a right not to exist, we don’t need to assume that the mirror-right should also exist, if only because there are some serious problems with the possible right to exist, as I’ve argued elsewhere).

Back to the main point of the argument. If you want to defend the right to non-existence you have to distinguish between two cases:

1. a right to non-existence belonging to a possible future child, and
2. a right to non-existence belonging to a future child.

Case 1 is a right of potential children before conception, and this right would – if we agree that it exists – justify (forced) sterilization and such. Which is already one indication that such a right does not or should not exist. Case 2 is a right of a fetus not to be born, and is a right that would justify some types of abortion.

If we accept the right to non-existence in case 1, we won’t impose harm on children – because they never leave the stage of potential being – but we may impose harm on parents’ procreation rights, privacy rights, physical integrity rights etc. If we accept the right in case 2, we will impose harm on parents if we have to force them to have an abortion in order to protect the fetus’ right to non-existence.

In either case, however, we are dealing with “people” who can’t possibly claim their right to non-existence for themselves, either because they don’t (yet) exist, or because they exist in a form in which they can claim rights. Hence, when we act to realize the right to non-existence, we always act on behalf of the wellbeing of others, potential others even. Given the many problems linked to paternalism, the burden of proof must be very high before we engage in such actions. For instance, it should be abundantly clear that “a life of unbearable suffering” will indeed be unbearable: a life of poverty and illiteracy would still be valuable enough and would not trigger the right to non-existence of the potential children of the poor and illiterate. Hence it would also fail to trigger paternalistic actions such as forced sterilization or forced abortion. On the other hand, a life of constant physical pain brought about by genetic facts could perhaps be of sufficiently low value to trigger the right and the corresponding paternalistic actions, although I personally find it repugnant to consider forced abortion or forced sterilization.

Also, the fact that the bearers of the right in question can’t possibly claim it themselves – either because they’re still a fetus or because they are as yet potential human beings (some, by the way, would claim that a fetus is also no more than a potential human being) – could indicate that it’s impossible to talk about a right in this case. However, some children and comatose patients also can’t claim their rights, but that’s no reason to state that they don’t have any. Maybe it would be better to frame the issue, not in terms of rights, but in terms of the duties that parents have when considering a decision to procreate. And yes, there can be duties without corresponding rights: if I have a duty to respect my promises given to you, you don’t have a corresponding human right to have these promises respected.

The Ethics of Human Rights (68): The Case Against the Sale of Human Organs

Or, better, a case against it. I believe that trade in human organs is morally wrong, at least if this trade is free and unregulated (but perhaps also when it’s regulated in some way). I don’t think the same case can be made against the sale of body products such as blood, hair etc., although some of the arguments against the sale of organs may also apply to the sale in body products. I will bracket this problem for now and concentrate on organs.

I make the argument against organ sales knowing full well that there’s a huge problem of organ shortages and that some people will benefit from free organ trade, and may even lose their lives if free trade is not allowed. Hence, if I claim that free organ trade is morally wrong, then I’m not necessarily making the claim that it should be forbidden in all circumstances. If there are other wrongs, such as people avoidably losing their lives, that overwhelm the wrongs resulting from organ trade, then the former wrongs may be preferable all things considered. However, I believe that the latter wrongs are commonly underestimated by those defending the legality of organ sales. I also believe that there’s a blind spot common among those who claim that the wrongs resulting from a ban on sales typically outweigh the wrongs resulting from a free organ market: it’s not as if the only choice is the one between the status quo – which is in most cases a ban on sales resulting in organ shortages – and a free organ market. There are other and perhaps better solutions to the shortage problem, even in the short term.

Here are some of the reasons why I believe a free organ markets causes serious wrongs:

1. Coercion by poverty

Not a single wealthy person will ever need or want to sell his or her organs. In a system of free organ trade, it’s the poor who will sell their organs to the rich. Maybe a legalized market will reduce the wealth disparity between buyers and sellers to some extent, given the fact that the number of potential sellers will be higher in a free market and that the number of potential buyers will not. This increase in supply compared to demand, following legalization, will reduce prices somewhat, making it feasible for more people to buy organs. Still, it will almost always be the relatively rich buying from the relatively poor, especially if the market is a global one (and I find it hard to understand arguments in favor of a free market limited to national borders).

Many of these poor will be desperately poor, particularly if the market is globally free. A decision to sell an organ isn’t made lightly, and requires some level of financial desperation. The extraction of an organ still carries a substantial risk (e.g. 1 in 3000 die from a kidney extraction even in the best medical circumstances), and few will be willing to take this risk from a baseline situation of wellbeing or happiness that is moderately high and that can not or need not be substantially improved by financial means.

Hence, if organ trade is allowed, many sellers will be desperately poor people, and there will be more of those in a legalized market than in a black market. Now it’s clear that desperation can be coercive: it forces people to do things that they would not otherwise do, that entail risks that they would avoid at higher levels of wellbeing, that may be harmful for them, and that go against their better judgment. If coercion is wrong, then free organ trade is wrong because free organ trade multiplies the number of desperately poor people that feel coerced to sell their organs.

2. Trade instead of justice

It’s reasonable to assume that rich people are responsible for the poverty that exists in the world, if not directly through their actions (trade policy, colonization etc.) then through their failure to prevent or remedy poverty. It will almost invariably be the same rich people who will want to buy organs from poor people. Now, if you first create poverty (or fail to do something about it, which in my mind is equivalent) and then tell poor people that you’ll give them money but only if they give you their organs in return, then you add insult to injury: you have a moral duty to give them your money unconditionally. Insisting on the possibility of trade while neglecting the necessity of justice is wrong.

3. Objectification and instrumentalization

There are some other good reasons why it’s wrong to buy an organ from someone, even if this person willingly agrees to the sale on the basis of informed consent, and even if he or she isn’t coerced into the sale by his or her poverty and isn’t someone who has a moral and unconditional right to the money he or she would get from a sale. For instance, buying an organ from someone means treating this person as an object and a means. It’s a failure to respect the person’s dignity as a being that should be treated as an end in itself rather than as a shop or an organ factory. It’s not outrageous to view organ trade as a new form of cannibalism.

4. Unjust distribution

The previous 3 arguments against organ trade focused on the wrongs it imposes on the sellers. But even the buyers are treated unjustly in a system of free organ sales. If the distribution of organs is regulated solely by way of free trade, then the patients who are most in need of an organ are not the ones who will get the organs. It will instead be those patients able to pay most who will get them.

5. Crowding out altruism

There’s even an argument that points to possible harm to society as a whole. If more and more human relationships are brought within the cash nexus, then giving and altruism will be crowded out. It’s obviously the case that when people can get money for something, they will stop giving it for free. Human nature is what it is. But given what it is, we shouldn’t encourage its darker sides. It’s reasonable to assume that free donation of organs will all but disappear when people can get cash for them. And it’s also reasonable to assume that this reduction in altruism can have a ripple effect throughout society and in many other fields of life, especially when we take account of the fact that more and more activities have already been brought within the cash nexus: sex, reproduction, politics …

No one assumes that everything should be tradable. Even the most outspoken proponents of organ trade draw the line somewhere: they won’t allow people to sell parts of their brains, I guess, or their children and wives, or the parts of aborted fetuses (perhaps fetuses specially conceived and harvested for their parts). So we have to stop somewhere and disallow the trade of some things. Why should it be evident that organs are not one step too far?

Alternatives

If organ sales do have harmful consequences, then what are the alternatives? If we don’t want to allow those willing to sell to go about and legally sell their organs to those capable of buying them, then how do we solve the shortage problem and save the lives of those in need of organs? We can do several things:

• We can try to increase the number of free cadaveric donations, by improving the way we approach bereaved relatives, by introducing a system of presumed consent, by promoting explicit consent (for example through the introduction of regulations that allay fears that doctors will stop life support when they need organs, or through some sort of priority system in which those who have pledged cadaveric donation can jump the queue when they themselves need organs) etc.
• We can try to increase living donation, by way of awareness campaigns.
• We can hope for scientific breakthroughs that make cadaveric recovery of organs easier or live donations less risky, or that make it possible to grow organ in vitro.

Organ sale is certainly not the only solution to the shortage problem.

A final remark: given the fact that proponents of organ trade often rely on the right to self-ownership – the right to do with your body as you please – we may have to tone down the importance of that right. Which is something we’ll have to do anyway: for instance, there’s no welfare state if the right to self-ownership is absolute.

Discrimination (13): Is Disability Just a Case of Bad Luck or Is It Discrimination?

When people think about disability they usually don’t see it as a moral issue. A disabled person supposedly suffers from bad luck, and the problems she encounters while living her life with a disability don’t result from the decisions or actions of her fellow citizens. They are instead caused by ill health or by biological and anatomical inadequacies, things for which no one is to blame. Brute misfortune, that is all.

Of course, a disability can be caused by someone else’s misconduct, for example industrial pollution or paralysis following an accident caused by someone else. However, let’s focus on blameless disability, the kind that is not anyone’s fault.

There’s a problem with the view that this kind of disability is no more than misfortune. The threshold level of normal human functioning that determines the difference between disability and non-disability isn’t just determined by biological facts, but also by social practices and the artificial social environment. For example, imagine a society that has developed technologically up to a point where people don’t have to use their hands anymore. No more computer keyboards, steering wheels in cars, remote controls etc. Let’s assume that everything that needs to be done can be done by programming and brain power (not a far-fetched assumption). A person who loses her hands in an accident will not be considered “disabled” in such a society. This accident will not push her below the threshold level of normal human functioning. In fact, most likely it won’t even be viewed as an accident, but rather a small nuisance, depending on the level of pain involved. Much like we in our existing societies react to a bee sting. It’s usually not disabling.

Now, when we take the same example of a person losing her hands, but situate her in a country such as the U.S. today, then we would say that she is disabled and that she has fallen below the threshold level of normal human functioning. But the reason we say this isn’t simply a biological or anatomical one, otherwise she would also have to be disabled in the imaginary society described a moment ago. The reason we say that she is disabled depends on the social circumstances and the social system in which she finds herself after losing her hands. Because U.S. society has been designed in such a way that people need to use their hands a lot of the time, we say that someone without hands is disabled. The decision to count someone as disabled has less to do with biology and anatomy than with the social practices and the artificial social environment we live in. The level of functioning a person can achieve depends less on her biological or anatomical abilities than on the artificial social environment in which she finds herself.

Hence, disability isn’t just something that happens to people; it’s something that we as a society have decided should happen to people. There’s nothing about our society that necessarily relegates people without hands to the category of the disabled. On the contrary, we have willingly designed our society in such a way that people without hands are disabled. We could just as well design our society in another way. Technology permitting, of course, but technology is also – up to a point – a choice: we just simply decided to develop technologies and the wider social environment in such a way that they don’t really take into account the needs of people without hands.

The fact that we designed our society in the way we did seems to indicate that we don’t care a lot about the disabled, at least not enough to do something for them. And such an absence of care can be viewed as a type of discrimination. After all, until some decades ago, men didn’t much care about the education of women, even though society was quite able to give women the same kind of education as men. The relative lack of education of women wasn’t a necessary fact of life but a choice. And that choice was a symptom of discrimination.

Of course, the analogy is shaky because gender discrimination was and is often a conscious choice, whereas the disabled are only rarely consciously disadvantaged. However, as I’ve stated before, the fact that discrimination is unconscious doesn’t automatically excuse it.

More on luck. More posts in this series.

What Are Human Rights? (39): Human Rights and Human Duties

For some people, there’s too much talk about human rights. They see human rights as a symptom of a typically modern type of moral decay, of a culture of self-importance and egoism, and of an exaggerated sense of entitlement. We want more and more of society and the state, and at the same time we are less willing to contribute. Instead of rights talk, they say, we should promote a sense of duty. Instead of rights declarations and rights in constitutions and treaties, we should have lists of duties and responsibilities, and have the state enforce those duties rather than rights.

You often hear this duty talk when the topic is crime (defendants have “too many rights”) or anti-social behavior (whatever that means), but it seems to be focused mainly on economic human rights. Rather than a right to unemployment benefits people have a duty to work and to support themselves. Rather than a right to very expensive healthcare for everyone, people have a duty to live a healthy life. And so on.

My point here is not to deny the importance of the duties mentioned above, or of a lot of other duties. And neither do I want to claim that human rights talk can’t be frivolous. I merely want to mention a couple of risks that come with duty talk. First of all, there’s the danger of rights becoming dependent on duties. If duties are given too much importance, people will be tempted to claim that your rights can only come after you have proven to be a responsible person. That would be wrong. Rights are unconditional. People have rights, end of story. They don’t have rights because they are responsible citizens respecting their social duties. Even irresponsible citizens, and even criminals have rights.

In addition, duty talk is somewhat superfluous. Duties are inherent in rights. Someone’s rights are everyone else’s duties. (It’s wrong to view respect for rights as the duty of the state only). I don’t have a right to violate your right; I have a duty to respect it. Rights would be meaningless words without such duties. So what’s the added value of emphasizing duties?

More posts in this series are here.

The Causes of Poverty (63): Stress, Ctd.

Poor people are often blamed for their own poverty. And indeed, it’s not difficult to find anecdotal evidence of poor people doing dumb and self-destructive things. However, even if we assume – and that’s a big if – that this evidence can be confirmed by more rigorous statistical analysis, then we’re still not allowed to claim that stupidity is in general – and not just in some cases – an important cause of poverty. First, it may very well be the case that everyone, rich and poor, is likely to make the same stupid mistakes but that the poor just have a smaller margin of error. The same stupid mistake made by a poor person costs him or her more dearly. Rich people on the other hand can afford to be stupid. Second, even if it’s true that the poor are on average somewhat more stupid and self-destructive, they should perhaps not be blamed for this. There’s some evidence from psychology that the pressure and stress of poverty reduces our cognitive abilities:

In a behavioral economics experiment several years ago, researchers asked shoppers at a New Jersey mall to handle the following decision: Have your faulty car repaired for either $150 or $1,500. While the participants were considering how to decide, they were given simple cognitive tasks like solving puzzles.

The researchers, Prof. Eldar Shafir and Jiaying Zhao, both from Princeton University, and Harvard University Prof. Sendhil Mullainathan, expected that the stress from contemplating the $1,500 expense would hurt performance. They were right. But participants with above-average incomes succeeded in their tasks under both scenarios, while those with average or low incomes did worse as repair costs climbed.

Even the prospect of spending any money at all damaged the ability of low-income earners to think rationally. (source)

Other tests measured IQ before and after a harvest, i.e. in uncertain times and in more comfortable times:

The farmers had better IQ results during the season of plenty. Before the harvest they had problems making fateful decisions, because of stress. (source)

The stress of poverty causes distractions, which in turn show up as cognitive deficiencies. It’s not cognitive deficiencies that cause poverty but the other way around. Or perhaps it would be more accurate to say that the causality goes both ways.

More on poverty and behavior, on poverty and stress, on poverty and intelligence and on poverty and brain functions.

More posts in this series.

What is Equality? (4): Equality of Opportunity

I wasn’t very pleased with my previous attempts, so here’s one more. Equality of opportunity is a type of equality that’s usually seen as a very moderate one, one that’s not too demanding – especially compared to other types of equality that focus on equal outcomes – and hence it’s supposed to be acceptable to those of us who are a bit squeamish about equality. However, I’ll try to show that this is a mistake. Real equality of opportunity is a very ambitious and difficult project. In order to show that, I’ll talk first about some of the causes of inequality of opportunity, and then about the things we can do to reduce this inequality.

Four source of inequality of opportunity

1. Unequal endowments and circumstances

Equality of opportunity means that different people should have an equal chance of success in a certain life project, conditional on the willingness to invest an equal amount of effort. Of course, in reality, people will never have such an equal chance. The lottery of birth means that we are unable to choose to be born in a wealthy family with caring parents who can finance our education and motivate us to achieve our goals. It also means that we can’t choose which talents and genes we are born with. Talents and genetic differences are no more a matter of choice than the character and means of our parents. And genetic differences affect our talents, skills and maybe even our capacity to invest effort. (It’s not impossible that they even determine our choices of projects in which we want to be successful). So two people with the same life projects will only rarely have the same chance of success.

What can we do to equalize their chances? We can’t (yet) redistribute beneficial genes or disable harmful ones, and we don’t want to intervene in people’s families (and force parents to behave in a certain way or possibly even redistribute children). So we can’t remove the impact of genes and parents. But we can correct it, partially. For example, we can compensate people born with a genetic defect that reduces their chances of success in their life projects. We can offer people suffering from a genetic disorder that has left them paralyzed certain instruments to enhance their mobility. We can offer children born in dysfunctional or poor families free education, child benefits and encouragement. Etc.

2. Discrimination

Equality of opportunity also means correcting for lack of opportunity not resulting from the lottery of birth. If African Americans are systematically discriminated in employment, then they don’t enjoy equality of opportunity. They don’t have an equal chance of success in employment. If working for a certain company is part of an African American’s life project, and this company prefers white employees, then this African American doesn’t have an equal chance of success in his life project compared to whites with the same project.

The rule of equality of opportunity is only violated when the African American is rejected for no other reason than his race, and when this rejection diminishes that person’s opportunities (in other words, when this rejection is common and widespread rather than occasional; see here). If his skills, talents, merit and efforts are equal to those of other candidates, he should have an equal chance of employment or advancement. Equality of opportunity means that he should be allowed to compete for positions on equal terms, and that the difference between winners and losers in such competitions can only be a difference based on skills, talents, merit or efforts. However, even when he is rejected for the position because his skills, talents, merit and efforts are below the level of those of other candidates, he may not have been granted equality of opportunity. That is because the lottery of birth (point 1 above) has landed him in a discriminated group and because his lesser skills and willingness to invest effort and strive for merit may be caused by this discrimination.

Even if all are eligible to apply for a … position and applications are judged fairly on their merits, one might hold that genuine or substantive equality of opportunity requires that all have a genuine opportunity to become qualified. (source)

3. Misfortune in life

The natural lottery can reduce your equality of opportunity. Misfortune in the circumstances of your upbringing (bad parents, bad schools etc.) can also do it. And discrimination throughout your life as well. On top of that, other types of misfortune can limit your opportunities: you may get sick or have an accident. So we have to promote equality of opportunity at every step in people’s lives.

4. Neglect of abilities and talents

And there’s yet one additional cause of inequality of opportunity. Until now, I’ve assumed that equality of opportunity means that different people should have an equal chance of success in a certain life project. But maybe people have an equal chance of success in whatever life project they choose (as long as the project is morally acceptable of course). If society recognizes, rewards and encourages only certain talents and abilities, then some people will not be able to be successful in the life projects that they choose and that are compatible with their talents and abilities. For example, it’s fair to say that someone like Elton John would not have enjoyed equality of opportunity in Sparta or Saudi Arabia.

How to promote equality of opportunity?

If we accept all that, then the promotion of equality of opportunity involves different things:

1. Social structures or traditions

At the most basic level, it means getting rid of social structures or traditions that assign people to fixed places in a social hierarchy, to occupations or to life projects on a basis that has nothing to do with skills, abilities, talents, merit and efforts. Patriarchy, in which women are forced to focus on family life and raising children, is incompatible with equality of opportunity. As is a caste society, a society in which racial or other minorities (or majorities) are systematically discriminated against, or a class society in which the class of your parents, your blood line, your religion, your friends and relationships (nepotism) determine your chances of success in life. Getting rid of such social structures and traditions may simply require legislation outlawing them, or may also require affirmative action or positive discrimination and other forms of compensation for past wrongs (if some still benefit in the present from past wrongs, then equality of opportunity will not be respected simply because the wrongs have ended).

2. Equalizing skills, abilities and talents

But the promotion of equality of opportunity also means equalizing skills, abilities and talents, to the extent that this is possible (e.g. offering poor children free education of the same quality as the education and private tutoring offered to children born in wealthy families). And compensating people when this isn’t possible (e.g. give a blind man some help if we can’t cure his blindness).

3. Upgrading ambitions

And the promotion of equality of opportunity means reducing differences in merit and effort that are not the consequences of people’s voluntary choices. E.g. a child raised in a poor and dysfunctional family may have involuntarily adapted her ambitions downwards. Helping her at a young age may allow us to prevent this down-scaling of ambitions. Perhaps this down-scaling of ambitions is the result of the structures and traditions described in 1 above.

4. Other types of misfortune

The promotion of equality of opportunity also means helping people whose skills, abilities, talents, merit and efforts have been limited by misfortune different from the misfortune caused by the lottery of birth. If two people have the same ambition, talents and skill to become a lawyer – perhaps after social corrections to their initial starting positions in life (e.g. free schooling for the poorest one of them) and after legislation providing equal employment access (e.g. for the black lawyer-to-be) – but an accident leaves one of them blind, maybe society should provide that person with law books in Braille and such.

5. Recognizing abilities

And, finally, it means that a broad range of talents and abilities should be recognized and rewarded in society, with the exception of those that involve limitations of other people’s talents and abilities.

Limits of equality of opportunity

So equality of opportunity is a very ambitious and far-reaching project, contrary to what people usually believe about this type of equality. Hence we have to limit it somehow. For example, it shouldn’t extend to people’s private lives. You can’t demand that the girl next door marries you even if that’s your project in life and even if you think you’re the best candidate who didn’t have his equal opportunity. And the girl can decide not to marry you simply because you’re black. A club of racists can decide not to accept your membership request. A racist restaurant owner can decide not to serve you food on his private property. None of this diminishes your equality of opportunity, at least not as long as enough of the same opportunities exist for you elsewhere.

There will be a problem of equality of opportunity if all or many restaurants, clubs etc. turn you away. But if that’s not the case, and enough of the same opportunities remain elsewhere, even businesses can discriminate on the basis of race in their employment decisions, as long as this practice is not widespread and not part of a wider system of discrimination not limited to employment. If, in a perfectly tolerant and egalitarian society, there’s one bakery insisting on being racist and refusing to hire or serve blacks, who cares? (More here).

Equality of opportunity and statistical discrimination

However, discrimination in employment doesn’t have to be taste based, as they say. It can be mere statistical discrimination. Is that a violation of equality of opportunity? I would say yes, because discrimination is discrimination and whatever the motives are – a taste for discrimination or just prudence based of statistical averages – it diminishes the opportunities of those affected by it. People who engage in statistical discrimination make no effort to assess the skills, merit and talents of individuals.

The Causes of Poverty (61): Geography

It’s commonly accepted nowadays that a multitude of causes determines whether a country is relatively rich or poor. The fact that I’m currently writing post number 61 in this series points in the same direction. However, this means that it’s still possible for a particular cause to be dominant in certain countries, outweighing other existing effects. Some focus on institutions for example, others on geography. Let’s have a look at geography, and more specifically at the argument made by Jared Diamond. He cites some geological, geographical and climatological facts that do seem to have a large effect on national prosperity in certain countries:

• Tropical climates are notoriously unhealthy. There are more parasitic diseases in the tropics because the temperatures are never cold enough to kill parasites. Carriers of diseases, such as mosquitoes and ticks, are also far more diverse in tropical than in temperate areas. Furthermore, tropical diseases – compared to other diseases – are more difficult to combat with effective vaccines. There’s still no vaccine against malaria for instance. Disease is obviously a drag on economic growth: when large parts of a population are sick for extended periods of time, they are unable to work and trade efficiently. Furthermore, disease leads to high fertility rates – as an insurance against infant mortality – which in turn removes many women from the economy for a substantial part of their productive lives.
• Agricultural productivity is on average lower in tropical than in temperate areas. Temperate plants store more energy in edible parts such as seeds than do tropical plants. Plant diseases borne by insects and other pests reduce crop yields more in the tropics than in the temperate zones because the pests are more diverse and not subject to cold winters. The soils are also better in temperate climates (rainfall washes away the nutrients in tropical soils, and these soils are older and not renewed by glaciers).
• Landlocked countries are at an economic disadvantage: if an area is accessible to ships because it lies either on the sea coast or on a navigable river, then trade is easier and less costly: it costs roughly seven times more to ship a ton of cargo by land than by sea. Hence, landlocked countries profit less from the advantages of trade.
• Similar advantages are shared by countries that have abundant reserves of natural resources such as fresh water, forests, minerals, fuels etc. (Although dependence on natural resources can also be a curse).

This being said, there is no overwhelming correlation between national wealth and geographic conditions that supposedly promote wealth: there are countries that are more prosperous than they should be given their geographic endowments, and vice versa. Other factors must therefore play a part, most notably institutions.

More posts in this series here.

The Causes of Poverty (59): Stress

Stress is often a consequence of poverty, but it can also make poverty worse. Esther Duflo and Abhijit Banerjee have noted in Poor Economics that

[t]here is a strong association between poverty and the level of cortisol produced by the body, an indicator of stress. Conversely, cortisol levels go down when households receive help. The children of the beneficiaries of PROGRESA, the Mexican cash transfer program [later renamed Oportunidades], have, for example, been found to have significantly lower levels of cortisol than comparable children whose mothers did not benefit from the program. (source)

Cortisol is a hormone, and high levels of it can cause brain dysfunctions which in turn make it difficult for affected individuals to escape their economic predicament.

The prefrontal cortex, for example, which is vital for suppressing impulsive responses, is rendered less effective by high cortisol levels, making us more likely to take hasty, ill-considered decisions. “When experimental subjects are artificially put under stressful conditions,” Duflo and Banerjee note, “they are less likely to make the economically rational decision when faced with choosing among different alternatives.” (source)

This poverty cycle or poverty trap can only be broken when external interventions reduce stress levels. For example, poor people can be given easier access to credit or insurance, which will reduce their fear of the future. They can be given a basic income. Etc. Perhaps cortisol-reducing medication is also an option.

More here on the way in which brain dysfunctions can cause poverty. And more here on the link between poverty, self-control and willpower. More posts in this blog series are here.

Economic Human Rights (41): Unemployment, a Cost-Benefit Analysis

Unemployment is a violation of an individual’s right to work. It stunts her creativity and diminishes her wellbeing, in a material, moral and psychological sense, in many cases even pushing her into poverty, ill health and depression.

For a person with no pre-existing health conditions, losing one’s job increased the chances of reporting a new health problem by 83 percent. Overall, the newly unemployed had a 54 percent chance of reporting fair or poor health. (source, source)

Unemployment is also self-perpetuating because it makes it harder to find a new job – employers prefer candidates who already have a job. In addition, it depresses wage levels, even decades after the end of a spell of unemployment.

Needless to say, these costs don’t affect only the unemployed themselves. Their families and children also suffer:

We find that a parental job loss increases the probability of children’s grade retention by 0.8 percentage points, or around 15 percent. After conditioning on child fixed effects, there is no evidence of significantly increased grade retention prior to the job loss, suggesting a causal link between the parental employment shock and children’s academic difficulties. These effects are concentrated among children whose parents have a high school education or less. (source)

And the ripple effect of unemployment covers the whole of society. Unemployment has a social cost: above and beyond the fiscal pressure – unemployment benefits have to be paid, either through increased taxes or cuts in other public services – it deprives society of valuable input and human ingenuity.

Still, all these costs should not blind us to the real benefits that unemployment can bring. And I’m not talking about those few individuals who are “liberated” from their mind numbing jobs and take the chance offered by unemployment to start a successful business doing something they always wanted to do but never had the chance or guts to do. Neither am I referring to kidults reveling in “funemployment”, staying with their parents well into their twenties or beyond, and taking the opportunity to prolong their childhood. Those are not the majority of the unemployed.

However, some among the majority may also find a silver lining. Maybe unemployment makes them less materialistic and more financially prudent; maybe some of them will use their free time to volunteer and educate themselves; society may become humbler and gentler; maybe concerns for social justice become more prevalent since the unemployed, ex-unemployed and their friends and families have become more conscious of the role of luck in life’s outcomes, as compared to the limited role of desert. Some health indicators may improve:

Interestingly, though high-stress events such as foreclosures and unemployment may hurt the health of those directly impacted, there’s some evidence that recessions have a positive impact on a nation’s health overall. In 2000, Christopher Ruhm, an economist at the University of North Carolina at Greensboro, found that a 1 percent rise in a state’s unemployment rate led to a 0.6 percent decrease in total mortality, looking at mortality changes in the United States between 1972 and 1991. … economic downturns could improve health through “declines in smoking, excessive alcohol consumption and overeating during recessions as people look for ways to save money.” (source)

Of course, there’s no way these benefits cancel out all of the costs. Unemployment is a scourge and a human rights violation, and capitalism doesn’t do itself any favors by maintaining and temporarily inflating its “industrial reserve army“.

More on the human cost of unemployment is here and here.

Economic Human Rights (40): How Do Poor People Live?

The poor tend to become a number, a statistic, an undifferentiated mass, especially here on this blog. Talk of the “bottom billion” and the one-dollar-a-day people only makes things worse. Of course, it’s important to know the numbers, if only to see how well we are doing in the struggle against poverty. But to actually know what we have to do, we need to know what poverty actually means to poor people. How do these people live? Which problems do they face? Who are they? None of this can be captured in numbers or statistics. Pure quantitative analysis doesn’t help. We need qualitative stories here, and these stories will necessarily differentiate between groups of people because poverty means different things to different people.

Keeping in mind the caveat that poverty is “multidimensional” and that it varies with the circumstances, is it possible to give a more or less general impression of the “lives of the poor”? There’s an interesting attempt here. Banerjee and Duflo analyzed survey data from 13 countries in order to distill a picture of the way people live on less than one dollar a day, of the choices they have and the limits and challenges they face.

The countries are Cote d’Ivoire, Guatemala, India, Indonesia, Mexico, Nicaragua, Pakistan, Panama, Papua New Guinea, Peru, South Africa, Tanzania, and Timor Leste. Obviously, the lives of the poor are very different in these different countries, and vary even for different groups within each country. Still, some general information can be extracted:

• The number of adults (i.e. those over 18) living in a family ranges from about 2.5 to about 5, with a median of about 3, which suggests a family structure where it is common for adults to live with people they are not conjugally related to (parents, siblings, uncles, cousins, etc.). When every penny counts, it helps to spread the fixed costs of living (like housing) over a larger number of people. Poverty has consequences for family structure, and vice versa.
• Poor families have more children living with them. The fact that there are a large number of children in these families does not necessarily imply high levels of fertility, as families often have multiple adult women.
• The poor of the world are very young on average. Older people tend to be richer simply because they have had more time to accumulate resources.
• Food typically represents from 56 to 78 percent of consumption expenses among rural households, and 56 to 74 percent in urban areas.
• The poor consume on average slightly less than 1400 calories a day. This is about half of what the Indian government recommends for a man with moderate activity, or a woman with heavy physical activity. As a result, health is definitely a reason for concern. Among the poor adults in Udaipur, the average “body mass index” (that is, weight in kilograms divided by the square of the height in meters) is 17.8. Sixty-five percent of poor adult men and 40 percent of adult women have a body mass index below 18.5, the standard cutoff for being underweight. Eating more would improve their BMI and their health, and yet they choose to spend relatively large amounts on entertainment. Which just shows that the poor have the same desires as anyone else and choose their priorities accordingly.
• The poor see themselves as having a significant amount of choice, and choose not to exercise it in the direction of spending more on food. The typical poor household in Udaipur could spend up to 30 percent more on food than it actually does, just based on what it spends on alcohol, tobacco, and festivals. Indeed, in most of the surveys the share spent on food is about the same for the poor and the extremely poor, suggesting that the extremely poor do not feel the need to purchase more calories. This conclusion echoes an old finding in the literature on nutrition: Even the extremely poor do not seem to be as hungry for additional calories as one might expect.
• Tap water and electricity are extremely rare among the poor.
• Many poor households have multiple occupations. They may operate their own one-man business, sometimes more than one, but do so with almost no productive assets. They also have jobs as laborers, often in agriculture. And they cultivate a piece of land they own. Yet, agriculture is not the mainstay of most of these households. Where do they find non-agricultural work? They migrate. The businesses they operate are very small, lacking economies of scale and without employment opportunities for people outside the family. That’s a vicious circle because it means that few people can find a job and are forced to start petty businesses themselves. This circle makes economies of scale very difficult.
• The poor tend not to become too specialized, which has its costs. As short-term migrants, they have little chance of learning their jobs better, ending up in a job that suits their specific talents or being promoted. Even the non-agricultural businesses that the poor operate typically require relatively little specific skills. The reason for this lack of specialization is probably risk spreading. If the weather is bad and crop yields are low, people can move to another occupation.
• The poor don’t save a lot, unsurprisingly. Some of it has to do with inadequate access to credit and insurance markets. Banks and insurers are unwilling to give access to the poor and saving at home is hard to do; it’s unsafe and the presence of money at home increases the temptation to spend (that’s true for all of us by the way).
• In 12 of the 13 countries in the sample, with the exception of Cote d’Ivoire, at least 50 percent of both boys and girls aged 7 to 12 in extremely poor households are in school. Schooling doesn’t take a large bite from the family budget of the poor because children in poor households typically attend public schools or other schools that do not charge a fee.

Measuring Human Rights (25): Measuring Hunger

First, and for those in doubt: hunger is a human rights violations (see article 25 of the Universal Declaration). Second, before we discuss ways to measure this violation, we have to know what it is that we want to measure. It’s surprisingly difficult to define hunger.

Definition of hunger

The word “hunger” in this context does not refer to the subjective sensation that we have when lunch is late. We’re talking here about a chronic lack of food or a sudden and catastrophic lack of food (as in the case of a famine). We measure a lack of food by measuring dietary energy deficiency, which in turn is computed based on average daily calorie intake. The FAO estimates that the average minimum energy requirement per person is 1800 kcal per day. The global average per capita daily calorie intake is currently about 2800 kcal. This average obviously masks extreme differences between the obese and the chronically undernourished.

The FAO minimum energy requirement per person of 1800 kcal is also an average. The minimum calorie need depends on many things: age, climate, health, height, occupation etc.

Usually, the concept of “hunger” as it is defined here is different from “malnutrition“. Hunger is a lack of food defined as a lack of calorie intake. Malnutrition is a lack of quality food, of micronutrients such as vitamins and minerals, and of a divers diet. Hence, people may have access to sufficient quantities of food and still be malnourished.

Hunger and famine are also different concepts. Hunger is a chronic and creeping lack of food, while a famine results from the sudden collapse of food stocks. A famine implies widespread starvation during a limited period. It can’t go on forever because it must stop when everyone has died or when food supplies are restored. Chronic hunger on the other hand can go on forever because it doesn’t imply widespread starvation. Of course, people do die of chronic hunger, and on a global level hunger kills more people than famines do. But whereas in the case of famine people die of starvation, the victims of chronic hunger usually don’t starve to death. When we say that hunger kills someone every 3.6 seconds we usually mean that this person dies from an infectious disease brought on by hunger. Hunger increases people’s vulnerability to diseases which are otherwise nonfatal (e.g. diarrhea, pneumonia etc.). In fact, most hunger related deaths do not occur during famines. Chronic hunger is much more deadly – it’s just not as noticeable as a famine. When and where famines occur, they are more deadly and catastrophic. But they occur, thank God, only exceptionally. Hunger on the other hand is a permanent fixture of the lives of millions and ubiquitous in many countries.

Measurement of hunger

Given this definition, how do we go about and measure the extent of chronic hunger? (The measurement of famine is a separate problem, discussed here). There are different possible methods:

• So-called food intake surveys (FIS) estimate dietary intake and try to relate this to energy needs determined by physical activity. Calorie intake below a minimum level means hunger. The problem here is that minimum calorie intake thresholds are somewhat arbitrary and do not always take people’s different calorie requirements into account. Even for a single individual, this threshold can vary over time (depending on the climate, the individual’s age, occupation and health etc.). Moreover, when trying to measure calorie intake, you’re faced with the problem of hunger due to imperfect absorption: it’s not because someone in a sample buys and consumes x number of calories that he or she actually absorbs those calories. The widespread incidence of diarrhea and other health problems often mean that only a fraction of calories eaten are absorbed by the body.
• In order to bypass this, some propose a measurement method based on revealed preferences. The greater the share of calories people receive from the cheapest foods available to them, the hungrier they are; and, conversely, the more they buy expensive sources of calories, the less hungry they are. Their choice of foods reveals whether they have enough calories. This method therefore eliminates the threshold and absorption problems.

Our approach derives from the fact that when a person is below their nutrition threshold, there is a large utility penalty due to the physical discomfort associated with the body’s physiological and biochemical reaction to insufficient nutrition. At this stage, the marginal utility of calories is extremely high, so a utility-maximizing consumer will largely choose foods that are the cheapest available source of calories, typically a staple like cassava, rice or wheat. However, once they have passed subsistence, the marginal utility of calories declines significantly and they will begin to substitute towards foods that are more expensive sources of calories but that have higher levels of non-nutritional attributes such as taste. Thus, though any individual’s actual subsistence threshold is unobservable, their choice to switch away from the cheapest source of calories reveals that their marginal utility of calories is low and that they have surpassed subsistence. Accordingly, the percent of calories consumed from the staple food source, or the staple calorie share (SCS), can be used as an indicator for nutritional sufficiency. (source, source)

• Still another method consists of measuring hunger’s physical effects on growth and thinness. Instead of measuring calorie intake, hunger or revealed preferences, you measure people’s length, their stunted growth and their body mass index. However, this is very approximative since length and weight may be determined by lots of factors, many of them unrelated to hunger.
• And finally there are subjective approaches. The WFP does surveys asking people how often they ate in the last week and what they ate, how often they skip meals, how far they are away from markets, if their hunger is temporary or chronic etc. Gallup does something similar.

More on hunger here. And more posts in this series here.

Economic Human Rights (38): A Silly Argument Against the Right to Food

The right to food (art. 25 of the Universal Declaration i.a.) doesn’t get a good press. Only a handful believe that it’s comparable in importance to rights such as free speech or freedom of religion. This disdain surprises me. And it’s not just that it shows a failure to understand the interdependence of rights – none of our rights make any sense on an empty stomach. If you know that 6 million children under the age of five die of hunger every year there is at least a prima facie reason – although not a sufficient reason, I admit – to claim that there should be a human right to food.

The counter argument goes as follows: if we grant people a right to food, they will stop working and just watch television all day while the government gives them food. That will destroy both the economy and people’s character.

I think that’s really silly. Let’s make an analogy with an uncontroversial right, the right to free movement. This right doesn’t mean that the government should “give people movement”. That doesn’t make sense. People claiming that right don’t ask for the government to move them. What they ask is

1. that the government doesn’t hinder their free movement (hence a legal prohibition on internal border controls, restricted zones etc.); and
2. that the government helps people to acquire the capability to move freely if they don’t have that capability (hence assistance to people with disabilities and the construction of public highways).

The same is true for the right to food. This right doesn’t tell the government to give people food. All it demands is that the government doesn’t take away people’s food or people’s ability to acquire food (as it did in the case of Ukraine’s Holodomor), and that it helps people acquire the ability to get food. The latter may imply temporary food provision (or giving cash for food) to those in dire need, but this provision is aimed at capacity building, and should stop when people’s capabilities are restored.

A closely related discussion is the one about positive and negative rights. See here.

The Causes of Poverty (52): Brain Dysfunctions Caused by Early Childhood Adversity

Children in orphanages, in poor quality day care centers, children of teenagers or children with one or two parents incarcerated often experience neglect, lack of stimuli, adversity and even abuse. Studies have shown that this kind of adversity, especially if it takes place during the first two years of life,

can damage the brain as surely as inhaling toxic substances or absorbing a blow to the head can. And after the age of two, much of that damage can be difficult to repair, even for children who go on to receive the nurturing they were denied in their early years. … For a long time, social science has known of correlations between childhood turmoil and all sorts of adult maladies that carry massive social and financial costs—mental illness, addiction, tendencies toward violence. … [Recent] science suggests that many of these problems have roots earlier than is commonly understood—especially during the first two years of life. … [A]dversity during this period affects the brain, down to the level of DNA. (source)

Early childhood adversity such as neglect, abuse or the stress produced by extreme poverty weakens and distorts the development of the brain and sets the body’s hormonal stress function on permanent high alert.

Here are some examples of the ways in which early childhood adversity affects the brain in a lasting manner:

[A] baby who endures prolonged abuse or neglect is likely to end up with an enlarged amygdala: a part of the brain that helps generate the fear response. Some of the earliest and most important research establishing this process dates to the 1950s, when investigators observed that rats were better at solving problems if they got more nurturing at very young ages. … Subsequent research showed that persistent childhood stress also leads to significant physical problems, such as far higher rates of cardiovascular disease and diabetes. … Early adversity … can interfere with planning ability, cognitive flexibility, problems with memory, and all of those will correlate with diminished IQ. … One 2010 paper from Psychological Medicine concluded that “childhood adversities”—a category that includes abusive parenting and economic hardship—were associated with about one in five cases of “severely impairing” mental disorders and about one in four anxiety disorders in adulthood. (source)

So there is evidence of a causal connection between trouble in very early childhood and problems that occur later in life. Notwithstanding the fact that some affected children end up OK and that others may benefit from later interventions, the cited effects are often tenacious in later life. That means that preventing them requires concentrated action during those crucial first two years. Providing very young children with stable, responsive and nurturing relationships in the family, in school and in the neighborhood can prevent or reverse the effect of early childhood adversity, stress and neglect.

And the interesting part from our point of view is that the effects of early adversity are not limited to mental disorders and crime. These effects cause and perpetuate poverty. Hormonal and brain functions that are distorted by adversity and stress result in learning difficulties:

Children who fail to develop coping mechanisms struggle from the earliest days in school, because even the slightest provocations or setbacks destroy their focus and attention. They can’t sit still and read. They have trouble standing in line. They lash out at classmates or teachers. And these struggles, naturally, lead to other problems that perpetuate the cycle of poverty. All of this is to say that the science of early childhood may play a significant role in the dominant political question of our time: rising inequality. (source)

That means that anti-poverty measures should focus on very young children. Such measures have lifelong benefits for learning, behavior and health. Not only are such early measures more effective in the struggle against poverty than attempts to reverse damage later in life – they are probably also less costly.

More posts in this series are here.

What Are Human Rights? (33): Something More Than Goals

You can often hear the claim that economic rights such as the right to healthcare, food and work are not really rights but merely desirable goals. A first reply would be that all types of rights, not just economic rights, are also goals. Free speech is just as much a goal as healthcare, food and work. But not all goals are rights, so it’s reasonable to ask if economic rights are really rights. What is a right? It can be different things, but it should, minimally, impose a duty. A duty implies feasibility. Ought implies can. There’s no point imposing duties on people which they are unable to respect.

A typical objection against economic rights is that they impose precisely such duties, duties which are not and will not be feasible in many countries in the world. Imposing a right to healthcare, food and work in Somalia, for instance, is imposing an illusion. It’s just too expensive. Hence, because they impose impossible duties, economic rights can’t really be rights. They are merely goals.

Now, I did argue before that the relative expensiveness of economic rights compared to “freedom” rights is often very much exaggerated. Which is why Somalia and other countries have also failed to secure freedom rights successfully. Part of their lack of success is due to their unwillingness to leave people be – which they could at no expense – but another part is due to their unwillingness and inability to fund the institutions necessary to enforce people’s freedom. Yet, no one claims that these failures turn free speech into a mere goal or aspiration rather than a right.

Furthermore, the international treaties that impose respect for economic rights have taken the cost criticism into account. They often frame economic rights in terms of “progressive realization”. Countries don’t violate the treaties if they can show that they have taken all possible measures to ensure the progressive – as opposed to immediate – realization of economic rights.

If we turn rights into goals, we lose a lot. Goals are a lot weaker in terms of moral force than rights. Those who are without food can no longer demand that something is done, that they are the victims of an injustice, and that they have a right to food. All they can do is ask or beg that a certain social goal, one among probably thousands, is taken a bit more seriously.

Finally, is it really so farcical to impose duties that exceed people’s abilities to comply? Aren’t we doing that all the time? It’s common to view “telling the truth” as a moral duty, a very strong one even. And yet, we all know that this exceeds our abilities to comply. We lie all the time, and if you deny this, you’re lying. The best we can do, morally, is precisely “progressive realization”: trying to lie as little as we can, and less than we’re used to. The same progressive realization rescues economic rights as rights: rather than imposing a duty to realize the goal inherent in the rights, they impose a duty to try to realize that goal.

Limiting Free Speech (45): Selling Violent Video Games to Children

A recent US Supreme Court ruling invalidated a California law that banned the sale of certain violent video games to children on the grounds that the law violated freedom of speech. The controversy is an old one, and goes roughly as follows. Proponents of laws banning violent media – especially the sale of violent media to children – point to different studies arguing that violence in media promotes violence in real life and that children in particular are at risk of becoming violent adults. Since people have a right to be protected against violence and children have a right not to suffer the psychological harm that purportedly comes from the consumption of violent games, we have here a case of rights conflicting with each other: on the one hand the free speech rights of the makers and sellers of games, and on the other hand the security rights of the potential victims of violent behavior provoked by the consumption of violent games, as well as the mental health rights of the consumers of those games. Hence, one of those rights should give way to the other rights.

Proponents of restrictions of free speech in this case argue that a prohibition of the sale of violent games to children is the best option since the speech value of a violent video game is small, and since producers of such games still have the freedom of “artistic expression” because they can still sell to adults. The cost of limiting free speech in this case is small compared to the gains in terms of physical security and psychological health. And there are precedents such as movie ratings.

The opponents of limitations on free speech can also point to studies showing the absence of an effect on real life violence or even the opposite effect – the so-called “pressure valve theory“. They can also use the slippery slope argument and claim that the sale of many classical works of fiction should then also be prohibited on the same grounds, since they also contain scenes of violence.

The US Supreme court sided with the opponents, unsurprisingly given the near absolutism of free speech protection in the US (only a couple of exceptions to free speech are recognized in US jurisprudence, and expression of violence isn’t one of them).

While I personally find US free speech jurisprudence difficult to accept and generally hypocritical – why can obscene material be censored but not violent material? – I think in this case the SCOTUS decision is probably right. The psychological evidence does not, as far as I can tell, clearly show an effect of media violence on real life violence, and even if there is a small effect, a general prohibition on violence in media probably goes too far, as does a general prohibition on the sale of media containing violence. Even a prohibition on the sale of such material to children is probably too much, even given the fact that children are more impressionable. Violence has many causes, and the “pressure valve” theory has some intuitive appeal (also in the case of pornography by the way). A rating system, allowing parents to do their job, is probably better.

Children’s Rights (13): Minimum Age of Marriage Laws Reduce Incidence of Child Marriage

In many countries, it’s customary for girls to marry at a very young age, voluntarily or not. This practice is detrimental to the human rights of women, as I argued before.

In the developing world, more than one third of women aged 20 to 24 report that they were married or in a union by the age of 18. (source)

This practice is often legally entrenched:

In 50 countries, the minimum legal age of marriage is lower for females. (source)

However, it seems that the law can also work the other way.

Or perhaps the causation goes the other way: countries where customs are against early marriage also adopt laws stipulating a high minimum marriage age. In general, we shouldn’t be too optimistic about the power of legislation.

The Ethics of Human Rights (47): What’s So Funny About Paternalism?

In general, those who promote human rights will not be tempted to engage in paternalistic policies. That’s because human rights are about protecting people against each other, not about protecting people against themselves. And one of the foundations of human rights is the moral value of personal autonomy: people have a right to organize their lives according to their own plans and reasons, free from the influence and manipulation of others, even if others believe they are mistaken or self-destructive. Personal autonomy in this sense of the word is the basis of rights such as the right to privacy, property, political participation etc.

So, paternalism can be seen as detrimental to human rights. On the other hand, all societies are to some extent paternalistic, with the apparent consent of all. So what’s the deal? Let’s go through this topic in a systematic way, starting with some definitions, typologies and proposed justifications of paternalism, in order to end up with a clearer vision about paternalism’s temptations, dangers and limits.

Definition of paternalism

Paternalism is

• interference
• usually by the government
• with an agent’s strictly self-regarding actions
• and against the will of the agent.

It’s the use of coercion, force or incentives, against the initial will of the agent, with the purpose of imposing or preventing a certain type of action or lifestyle that has, respectively, positive or negative consequences for the agent and that does not harm or benefit a third party.

The purpose of paternalism is therefore to make the agent who is the object of paternalistic force, better off. She’s better off because she is forced, by the paternalist, to do good things to herself or to abstain from doing harm to herself.

Types of paternalism

This definition allows us to distinguish two types of paternalism: positive and negative (these qualifiers do not imply value judgments):

• positive paternalism means forcing people to benefit themselves
• negative paternalism means forcing people not to harm themselves.

The latter is much more common, I believe. Examples are anti-drug legislation, laws forcing people to wear seat belts or crash helmets etc. An example of the former are laws requiring people to contribute to a pension fund (although that case may not be strictly self-regarding since part of the motivation for such laws is the protection, not only of the future pensioner, but of his or her descendants or society in general).

Paternalism should therefore be distinguished from other types of coercion that aim at preventing people from harming others or forcing people to benefit others (such as laws against murder or laws imposing taxation respectively). Such non-paternalistic types of coercion focus on other-regarding consequences, whereas paternalistic coercion focuses on self-regarding consequences. Paternalism wants to limit the harm people’s actual or possible voluntary actions can do to themselves, and maximize the benefits that people’s possible but not voluntarily chosen actions can produce for themselves.

Paternalists are therefore “do-gooders” who want to maximize people’s utility, benefits, happiness, wellbeing etc. and who believe that this requires more than mutual protection.

(Other typologies of paternalism are, of course, possible: a soft form of paternalism would not intervene if people consciously and with full knowledge harm themselves, and only when self-harm results from lack of information; or would only intervene using incentives or “nudges” rather than coercion; hard paternalism would discount knowledge and intervene anyway; paternalism may be limited to the means people choose for their ends, or may also include these ends etc.).

Justifications of paternalism

Paternalists offer different reasons why they think that people, in some cases, should be prevented from engaging or forced to engage in certain actions.

• As stated a moment ago, there may be a lack of knowledge on the part of the agent forcing the agent to unwittingly harm herself or fail to benefit herself. And this can be a lack of knowledge of different kinds:
  • First, the agent may not be aware of the harmful self-regarding consequences of a chosen or intended action, or may not be aware of the beneficial self-regarding consequences of an unchosen and unwanted action. In such cases, there are two possibilities. Either the simple delivery of information regarding the consequences – for example through education or communication – is enough to convince the agent to avoid harmful action or to choose beneficial action, and then no paternalistic action is necessary. Or this is not enough and paternalistic action is necessary. An example of the latter can be marijuana: according to some paternalists, the consequences of marijuana use are harmful, but this “information” doesn’t seem to register with users.
  • The absence of knowledge may be a deeper problem. The agent may not be aware of her true interests. Example: a terminally ill patient who wants to die may not be aware that her true interest – according to some – is respecting God’s will and God’s rules against suicide.
• In many cases, people justify paternalism not because there’s a lack of knowledge, but because there’s a lack of “character” on the part of the agent. The agent may know very well what is and is not in her interest and what actions have beneficial or harmful consequences, but she just can’t bring herself to engage in or avoid those actions. There’s clarity about her interests and about consequences, but not the will, the courage, perseverance etc. to act correctly.

Most cases of paternalism, I guess, are of the first kind, where it is assumed that there’s a lack of continuous knowledge and a lack of conscious and lasting awareness of the consequences of certain actions, and that someone else, e.g. the state, knows better.

Hence, paternalism deserves its name. Paternalists assume – much like Plato – that society is divided into two groups of people, the “fathers” and the “children”, those who know better and are more rational, and those who don’t know and can’t be counted on to take their lives into their own hands. However, paternalism goes beyond the father-child metaphor because it believes that the “children” will never fully grow up: knowledge about consequences acquired through information and education, knowledge about which actions are or are not in the best interests of people, or knowledge about how people can act to best serve their true interests will often not be enough to act in a certain way. Apart from knowledge, character can be lacking, and that’s a fault that is much more difficult to correct without continuous paternalistic force.

The temptation of paternalism

So, all that sounds pretty awful, and yet all or most societies engage in some kind of paternalism without much public opposition. The examples given above are quite common. And indeed, some forms of paternalism are quite harmless and difficult to avoid. John Stuart Mill cites the case of a bridge that is about to collapse. The circumstances are such that only engineers are in a position to know this. Regular drivers don’t and can’t know the consequences of their actions – in this case driving across the bridge – and should therefore be prevented from acting by those who know better. This isn’t usually called paternalism, but there doesn’t seem to be a clear difference between this case and real cases of paternalism, such as laws forcing people to wear crash helmets (assuming that the reason why people don’t wear helmets is an insufficient awareness of the possible consequences), or moral rules dictating that we should try to convince our friends not to commit suicide if they are so inclined.

So, paternalism is there to stay. I don’t think there are many “hard anti-paternalists” around. Hence, as is often the case on this blog, we are faced with value pluralism and two contradicting values: in some cases it’s obviously good to protect people against themselves, but at the same time it is generally correct to respect people’s autonomy, their self-determination and their right to make their own decisions and to live according to their own reasons and motives, free from external forces.

Where’s the trade-off? I would say that the burden of proof is on those wishing to limit people’s autonomy, given the general importance of autonomy. Their case can made stronger when, for example, there’s absolutely no doubt that a certain course of action will produce serious harm to the agent. Otherwise the case for paternalistic coercion is less strong and the best we can do is simply warn people of the possible consequences. Their case can also be made stronger when medical opinion about an agent’s neurological or psychological disorders is unanimous.

The dangers of paternalism

The burden of proof is on paternalists because of the risks inherent in paternalism. We also tend to overestimate the effectiveness of paternalism. Generally, individuals are the best judges of their own needs and wants and of the means to realize them. It’s not obvious that a paternalistic class of “fathers” can have better knowledge, given the vast number of people, options and risks involved. And even if individuals make mistakes, the harm done by forcing them into a system in which they are treated like children may be greater than the harm they do to themselves when left alone. Most people value the freedom to decide for themselves and the value of this freedom can sometimes compensate the cost of self-inflicted harm. It’s also likely that mistakes make people better judges.

Does that mean that people should have the freedom to damn themselves? In most cases, yes, if that’s someone’s free and voluntary choice, made in the light of all the information available and accessible to her.

Why Do Countries Become/Remain Democracies? Or Don’t? (19): Psychological Reactions to the Threat of Disease

There sure are many reasons why countries become or fail to become democracies. In this blog series I’ve mentioned climate, geography, inequality, external triggers, prosperity, religion, resources, education etc. An original approach to this question looks at psychological reactions to the threat of disease:

Conventional explanations for a country’s political system would draw on its history, economy and culture. Randy Thornhill from the University of New Mexico, Albuquerque, however, thinks it might be determined by the threat of disease in a region. This triggers psychological biases, which originally evolved to prevent illness spreading, that also hinder the emergence of democratic ideals. (source)

The logic is that people develop psychological reactions – call them biases – which they need to protect themselves against infectious diseases, and these reactions in turn make it difficult to adopt democracy, individualism and an attitude of criticism of authority.

The starting point for Thornhill and Fincher’s thinking is a basic human survival instinct: the desire to avoid illness. In a region where disease is rife, they argue, fear of contagion may cause people to avoid outsiders, who may be carrying a strain of infection to which they have no immunity. Such a mindset would tend to make a community as a whole xenophobic, and might also discourage interaction between the various groups within a society – the social classes, for instance – to prevent unnecessary contact that might spread disease.

What is more, Thornhill and Fincher argue, it could encourage people to conform to social norms and to respect authority, since adventurous behaviour may flout rules of conduct set in place to prevent contamination. Taken together, these attitudes would discourage the rich and influential from sharing their wealth and power with those around them, and inhibit the rest of the population from going against the status quo and questioning the authority of those above them. This is clearly not a situation conducive to democracy. (source, source)

What is, initially useful for public health, becomes detrimental for self-government:

[S]pecific behavioural manifestations of collectivism (e.g. ethnocentrism, conformity) can inhibit the transmission of pathogens; and so we hypothesize that collectivism (compared with individualism) will more often characterize cultures in regions that have historically had higher prevalence of pathogens. Drawing on epidemiological data and the findings of worldwide cross-national surveys of individualism/collectivism, our results support this hypothesis: the regional prevalence of pathogens has a strong positive correlation with cultural indicators of collectivism and a strong negative correlation with individualism. (source)

Why Do We Need Human Rights? (23): Privacy, Justifications and Objections

The right to privacy has become increasingly important and contested. Here are just a few examples of areas in which violations of privacy have become more common over the last decades:

• Public safety: many governments claim that the war on terror requires the following limitations of the right to privacy (just as it requires limitations of other rights):
  • wiretapping
  • CCTV surveillance
  • data mining
  • airport security checks
  • drone monitoring
• Medicine:
  • the debate on abortion is now commonly framed as a privacy issue
  • there’s also the issue of genetic patenting
  • there’s mandatory drugs testing
• Employment:
  • background checks
  • monitoring of workers’ activities, either for safety reasons or for productivity reasons
• Transportation and road safety:
  • GPS tracking
  • Google Streetview
• Criminal justice:
  • sex offender registers
  • satellite tracking for criminals as an alternative to incarceration
• Commerce: sales tracking using fidelity cards or credit cards
• Etc.

Since it’s always good to cite the Universal Declaration when talking about human rights, here’s the article about privacy (#12):

No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honor and reputation. Everyone has the right to the protection of the law against such interference or attacks.

Types of privacy

Privacy is what is called a cluster concept: it covers many different things, things which may seem unrelated at first sight. So, before I go on, here’s a short and tentative typology of different kinds of “privacies” (I’ll mention later what they have in common):

• Domestic privacy. People have a right to remain secluded and alone in their homes, to keep what happens in their homes and houses to themselves, and to repel intrusion. That’s mostly what is protected by the Fourth Amendment in the US. Issues related to obscenity or pornography laws for example also fall under this type of privacy.
• Personal privacy. People have a right to keep their thoughts, opinions, or feelings to themselves. The secrecy of postal communication for example falls under this type, as does the secret ballot.
• Physical (or intimate) privacy. People have a right not to expose their bodies, as well as a right to repel physical intrusion into their bodies. Abortion and some security checks belong here.
• Informational privacy. People have a right to control what happens to information about themselves (or their families), and to limit involuntary distribution or disclosure of such information. Information here means facts, whether embarrassing or not, rather than opinions. The latter are part of libel law. Information about sexual orientation or salaries is an example of informational privacy.
• Relational privacy. People have a right to keep some of the details about their relationships to themselves. This includes whom they have what type of sexual intercourse with. Sodomy laws violate this kind of privacy, as do laws regulating the use of contraceptives. People also have a right to decide without interference on the type of relationship that suites them best. This covers laws regulating interracial marriages, same-sex marriages etc.

(There’s also the concept of private property, but I think this can be separated from privacy issues, although private property of a home is obviously a necessary condition for domestic privacy, for example).

All these types of privacy have something in common: they are all about independence. Privacy protects an individual’s interest in making independent decisions about her life, family, home, lifestyle, relationships, behavior and communication. All these types of privacy are also about the restriction of access or intrusion. Privacy gives an individual the right to deny access or intrusion by others, more specifically access to or intrusion in her body, her home, her relationships, her mind and certain facts about her life. It’s a right to be let alone.

Justification of privacy

Privacy is justified because it restricts access. Some restrictions of access are necessary for personal identity. There is no “I”, no person, no individual without a border between me and the rest of the world. Such a border is an absolute requirement for the basic human need of personhood and individuality. If people have unlimited access to each other, then there simply won’t be any separate people left. People understood as separate entities require some level of privacy protection. The exact level of privacy and the justified intrusions into people’s private lives are not yet determined by this argument, but the need for some level of privacy and some limitations of intrusions is clear. Other justifications of privacy could be based on the interest people have in intimacy, close personal relationships etc. It’s clear that a world without privacy or even without strong privacy rights would be a horrible world indeed.

Objections to privacy

Some argue that there’s nothing special about privacy and that the concept doesn’t merit an independent existence, let alone legal protection. The many different interests protected by privacy can indeed be protected by other means, such as a right to private property, liberty, bodily security and integrity, or independence.

However, I’m not sure that this is true for all the interests protected by a right to privacy. And an independent notion of privacy gives at least an added protection, partly because of the strong roots of the notion in common language and belief.

Some go even a step further and consider privacy to be detrimental rather than merely superfluous. Marx, for example, viewed privacy as a symptom of an atomized and selfish society, intent on protecting the material self-interest of the haves faced with a possible revolt of the have-nots.

Some feminists as well have forcefully argued that privacy is detrimental to women because of its use as a shield to protect male domination, superiority and abuse. However, it’s not because a right can be abused that it loses all meaning. There wouldn’t be any rights left if that were the case. The challenge is to avoid intrusion in people’s private lives that go too far, while at the same time allowing intrusion that counters abusive private actions. The right to privacy is therefore not an absolute right. But it is a right, and feminists should remember that intrusions into the private sphere can also be detrimental to women (e.g. abortion legislation, forced sterilization etc.).

The Causes of Poverty (41): Racism

There’s a clear discrepancy between poverty rates for blacks and whites in the U.S. (as between races in many other countries). The question is to what extent racism is to blame. I mentioned here, here and here that some of the irrational and self-destructive behavior of a lot of poor people causes many to believe that the poor are themselves to blame for their poverty and that one shouldn’t look for external reasons such as racism.

If you finish high school and keep a job without having children before marriage, you will almost certainly not be poor. Period. I have repeatedly felt the air go out of the room upon putting this to black audiences. No one of any political stripe can deny it. It is human truth on view. In 2004, the poverty rate among blacks who followed that formula was less than 6 percent, as opposed to the overall rate of 24.7 percent. Even after hearing the earnest musings about employers who are less interested in people with names like Tomika, no one can gainsay the simple truth of that advice. Crucially, neither bigotry nor even structural racism can explain why an individual does not live up to it. (source)

Opinions like this are very common. But are they correct? Is it true that “neither bigotry nor even structural racism” can explain why an individual does not make a few simple choices that will drastically improve her life?

At first sight, it does seem that a few simply rational decisions about life will allow you to escape or avoid poverty. But on closer inspection that’s just begging the question: if things are so simple, why don’t people make those choices? Hell, it’s so simple that it should be obvious even to the stupidest among the poor! But if it’s not stupidity that causes people to fail to take the advice of finishing high school and not having children early, and not bigotry or racism, then what?

[The] insistence that the failure of so many blacks to avoid the perils that come with not finishing high school and getting pregnant before marriage cannot be explained by structure or bigotry is too outrageous to let pass with no reply. In fact they can be easily explained by structure. …

The school systems in black neighborhoods are underfunded and undeniably worse on average than those in white neighborhoods.  The quality of the school, its teachers and leadership has a direct influence on graduation rates.  Sex ed and access to contraceptives are also far worse in black communities.  The public health failures come well before this for many black youth.  The failure to provide adequate health care and nutrition to black adolescents has been linked to the behavioral and learning disabilities so prevalent in black schools.  The diagnosis of a learning disability is one of the biggest predictors of eventually dropping out of school, particularly in poor urban schools. (source)

And having more trouble finding a job because you’re name sounds black obviously has an impact on your prosperity, also for your children. And growing up in a poor family has consequences for your adult prosperity. When we look at incarceration rates by race, and assume – wrongly – that there’s no racism in play, what do you think it does to a child having to grow up without a father?

This means that there’s one less parent to earn an income, one less parent to instill the sort of discipline all children need to graduate school and avoid unplanned pregnancies.  Even if the incarceration only lasts briefly, it still means that once the parent is out of jail he or she will find it much harder find employment. (source)

More posts in this series are here.

Measuring Human Rights (16): The Right to Healthcare

(There’s a more theoretical post here about the reasons why we should call health care a human right. But even if you think those are bad reasons, you may find the following useful).

The right to health care is one of the most difficult rights to measure. You can either try to measure people’s health directly and assume that good health means good health care, or you can measure the provision of health care and assume that there will be good health with a good health care system. Doing the latter means, for example:

• measuring the number of health workers per capita for countries
• measuring the quality of hospitals
• measuring health care spending by governments
• measuring the availability and affordability of health care
• measuring the availability and affordability of health insurance
• etc.

Doing the former means:

• measuring life expectancy
• measuring infant mortality
• measuring maternal mortality
• measuring calorie intake
• measuring the incidence of certain diseases
• measuring the survival rates for certain diseases
• etc.

Needless to say that every single one of these measurements is fraught with problems, although some more so than others. Even if you’re able to have a pretty good measurement for a single indicator for a single country, it may be difficult to compare the measurement across countries. For example, health insurance is organized in so many different ways that it may be impossible to compare the level of insurance across different countries.

But let’s focus on another measure. Life expectancy is often used as a proxy for health. And indeed, when people live longer, on average, we can reasonably assume that they are healthier and that their health care system is better. It’s also something that is relatively easy to measure, compared to other indicators, since even developing countries usually have reasonably good data based on birth and death certificates. And yet, I say “relatively” because there are some conceptual and definitional problems:

• Exceptional events such as a natural disasters or a war can drag down life expectancy numbers, but those events need not influence health in general or the quality of health care.
• Wealthy countries may have more deaths from car accidents than poorer countries, simply because they have more cars. This will pull their relative life expectancy down somewhat, given that younger people are more likely to die in car accidents. And if you use life expectancy to measure health you’ll get a smaller health gap compared to poorer countries than is the case in reality (at least if life expectancy is not corrected for this and if it’s not supplemented with other health indicators).
• How are miscarriages counted? If they are counted as child mortality, they drag down life expectancy rates compared to countries where they are not counted.
• What about countries that have more homicides? Or suicides? Although the latter should arguably count since suicides are often caused by bad mental health. If a country’s life expectancy rate is pulled down by high suicide rates, life expectancy rates are still a good indicator of health and of the quality of health care, assuming that health care can reduce suicide rates and remove, to some extent, the underlying health causes of suicide. However, homicides are different: a country with a very good health care system, a very high level of health and a high murder rate can have its health rating pulled down artificially when only life expectancy is used to measure health.
• Differences in diet and other types of risky behavior should also be excluded when comparing health and life expectancy across countries. It’s wellknown, for instance, that obesity is more of a problem in the U.S. than in many countries that are otherwise comparable to it. Obesity drags down life expectancy and reduces the average level of health, so life expectancy rates which are not corrected for obesity rates are still a good measure for health, but they are not a good measure for the quality of the U.S. health care system. If you want to use life expectancy rates to compare the quality of health care systems you’ll have to correct for obesity rates and perhaps for other types of risky behavior such as smoking or the absence of exercise. Maybe the U.S. health care system, even though it “produces” somewhat lower life expectancy rates than in comparable countries, is actually better than in other countries, yet still not good enough to offset the detrimental effects of high average obesity.

Hence, uncorrected life expectancy rates may not be such a good indicator of national health and of the quality of a national health care system. If we return to the case of the U.S., some of this may explain the strange fact that this country spends a lot more on health and yet has somewhat lower life expectancy rates than comparable countries.

Or maybe this discrepancy is caused by a combination of some misuse and waste at the spending side – more spending on health doesn’t necessarily result in better health – and some problems or peculiarities with the measurement of life expectancy. Let’s focus on the latter. As stated above, some cultural elements of American society, such as obesity, pull down life expectancy and worsen health outcomes. But there are other peculiarities that also pull down life expectancy, and that have nothing to do with health. I’m thinking of course of the relatively high levels of violence in the U.S. Death by assault is 5 to 10 times higher in the U.S. than in comparable countries (although those numbers tend to go down with the passing of time). This affects younger people more than older people, and when more young people die, life expectancy rates drop sharper than when more old people die.

However, even if you correct U.S. life expectancy rates for this, the rates don’t move up a lot (see here). The reason is that the numbers of deaths caused by homicide pale in comparison to other causes. Obesity levels, for instance, are a more important cause. But correcting life expectancy rates for obesity levels doesn’t seem appropriate, because we want to measure health. If you leave out all reasons for bad health from life expectancy statistics, your life expectancy rates go up, but your average health doesn’t. Obesity isn’t the same as homicide. Correcting life expectancy statistics for non-health related deaths such as homicide makes them a better indicator of health. Removing deaths from obesity doesn’t. If you have life expectancy rates without obesity, they may be a fairer judgment of the health care system but not a fairer judgment of health: a health care system in a country with a lot of obesity may be equally good as the one in another country and yet result in lower life expectancy. The former country does not necessarily have lower life expectancy because of its underperforming health care system – we assumed it’s of the same quality as elsewhere – but because of its culture of obesity.

However, if you really want to judge health care systems, you could argue that countries plagued by obesity should have a better quality system than other countries. They need a better quality system to fight the consequences of obesity and achieve similar life expectancy rates as other countries that don’t need to spend so much to fight obesity. So, life expectancy is then reinstituted as a good measure of health.

The Causes of Human Rights Violations (23): Unconscious Bias

No matter how egalitarian, unbiased and unprejudiced we claim to be and believe to be, underneath it all many of us are quite different.

If you ask people whether men and women should be paid the same for doing the same work, everyone says yes. But if you ask volunteers how much a storekeeper who runs a hardware store ought to earn and how much a storekeeper who sells antique china ought to earn, you will see that the work of the storekeeper whom volunteers unconsciously believe to be a man is valued more highly than the work of the storekeeper whom volunteers unconsciously assume is a woman. If you ask physicians whether all patients should be treated equally regardless of race, everyone says yes. But if you ask doctors how they will treat patients with chest pains who are named Michael Smith and Tyrone Smith, the doctors tend to be less aggressive in treating the patient with the black-sounding name. Such disparities in treatment are not predicted by the conscious attitudes that doctors profess, but by their unconscious attitudes—their hidden brains. (source)

And even if most of our actions are guided by our conscious beliefs, some will be caused by unconscious prejudice, in which case we’ll have identified a cause of discrimination, a cause that will be very hard to correct.

Discrimination (7): Statistical Discrimination v. Background Checks?

Employers often use background checks before deciding to hire someone. For example, they may check the criminal record of job candidates, their credit scores, health history etc. It’s somewhat understandable although not always acceptable that they are reluctant to hire someone who has been in jail, has been sick for a long time, or has proven to be undisciplined by not paying her bills.

Let’s focus on ex-convicts for the moment. These people have a hard time as it is, sometimes even for no good reason because they shouldn’t have been incarcerated in the first place (I argued here that many countries, and especially the U.S., put too many people in jail). So, allowing employers to use criminal background checks can force ex-convicts into a vicious circle: unable to find a job, they may be forced to go back to crime.

Furthermore, there’s a racial aspect to all of this: in the U.S., African Americans are more likely to be ex-convicts. According to some, this racial discrepancy is precisely the reason to allow criminal background checks. If employers aren’t allowed to check individual candidates, they will resort to statistical discrimination: they know that blacks are more likely to have a criminal record and so they won’t hire any blacks at all, just to be safe.

However, if you espouse this argument in favor of background checks, you essentially want to make things better for one disadvantaged group – blacks, who are generally disadvantaged in employment – by making things worse for an even more disadvantaged group, namely ex-convicts. And that’s assuming that employers will hire more black people if they can use criminal background checks; but assuming that means assuming there’s no racism. Helping a disadvantaged group by harming an even more disadvantaged group is plainly absurd, and you can only fail to see that it’s absurd if you have an overriding fear of government regulation. Regulation should be kept in check but not at any price. I think in this case regulating businesses and outlawing background checks is the appropriate thing to do.

Let’s turn briefly to another type of background check: credit scores.

[M]illions of Americans, as a direct consequence of looking for work, have lower credit scores. … The use of credit checks in employment decisions should be banned. It is a form of discrimination against the poor — the codification and enforcement of class barriers. It is therefore a form of discrimination against those groups more likely to be poor. (source)

It seems there’s a

growing tendency of HR departments to check the credit scores of potential employees apparently deeming this data to be an important predictor of employee behavior. This creates a Catch-22 scenario for the unemployed where you can’t improve your credit score unless you get a job and you can’t get a job until you improve your credit score. (source)

Apart from the obvious fact that credit scores seem to be a type of knowledge that is much less useful for an employer compared to a criminal record – if your house burned down and your credit score is low as a result, does that make you a bad employee? – there’s a real issue for the poor here. They shouldn’t be discriminated against just for being poor. It’s not just a lack of conscientiousness or discipline that can lower your credit score. Back luck and poverty won’t help either. Some say the free market and competition will take care of this: employers stupid enough not to hire good poor people simply because they have a credit problem will lose out. Their competitors who don’t engage in credit checks will hire them, and those businesses will acquire a commercial advantage. I don’t know. Seems awfully optimistic to me.

What is Poverty? (5): A Psychological Thing

Poverty is not just the absence of sufficient income or a level of consumption that is below a minimum threshold. Poverty is multidimensional: it also means bad health, high mortality rates, illiteracy etc. And these different elements of poverty tend to have a negative effect on each other (the so-called poverty trap). Being deprived of literacy or education is usually seen as an obstacle to material wellbeing.

The absence of material wellbeing – whether expressed in terms of income, consumption, health, mortality etc. – is often viewed as an isolated evil. However, it’s possible to make the case that it can also have psychological effects that harm people’s mental wellbeing. If this is true, and I think it is, then poverty does more harm than we usually think it does.

I believe it’s widely accepted that poverty does some psychological damage, such as stress, depression, loss of self-esteem and of the feeling of control, loss of ambition and aspirations etc. Although usually people assume – correctly or not – that this type of damage is less severe or less urgent than the physical damage that results from poverty (such as bad health, mortality, hunger etc.). Some even argue that there’s a tendency to overemphasize the link between material deprivation and (the perception of) subjective wellbeing, and that psychological problems which may seem to be caused by material deprivation have in fact other causes (genetics, upbringing, personality etc.).

However, I think the tendency is rather to underestimate the effects on mental wellbeing. A recognition of the psychological effects of poverty would also open the possibility of a more positive evaluation of notions such as poverty as vulnerability and relative poverty. Vulnerability, or a high level of risk of poverty, can perhaps produce the same amount of stress as actual poverty. And one’s self-esteem can suffer as much from actual deprivation (including illiteracy) as from comparative (or relative) deprivation (e.g. comparatively low levels of education or income).

The Ethics of Human Rights (36): A Human Right to Existence?

Can people have a right to exist? If there is such a right then it has to be distinguished from the right to life. In fact, what I’m talking about here is a right to be conceived and/or born, not a right to continue your life after you’re born.

The supposed right to exist is sometimes used to invalidate abortion, and indeed we should distinguish between two possible meanings of the right to exist: the right to exist of a fetus and the right to exist of a merely potential or possible human being (e.g. a human being as the potential child of parents considering conception). I personally would argue that neither a fetus nor a potential human being have a right to exist.

1. A fetus doesn’t have a right to exist in the sense in which we understand that right here, not because we are allowed to “terminate” it at will, but because it is already an existing human being (life for me starts at conception, which doesn’t mean that I rule out abortion completely). However, other people who are more willing to tolerate abortion often equate a fetus with a mere potential human being and for them the distinction I make here may seem to be irrelevant.
2. Potential human beings, as I understand them (see above), don’t have a right to exist either, in my opinion. If you want to argue the opposite, you would have to claim that all or most possible human beings (given some exceptions) should be born, and that’s physically and biologically impossible. All combinations of sperm and egg should then exist, but once a sperm fertilizes an egg it can’t fertilize another egg. Protecting the right to exist would also mean outlawing spontaneous abortions and male masturbation*, and that’s wildly counterintuitive. It would also mean a correlative obligation to procreate, which is also counterintuitive.

The Environment and Human Rights (4): A Right to Water

The United Nations General Assembly recently voted in favor of an international human right to water. It’s only appropriate that people have a right to the most basic resource. Only a few countries (e.g. South Africa) have already instituted this right. The recognition of this right of course doesn’t mean that the water crisis has magically disappeared. Like the right to free speech doesn’t mean that there’s no more censorship. The real work of bringing water to people who don’t have enough still needs to be done, and some serious thinking and debating is required. Opponents and proponents of privatization, of the introduction of a water market and of other possible policies (including the policy of setting water prices high enough to discourage waste and low enough to help the poor) will continue to disagree and it will have to be settled empirically which water policy provides the best access to all.

On the other hand, the water crisis seems to be abating:

some 5.9 billion people, or 87% of the world’s population, enjoyed access to drinking water from an “improved” source in 2008. In other words, those people had water piped to a dwelling, or got it from a public tap or a protected well. Back in 1990 only 77% of the world’s population enjoyed such a luxury. Yet in some parts of the world, notably in Africa, great improvements in water supply are still needed. Some 884m people are still not using an improved water source, more than a third of them in sub-Saharan Africa. Eastern Asia has seen the greatest recent progress: 89% of the population in that region now have access to an improved water source, up from just 69% in 1990. (source)

Economic Human Rights (34): The Cost of Human Rights, and of Economic Rights More Specifically

Human rights cost money. It’s often claimed that economic human rights aren’t really human rights because they are so expensive for many governments in the world that they can’t realistically impose duties: governments of poor countries can’t be expected to respect a duty to provide healthcare, housing, food, work etc. Ought implies can. You can’t be under an obligation if there’s no way you can honor that obligation. It’s claimed, therefore, that economic rights are mere aspirations rather than rights.

Yet, the same argument can be made about the supposedly more distinguished and respectable freedom rights. It’s strange, many countries in the world can’t manage to create the institutions and the governance to enforce freedom rights, simply because they don’t have the means (and sometimes the willingness), and yet this fact doesn’t make people think twice about the reality of freedom rights.

Providing effective and non-corrupt police forces and judiciaries is expensive. Probably just as expensive as providing a good public healthcare system. True, rights have to be enforceable, and duties shouldn’t be farcically unrealistic. But I fail to see the ontological difference here between freedom rights and economic rights.

We also shouldn’t overestimate the cost of economic rights. The purpose of these rights is not to have a government that gives healthcare, food, work etc. to every single citizen. That would destroy the economy. A system of economic rights will require that most people provide these goods for themselves through work and economic activity. It will also require that citizens show generosity and help each other. Economic rights also create duties for fellow-citizens. The government supplies the goods in the remaining cases, when self-help and mutual help are not enough.

As a result, the cost of economic rights isn’t as high as a cursory reading of these rights would imply. Conversely, the cost of freedom rights is often higher than one would conclude at first sight: true, these rights often require abstinence and forbearance (“don’t invade my privacy or inhibit my speech”) and that’s something cheap. But the enforcement and equal protection of those rights and the enforcement of forbearance requires an efficient government, which is expensive.

Something about another cost issue related to human rights, namely the relative cost of freedom and dictatorship, is here.

Why Do We Need Human Rights? (17): Freedom From Nature

From the beginning of human history, man has always tried to escape from natural necessity. Christianity views our earthly existence as a valley of tears and is generally hostile to nature, especially the nature within us. Genesis 1:26-27 states that man has been made to rule over nature, rather than the other way around. Philosophers also have long believed that the body is the prison of the mind, limiting the mind with its passions and natural needs.

Indeed, these needs are particularly powerful. We have to struggle continuously in order to preserve our biological organism, to feed the biological process of our body and to stay alive. During much of history and still today in many places in the world, this struggle has been a tough one and has left people without time or energy for anything else. But even the wealthy among us have to work to acquire the necessities of life, and this work has no end except death. And those very few who don’t have to work at all and can live off their capital, have to consume in order to survive. So even they are still tied to natural necessity. Necessity is always there, it’s just its weight that differs from person to person.

The current level of scientific, technological and economic development, resulting from centuries of intellectual progress, makes it possible for many of us to mimic the rentiers, to introduce some moments of leisure in between sessions of work and to focus on something else besides mere survival. Moreover, it has eliminated many harmful types of work or softened the harmful consequences of work. Division of labor has allowed us to gain efficiency through specialization and serialization so that each of us doesn’t have to produce all goods necessary for consumption by ourselves. However, no matter how technologically advanced and economically efficient we are, our needs always reaffirm themselves and we regularly have to give up leisure and return to work and consumption. Some of us have to return to work more rapidly than others, depending on the use our society can make of the available technologies.

Nature is an eternal necessity, imposed on human and animals alike. During our entire existence, nature imposes certain very powerful and compelling needs on us, which we have to fulfill over and over again if we want to stay alive. By producing and consuming we serve nature and nature rules over us. This submission to nature is part of the human condition. Working is a kind of metabolism between man and nature, an eternal, repetitive circle prescribed by nature and biology, a circle of need, labor, production, consumption and then need again. The activities that are necessary in order to stay alive cannot be executed once and for all. Except for birth and death, there is no beginning or end. We always have to go back to work. Men daily remake their own life, in the words of Marx. And the fact that this is easy for some of us doesn’t change the fact that it is necessary.

This perpetual struggle to respond to the biological necessities of our bodies can be painful and a limit on our freedom. It can be tough in itself and when it is, it also limits our capacity to do other things. Nature is a yoke and a burden and we try to get rid of it or at least to soften it and to make it less painful through technology, cooperation etc. Indeed, it seems that we have managed to improve our production methods to such an extent that a certain level of freedom from nature has become possible, at least for those of us lucky enough to live in parts of the world where the use of this technology is affordable. The lucky ones stopped suffering the pain of toil and became able to do other things.

However, as long as we are biological beings – and even the luckiest among us still are – we will never be able to free ourselves completely from natural necessity and labor. All we can do is control it and soften it, make the yoke a bit less heavy and painful, and thereby dedicate ourselves to something “higher”, such as culture, science etc. We can put effort in the production of more durable goods, such as art, cities, homes and machines, some of which we can then use to achieve even more freedom from nature. We no longer have to enslave other people or oppress them, although we still do for other reasons. Other people do not have to carry our yoke together with their own. Slaves, the human instruments (slaves were called “instrumentum vocale”), can be replaced by mechanical and electronic instruments.

The relative ease of modern labor for some of us should not make us forget that we always remain natural beings bound by natural necessity. Necessity of the bearable kind is still necessity. Our artificial world is always situated on earth and in nature, and we will probably always remain natural beings. And I don’t believe genetic modification, nanotechnology, space travel or biotechnology will fundamentally change this. No matter how comfortable our lives are, we always run the risk of a sudden relapse into a tougher kind of natural necessity. And you don’t need an apocalyptic imagination to understand this; sickness, unemployment, a natural disaster or a producers’ strike will suffice. We may think we are free but small events can throw us back into full-fledged necessity.

So even the situation of the luckiest among us is potentially precarious. Nevertheless, on average human naturality has been substantially eroded during the last centuries, and this has often been described as progress, not without reason. Some even go further and claim that this progress in our mastery of natural necessity has contributed to the progress of humanity as a whole because life is supposed to become less oppressive and violent when poverty and natural necessity retreat to the background. Natural necessity indeed causes strife, conflict over scarce resources, slavery, corruption etc. but things are probably much more complicated that this and so it is fair to say that one should be careful with generalizations about the progress of humanity.

One of the perhaps most depressing aspects of life in nature is the impossibility the create memory. It was Hannah Arendt who stressed that life in nature creates survival, if we are lucky, and even decent and comfortable survival, if we are very lucky, but not anything else. The products needed for survival can hardly be called creations because they don’t last. Obviously there can only be memory when something lasts. The permanence of the activity of labor is in strange contrast with the ephemeral nature of the things produced by this activity. The only thing that remains after the activity is done, is life itself. The products of the activity are destroyed by consumption (or decay if they aren’t consumed). The laboring person leaves nothing behind. This ephemeral nature or work (Arendt actually distinguished between “labor” and “work” but I’ll keep that for another time) is an insult to our craving for something permanent and durable, for history, posterity and memory.

That is why, in its struggle against nature, humanity does not only use technology or economic efficiency. It also uses culture. The word “culture” comes from the Latin verb “colere” of which “cultus” is a conjugation. “Colere” means to cultivate, to preserve, to maintain, to care etc. Culture, therefore, initially meant the use of nature, of the earth and of the instruments and technologies appropriate for this use (“to cultivate”). But culture has quickly acquired another, metaphorical sense in which it not only means the cultivation, maintenance and care of nature as a weapon in the struggle against necessity, but also the construction and preservation of durable things that run counter to the cyclical and ephemeral processes of nature, things that are not consumed and do not immediately disappear after being used because they are cared for (care is part of the meaning of culture). Hence the association between culture and art, art being the most durable of human activity (at least it used to be). Culture in the sense of durable human production means production of memory, and hence, derivatively, the cultivation of the mind on the basis of memory (study, schooling etc.).

Our durable world is a world of cultural products that do not need to be consumed. Contrary to the products of the economy, they do not have to be destroyed in order to fulfill their function. On the contrary, they exist because they have to last. And because they last they bestow durability and memory on the world. They are used and cared for rather than consumed, and often they are even useless. As such, they are another step in our liberation from nature, together with but in a way very different from science, technology and economic efficiency.

What’s the relevance of all this for human rights? An obvious and unoriginal point is that human rights need science and technology. In very primitive and prehistoric societies – with the possible exception of those few idyllic and probably imaginary societies where people didn’t have to work and could just pick the fruits from the trees – many human rights were irrelevant in the sense that they couldn’t even arise as an issue: what’s the point of free speech when you’re neck-deep in the struggle for survival? Only rights such as the right to life, to physical security and a few others could even make sense in such societies because the prerequisite for other human rights – leisure for example – simply did not exist. And even these basic rights couldn’t be conceptualized because the people who would have to do the conceptualizing simply didn’t have the time for it.

Another, perhaps more original point is that human rights don’t only require science and the technological applications of science, but culture as well. Cultural products, such as a Constitution – a highly “cultivated” durable product – and permanent government institutions are also prerequisite for human rights. Societies that have neither a scientific mastery of nature, nor a cultural mastery, can’t be rights based societies: they can’t be because they can’t protect human rights, and they can’t protect them because they are inconceivable to them.

This is related to the distinction between negative and positive definitions of human rights. Rights can be viewed as negative, which means that they merely require omissions or forbearance. Given the discussion above, it’s clear that this view is incomplete. Under a negative conception of human rights, a meaningful enjoyment of these rights is frustrated by inadequacies in the scientific and cultural mastery of nature. (I deliberately ignore the ecological dimension of human rights; I’ll talk about that problem another time). In other words, rather than saying that people have a specific human right, we should perhaps say that they have a right to access the means necessary for the enjoyment of that right.

Discrimination (5): Statistical Discrimination

Definition

Here’s the New Palgrave Dictionary of Economics definition of statistical discrimination:

Statistical discrimination is a theory of inequality between demographic groups based on stereotypes that do not arise from prejudice or racial and gender bias. When rational, information-seeking decision makers use aggregate group characteristics, such as group averages, to evaluate individual personal characteristics, individuals belonging to different groups may be treated differently even if they share identical observable characteristics in every other aspect. … group-level statistics, such as group averages, are used as a proxy for the individual variables. (source)

Statistical discrimination, also called rational prejudice (or rational racism), occurs when some stereotypes are considered to be statistically “accurate”. Accurate here in the sense of statistical generalization or average behavior (or characteristics).

Some examples

Young drivers are on average more likely to be involved in traffic accidents. Hence, auto insurers impose higher auto insurance premiums on young people. This insurance discrimination is called statistical discrimination because it’s based on some level of accuracy regarding the stereotype, and not on plain prejudice of or disgust for young people.

Regarding life insurance premiums, the customer’s likelihood of dying is one of the most relevant variables affecting the insurers profitability. Since gender is highly correlated with life expectancy, it is therefore optimal for the company to adopt a policy setting higher premiums for men, even for those men who may be healthier and less risk prone than the average woman. (source)

Employers often use the average performance of an applicant’s group to determine whether to hire him or her.

You don’t hire a guy with a Mohawk as a receptionist at a law firm – even if he promises to get a hair cut. Why not? Because on average, … guys with Mohawks have trouble with authority. (source)

Similarly, people with facial tattoos are unlikely to be hired as CEO’s, perhaps because they signal an anarchic, counter-cultural, contrarian, nonconformist, bohemian and “wandering” attitude.

Why?

The reason people engage in statistical discrimination is the high cost of making case-by-case judgments and the relative accuracy of group averages. Given that it’s not a product of bigotry, irrational prejudice, hatred and dislike, is it correct to call it discrimination? It is in the sense that people judge other people simply on the basis of group membership, not individual merit, as in “regular”, “irrational” discrimination or prejudice. Yet it’s not discrimination because people engaging in statistical discrimination often don’t do so because of their dislike or hatred of the discriminated group but because of economic self-interest and risk avoidance, as is shown by the examples above. The stereotypes are not baseless as most stereotypes are (“Blacks are lazy”, “Jews are money hungry”, “women are only productive at home” etc.).

This discrimination is “statistical” because contrary to normal prejudice it acknowledges that a relatively large number of members of a group do not conform to the stereotype. Just as it isn’t irrational to claim that it’s statistically accurate that republicans in general are pro-life while at the same time knowing that many aren’t. “Irrational” prejudice doesn’t have so much tolerance for exceptions. “People see others as average members of their groups until proven otherwise”. (source)

Is it acceptable?

So we know what it is and why people do it, but is it morally and legally acceptable? I think it depends on the type.

While such discrimination is legal in some cases (e.g., insurance markets), it is illegal and/or controversial in others (e.g., racial profiling). (source)

The difference between acceptable and unacceptable statistical discrimination hinges on several facts, I think:

1. How accurate are the group generalizations? You can forgive profit-seeking insurers for imposing higher auto insurance premiums on young people. However, wage gaps between genders resulting from theories about lower productivity of women (said to result from higher female investment in child rearing and a focus on “caring jobs” as opposed to jobs that tend to pay well) are less acceptable because the generalization is more dubious and the category of “women” too broad. Generalizations may be more accurate when they are not about behavior but about more “technical” and less controversial things such as life expectancy.

2. What is the “weight of history”? Statistical discrimination of blacks or women is by definition less acceptable than statistical discrimination of young people, given the history (maybe that’s a stereotype about discrimination…). Differentiated treatment, even if it isn’t really discrimination, can still cause harm given a certain history. The harm can be feelings of insecurity regarding a possible repetition of the past, feelings of continued attacks on self-esteem etc.

3. What are the consequences of statistical discrimination? Paying a slightly higher insurance premium is a lesser harm than being pulled over by the police a few times a week because of your skin color, even if your skin color is a statistically “accurate” prediction of the probability that you engage in crime in your neighborhood.

4. To what extent is statistical discrimination self-fulfilling? To some extent it clearly is.

People think teen-age males are criminally inclined (and they are), this angers the teen-age males, leading them to commit more crimes. (source).

If everyone assumes that boys are not good at domestic work, the benefit of learning domestic work is zero because no one will hire you as a domestic worker. In some areas, this self-fulfilling process is obviously harmful, and hence statistical discrimination is harmful as well.

It is possible that, because employers are less likely to hire women in jobs that require labour market attachment, then women are more likely to be involved in child-rearing than men, and are less prone to acquire the skills that are necessary to seek and perform well in those jobs, confirming the asymmetric belief that employers hold regarding labour market attachment. (source)

This phenomenon is called the stereotype threat. On the other hand, there can be self-reversing prophesies at work as well. A-typical members of a group, who of course suffer from the prejudice in the same way as typical members, may incite the latter to change their behavior. E.g. responsible young drivers who pay too much insurance because of the typical behavior of their fellow group members, may pressure the latter to change their ways. In this way, statistical discrimination may work to undermine itself. The same result will occur because a non-typical member of a group may get relatively more exposure. A woman who’s relatively good at soccer – compared to other women – but just as good as an average male soccer player, may get more attention than the latter. This excess of attention may undermine the stereotype on female soccer players.

The Ethics of Human Rights (30): Organ Donation and Presumed Consent

Health and survival are human rights. Many people’s health and survival depend on organ transplants. However, there are more people requiring organs than people donating them. Hence, the question of how to increase organ availability, which I have discussed many times before on this blog (see here for instance). My favorite policy is presumed consent : if people during their lifetime don’t explicitly opt-out and deny the use of their organs after death, it is assumed that they consent to this use. There’s evidence that presumed consent raises donation rates by perhaps 20-30%.

However, presumed consent may perhaps not be enough to eliminate the shortage. And although it may solve part of the problem, it may also create some problems. Some people might feel uneasy when the state can automatically decide what happens to their bodies or to the bodies of their loved ones after death. The public might also start to wonder whether surgeons would become too eager to harvest organs, stop life support somewhat early and move the border between life and death (the definition of the moment one dies isn’t an unchanging variable throughout human history). But that’s also a problem with opt-in systems.

Another problem with presumed consent, but also other types of cadaveric donation such as opt-in, is the constraint imposed by the number of people who die in a way that makes their organs available for transplant.

Does all this mean we have to abandon cadaveric donations in general and presumed consent in particular? And rush towards a free market in organs for the living? That could perhaps eliminate the shortage completely, at least for those able to buy the organs and on the condition that there are enough desperate souls “willing” to sell. The latter is of course a condition that’s easily met when we allow international free trade – many places in the world are vast resources of desperateness.

(If you doubt the risk of free trade pushing desperate people to sell their organs, look at Iran. Most donors in Iran are extremely poor. Maybe you think it’s good that poor people have options to do something about their poverty. I agree, but I prefer that they have other options and aren’t forced to commodify themselves, especially when this commodification entails health risks).

I don’t think free organ trade of live donations is a good idea, given the problems with that option outlined here. (Although I might be persuaded by the argument that prohibition of a widespread activity is always futile and a regulated market a lesser evil; e.g., one could offer tax credits for live donations). There’s still a lot of elasticity in presumed consent and the few problems it raises can be solved, in my opinion. The horror story of doctors switching off life support and plundering bodies is precisely that, a story. Countries that are reluctant to implement presumed consent because of such reasons can be convinced, I think, especially given the success of other countries that have it.

Even in countries that have presumed consent and that have therefore increased organ availability, things can be improved. The rights of relatives to veto could be restricted. (Personally, if I would have made the conscious choice of opting in or of not opting out, I wouldn’t be comfortable with the possibility that my relatives have the right to disrespect my will after death). In addition, the transplant system (logistics, transport, availability, procurement etc.) could be made more effective, including in countries that decide to stick with opt in.

Beyond presumed consent of cadaveric donation, live donation of certain organs could be encouraged (though preferably not through market systems). Countries that don’t want to go to presumed consent could make it more likely for people to opt in in a system of cadaveric donation: Israel for example allows opt-in donors and their families to jump the waiting line for transplants when they should need an organ themselves. That’s an interesting idea, but it could throw up some other problems. Also, technology could come to our aid; perhaps in some time we can make organs from stem cells.

Measuring Poverty (7): Different Types of Poverty

I already mentioned the obvious but consequential fact that poverty measurement depends on the choice of the type of poverty you want to measure. Definitional issues are always important, but when it comes to poverty the choice of a definition of poverty determines who will benefit from government benefits and who won’t. For example, in the U.S. you’re poor when you’re income is below a certain poverty line. If that’s the case, you’re eligible for certain benefits. So poverty is a function of income.

1. Insufficient income

Usually, and not only in the U.S., poverty is indeed understood as insufficient income (preferably post-tax and post-benefits). Measuring poverty in this case means

1. determining a sufficient level of income (sufficient for a decent human life); this is usually called a “poverty line” or “poverty rate”
2. measuring actual income
3. counting the number of people who have less income than the sufficient level.

There are some problems with this measurement system or this choice of type of poverty. Actual income levels are notoriously difficult to measure. People have a lot of informal income which they will not disclose to people doing a survey. Likewise, there is tax evasion and income in kind (market based or from government benefits, e.g. social housing), and material or immaterial support by local social networks. None of this is included correctly if at all in income measurement, leading to an overestimate of poverty. Another disadvantage of income based measurements: they neglect people’s ability to borrow or to draw from savings in periods of lower income. Again, this overestimates poverty (although one could say that it just estimates it a bit too early, since borrowing and eating up savings can lead to future poverty).

2. Insufficient consumption

Because of these problems, some countries define poverty, not by income levels, but by consumption levels. Measuring poverty in this case means

1. determining a sufficient level of consumption (sufficient for a decent human life)
2. measuring actual consumption
3. counting the number of people who consume less than the sufficient level.

However, this measurement isn’t without problems either. As is the case for income levels, actual consumption levels are difficult to measure. How much do people actually consume? And what does it mean “to consume”? Is it calorie intake? Is it financial expenses? Or something else perhaps? Consumption levels are also deceiving: people tend to smooth their consumption over time, even more so than their income. If they face a financial crisis because of unemployment, bad health, drought etc. they will sell some of their assets (their house for instance) or take a loan. If you determine whether someone is poor on the basis of consumption levels, you won’t consider people dealing with a crisis as being poor because they continue to consume at the same levels. However, because of loans or the sale of assets, they are likely to face poverty in the future. They may also shift their diet away to low quality food, taking in the same amount of calories but risking their health and hence their future income. Similarly, they may be forced by their crisis situation to delay health expenditures in order to smooth consumption, with the same long term results.

And even if you manage somehow to measure consumption, you’re still faced with the problem of the threshold of sufficient consumption: that’s hard to determine as well. Consumption needs differ from person to person, depending on age, gender, occupation, climate etc.

3. Direct physical measures of real consumption

Rather than trying to measure total income or consumption, you can choose to measure consumption of certain specific physical items, and combine that with some easy to measure elements of standard of living, such as child mortality or education levels. It’s possible to argue that poverty isn’t an insufficient level of overall income or consumption, but instead the absence of certain specific consumption articles. People are poor if they don’t have a bicycle or a car, a solid floor, a phone etc. Or when their children die, can’t go to school or are undernourished. These items or indicators are relatively easy to measure (for example, there’s the Demographic and Health Survey). While they may not tell us a lot about relative living standards in developed countries (where few children die from preventable diseases for instance), they do provide poverty indicators in developing countries.

The OECD has done a lot of good work on this. They call it “measuring material deprivation“. It’s the same assumption: there are certain consumer goods and certain elements of living standard that are universally considered important elements of a decent life. The OECD tries to measure ownership of these goods or occurrence of these elements, and when people report several types of deprivation at the same time, they are considered to be poor.

Take note that we’re not talking about monetary measures here, contrary to income and overall levels of consumption. Sometimes, all that has to be measured is a “yes” or a “no”. Which of course makes it easier.

Unfortunately, not easy enough. This type of poverty measurement has its own drawbacks. Measures of material deprivation often fail to distinguish between real deprivation and the results of personal choices and lifestyles. Some people can’t have a decent life without a car or a solid floor; others voluntarily choose not to have those goods. It’s likely that only the former are “poor”. Furthermore, since these measurements are often based on surveys, there are some survey related problems. The really poor may be systematically excluded from the survey because we can’t find them (e.g. the homeless). These surveys measure self-reported poverty, and self-reported poverty can be affected by low aspirations or habit. People may also be ashamed about their poverty and hence not report it correctly.

Conclusion

There isn’t a perfect system for poverty measurement. And that has a lot to do with the fact that poverty is an inherently vague concept. It really shouldn’t be a surprise that people choose different definitions and types, and hence different measurement methods that all provide different data. There’s no “correct” definition of poverty, and hence no correct poverty measure.

More posts in this series on the difficulties of poverty measurement.

What is Democracy? (51): Representatives as Actors and Authors

Sorry for this very long post, but I think this is important. During the discussions about healthcare reform in the U.S., opponents frequently mentioned the unpopularity of the proposed Bill (although now, after the Bill has been accepted and turned into law, it seems that its popularity has gone up). I don’t wish to engage in a discussion about the accuracy of the opinion polls that measure the popularity of healthcare reform (it’s obvious that extremely negative political propaganda has played a role, as well as lack of knowledge about the actual proposals).

What I want to do here is look at the deeper discussion about the problems arising from a representative body voting laws that are unpopular (or seem to be). One of the more eloquent dismissals of unpopular legislation, especially the healthcare legislation, comes from Megan McArdle:

Are we now in a world where there is absolutely no recourse to the tyranny of the majority? Republicans and other opponents of the bill did their job on this; they persuaded the country that they didn’t want this bill. And that mattered basically not at all. If you don’t find that terrifying, let me suggest that you are a Democrat who has not yet contemplated what Republicans might do under similar circumstances. Farewell, Social Security! Au revoir, Medicare! … Oh, wait–suddenly it doesn’t seem quite fair that Republicans could just ignore the will of their constituents that way, does it? … What I hope is that the Democrats take a beating at the ballot box and rethink their contempt for those mouth-breathing illiterates in the electorate. (source)

Apart from the fact that we usually mean something else by “tyranny of the majority” (i.e. majority approved and popular decisions violating the rights of minorities), she and others like her seem to have a valid point, but only at first glance. While I don’t believe that they advocate getting rid of the whole notion of elections and just leave decisions up to opinion polls, they certainly want to give opinion polls much greater weight and turn them into some sort of check on parliamentary majorities (however, it’s not clear how that is supposed to work).

I want to argue against this. It’s true that a democracy is all about electing leaders who are supposed to execute the will of the people by way of laws and policies (if we sidestep the important issue of direct participation). The people don’t vote laws and don’t decide and pursue policies themselves. They decide what can and cannot be viewed as the will of the people, but then they give someone else the power to execute this will in their name and to frame the laws and policies necessary for the execution of this will.

That’s because it’s practically very difficult to allow all people to participate in all decisions. In a representative system, the people can influence the laws and the policies of the government only indirectly. They elect those representatives who they think are likely to vote laws and implement policies in accordance with their wishes, and if, afterwards, the people find out that they elected the wrong representatives, they replace them. The desire to hold on to power, forces the representatives to act in accordance with the wishes of the people.

This means that representatives do not necessarily follow their own personal judgment or their own conscience. The people instruct them and tell them, in a general way perhaps, what kinds of laws or policies to implement, or at least they tell them which values should be promoted by laws and policies. In all their actions, the representatives must never forget whence they came, who elected them and for what reason. They are the servants of the people whom they represent and whose wishes they are supposed to realize with the help of laws and policies. If their own wishes and opinions collide with those of the people, then they should either set them aside or resign from their posts.

In other words, representatives are actors and not authors. The people are the authors and the representatives act out the words of the authors instead of their own words (although of course their own words may coincide with those of the people). This guarantees the congruence of power and society. The political actors speak and act the words owned by those whom they represent (the authors) and, if necessary, leave their own personality behind while doing their work. Their official personality must be the sum of the opinions of the electors who, for this reason, recognize themselves in the representatives. The representatives act with authority (a word related to the word “author”) and are likely to remain in office as long as this recognition lasts and as long as the representatives act in the way they were authorized to do. The difference between rulers and ruled is hereby eliminated, notwithstanding the fact that the representatives and the represented are not the same persons. They are not the same persons but they share the same personality (notice also the etymological origin of the word “person”, namely a mask worn by actors). Not only the election results, but also the laws and the government policies must be the reflection of the will of the people. Representatives do not only have authority on the basis of an election result, but also on the basis of their performance in office.

All that would vindicate the position of McArdle and other opponents of the healthcare bill. However, things are not as simple as this. Representation is more than just a convenient tool for self-government in large communities. It has certain other advantages.

[L]imitation to a small and chosen body of citizens … [is] to serve as the great purifier of both interest and opinion, to guard ‘against the confusion of a multitude'”. Hannah Arendt in On Revolution.

It’s not always easy for a representative to know what the people think, if they think something at all. It often happens that a representative guides, purifies or clarifies the thoughts of the people by presenting his own thoughts in a clear and concise way. At the next election, the people are of course free to express acceptance or rejection of these thoughts and to vote for or against the person defending them.

So it’s clear that the definition of the representative as an actor is a simplification. Representatives should be more than mere errand boys faithfully executing the will of their masters and speaking, not with their own voice, but with the voice of the voters. They are more than robots or parrots doing deeds and saying words that are not their own. Of course, a representative of the people “re-presents” someone, makes someone else present in parliament or in an executive function. He plays a part. He represents something that is pre-existent.

However, this is not always the case. What is represented often arises after and through the act of representation. By presenting his ideas in a clear and convincing way, the representative can convince the people to adopt his ideas. He can also try to add a certain clarity, direction, consistency and unity to the opinions of the voters. In the case of contradicting desires for example, he can establish a certain priority and favor one desire while putting another one temporarily aside. He decides an issue in the name of the undecided electorate torn between two conflicting desires (for example employment and limiting the arms trade) and defends this decision by giving clear arguments to the voters.

At the next election, the voters can always disavow the choices of the representatives, but then at least they are forced to decide what is their point of view, to make up their minds, to focus on one of their conflicting views and to end an internal conflict.

Politics should not always focus on every wish or follow every erratic movement in the opinions of the people. It should also try to guide these wishes by offering and forcing a clear choice. This means that it’s quite all right for a representative to follow his own judgment now and then instead of simply saying what his electors instructed him to say. This kind of independence is of course limited. It cannot be applied to fundamental opinions. For example, a representative chosen on a ticket of anti-racism cannot express racist ideas or execute racist policies while in office.

The simple model of democracy—the people making up their minds beforehand and choosing representatives who will faithfully implement their opinions—is sometimes a simplification of reality. The politician is often the midwife of the truth of society, in the words of Guéhenno, and shapes the will of the people. Politicians necessarily take over characteristics of the people and start to resemble the people, otherwise they cannot represent the people and the people will never support the politicians. However, the opposite is also true. The people often start to resemble the politicians because the politicians clarify the sometimes vague and contradictory opinions of the people.

If the representatives were only allowed to follow the instructions of the electorate, then the affairs of parliament would be no more than an exercise in arithmetic, a sum of opinions. Representatives in parliament could not and should not discuss, deliberate and convince each other. If a representative changes his opinions as a consequence of discussion and argumentation in parliament—and this happens very often, because otherwise discussion and argumentation would be useless—then his opinions are no longer those that won him the election and he no longer represents the people who elected him. If representatives must follow the instructions of the electorate in every case, then parliament cannot be a place where different opinions are juxtaposed and discussed and where people try to come to a common opinion based on argumentation rather than the coincidence of identical opinions.

Parliament is not a congress of ambassadors from different and hostile interests, which interests each must maintain, as an agent and advocate, against other agents and advocates; but Parliament is a deliberative assembly of one nation, with one interest, that of the whole—where not local purposes, not local prejudices, ought to guide, but the general good, resulting from the general reason of the whole. Edmund Burke

More posts in this blog series.

Gender Discrimination (22): Gendercide

The Economist has a front page story this week on “gendercide”, the millions of girls missing in the world, especially in India and China. Perhaps as many as 100 million girls have disappeared in the last decades because of

• selective abortions encouraged by new medical technology (ultrasounds and fertility technology)
• childhood neglect of girls (nutritional, educational neglect and neglect in health care)
• prejudice, preference for male offspring and
• population policies such as the “one child policy” in China.

Interestingly, the skewed sex ratios that result from gendercide (in some areas of China, 130 boys are being born for every 100 girls) are coming back to haunt the men that are responsible (although many mothers probably aren’t without fault either). Because of their relative scarcity, women have found an unlikely source of power. They have a competitive advantage in the marriage market, and can demand more in marriage negotiations, or at least be more selective when choosing a mate.

Causes

In my view, the word “gendercide” is somewhat overwrought because, contrary to genocide, the word that inspired the neologism of gendercide, there’s no centralized plan to exterminate women. Femicide would be a better term since it’s obviously only one of two genders that’s targeted, but it still sounds like a government organized campaign of extermination. Gendercide is the result of a combination of causes:

• individual choices based on
• plain prejudice against girls
• cultural and legal traditions, or
• economic incentives that have been formed by historical prejudice.

Perhaps girls still need a dowry, and poor parents may find it difficult to save enough and hence prefer a boy. Or perhaps they prefer a boy because the law of their country or tribe – inspired by age-old prejudice – says that only boys can inherit land or the family business. Again, the parents may prefer a boy for this reason, not because they dislike girls. Or perhaps tradition holds that girls marry off into their husbands families, and parents simply want to be sure to have someone in their home to care for them when they are old (“raising a daughter is like watering your neighbor’s garden”, is a Hindu saying).

Consequences

The consequences of gendercide are mixed. It’s obviously horrible to the girls that are aborted or neglected to death. But, as in the “boomerang” case cited above, gendercide may ultimately empower women. However, the skewed sex ratios also spell trouble: the presence of armies of men who can’t find wives and have children (“bare branches” or “guanggun” they are called in China) may result in more sexual violence, depression, suicide, human trafficking etc. It’s estimated that in 10 years time, one in five young Chinese men won’t be able to find a bride. On the other hand, a shortage of women will encourage immigration, and immigration may help some women escape poverty, and perhaps will also result in more intercultural tolerance.

Solutions

Economic development won’t stop it. In China and India, the regions with the worst sex ratios are wealthy ones, with educated populations. Even in some population strata in the U.S. sex ratios are skewed. When people escape poverty, fertility rates drop, and when families have fewer children, the need to select for sex only becomes more important in order to realize their son preference. In poor societies with high fertility rates, families are almost destined to have a boy at some point. Female children will suffer relative neglect and may die more often and more rapidly (skewing the sex ratios), but selective abortions aren’t much of a risk: families don’t really feel the need to limit the number of children (on the contrary often, because children are a workforce), and ultrasound technology for sex determination of fetuses isn’t as readily available as in rich countries or regions. When families want few children – as they do in more developed regions – or are forced by the government to limit their number of children (as in China), they will abort female fetuses in pursuit of a son.

Ultimately, only a cultural change will help. The son preference has to die out. Education probably will help, as it always does. Ending pernicious policies such as the one child policy will also help, but then overpopulation hysterics will have to be dealt with. This policy didn’t help stop population growth anyway. Other East Asian countries reduced population pressure as much as China without brutal policies.

Old customs and discriminating laws should also be abolished. Think of the dowry system, or inheritance rights. Stigmatizing abortion, especially sex selective abortion, will also help.

Measuring Poverty (5): The Mystery of the Feminization of Poverty

Some have called it a baseless claim: 70% of the world’s poor are women. This is a number that seems to have come from nowhere yet it has taken on a life of its own. The reason is probably that it has some intuitive appeal. Theoretically, the claim that being female places someone at a greater risk of being poor is convincing. Gender discrimination – which is a deceptively neutral term meaning discrimination of one gender only – is a widespread problem and it’s highly probable that women who suffer discrimination are more likely to be poor and to remain poor. They

• receive less education
• receive lower wages
• cannot freely choose their jobs in some countries
• have less inheritance rights than men in some countries
• perform the bulk of the household tasks making it relatively hard to accumulate income
• are responsible for the household income (men are often culturally allowed to escape into leisure and get away from the burdens of poverty)
• suffer disproportionately from some types of violence
• and face very specific health risks related to procreation.

All these problems faced by women who suffer discrimination make it more likely that they are relatively more burdened by poverty, compared to men who usually don’t suffer these types of discrimination.

Moreover, when young women begin to enjoy better education and employment we often see that the discriminatory features of the family structures and patriarchal systems in which they live make fresh appeals to their newly found human capital. As a result, their improved capabilities only serve to push them more into poverty. Poverty, after all, isn’t merely a question of sufficient income and capabilities, but is also determined by the availability of choice, opportunities and leisure.

So it’s obvious that men and women are poor for different reasons, and that some of the reasons that make women poor make them relatively more poor compared to men.

This is the intuitive case, but it appears that it’s very difficult to back this up with hard numbers. The “70%” claim is unlikely to be correct, but if we agree that discrimination skews the distribution, then how much? And how much of it is compensated by factors that skew the distribution towards male poverty (e.g. male participation in wars). The problem is that poverty data are usually available only for households in aggregate and aren’t broken down by individuals, sex, age etc. So it’s currently impossible to say: “this household is poor, and the female parent/child is more poor than the male parent/child”. In addition, even in households that aren’t poor according to standard measures, the women inside these households may well be poor. Women is non-poor households may be unable to access the household’s income or wealth because of discrimination.

Given the problems of the current poverty measurement system, I think it’s utopian to expect improvements in the system that will allow us to adequately measure female poverty and test the hypothesis of the feminization of poverty.

Types of Human Rights Violations (4): Boomerang Human Rights Violations

We usually see human rights violations are zero-sum: a rights violation is a harm inflicted by one person on another, for the benefit of the former. I mentioned before that this isn’t always the correct way of viewing rights violations, but it’s adequate in most cases. One case in which it’s only superficially adequate is what I would call the boomerang human rights violation: you think that violating someone’s rights may produce some benefit for you, and it does so initially, but the actual and final results mean that you become worse off. There’s the obvious and uninteresting example of the dictator using extreme oppression and causing revolt, but here are some other, more intriguing examples. The first one has to do with the right to work.

Gene Marks is … a small business owner (he sells customer relationship management tools), who is attempting to speak to other small business owners, all of whom, presumably, are also delighted that the potential hiring pool is so chock full of talent desperate to be exploited right now. But one wonders who exactly is supposed to purchase all those products and services from the small businesses of the world, if unemployment creeps up to the 10 percent mark or higher? High unemployment means low consumer demand. Which usually means small businesses end up going out of business, or at the very least, laying off more employees, who push the unemployment rate even higher. And so on. (source)

If, as a “capitalist” (i.e. employer), you want to take advantage of unemployment – or the risk of unemployment – to put downward pressure on wages and workers benefits – and thereby violate workers’ rights (a fair wage is a human right, as are favorable working conditions) – you’ll end up shooting yourself in the foot because neither hard working laborers who don’t earn a lot nor the unemployed will consume many of your products or services. I can see the appeal of the statement that generous unemployment benefits discourage people from finding a job, but such benefits do have advantages that go beyond the mere self-interest of the direct beneficiaries.

An ideal policy … would allow people to collect unemployment insurance indefinitely, and let the unemployed borrow or save money. This way, unemployment insurance would not merely be a financial band-aid letting people take risks on the job market and endure some jobless spells, but a critical source of “liquidity,” allowing the unemployed to keep spending reasonable amounts of money — which in turn helps create demand, something sorely lacking from the economy at the moment. (source)

And here’s another example, related to gender discrimination. In many countries, there’s a son preference: male offspring is considered more valuable than female offspring, for reasons to do with gender discrimination and social, cultural or religious views regarding the proper role of women in society. One of the consequences is the “missing girls” phenomenon. The sex ratios in many countries – India and China stand out – are out of balance. Some estimates say that 90 million women are “missing” worldwide. In somewhat overwrought rhetoric this is called gendercide. Girls are often aborted in selective abortions (a one child policy can make this even more widespread), and young girls are often prejudiced against when it comes to nutrition and health care resulting in higher mortality rates. The son preference and the missing girls phenomenon have their roots mainly in cultural beliefs, but economic considerations also play a role. Some professions are open only to men; girls marry “into” other families and hence can’t continue the family business; there’s the dowry problem etc. However, these economic considerations don’t stand on their own and are often the result of discriminatory cultural beliefs. When we accept that gender discrimination and the will to sustain patriarchy is the cause of the son preference and the missing girls phenomenon, then we are dealing with a human rights violation. And also this rights violation can come back to haunt those responsible for it.

A societal preference for boys here has become an unlikely source of power for Indian women. The abortion of female fetuses in favor of sons — an illegal but widespread practice — means there are more eligible bachelors than potential brides, allowing women and their parents to be more selective when arranging a match. (source)

Rather than cementing patriarchy, the son preference and the resulting unbalanced sex ratios give women more bargaining power. These and other boomerang rights violations are variants of what I’ve called self-inflicted rights violations: people violate other people’s rights, and in so doing they ultimately violate their own rights.

Racism (10): Race and Health

African Americans in the U.S. are more likely to die of cancer. It seems that a similar disparity exists for strokes and lead poisoning.

Many ethnic groups have a higher death rate from stroke than non-Hispanic whites. Although the death rate from stroke nationwide dropped 70% between 1950 and 1996, minorities the decline was greatest in non-Hispanic whites. The greatest number of stroke deaths compared to whites occurred in African-Americans and Asians/Pacific Islanders. Excess deaths among racial/ethnic groups could be a result of a greater frequency of stroke risk factors, including obesity, hypertension, physical inactivity, poor nutrition, diabetes, smoking and socioeconomic factors such as lack of health insurance. (source)

Lead poisoning causes, i.a., cognitive delay, hyperactivity, and antisocial behavior.

The Causes of Poverty (30): Lack of Economic Growth

When a country achieves a certain level of economic growth – or, more precisely, rising levels of GDP per capita because economic growth as such can be the result of rising population levels – it is assumed that this reflects a higher average standard of living for its citizens. Economic growth is therefore seen as an important tool in the struggle against poverty. If a country is richer in general, the population will also be richer on average. On average meaning that GDP growth isn’t necessarily equally distributed over every member of the population. That is why GDP growth isn’t sufficient proof of poverty reduction. Separate measurements of poverty and inequality are necessary.

So in theory, you can have GDP growth and increasing levels of poverty, on the condition that GDP growth is concentrated in the hands of a few. However, that’s generally not the case. GDP growth benefits to some extent many of the poor as well as the wealthy, which is shown by the strong correlation between poverty reduction and levels of GDP growth (always per capita of course). It’s no coincidence that a country such as China, which has seen strong GDP growth over the last decades, is also a country that has managed to reduce poverty levels substantially.

Unfortunately, growth isn’t a silver bullet. Poverty is a complex problem, requiring many types of solutions. Promoting economic growth will do a lot of the work, but something more is required. In a new paper, Martin Ravaillon gives the example of China, Brazil and India. The levels of poverty reduction in these three countries, although impressive, do not simply mirror the levels of economic growth. Although half of the world’s poor live in these three countries, in the last 25 years China has reduced its poverty level from 84% of the population in 1981 to just 16% in 2005. China is exceptional, but Brazil also did well, cutting its rate in half over the same period (8% of Brazilians still live on less than $1.25 a day). Regarding India, there are some problems with its statistics, but whichever statistic you use, there’s a clear reduction.

Ravaillon points out that the intensity of poverty reduction was higher in Brazil than in India and China, despite lower GDP growth rates.

Per unit of growth, Brazil reduced its proportional poverty rate five times more than China or India did. How did it do so well? The main explanation has to do with inequality. This (as measured by the Gini index, also marked on the chart) has fallen sharply in Brazil since 1993, while it has soared in China and risen in India. Greater inequality dampens the poverty-reducing effect of growth. (source)

Which is rather obvious: lower levels of income equality means a better distribution of the benefits of growth. So the “pro-growth strategy” against poverty is important but not enough, and should be combined with Brazilian type anti-inequality measures (focus on education, healthcare and redistribution).

Gender Discrimination (21): The Politics of the Body

The politics of the body, or “body politics”, is a concept, originally used by early feminists I believe, to describe government policies or laws and cultural or social practices used by society to regulate and control the human body. Feminists focus on the female body but the case can be made that society controls both the female and the male body, obviously not always in the same way. The concept is also used to describe the opposite: the struggle against the social and political powers that try to control the body and the act of reclaiming bodily self-control, or corporal self-determination. Body politics has therefore a positive and a negative meaning: it’s both subordination and emancipation.

Corporal self-determination is obviously an important value. People should, in general, be able to do with their body what they want, free from interference by the state, by individuals or by groups in society.

Here are some examples of body politics:

Abortion

Whether or not you believe that abortion should be allowed, you have to accept that legal prohibition and moral dissuasion of abortion are examples of body politics. In both cases, women who want an abortion lose their power to decide autonomously what to do with their bodies; society imposes rules on what individuals are allowed to do with their bodies; and power – legal or moral – is used to enforce these rules. You may believe that these rules are necessary in order to protect an overriding value that trumps the value of self-determination, in this case probably the value of the life of the unborn infant, or perhaps even the right to self-determination of the unborn infant. But you can’t dispute that you engage in body politics.

Organ trade

Similarly, legislation or social taboos prohibiting the free trade of organs (see also here) impose restrictions on the things people can do with their bodies. However, the analogy with abortion isn’t perfect, because proponents of restrictions can arguably claim that the sale of organs isn’t an expression of self-determination but of the lack of it: it’s typically poor people who are driven to the extreme of organ sale as a means to stay alive, while the richer you are the easier it is to get an abortion. Organ sale is then not an expression of the freedom to do with your body what you like, without paternalistic interference, but an expression of necessity and lack of freedom. Whatever the merits of this argument, restrictions on organ trade are clearly an example of body politics.

Capital punishment, corporal punishment, imprisonment

The state uses power in order to enforce or enact criminal punishment, and this is often power directed against the body of the convicted criminal and eliminating the criminal’s corporal self-determination. There’s also the quasi-institutional practice of prison rape.

Sex trafficking and slavery, sexual violence, arranged marriages

Cultural norms regarding the acceptability of sexual violence (e.g. rape as a form of punishment and female genital mutilation), of arranged marriages (which can be labeled a form of sexual violence), of the sale of children or wives for the purpose of prostitution are also examples of body politics. The women and children in question obviously lose their corporal self-determination.

Gender discrimination

Gender discrimination, the inferior treatment of women, and the imposition of gender roles, whether legally sanctioned or not, are other examples, although with a twist. Gender discrimination can remove the power of corporal self-determination of the women who fall victim to it – e.g. in the case of gender discrimination as expressed in sexual violence or in rules restricting the freedom of movement of women. But it doesn’t have to. For example, gender discrimination in wages (the wage gap) doesn’t affect corporal self-determination.

The body politics inherent in gender discrimination is more evident in the origins of discrimination than in the results. Gender roles, which often result in gender discrimination, are based on certain convictions regarding the physical inferiority of women (e.g. their lack of physical strength), or on the belief that the female body is made for specific tasks, and is perhaps even better than the male body for these tasks.

Likewise, rules that discriminate against women and restrict the things they can do, are generally based on dubious theories regarding the nature of the female body. Women are said to promote carnal lust, and their equal participation in life would have disrupting and destructive consequences.

Homophobia

Similarly, legislation or social taboos against homosexual relationships remove corporal self-determination and are based on certain beliefs about the nature of the human body.

Clearly, this isn’t a complete list of all possible cases of body politics, but it can serve the purpose of illustration (other examples could include rules prohibiting interracial marriage, bestiality taboos, legislation against assisted suicide etc.). What is also clear is that every case isn’t equally detrimental for self-determination. Some cases can even be justifiable from a liberal perspective. Self-determination, after all, isn’t the only value, and neither is it a value that necessarily trumps other values.

The Causes of Poverty (29): Overview

Our research shows that if you want to avoid poverty and join the middle class in the United States, you need to complete high school (at a minimum), work full time and marry before you have children. If you do all three, your chances of being poor fall from 12 percent to 2 percent, and your chances of joining the middle class or above rise from 56 to 74 percent. (We define middle class as having an income of at least $50,000 a year for a family of three). Isabel V. Sawhill and Ron Haskins (source, source)

However, that seems to be a bit reductionist. There are many other possible causes of poverty. Some more convincing than others. For example, here’s Montesquieu according to whom people in hot places are simply too lazy to become rich:

In Europe there is a kind of balance between the southern and northern nations. The first have every convenience of life, and few of its wants: the last have many wants, and few conveniences. To one nature has given much, and demands but little; to the other she has given but little, and demands a great deal. The equilibrium is maintained by the laziness of the southern nations, and by the industry and activity which she has given to those in the north. (source)

According to Thomas Malthus, poverty is caused by overpopulation. Food and other resources are limited, and a population growth that exceeds a certain pace will inevitably hit a resource ceiling, and will result in decreasing standards of living, poverty, conflict over scarce resources, famine etc.

Max Weber believed that protestant work ethic put protestant nations at an advantage compared to other nations. Certain values, such as the opinion that God will reward those who work hard and save money, or the belief in predestination—getting rich is a sign of God’s approval—make some nations rich and others, that lack these values, poor.

Jeffrey Sachs focuses on geography and weather. In the poorest parts of the world, the soil is nutrient-starved, making it difficult to produce food. Moreover, tropical climates foment disease, particularly malaria. The UK, on the other hand, the country where the Industrial Revolution started, has a fertile soil, a lot of coal, and good waterways.

Daron Acemoglu states that nations are not like children — they are not born rich or poor. Their governments make them that way.

People need incentives to invest and prosper; they need to know that if they work hard, they can make money and actually keep that money. And the key to ensuring those incentives is sound institutions — the rule of law and security and a governing system that offers opportunities to achieve and innovate. … if you wish to fix institutions, you have to fix governments. [People should be able to] enjoy law and order and dependable government services — they can go about their daily activities and jobs without fear for their life or safety or property rights. (source)

There are obviously many more explanations of poverty, both “exotic” and sensible ones. And regarding the latter, it’s extremely difficult to say which ones are more important. Poverty is surely one of the most complex and intractable problems facing humanity. However, if we look at the country that has been most successful in the reduction of poverty – China – then the last quote above seems to be the most convincing one. China still has institutional and legal weaknesses today, but it did start to develop only after it abandoned the follies of the Cultural revolution and communist rule in general, and started to protect property rights and build its government institutions. Which doesn’t mean that institutions are a “silver bullet” solution to the problem of poverty. There’s no such thing, unfortunately.

The Causes of Wealth Inequality (3): Marital Homogamy and Declining Manufacturing & Unionization

Part of the increase [in inequality during the last decades, particularly in the U.S. and the U.K.] stems from declining manufacturing employment, part from shrinking unionization and fragmenting collective bargaining, part from heightened immigration and other aspects of globalization, and part from technological change. … [A]nother source of the rise in inequality: changes in household size and composition. Due to later marriage and more prevalent divorce, more and more households have just one adult, and hence only one potential earner. At the same time, coupling between people with similar education and thus similar earnings potential (“marital homogamy”) has increased, and the share of highly educated women who are employed continues to rise. The result of these developments is that many countries have more two-adult households with high earnings and more one- or two-adult households with low earnings than used to be the case. Lane Kenworthy (source)

The Ethics of Human Rights (25): Free Organ Trade and the Commodification of the Body

The case for allowing free organ trade seems like a no-brainer. Many countries, including the U.S., now forbid the sale and purchase of most organs, and, as a consequence, sick people die because of organ shortages, and poor people stay poor because they can’t “monetize” their organs. Poor people suffer a “double injustice”:

[We say] to a poor person: “You can’t have what most other people have and we are not going to let you do what you want to have those things”. (source, source)

However, when organs are freely tradable, many extremely poor people, especially those struggling to survive, will be tempted and even forced to sells parts of their bodies. Moreover, the rich will be able to benefit disproportionately from the market because prices will be high, given that demand will outstrip supply in an ageing society. The most obvious means to balance supply and demand, and to force down prices and allow the less than wealthy patients to participate in and benefit from the market, is to create a global market without trade restrictions, an organ-GATT if you want. This will bring in the masses of poor people from Africa and Asia, pushing up supply of organs and hence bringing down prices. This will supposedly benefit both the less than wealthy patients and the very poor donors. The latter will benefit even with prices for organs falling because of increased supply, because they start at extremely low levels of income. Even the sale of a cheap kidney can mean years of income for them.

The problem with this global market is that organ extraction will take place in sub-optimal medical conditions, creating risks for donors (if you can still call them that), also in the case of renewable tissue donation. Paradoxically, the poor are driven to risk their lives in the process of saving their lives. Even in the best healthcare systems in the world, organ extraction is often very risky. In the U.S., the extraction of a section of the liver, for example, carries a risk to the donor’s life of almost 1 percent (source). That’s not negligible. I doubt anyone would cross a street if that were the odds of getting hit by a car.

I’m convinced that an opt-out regulation for cadaveric donors (meaning that everyone’s a donor after death unless an explicit opt-out), combined with non-financial encouragement of voluntary pre-death donation, is the best way to solve the organ shortage problem. A free organ market will obviously also solve the organ shortage problem, but will create new problems instead.

The distinction between renewable tissue such as bone marrow, and non-renewable organs such as kidneys, eyes, etc. is a relevant one. If the donation of renewable tissue can take place in medically safe conditions, I can’t see a problem with being allowed to trade, on the condition that poor patients have the same opportunity and power to buy as rich ones (and that’s a pretty big “if”). The needs of the sick or disabled who risk dying or suffering because of a lack of available organ, clearly outweigh any remaining concerns.

One of those remaining concerns is the problem of the commodification of the body. Organ trade is obviously commodification, and commodification is dehumanization. I don’t want to imply that organ trade liberalization necessarily results in “organ farms”, dystopian places where people are “cultivated” solely for the harvesting of their organs – although the Chinese criminal justice and capital punishment system for instance comes awfully close. (I sometimes wonder if deterrent and punishment is the real goal of executions in China). But people can commodify and dehumanize themselves. And although we should normally respect people’s self-regarding choices, what looks like a choice may not always be a true choices.

The logic of economics tends to overtake all other domains of life, even those where it doesn’t belong and can do serious harm. Why is it so evident to so many that body parts are something that it supposed to be tradable? Even the most outspoken proponents of organ trade draw the line somewhere: they won’t allow people to sell parts of their brains, I guess, or their children and wives, or the parts of aborted fetuses (perhaps fetuses specially conceived and “harvested” for their parts), not even if this would fill a great social need. And yet they accept as natural that non-vital body parts should be tradable and seem to forget that irreplaceable body parts form our body and that we can hardly exist without our body. If we allow total freedom of organ trade, we will have to accept the case in which a poor father decides to sell off every single one of his organs for the survival of his family. After all, he is the master of his own body, he has a right to self-determination, and the government has no right to limit what masters of their own bodies should be allowed to do with it. If you don’t accept the legitimacy of this extreme case, you accept limitations on the freedom to trade organs. Since most opponents of organ trade also accept certain types of trade – e.g. renewable organs such as bone marrow and skin – the disagreement isn’t a principled one but one about degree.

Underlying the argument in favor of organ trade is the fiction of a market populated by free, equal and self-determining individuals who make free and rational economic decisions and agreements on what to sell and buy, free from government interference. The reality is of course that organ trade isn’t an expression of self-determination or autonomy but rather of the absence of it. And that organ trade, just like a lot of other trade, is radically asymmetrical: some are forced to sell in order to survive, especially if the price and hence the reward is very high, as it will be relatively speaking for the poor. And others will sell without rationally examining the benefits for or risks to their interests (absence of informed consent). It’s beyond my powers of comprehension that all this can be denied:

It’s true that I don’t find any of the arguments about the coercive effects of money on peoples’ decisions particularly compelling.  Megan McArdle (source)

Any potential paid organ donor is always free to decline the transaction, and is left no worse off than before. What next, will you tell me that I “coerced” Apple into sending me a Macbook? (source)

This seems to me to be more correct, or at least less outrageous:

Talk of individual rights and autonomy is hollow if those with no options must “choose” to sell their organs to purchase life’s basic necessities. … Choice requires information, options and some degree of freedom. (source)

Of course, some would say: if someone is forced by poverty to sell her organs, would you stop her and make her worse off by imposing legal restrictions on her autonomy and “reducing her resources”? That’s again the myth that markets always make things better. What if she does get some money, has a better life in the short run, but gets sick because of the operation (or do we also assume the myth of perfect healthcare for the world’s poor?) or because of the lack of an organ? Who would make her worse off? The one allowing her to sell, or the one stopping her? And anyway, there are better ways to protect the poor than to allow them to harvest their organs.

So, if we’re afraid that free organ trade might be exploitative for the poor, why not allow free trade but exclude the poor from selling? Because the poor will be, in general, the only ones tempted to sell. A wealthy person has no incentive to sell organs. Hence a free trade system restricted in this way will not solve the shortage problem, the main concern of proponents of free trade.

I’ve stated before that government interference can promote rather than restrict freedom. In the case of organ trade and donation, two specific types of interference can help:

• Restricting the freedom to trade non-renewable organs, as well as renewable organs in circumstances in which extraction poses a health risk to donors, will protect the freedom of the poor. Not their freedom to sell organs obviously – which isn’t freedom for them anyway but compulsion – but the freedom to live a healthy live.
• Imposing default cadaveric donation with an opt-out clause will protect the freedom to live a healthy live of patients in need of replacement organs. Of course, if it’s the case that for some organs cadaveric donation isn’t possible medically, I’m willing to accept an exception.

How about allowing people to sell their organs after death? This would evidently remove the health risks for donors. It could be considered a kind of life insurance for the deceased’s family. That would indeed remove all the concerns from the donor side. (The counter-argument that such a system would encourage families to kill their members for the “insurance money” seems a bit weak, and just as weak as the similar counter-argument against generalized organ trade liberalization, namely that people would murder in order to sell organs; I guess they already do).

But assume that we would allow free post-mortem trade: what would happen with the organs? They would be sold of course, but to whom? The most wealthy first, and hence we still have our problem on the beneficiary side: wealth yields better health. Of course, that’s already the case in healthcare in general: rich people also have better dental care etc. But do we want to add to the existing injustice by allowing wealth to determine who gets an organ?

If we allow limited organ trade of deceased’s organs, we’ll have to do something on the beneficiary side in order to neutralize the effects of wealth. A lottery system could be an option. Or subsidies for the poor, or price caps etc.

Lies, Damned Lies, and Statistics (22): Objects in Statistics May Appear Bigger Than They Are

From a news report some weeks ago:

French Finance Minister Christine Lagarde Thursday voiced her support for France Telecom’s chief executive, who is coming under increased pressure from French unions and opposition politicians over a recent spate of suicides at the company.

Ms. Lagarde summoned France Telecom CEO Didier Lombard to a meeting after the telecommunications company confirmed earlier this week that one of its employees had committed suicide. It was the 24th suicide at the company in 18 months.

In a statement released after the meeting, Ms. Lagarde said she had “full confidence” that Mr. Lombard could get the company through “this difficult and painful moment.”

The French state, which owns a 27% stake in France Telecom, has been keeping a close eye on the company, following complaints by unions that a continuing restructuring plan at the company is putting workers under undue stress.

The suicide rate among the company’s 100,000 employees is in line with France’s national average. Still, unions say that the relocation of staff to different branches of the company around France has added pressure onto employees and their families.

On Tuesday, a spokesman for France’s opposition Socialist Party called for France Telecom’s top management to take responsibility for the suicides and step down. Several hundred France Telecom workers also took to the streets to protest against working conditions.

In the statement released after Thursday’s meeting, France’s Finance Ministry said Mr. Lombard had set up an emergency hotline aimed at providing help to depressed workers. The company has also increased the number of psychologists available to staffers, according to the statement. (source)

More on the problems caused by averages is here.

The Compatibility of Freedom and Equality (8): Liberty = Freedom From the State + Freedom From Social Pressure + Equality of Opportunity

Libertarians traditionally adopt a negative kind of freedom, and, more precisely, limited negative freedom: they believe that individuals should be free from interference by the government. They seldom accept that individuals can be coerced by private and social constructs, such as tradition, the family, gender roles, cultural racism etc. Here’s a rather long but exceptionally well-written quote that makes this point:

I am disturbed by an inverse form of state worship I encounter among my fellow [libertarian] skeptics of government power. This is the belief that the only liberty worth caring about is liberty reclaimed from the state; that social pathologies such as patriarchy and nationalism are not the proper concerns of the individualist; that the fight for freedom stops where the reach of government ends. … [L]ibertarians for whom individualism is important cannot avoid discussions of culture, conformism, and social structure. Not every threat to liberty is backed by a government gun. … [W]hen a libertarian claims that his philosophy has no cultural content — has nothing to say, for instance, about society’s acceptance of gays and lesbians — he is engaging in a kind of cultural politics that welcomes the paternalism of the mob while balking at that of the state. …

To take a very basic example, at mid-century 5.5 percent of Americans entering medical school happened to have female bodies. This number may well have reflected women’s limited interest in pursuing medicine as a career. But that level of interest also reflected a particular view of women in positions of authority, a certain range of social spaces that girls could imagine themselves inhabiting. Norms that positioned women as wives and mothers obviously functioned as constraints on identity formation. None of this has much to do with limited government, but it has everything to do with individuals struggling to assert themselves against a collective. …

Libertarians will agree that laws requiring racial segregation and prohibiting victimless, though controversial, sexual practices are contrary to their creed. But if the constraints on freedom of association suddenly become social rather than bureaucratic [or legal] — if the neighborhood decides it does not want black residents, or the extended family decides it cannot tolerate gay sons — we do not experience a net expansion of freedom. Kerry Howley (source)

In other words, libertarians are stuck in the first part of the following equation:

Liberty = Freedom From the State + Freedom From Social Pressure + Equality of Opportunity

But there is also a tendency to go no further than the second part. Many accept that society can restrict the freedom of individuals, but don’t grant the same powers to inequality of opportunity. As I stated in two previous posts (here and here), it makes sense to view freedom more positively as the possession of resources and capabilities that are necessary to make a really free choice between alternatives and opportunities. The freedom of those without certain resources and capabilities (such as education, health and a basic income) is futile because they can’t exercise their freedom, not because they are actively interfered with by the state or by their social environment, but because they can’t choose between opportunities. Someone who’s left alone by her government, and who isn’t pressured by her family, tradition or society, may still lack freedom because she doesn’t have a basic income or education necessary to make choices and realize these choices. Amartya Sen has pioneered this view. Hence the importance of helping people to develop their capabilities, e.g. anti-poverty programs, investments in education and healthcare etc. Of course, it’s precisely such programs that often horrify libertarians…

All this is of course a gross simplification, but if you wanted to explain human political ideology to Martians, that’s probably how you could start:

• Libertarians focus on freedom against the state; freedom against social pressure isn’t very interesting or at least not a priority; equalizing opportunities, resources and capabilities is harmful because it empowers the state and violates property rights.
• Conservatives agree with libertarians on the first and last part of the equation, but preserve the right to use social pressure to impose their – often Christian – ideology (e.g. same-sex marriage), sometimes even with the help of the state (in which case the freedom from the state isn’t important anymore).
• Liberals think all three parts of the equation are important but sometimes struggle to find the right balance. So-called “big spending liberals” may accept a large state apparatus.
• Socialists focus on the last two parts, often at the expense of the first. State intervention is believed to be highly beneficial, without substantial risks to individual freedom.

The Causes of Poverty (26): Hereditary Poverty, Another Poverty Trap

For you always have the poor with you, and whenever you wish you can do good to them; but you do not always have Me. Mark 14:7

For the poor will never cease to be in the land; therefore I command you, saying, “You shall freely open your hand to your brother, to your needy and poor in your land”. Deuteronomy 15:11

As a result of having parents who are poor, children

• receive substandard education because they enroll in substandard schools (if at all)
• may be forced to quit school early and start working
• do not receive quality healthcare (because of the costs)
• are more likely to be obese, with negative consequences for their health
• have a lower birth weight, something which also has a negative impact on health.

Growing up in poor families has negative effects on children’s education and health, and these effects in turn make it more likely that these children grow up to become poor as well. And their children will go through the same process, and so on. Hence the concept of hereditary poverty.

Just a few more words on the effect of substandard education. The quality of schools (or better the cost of good schools) and the element of child labor aren’t the only factors limiting the education levels of children in poor families. An interesting article in The Economist points to effects discovered by neuroscience. It seems that stress, induced by poverty, lowers memory capacity, and this lowered memory capacity makes it more difficult to learn and to obtain a good education as a means to escape poverty traps. It’s been well known for a while that stress lowers memory capacity (it reduces the volume of the prefrontal cortex and the hippocampus, parts of the brain associated with memory). However, Evans and Schamberg (see the paper here) showed that stress caused by poverty reduces memory capacity. First they showed that poverty is correlated with higher stress, and then that higher stress is correlated with lower memory capacity. Comparisons of the memory capacities of poor and middle class people showed indeed a difference in memory capacity, and this is caused by poverty induced stress rather than other elements of poverty. Poverty causes stress, which reduces memory, which in turn makes it harder to learn, which in turn makes it more difficult to escape a poverty trap. How does poverty cause stress? Well, there’s the obvious cause: financial insecurity. But low self-esteem caused by poverty (including for children in poor families) also seems to contribute. See this paper for instance.

The poor indeed will always be with us. At least if we don’t help them to get out of the traps in which they find themselves.

The Causes of Poverty (25): The Matthew Effect

The Matthew Effect – a concept invented by sociologist Robert K. Merton – is based on the following extract of the Gospel of Matthew:

For to all those who have, more will be given, and they will have an abundance; but from those who have nothing, even what they have will be taken away.

This statement is intuitively convincing. Those who already have economic resources can use these to acquire even more of them, often if not by definition at the expense of those who don’t have them. It’s easy to see how wealthy people have better information to use their wealth in such a way that they can increase it. How they know the right people, how they can use the education system to their advantage (and to the advantage of their offspring), how they can use the political system to their advantage etc. Conversely, poor people are often stuck in a poverty trap: their poverty makes them sick, and their sickness even more poor; their poverty makes it hard to access education, and their lack of education makes them more poor etc.

You can see at once how this is relevant to the issue of human rights. While income or wealth inequality as such isn’t a human rights violation, it does have implications for human rights. And poverty is a human rights violation. But the Matthew Effect can be observed in other human rights as well. Take for instance the wiretapping that is used in the war on terror. Initially, wiretapping is targeted towards individuals who are suspected of plotting an attack. However, it seems inevitable that those who are authorized to use wiretapping expand the field of their authority. Instead of targeted wiretapping, they go on fishing expeditions: throwing out the nets as wide as possible and see which fishes end up in it. They start to use data-mining, for instance, checking private information of entire populations in order to filter out suspect individuals.

Another example of the Matthew Effect in human rights can be found in hate speech laws. The laws may initially impose limits on the freedom of speech that crack down on cases of hate speech that may cause violence and riots. However, once certain exceptions on the freedom of speech are legal and legitimate, the boundaries may move towards more restrictions. Maybe speech that doesn’t pose an imminent threat of violence but perhaps a longterm threat to the stability of a multicultural society – such as derogatory speech, or blasphemous speech – should also be prohibited. And then you may find yourself on a slippery slope.

I can also mention what I called “searchlight human rights violations” (see this previous post): for example, a certain level of sexual violence against women in a particular society, can teach young men a certain culture, mentality and value system that automatically leads to a wider use of violence.

However, I don’t believe things are as simple as this. While the Matthew Effect is certainly a force that is driving human rights violations, I don’t think there is anything inevitable or mechanical about it. There are other forces at play as well, and some of them go in the other direction. If that wouldn’t be the case, then the Matthew Effect would have landed us in a place where respect for human rights is non-existent, and would have done so a long time ago.

Regarding the particular case of wealth inequality, a simple application of the Matthew Effect would require a vision of the world with limited resources. And although some – important – resources are indeed limited, others – equally important ones – are not. It’s not because one person receives a good education, that another one must receive less education. And when one person accumulates riches, this can benefit others (his or her employees for example).

Lies, Damned Lies, and Statistics (12): Generalization

An example from Greg Mankiw’s blog:

Should we [the U.S.] envy European healthcare? Gary Becker says the answer is no:

“A recent excellent unpublished study by Samuel Preston and Jessica Ho of the University of Pennsylvania compare mortality rates for breast and prostate cancer. These are two of the most common and deadly forms of cancer – in the United States prostate cancer is the second leading cause of male cancer deaths, and breast cancer is the leading cause of female cancer deaths. These forms of cancer also appear to be less sensitive to known attributes of diet and other kinds of non-medical behavior than are lung cancer and many other cancers. [Health effects of diet and behavior should be excluded when comparing the quality of healthcare across countries. FS]

These authors show that the fraction of men receiving a PSA test, which is a test developed about 25 years ago to detect the presence of prostate cancer, is far higher in the US than in Sweden, France, and other countries that are usually said to have better health delivery systems. Similarly, the fraction of women receiving a mammogram, a test developed about 30 years ago to detect breast cancer, is also much higher in the US. The US also more aggressively treats both these (and other) cancers with surgery, radiation, and chemotherapy than do other countries.

Preston and Hu show that this more aggressive detection and treatment were apparently effective in producing a better bottom line since death rates from breast and prostate cancer declined during the past 20 [years] by much more in the US than in 15 comparison countries of Europe and Japan.” (source)

Even if all this is true, how on earth can you assume that a healthcare system is better because it is more successful in treating two (2!) diseases?

Another example: the website of the National Alert Registry for sexual offenders used to post a few “quick facts”. One of them said:

“The chance that your child will become a victim of a sexual offender is 1 in 3 for girls… Source: The National Center for Victims of Crime“.

Someone took the trouble of actually checking this source, and found that it said:

Twenty-nine percent [i.e. approx. 1 in 3] of female rape victims in America were younger than eleven when they were raped.

One in three rape victims is a young girl, but you can’t generalize from that by saying that one in three young girls will be the victim of rape. Perhaps they will be, but you can’t know that from these data. Like you can’t conclude from the way the U.S. deals with two diseases that it “shouldn’t envy European healthcare”. Perhaps it shouldn’t, but more general data on life expectancy says it should.

These are two examples of induction or inductive reasoning, sometimes called inductive logic, a reasoning which formulates laws based on limited observations of recurring phenomenal patterns. Induction is employed, for example, in using specific propositions such as:

This door is made of wood.

to infer general propositions such as:

All doors are made of wood. (source)

More posts in this series.

The Environment and Human Rights (3): Water and Human Rights

We obviously need water to survive, and no human rights without survival. Inadequate water supplies also cause diseases, violating our right to health. We need water – and clean water – to drink, but also to eat. Or rather, to produce our food. And we need a lot. People drink on average just a few liters a day, but they consume thousands of liters a day if we count the water required to produce their food. And evidently we should count it. Many areas of the world face already now face water shortages. A fifth of the world’s population already lives in areas short of water. A global water crisis waits around the corner, and one likely consequence is famine, another human rights violation.

If we want to do something about the water crisis, we should be aware of the effect of food production on water shortages. Especially the production of meat requires huge amounts of water, compared to the production of grains or even rice. People in the West eat a lot a meat, and therefore contribute substantially to water shortages. As incomes in the developing world increase, people there will consume more meat. Hence, global water consumption will also increase. Combine this future increase with the fact that there are already shortages and that these shortages will get worse with global warming, desertification etc., and you get a real crisis.

What are the solutions? Or how can we prevent things from getting worse?

• Jokingly we could ask people to become vegetarians. That would also be better for greenhouse gas emissions, by the way.
• More realistically: food production, and especially agriculture and farming, represent 70% of global water consumption. That number could be cut down significantly with better irrigation; “more crop per drop”. There’s incredible waste going on there. 70% of irrigation water is lost in the process. One reason: farmers rarely pay their water bills at market prices, hence no incentives to cut waste. Unfortunately, pricing water at market prices would drive up food prices, pushing many consumers into poverty. And many poor farmers already can’t pay for expensive irrigation systems. More expensive water surely wouldn’t help them. Moreover, market prices may mean the privatization of water, and that’s dangerous. You might as well privatize oxygen.
• Other solutions: cut waste in households and industries. Here, everyone can help. Also more recycling efforts are needed. Desalination, although expensive, is an option. As are better water storage facilities, especially for poor families in developing countries. All these efforts will not only reduce the risk of a major global water crisis, but will also improve crop yields, thereby reducing the price of food and hence the risk of poverty and famine.

Types of Human Rights Violations (3): Lighthouse Violations and Searchlight Violations

I think it may be helpful to distinguish two types of human rights violations. Or, to be more precise: two types of effects of human rights violations, because many violations will show characteristics of the two types. I’ll call the two types “lighthouse violations” and “searchlight violations”. To clarify these weird sounding names, I have an example.

In the UK, about 85.000 women were raped in 2006. In the US, during the same year, 92.455 rapes were reported. Real numbers are much higher, of course, because there are many unreported cases. In South Africa, one in four men admits to having raped someone. One in 8 more than once. Rape, as well as other types of violence against women (but not only women), is obviously a wide-spread social practice and not merely acts of sick individuals.

As with any case of widespread rights violations, one can understand this in two ways. One can believe that these violations are what I call lighthouse rights violations. In our example, the very fact that rape is a widespread phenomenon makes women aware of the dangers and forces them to adapt their behavior so that they limit the risks. (I talked about human rights and risk here). So the optimist view would be that there are certain automatic restrictions operating in order to limit the number of human rights violations.

The other, more pessimist view, would call widespread human rights violations searchlight violations. If we take the same example, the widespread occurrence of rape can give (certain) men the impression that the practice is normal and acceptable. As a result, the practice becomes even more widespread. Moreover, the practice not only benefits those men who actively engage in it, but men in general because it creates uneven gender relationships, female subjugation, inferiority complexes in women etc. Hence, also women who are not directly victimized by rape tend to be harmed by the practice. Rape shapes cultures, mentalities, gender roles etc.

This is of course a “glass half full or half empty” thing. Rape is both a lighthouse and a searchlight human rights violation. However, I think the more optimist view is probably more correct. If not, we would have to see ever increasing numbers of rights violations, which isn’t the case (at least that’s the intuitive conclusion; human rights measurement is still not a very sophisticated field of research).

Economic Human Rights (28): The Health Consequences of the Recession and of Unemployment

The Economist called it the “unsurprising research finding of the day“, but I think it’s a useful confirmation of an existing intuition: this paper finds that the recession can have a beneficial effect on the health of some people who lose their job because of it, namely those people spending their new leisure time in a healthy way. Other people, however, spend their leisure time cultivating some of their pre-existing unhealthy habits, or find themselves depressed and without employer-provided healthcare (especially in the U.S.). Because their healthcare has become more expensive now that they are unemployed, they decide to go without treatment or tests.

Results showed the body mass of the average laid-off food-lover increasing by the equivalent of more than 7 pounds for a 5-foot, 10-inch man weighing 180 pounds during unemployment. Similarly, frequent drinkers on average doubled their daily alcohol intake after losing their jobs and before finding another one. (source)

Elsewhere in the world, and especially sub-Saharan Africa, it seems that the health consequences of the global recession are more dramatic:

The financial crisis will kill between 28,000 and 50,000 babies in sub-Saharan Africa this year, according to this paper. The reasoning here is straightforward. For people on subsistence incomes, a fall in GDP can be fatal. The paper’s authors, Jed Friedman and Norbert Schady, estimate that a one percentage point fall in per GDP across sub-Saharan Africa is associated with a rise in infant (defined as under-ones) mortality of between 0.34 and 0.62 per 1000. If we multiply this increase by the number of births this year and by the 2.4 percentage point difference between GDP growth this year and last (a reasonableish estimate of the effect of the crisis), we get a figure of between 28,000 and 50,000. … Of course, you can quibble with the numbers. But the general story holds. For the poor, income is a matter of life or death. Which brings me to my question. If one-in-seventeen British babies were to die this year because of the financial crisis, it would be the biggest media story for years and there’d be rioting in the streets until the government did something. So, why the silence? Chris Dillow (source)