Water struggles and contested use: A capabilities assessment of household water security in marginalized communities

In this study, we apply a capabilities approach to analyze a water consolidation project and water security outcomes following a severe drought in East Porterville, California. By combining hydro-social theory with the capabilities approach, we provide a holistic approach to household water security that is historically situated, considers residents' needs, and accounts for areas of life beyond hydration and domestic use. In addition, we offer a critical analysis of water system consolidation, a process of combining water systems physically and/or managerially as a solution to water insecurity in small towns. Drawing on interviews with residents, local experts, and government officials as well as archival research and participant observation, we find that the water consolidation project has mixed results for the East Porterville community, with beneficial, limiting, and contested effects on residents' social, cultural, and economic life. Although residents now have a consistent source of water in their homes, they find themselves limited in their ability to use water for drinking and cultural and economic purposes. Water negotiations and contestations also affected property values, independence, and livability. Through this empirical application of the capabilities approach, we demonstrate the need to expand the concept of water security and consolidation outcomes through needs-based perspectives. Furthermore, we show how the coupling of capabilities approach with a hydro-social framework provides descriptive, analytical, and explanatory tools for understanding and addressing household water security.

Learning while earning: Barriers and pedagogies toward Sustainable Development Goal 4, "quality education" for child street-sellers in Siem Reap, Cambodia

BACKGROUND

For children living in a village near Angkor Wat, Siem Reap, Cambodia, selling low cost goods to tourists supplements family incomes and progresses familial social and educational aspirations. However, the Cambodian Government has legislated to remove children selling on the streets in order to project a modern, orderly society. Simultaneously, the tourist campaigns of local non-governmental organisations (NGOs) discourage tourists from purchasing goods from children, based on the premise that work prevents school attendance.

OBJECTIVE

To explore the lived experiences of street-selling children focusing particularly on formal and non-formal education within a human development framework and compare and contrast this to the positions of the Cambodian Government and local NGOs.

PARTICIPANTS AND SETTING

The research participants comprised 22 Cambodian street-sellers aged 8-15 years in central Siem Reap, Cambodia.

METHOD

Rights-based, participatory research was conducted over two periods totalling five months, between 2013 and 2015.

RESULTS

The child street-sellers were initially able to work and attend school with their selling financing their schooling costs. During the research, 14 participants (64%) were forced from their selling activities and unable to pay schooling costs, subsequently left school. However, the successful child street-sellers devised strategies to continue selling, remain in school, learn English through tourist interactions and fulfil their familial and cultural obligations.

CONCLUSION

Contrary to Government policy and NGO campaigns, many child streets-sellers in Siem Reap work to finance their own schooling and progress their own human development and are adversely impacted and have their rights violated when removed from the street.

Anent the theoretical justification of a sex doula program

The Human Condition is neither a well-defined nor well-described concept-nevertheless, it is generally agreed that human sexuality is a fundamental and constituent part of it. For most able-bodied persons, accessing and expressing one's sexuality is a (relatively) trouble-free process. However, many disabled persons experience difficulty in accessing their sexuality, while others experience such significant barriers that they are often precluded from sexual citizenship altogether. Recognising the barriers to the sexual citizenship of disabled persons, the concept of a Welfare-Funded Sex Doula Program has been advanced - a program specifically aimed at meeting the various (and often complex) sexual needs of disabled people. Below we show how that program can be justified within at least two different moral frameworks, the capabilities approach and liberal utilitarianism, and consider and repudiate arguments against it.

Psychometric properties of the measure of achieved capabilities in homeless services

BACKGROUND

Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one's potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their effectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity.

METHODS

We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n = 245) or treatment as usual (n = 320).

RESULTS

Exploratory and confirmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure's concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities.

CONCLUSIONS

Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed.

One slope does not fit all: longitudinal trajectories of quality of life in older adulthood

PURPOSE

Maintaining or improving quality of life (QoL) in later life has become a major policy objective. Yet we currently know little about how QoL develops at older ages. The few studies that have modelled QoL change across time for older adults have used 'averaged' trajectories. However, this ignores the variations in the way QoL develops between groups of older adults.

METHODS

We took a theoretically informed 'capabilities approach' to measuring QoL. We used four waves of data, covering 6 years, from the New Zealand Health, Work and Retirement Study (NZHWR) (N = 3223) to explore whether distinct QoL trajectories existed. NZHWR is a nationally representative longitudinal study of community-dwelling adults aged 50 + in New Zealand. Growth mixture modelling was applied to identify trajectories over time and multinomial regressions were calculated to test baseline differences in demographic variables (including age, gender, ethnicity, education and economic living standards).

RESULTS

We found five QoL trajectories: (1) high and stable (51.94%); (2) average and declining (22.74%); (3) low and increasing (9.62%); (4) low and declining (10.61%); (5) low and stable (5.09%). Several differences across profiles in baseline demographic factors were identified, with economic living standards differentiating between all profiles.

CONCLUSIONS

The trajectory profiles demonstrate that both maintaining and even improving QoL in later life is possible. This has implications for our capacity to develop nuanced policies for diverse groups of older adults.

Scoping review of the World Health Organization's underlying equity discourses: apparent ambiguities, inadequacy, and contradictions

BACKGROUND AND OBJECTIVE

Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications.

ELIGIBILITY CRITERIA

Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded.

SOURCES OF EVIDENCE

We focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search.

RESULTS

Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice.

CONCLUSIONS

Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.

Patient empowerment as capabilities: The perspective of patients with epilepsy at a medical-social center in France

The aim of the study was to develop a new conceptual framework of empowerment based upon the perspective of patients with refractory epilepsy at the medical-social center of La Teppe (France). A qualitative research methodology was used, which consisted of focused ethnography and in-depth interviews. The 19 patients interviewed came from three hospital services and were in the age range of 20-60. Ten interviews were also conducted with healthcare providers, which included neurologists, psychiatrists, nurses, and social educators. Results were analyzed via an intuitive process of thematic analysis. The researcher also constructed narrative cases of the patient interview to better understand patient responses in context. The results show that patients understood empowerment as the ability to develop and take advantage of opportunities in their overall lives. This included searching to be healthy by reducing their seizures, developing their practical reason in order to be able to make more autonomous life choices, and living with and toward others in positive social relationships. The patient's perspective on empowerment encompasses but also goes beyond their medical care. We therefore propose a novel conceptual framework for empowerment as the patient's capabilities to develop and make their life choices, with help as needed from their support network. In order to help patients toward empowerment, clinical care can include discussions and dedicate resources that help patients work toward their overall life projects. Several methodologies, including the use of a personalized project and therapeutic patient education, are elaborated to give ideas for empowerment programming in epilepsy care.

Development through vocational education. The lived experiences of young people at a vocational education, training restaurant in Siem Reap, Cambodia

In Cambodia, approximately half the population experience multidimensional poverty. The youthful population provides a demographic opportunity to achieve sustained and diversified economic growth in support of increased well-being of the population, however, skill shortages amongst youth significantly limit Cambodia's ambitions. This paper explores whether vocational education is a constructive development initiative to redress gaps in education in Cambodia, and progress social and economic outcomes for the future. The dataset that underpins this article includes empirical research that was conducted on-site over two months in a Non-Government Organization (NGO) vocational hospitality school strategically located in the tourist district of Siem Reap, Cambodia. In addition to hospitality skills training, the NGO supported the human development of the students through a capabilities approach. The rights based, participatory research enquires into the lived experiences of one cohort of students who migrated to Siem Reap from poor rural communities to find employment and escape poverty and hunger. Results conclude that students faced competing demands between their gendered, traditional cultural values and the experiences of equity and empowerment provided in their hospitality training. Conclusions drawn through the student's narratives facilitate a deeper understanding of the lived experiences of impoverished migrant youth in Siem Reap and contribute to a better understanding of the human development impact of vocational training through a capabilities approach. These findings are pertinent for other communities navigating through development based, vocational education programs.

The right to assistive technology

In this paper, I argue that disabled people have a right to assistive technology (AT), but this right cannot be grounded simply in a broader right to health care or in a more comprehensive view like the capabilities approach to justice. Both of these options are plagued by issues that I refer to as the problem of constriction, where the theory does not justify enough of the AT that disabled people should have access to, and the problem of overextension, where the theory cannot adequately identify an upper limit on the AT that people have a right to. As an alternative to these justificatory frameworks, I argue that disabled people are owed access to AT at the expense of nondisabled people as a matter of compensatory justice. That is, I defend the position that disabled people are owed AT as part of due compensation for the harms they experience from being disadvantaged by society's dominant cooperative scheme and the violation of their right to equality of opportunity that such disadvantage entails. I also propose a method for identifying an upper limit to what this right to AT requires. In this way, I argue that compensatory justice avoids both the problem of constriction and the problem of overextension.

A Capabilities Approach to Prenatal Screening for Fetal Abnormalities

International guidelines recommend that prenatal screening for fetal abnormalities should only be offered within a non-directive framework aimed at enabling women in making meaningful reproductive choices. Whilst this position is widely endorsed, developments in cell-free fetal DNA based Non-Invasive Prenatal Testing are now raising questions about its continued suitability for guiding screening policy and practice. This issue is most apparent within debates on the scope of the screening offer. Implied by the aim of enabling meaningful reproductive choices is the idea that screening services should support women in accessing prenatal tests that best enable them to realize the types of reproductive choice that they find important. However, beyond whatever options meet the quality standards required for facilitating an informed decision, the remaining criteria of facilitating autonomous choice is strictly non-directive. As a result, policy makers receive little indication prior to consultation with each individual woman, about what conditions should be prioritized during the offer of screening. In this paper we try to address this issue by using the capabilities approach to further specify the non-directive aim of enabling meaningful reproductive choice. The resulting framework is then used to assess the relative importance of offering prenatal screening where concerning different types of genetic condition. We conclude that greater priority may be ascribed to offering prenatal screening for conditions that more significantly diminish a woman's central capabilities. It follows that serious congenital and earlier-onset conditions are more likely to fulfill these criteria.

Grounding the right to live in the community (CRPD Article 19) in the capabilities approach to social justice

For advocates of the rights of persons with disabilities, particularly persons with mental disabilities, the human right to live in the community as an equal member is seen to be central and, often, even as the basis for all other human rights. Yet, despite its articulation in human rights law in the Convention on the Rights of People with Disabilities (CRPD), foundational issues about the right remain undertheorized and unclear. This paper brings to bear the capabilities approach, a normative framework about human well-being, social development and social justice, to this central concern in disability rights, mental health ethics, and international human rights law: protecting and respecting a person's right to live in a community as an equal. We argue that this human and moral right is best conceptualized as a capability to live in the community as an equal member. The capabilities approach provides this capability with a strong ethical framework and conceptual resources to guide reasoning and its practical realization.

Mothers supporting play as a choice for children with disabilities within a culturally and linguistically diverse community

Background: Play is a right for children; an essential childhood occupation influenced by their family environment. Despite increasing recognition of unstructured outdoor play benefits, children with disabilities experience limited play opportunities.Aim: To apply a capabilities approach lens to understand outdoor play decision-making by mothers of children with disabilities within a culturally and linguistically diverse community.Materials and methods: Data collection for this case study involved semi-structured interviews with five mothers of primary school-aged children with disabilities and a week-long survey that profiled their children's outdoor play. Analysis was thematic and involved identifying barriers and opportunities at each ecocultural layer, aggregating strategies families used to address the barriers, and understanding their overall play decision-making.Findings: Mothers considered the child's interests and abilities, valued play as both a means and ends, planned for play, and facilitated in the moment as required. Multiple factors influenced mothers' outdoor play decisions. Mothers' values were child-centred, positively influencing the child's play opportunities.Conclusion and significance: This study's capabilities lens could inform professions such as occupational therapy to support families of children with disabilities from culturally diverse communities to advocate for play opportunities across settings.

Science, Technology and Innovation as Social Goods for Development: Rethinking Research Capacity Building from Sen's Capabilities Approach

Science and technology are key to economic and social development, yet the capacity for scientific innovation remains globally unequally distributed. Although a priority for development cooperation, building or developing research capacity is often reduced in practice to promoting knowledge transfers, for example through North-South partnerships. Research capacity building/development tends to focus on developing scientists' technical competencies through training, without parallel investments to develop and sustain the socioeconomic and political structures that facilitate knowledge creation. This, the paper argues, significantly contributes to the scientific divide between developed and developing countries more than any skills shortage. Using Charles Taylor's concept of irreducibly social goods, the paper extends Sen's Capabilities Approach beyond its traditional focus on individual entitlements to present a view of scientific knowledge as a social good and the capability to produce it as a social capability. Expanding this capability requires going beyond current fragmented approaches to research capacity building to holistically strengthen the different social, political and economic structures that make up a nation's innovation system. This has implications for the interpretation of human rights instruments beyond their current focus on access to knowledge and for focusing science policy and global research partnerships to design approaches to capacity building/development beyond individual training/skills building.

Animal Morality: What It Means and Why It Matters

It has been argued that some animals are moral subjects, that is, beings who are capable of behaving on the basis of moral motivations (Rowlands 2011, 2012, 2017). In this paper, we do not challenge this claim. Instead, we presuppose its plausibility in order to explore what ethical consequences follow from it. Using the capabilities approach (Nussbaum 2004, 2007), we argue that beings who are moral subjects are entitled to enjoy positive opportunities for the flourishing of their moral capabilities, and that the thwarting of these capabilities entails a harm that cannot be fully explained in terms of hedonistic welfare. We explore the implications of this idea for the assessment of current practices involving animals.

Why Health and Social Care Support for People with Long-Term Conditions Should be Oriented Towards Enabling Them to Live Well

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When (the promotion of) support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes (and then of failing to notice that as harmful); limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live (and die) well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people (both generally and more specifically) for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice.

Reconciling ethical and economic conceptions of value in health policy using the capabilities approach: A qualitative investigation of Non-Invasive Prenatal Testing

When evaluating new morally complex health technologies, policy decision-makers consider a broad range of different evaluations, which may include the technology's clinical effectiveness, cost effectiveness, and social or ethical implications. This type of holistic assessment is challenging, because each of these evaluations may be grounded in different and potentially contradictory assumptions about the technology's value. One such technology where evaluations conflict is Non-Invasive Prenatal Testing (NIPT). Cost-effectiveness evaluations of NIPT often assess NIPT's ability to deliver on goals (i.e preventing the birth of children with disabilities) that social and ethical analyses suggest it should not have. Thus, cost effectiveness analyses frequently contradict social and ethical assessments of NIPT's value. We use the case of NIPT to explore how economic evaluations using a capabilities approach may be able to capture a broader, more ethical view of the value of NIPT. The capabilities approach is an evaluative framework which bases wellbeing assessments on a person's abilities, rather than their expressed preferences. It is linked to extra-welfarist approaches in health economic assessment. Beginning with Nussbaum's capability framework, we conducted a directed qualitative content analysis of interview data collected in 2014 from 27 Canadian women with personal experience of NIPT. We found that eight of Nussbaum's ten capabilities related to options, states, or choices that women valued in the context of NIPT, and identified one new capability. Our findings suggest that women value NIPT for its ability to provide more and different choices in the prenatal care pathway, and that a capabilities approach can indeed capture the value of NIPT in a way that goes beyond measuring health outcomes of ambiguous social and ethical value. More broadly, the capabilities approach may serve to resolve contradictions between ethical and economic evaluations of health technologies, and contribute to extra-welfarist approaches in the assessment of morally complex health technologies.

Why do people with mental distress have poor social outcomes? Four lessons from the capabilities approach

Macro level data indicate that people experiencing mental distress experience poor health, social and economic outcomes. The sociology of mental health has a series of dominant competing explanations of the mechanisms at personal, social and structural levels that generate these poor outcomes. This article explains the limitations of these approaches and takes up the challenge of Hopper (2007) who in this journal proposed the capabilities approach as a means of normatively reconceptualising the experiences of people with mental distress, with a renewed focus on agency, equality and genuine opportunity. Using an innovative methodology to operationalise the capabilities approach, findings from an in-depth qualitative study exploring the lived experiences of twenty-two people with recent inpatient experience of psychiatric units in Scotland are presented. The paper demonstrates that the capabilities approach can be applied to reconceptualise how unjust social outcomes happen for this social group. It distinguishes how the results of using a capabilities approach to analysis are distinct from established dominant analytical frameworks through four added features: a focus on actual lived outcomes; the role of capabilities as well as functionings; being normative; and incorporating agency. The capabilities approach is found to be an operationalisable framework; the findings have implications for professionals and systems in the specific context of mental health; and the capabilities approach offers a fertile basis for normative studies in wider aspects of health and wellbeing.

Promoting the freedom of thought of mental health service users: Nussbaum's capabilities approach meets values-based practice

This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum's capabilities approach and Fulford's and Fulford et al's values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based practice. The article points out that both Nussbaum's approach and values-based practice recognise that people's values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum's approach and values-based practice. However, there are also differences in that values-based practice relies on a 'good process' in decision-making, whereas the capabilities approach is oriented towards a 'right outcome'. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies.

The Capabilities Approach: Fostering contexts for enhancing mental health and wellbeing across the globe

Concerted efforts have been made in recent years to achieve equity and equality in mental health for all people across the globe. This has led to the emergence of Global Mental Health as an area of study and practice. The momentum that this has created has contributed to the development, implementation and evaluation of services for priority mental disorders in many low- and middle-income countries.

This paper discusses two related issues that may be serving to limit the success of mental health initiatives across the globe, and proposes potential solutions to these issues. First, there has been a lack of sophistication in determining what constitutes a ‘good outcome’ for people experiencing mental health difficulties. Even though health is defined and understood as a state of ‘wellbeing’ and not merely an absence of illness, mental health interventions tend to narrowly focus on reducing symptoms of mental illness. The need to also focus more broadly on enhancing subjective wellbeing is highlighted. The second limitation relates to the lack of an overarching theoretical framework guiding efforts to reduce inequalities and inequities in mental health across the globe. This paper discusses the potential impact that the Capabilities Approach (CA) could have for addressing both of these issues. As a framework for human development, the CA places emphasis on promoting wellbeing through enabling people to realise their capabilities and engage in behaviours that they subjectively value.

The utilization of the CA to guide the development and implementation of mental health interventions can help Global Mental Health initiatives to identify sources of social inequality and structural violence that may impede freedom and individuals’ opportunities to realise their capabilities.

Social Change: Toward an Informed and Critical Understanding of Social Justice and the Capabilities Approach in Community Psychology

Community psychology has long been concerned with social justice. However, deployments of this term are often vague and undertheorized. To address this weakness in the field's knowledge body we explored John Rawls's theory of social justice and Amartya Sen's economic theory of the capabilities approach and evaluated each for its applicability to community psychology theory, research, and action. Our unpacking of the philosophical and political underpinnings of Rawlsian theory of social justice resulted in identifying characteristics that limit the theory's utility in community psychology, particularly in its implications for action. Our analysis of the capability approach proposed by Amartya Sen revealed a framework that operationalizes social justice in both research and action, and we elaborate on this point. Going beyond benefits to community psychology in adopting the capabilities approach, we posit a bi-directional relationship and discuss how community psychology might also contribute to the capabilities approach. We conclude by suggesting that community psychology could benefit from a manifesto or proclamation that provides a historical background of social justice and critiques the focus on the economic, sociological, and philosophical theories that inform present-day conceptualizations (and lack thereof) of social justice for community psychology.

Valuing patients' experiences of healthcare processes: towards broader applications of existing methods

Healthcare policy leaders internationally recognise that people's experiences of healthcare delivery are important, and invest significant resources to monitor and improve them. However, the value of particular aspects of experiences of healthcare delivery - relative to each other and to other healthcare outcomes - is unclear. This paper considers how economic techniques have been and might be used to generate quantitative estimates of the value of particular experiences of healthcare delivery. A recently published conceptual map of patients' experiences served to guide the scope and focus of the enquiry. The map represented both what health services and staff are like and do and what individual patients can feel like, be and do (while they are using services and subsequently). We conducted a systematic search for applications of economic techniques to healthcare delivery. We found that these techniques have been quite widely used to estimate the value of features of healthcare systems and processes (e.g. of care delivery by a nurse rather than a doctor, or of a consultation of 10 minutes rather than 15 minutes), but much less to estimate the value of the implications of these features for patients personally. To inform future research relating to the valuation of experiences of healthcare delivery, we organised a workshop for key stakeholders. Participants undertook and discussed 'exercises' that explored the use of different economic techniques to value descriptions of healthcare delivery that linked processes to what patients felt like and were able to be and do. The workshop identified a number of methodological issues that need careful attention, and highlighted some important concerns about the ways in which quantitative estimates of the value of experiences of healthcare delivery might be used. However the workshop confirmed enthusiasm for efforts to attend directly to the implications of healthcare delivery from patients' perspectives, including in terms of their capabilities.