A Public Health Perspective on the Capability Approach

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Acknowledgements

Support to complete this work was provided during the author's research fellowship at the Jawaharlal Nehru Institute of Advanced Study, Jawaharlal Nehru University, Delhi, and during her post as Visiting Associate Professor at the Department of Public Health and Community Medicine at the University of New South Wales. Thanks are due to David Clark for contributing greatly to improving this paper, and to an anonymous referee. The generosity of the Oxford University Press, USA, in granting gratis permission to reproduce Figure 1 is also acknowledged.

Notes

Details of these developments and their role in influencing policy can be found in Susser and Susser (1996a, 1996b) and Krieger (2011).

Krieger (1994) refers to the underlying framework as one of ‘biomedical individualism’.

This has also been referred to by other terms – ‘eco-epidemiology’ by Susser and Susser (1996b) and ‘social–ecological systems perspective’ by McMichael (1999).

Krieger lists the core features of ecological studies as follows: (a) scale – an analysis of processes across space and time, thus across geographical regions and historical time scales; (b) levels of organization – individual to the population to the eco-system each nested within the next level; (c) dynamic states – the interplay between the environment and biological organisms; (d) mathematical modelling – undertaken to explain intelligibly the workings of complex systems (involving groupings of organisms and processes) given the difficulty of conducting large-scale experiments; and (e) recognizing unique phenomena (e.g. features of different forests) but linking them to promote understanding of general processes (e.g. to allow an understanding of the degradation of forests).

Frohlich et al. (2001) – independently of Ruger's work – propose applying Sen's capability approach as a possible way to bring together the analysis of contextual and compositional factors in epidemiology. While there is no systematic detail on how Frohlich et al. envisage this application, the point is mentioned here to emphasize the intrinsic theoretical aspect of the capabilities and the eco-social frameworks that both take into account the interaction between environmental, group and individual-level factors.

Some of the properties of complex systems listed by Diez-Roux (2007) include being composed of many interdependent heterogeneous units, which interact with and influence each other, so as to result in emergent properties (i.e. properties that are not just an aggregate of properties of the components), exhibiting feedbacks and non-linear relationships, and difficulty in prediction as a small initial change could have unpredictable and large effects.