Genetic engineering and social justice: A reflection on Amartya Sen’s capability approach

Background

During the last 200 years, moral principles protecting the weak have become increasingly effective and inclusive, and 18th- and 19th-century practices and social organizations like genocide, colonialism, domestic violence, slavery, and forced labour that were formerly perceived to be morally acceptable are now considered social injustices and moral wrongs. The world is becoming more just, and with it is the presupposition that the worst-off are becoming more developed. The rise of liberal democratic ideas in radicalizing political reformations has certainly brought the promise of liberal equality. The longstanding history of oppression is slowly coming to an end; so that Francis Fukuyama emphatically asserts that humanity has reached “the end of history as such” (Fukuyama, 2019). Over the last few decades, the majority of the world has embraced the fundamental principles of liberal democracy. We are now egalitarians.

Yet, how well are the poor and the weak doing today? Despite the considerable increase in the world’s economy and affluence, severe inequality among the global populations persists. Forty-six percent of the world’s population live in countries whose income differentials are large (below the poverty threshold set by the World Bank’s poverty line index of US$1.90 per day), and where opportunity for development is scarce. In 1990, there were about 1.9 billion people living in extreme poverty; the majority of these lived in sub-Saharan Africa and South Asia. However, it cannot be denied that over the course of the last two decades since the inauguration of the United Nations Development Program (UNDP) and the Sustainable Development Goals (SDG) program there has been a significant decline in the numbers of people living in extreme poverty.

In 2015, the number of extremely poor people had reduced to 735 million from the 2 billion recorded in 1990. That is, every day from 1990 to 2015, 128,000 fewer people were below the poverty threshold of US$1.90 per day. What this means is that in the last 25 years the world has experienced a decline in extreme poverty of 10 percent (Roser and Ortiz-Ospina, 2019). However, in spite of this development, the demoralizing and dreadful effects of poverty for poor people all over the world are undeniable. During the first few years of development from 1990 to 2005, annually there were 18 million deaths from infections and poverty-related causes. Every day, this number was 50,000 adults and 34,000 children below the age of five, and half of these children were infants in their first month of life. Despite the reduction in the number of deaths during the last 25 years, in 2005, 8.9 million deaths were recorded, and in 2015, 8.0 million, with 96 percent of these occurring in poorer societies (Alkire et al., 2018). The number of unnecessary deaths among poor people in the world remains scandalously high.

The world over the past decades has made great progress in finding ways of treating diseases which were considered in the past to be incurable. The struggle for longevity and positive health has been addressed by medical science. People who can afford it are assured by the promise of genetic engineering. But while there has been considerable development in the treatment of diseases, the number of mortalities in poor countries remains high, especially in Sub-Saharan Africa and South Asia, as noted above. Illnesses that could kill even the richest person during the 19th century can now be cured with the emergence of genetic therapy in medical procedures. Science and medicine have finally met in the development of genetic engineering applied in medicine and health care procedures. The richest people in the 18th and 19th centuries whose cause of death was infection could have been cured easily had the genetic therapy breakthrough come earlier (Roser and Ortiz-Ospina, 2019). Yet, despite the present progress in medical science, the number of deaths unnecessarily suffered by the poor from preventable and amenable diseases remains very high.

Furthermore, recent studies in global health insist that non-communicable diseases which were previously associated with high-income societies, such as cancer and neuropsychiatric and cardiovascular diseases, are now some of the many causes of death among the global poor (Stevens, 2004). This means that at the present moment diseases suffered by the rich and the poor are rapidly converging. And that such convergence will eventually allow for the decline of mortalities among the poor in the near future, insofar as the poor will benefit from the medical researches intended for the rich (Stevens, 2004). It is undeniable that with the radical progress of medical science, longevity and positive health are almost an assurance for all. But the pressing moral need for evaluating the development of modern medical services and practices is driven by the dehumanizing deaths that the poor in low-income societies unnecessarily suffer. The main question is not whether both the rich and the poor are suffering from the same non-communicable diseases, for such naive comparative assessment of global diseases will not grant us the opportunity to see the real extent of the suffering of the poor from illnesses that are already curable, but whether the very poorest people are given equal opportunity for quality health care. The fact remains that in spite of progress in medical science (genetic therapy for instance), the poorest people in the world die of diseases that the rich can easily escape through sophisticated medical interventions.

The persistent inequality of opportunity for quality health care between the rich and the poor raises problems of social justice. More often than not, the rich with their financial capabilities are more likely to refer themselves to the most sophisticated medical care and facilities. They can afford to buy the most expensive medicine and be admitted to the most expensive private hospitals. While for the rich longevity and positive health are possibilities that are readily available, the majority of the poorest population can only wish for the same possibilities. This inequality calls for the need for assessments of social justice. It cannot be denied that those capable of obtaining the best health care services are in a superior position compared to those who are not (Kotze, 2016).

This article will argue that poverty and the existence of infectious diseases are inseparable social phenomena that affect the fate of the poor in developing countries. Following Amartya Sen, it will argue that access to advanced health care services should be affordable to all and should form part of individual freedoms that the national policies of a country must secure. However, this article does not intend to discuss, in full length, the general problems of social justice theory, since that would mean a more extensive and broader account of the topic, which would help less in clarifying my point for the article. In insisting for the moral evaluation of genetic therapy (especially on the basis of equal opportunity), this article is not concerned with limiting the rich from acquiring the best medical services they can afford. Neither does it intend to insist on levelling equality, which is a thing of moral unacceptability. It is ultimately directed to presenting the prevalent problem of unequal opportunity in health care services between the rich and the poor, and the moral consequences of this problem.

Positive health and the diseases of poverty

The world is constantly battling against previously deadly diseases, such as tuberculosis, malaria, HIV/AIDS, meningococcal meningitis, and hepatitis B. These diseases constitute 18 percent of the poorest nations’ disease burden. Thanks to the rise of genetic engineering and gene therapy, the casualties of these fatal diseases have dramatically declined during the last 25 years.

However, despite these significant developments and progress in biomedical health care and services, the depressing truth remains that the majority of the poor die of preventable diseases each year and their number is not declining. The rate of poor children dying of vaccine-preventable diseases in comparison to children of high-income societies remains scandalously high. Accordingly, children from low-income societies are 60 times more likely to die of preventable diseases during their fifth year of life than children from high-income societies. In 2017, an estimated 6.3 million children died of infections and amenable diseases, some 5.4 million of whom were children under the age of five. One child under 15 years old dies every five seconds, with half of these deaths in Sub-Saharan Africa and 30 percent in Southern Asia (World Health Organization, 2018). The disparities of the ratio of children dying per population in Sub-Saharan Africa and in high-income societies is depressingly high; in the former, one in 13 children dies before their 15th birthday, while in the latter that number is one in 185 (World Health Organization, 2018). Moreover, babies in low-income societies are nine times more likely to die of infections and diseases during their first month of infancy. In total, in 2017, 2.5 million children died in their first month. Lawrence Chandy, UNICEF Director of Data, Research and Policy, insists that if no urgent counter actions are taken to solve the problem of infant and child mortality by 2030, 56 million more children under the age of five will die. He asserts that:

We have made remarkable progress to save children since 1990, but millions are still dying because of who they are and where they are born. With simple solutions like medicines, clean water, electricity and vaccines, we can change that reality for every child. (World Health Organization, 2018)

“Equality of what?” and the capability approach

Sen’s answer to the problem of global poverty and inequality begins with the question “equality of what?”. The question entails that we are egalitarians now. And that inequality in all its forms must be resolved by treating everyone as equal and by providing due consideration to every member based on their specific needs and entitlements. The capability approach was designed to answer and supplement the inefficiencies in the previous formulations of development. Sen proposed his capability approach theory as a framework of thought whereupon everyone can begin to think about what constitutes a realistic account of human flourishment. He rejected the conventional ideas of development based “mainly on the welfarist approaches in welfare economics and utilitarian and Rawlsian theories” (Robeyns, 2000). Development, as expressed in the aforementioned welfarist approaches, is reduced to crude satisfaction of preferences realized in the mere acquisition and consumption of resources. Although Sen does not absolutely deny the instrumental value of commodities and economic development for human flourishing, he nevertheless considers them as means for development and not ends.

The capability approach does not just seek to dethrone GNP/GDP as the criteria for determining welfare, it seek to propose as well a feasible alternative of development metrics that centers on the valued options a person may find reasonable to possess and her actual capacity to freely act in pursuit of those options. Contrary to welfare economics, which is aimed at maximization of economic development with its inevitable consequence of people being reduced to mere means for economic welfare, the capability approach insists on “the ability of people to lead the kind of life they have reason to value” (Anand and Sen, 2000: 84). With that, Sen formulated his capability theory in order to place the ‘human’ into development. Sen insisted on the necessity of freedom as the proper space for development (Sen, 1999).

In contrast to the welfarist approaches, the capability approach, by focusing on freedom, defines individual advantage on the basis of the person’s capacity to freely choose the kind of life she values living. Sen explains that although the things we value most are obviously vital for us to achieve, the idea of freedom posits the necessity of respecting our individual capacity to freely identify for ourselves the things we find valuable and the course of action we take in pursuit of those things. For instance, to be well educated is certainly valuable for everyone as it frees us from ignorance and capacitates us to freely decide the course of our lives guided by the knowledge we have received in education. But inasmuch as we are free, there should never be the presupposition that forcing students to study one particular course, regardless of their personal preferences, will yield the same universal result. For, as Sen argues, “freedom also respects our being free to determine what we want, what we value and ultimately what we decide to choose” (Sen, 2009: 232).

In order to better comprehend the nature of the capability approach, Sen further identifies two main features that need to be properly understood to avoid misconceptions. First, “the capability approach points to an informational focus in judging and comparing overall individual advantages, and does not, on its own, propose any specific formula about how that information may be used” (Sen, 2009: 232). That is, although the capability approach as a framework of thought for judging individual advantages presents an informed description and assessment of social disparities, it nevertheless does not provide any fixed or material guidelines on how a society should be designed. That is, the “capability perspective does point to the central relevance of the inequality of capabilities in the assessment of social disparities, but it does not, on its own, propose any specific formula for policy decisions” (Sen, 2009: 232). Sen is clear that assessing the social states of advantages and disadvantages among members maybe affected by the information the capability approach provides but it does not presuppose any blueprint for how to solve conflicts over distributive pattern. Influencing the assessment of the developmental patterns in society is precisely the main objective of the capability approach (Sen, 2009).

Second, the capability approach is “inescapably concerned with a plurality of different features of our lives and concerns” (Sen, 2009: 233). Human existence posits a plurality of states of being and doing that cannot simply be reduced to sheer consumption or acquisition of material goods. The capability that is being presupposed is not simply the ability to acquire income in the way welfare economics would identify economic development as the main criterion for development. Rather, the capability that Sen is concerned about is the “ability to achieve various combinations of functionings that we can compare and judge against each other in terms of what we have reason to value” (Sen, 2009: 233). The concern with positive freedom is derived from the fact that capability theory is directed towards assessing human life, with all its complexities and pluralities of features and concerns. Choices in life options vary for each individual person, according to e.g. level of nourished, level of education, capacity to avoid avoidable morbidity, social and community participation, and the capacity to pursue one’s plans in life. The capability perspective is more concerned with human functionings rather than with detached objects of desire such as income and commodities which are often used to define human flourishing. Economic development is a means for development and not an end. Sen argues that the capability theory is “particularly concerned with correcting this focus on means rather than on the opportunity to fulfill ends and the substantive freedom to achieve those reasoned ends” (Sen, 2009: 234).

Development as freedom

It is clear in the above discussion that the capability approach is concerned with assessing individual development not on the basis of certain material belongings but on the actual lives the people are living and whether they can truly choose from among diversified life functionings. Development is conceived of as the expansion of individual freedom (Sen, 1999). Sen explains that focusing on individual substantive freedom allows for a broader perspective in looking at the problem of poverty and inequality, insofar as it extends the space of moral valuations on the criteria for developmental assessments. That is, by focusing on freedom we are driven from considering development simply as the increase of income and the growth of GNP/GDP, which are by no means inefficient to account for the extent of the people’s deprivations. The capability perspective allows for an all-encompassing assessment of individual advantages insofar as it centers its account of development in the “comprehensive opportunities” the person is capacitated to pursue, and the extent of their freedom to achieve certain life functionings.

Sen explains that the analysis of development in the capability approach takes individual substantive freedom to be the building block whereupon all of our presuppositions of social, political and economic advantages are to be assessed. Therefore, special attention is given to the expansion of individual capabilities being the ones which guarantee an all-inclusive and comprehensive account of development. The capability approach sees development as the “expansion of the capabilities of the person to lead the kind of lives they value – and have reason to value” (Sen, 1999: 18). This primacy of individual substantive freedom is based upon two fundamental reasons which justify its vitality in the conception of development. The first reason why substantive freedom is crucial is that freedom, as was discussed above, takes an evaluative position in determining the actual state of development of an individual based not on the traditional focus of income and commodities but on her capacities to choose and achieve different states of doing and living. The success of the community or society is to be evaluated by the substantive freedom the members enjoy, so that a society is developed when its members are able to exercise their positive freedom to choose the kinds of things they have reason to value (Sen, 1999). Sen argues that having “greater freedom to do the things one has reason to value is significant in itself for the person’s overall freedom, and important in fostering the person’s opportunity to have valuable outcomes” (Sen, 1999: 18). The second reason is that focusing on individual freedom and capability not only allows an all-encompassing evaluation of development, but also provides a substantial account of individual initiative and social effectiveness.

The greater the freedom, the larger the possibility of individuals developing themselves and, in the process, helping in the success of the society (Sen, 1999). Such is the case insofar as, for Sen, development is not entirely subjective; it is quintessentially social. The capability approach, though insisting on the necessity of individual freedom being a vital aspect for human flourishing, does not ignore the crucial role that society and institutional arrangements play in the realization of human development. Despite Sen’s emphatic insistence on the vitality of individual freedom – being both the end and the means of development – the capability approach does not isolate the individual from the social milieu to which they belong. That is, “Sen’s capability approach does not separate the thoughts, choices and the actions of individual human beings from the society in which they live, since individuals are quintessentially social creatures” (Deneulin, 2008: 106). What this means is that the freedom and agency that a person enjoys are determined by the social structures they are a part of. A person’s modes of choosing and acting are always determined by the collective consciousness prevalent in the social milieu they find themselves in. That is, the individual subject may have freedom to act in accordance to what they think good and reasonable for them, but their “choices are heavily influenced by norms and institutions (market as well as social)” (Stewart, 2013: 6). This is so because: “Individual freedoms are inescapably linked to the existence of social arrangements, and our opportunities and prospects depend crucially on what institutions exist and how they function” (Sen, 1999: 142).

The link between individual freedom and the prevalent socio-political arrangements, which heavily determine the judgment of the person of what is a worthwhile life, is further elucidated in Sen’s distinction between the constitutive and instrumental roles of freedom. It has been argued that development, for Sen, consists in the expansion of real freedom the person enjoys (Sen, 1999). The constitutive role of freedom, therefore, consists in the substantive freedom’s enriching of human life. Sen explains that substantive freedoms consist in elementary freedoms to be able to avoid certain capability deprivations such as starvation, undernourishment, escapable morbidity, and premature mortality, as well as freedom from ignorance, political freedom, and freedom of speech (Sen, 1999). Human development, under the constitutive role of substantive freedom, seeks to extend the elementary freedoms and thereby allows a more comprehensive assessment of development informed by such considerations. A person may be very rich but will lack development if, for instance, her freedom of speech and political engagement are denied her. Development as the process of expanding individual freedom must remove these unfreedoms. Even if she has no intention of retrieving and practicing such freedoms, for a real development to transpire, human development necessitates the removal of such deprivations. Such constitutive analysis of freedom in the conception of development is lacking in the usual economics-based analysis (Sen, 1999).

The constitutive role of political freedom as expressed in the above discussion must be distinguished from the instrumental role of political freedom, when we speak of freedom as a means to development. Although the instrumental perspective of freedom does not in any way reduce the constitutive value of freedom as an end in itself, nevertheless the crucial role of the instrumental value of freedom as a means in the realization and promotion of human development is undeniable. Such instrumental consideration of freedom presupposes the “the way different kinds of rights, opportunities, and entitlements contribute to the expansion of human freedom in general, and thus to promoting development” (Sen, 1999: 37). Development, as necessarily the expansion of real freedom the person enjoys, is made possible by the effectiveness of the instrumental role of freedom. That is how the different kinds of freedom interrelate with one another (Sen, 1999). For example, the elementary capabilities of being able to avoid starvation and undernourishment may be more relevant to the development of the person when they are coupled with freedom from ignorance. A person who is well-nourished and educated is more able to pursue the life she finds valuable than one who lacks any of the elementary capabilities mentioned.

In order to better comprehend the above discussion, one needs to take into account Sen’s description of the five types of instrumental freedoms: political freedoms, economic facilities, social opportunities, transparency guarantees, and protective security. These freedoms contribute to the actual development of the person in their necessary interrelation with one another. Sen asserts that although definitions of development are ultimately determined by the actual development of the person’s individual substantive freedom – the actual capacity to choose certain functionings and the positive freedom to pursue courses of action – they must also take into account the instrumental roles and empirical linkages of the above freedoms. Such is the case insofar as “freedom is not the only primary object of development but also its principal means relates particularly to these linkages” (Sen, 1999: 38).

First, political freedom, according to Sen, refers to the actual opportunities that people have in choosing who should govern and being able to criticize and scrutinize institutional schemes that are not of great relevance to the actual development of the people’s substantive freedom. This includes the political entitlements to opportunities of political dialogue, dissent, and critique, the right to suffrage, the right to participate in political parties, and so on. Such a conception of freedom is often identified with democratic institutions. A truly functioning democracy allows for healthy political engagement and criticism. The instrumental role of political freedom rests in its enabling of the people to insist what is good and worthwhile for them. Second, economic facilities refer to the actual opportunities the people have to secure economic incentives in view of their individual economic entitlements. That is, by economic facilities the individual is capacitated to secure for herself economic resources that she can enjoy for purposes of consumption and exchange. The increase of GNP/GDP must be translated into individual (family) wellbeing insofar as the increase of a country’s economic wealth and income is reflected in the enhancement of the population’s economic entitlements. Real economic development is identified with an increase in the people’s purchasing power and when the people are able to achieve certain modes of life’s functionings, like being well-nourished, healthy, well-educated, able to buy the things they want, and so on.

Third, social opportunities refer to how the basic institutions (education, health care, judiciary, police, and so on) are arranged such that they allow for the development of the individual’s substantive freedom. Transparency guarantees refer to the need for transparency and openness in public engagements and decision making. The instrumental role of transparency guarantees rests in its assurance that corruption, financial irresponsibility, and underhand dealings are prevented. Finally, protective security refers to the need for the government to provide fixed and feasible social safety nets that prevent the affected population, say in some economic crisis or even in famines, from being reduced to a dehumanizing state of existence. This includes the formulations of famine relief programs, unemployment benefit schemes or emergency public employment for the poor and affected, health insurance, and so on (Sen, 1999).

All the above instrumental types of freedom necessarily interrelate with each other for a real development to transpire. It has been said that instrumental freedom helps in developing the individual’s substantive freedom insofar as development is quintessentially social. The enhancement of the individual’s economic state also reflects the nation’s economic wellbeing and vice versa. The country’s increase in income may help in instituting social schemes for public wellbeing such as the standard health care system, education, and so on. Similarly, the enhancement of social opportunities allows for a more active economic engagement which will eventually lead to economic flourishing. The development of state income can likewise provide ample social safety nets that help sustain the lives of the destitute people who are affected by, for instance, the free movement of the market or uncontrollable socio-political and economic circumstances. The people, being able to decide for themselves, can actively participate in political activities and make the choices they deem most useful and effective. Freedom which is both an end and means of development must be understood on the basis of its constitutive and instrumental roles.

Development and individual heterogeneities

It has been discussed how the capability approach is critical to the welfarist perspective of development that reduces human development to sheer acquisition and consumption of income, and that the income perspective of development serves simply as an instrument for development and not an end. The mere reductionism of development to a commodity perspective does not provide an extensive account of the real state of deprivation a person is suffering, and neither can it provide a substantial reason why such a person is poor and destitute. Although we discussed the five instrumental freedoms that determine the development of the person depending on whether the empirical linkages among freedoms are realized in the process, Sen further argues that aside from reasons of instrumental value of freedom there are circumstances both social and personal that can hamper the real development of the individual. There are five sources of undevelopment in welfare economics:

1) Personal heterogeneities: People have diversified states of health and physical characteristics (connected with age, gender, illness, and disabilities) which make their needs diverse. Such heterogeneities affect the capability of the person to translate certain commodities and income to actual functionings. A person who is suffering from a terminal illness may need more income to support her state of deprivation; and even with the amount of money she has, it may not yield the same satisfaction and happiness compared to a healthy individual with the same amount of money.

Sen explains that these “different sources of variations in the relation between income and well-being, make opulence – in the sense of high real income – a limited guide to welfare and the quality of life” (Sen, 1999: 71). An equal amount of resources for people with different needs does not necessarily yield equal development.

Wellbeing, functionings, and capability

Following Sen, we have argued that the proper space for defining development is neither that of utility in welfare economics nor that of the primary goods advanced by John Rawls in his theory of justice. Rather, the proper space for evaluating development is individual substantive freedom, i.e. the capability to choose the worthwhile life one has reason to live. That is, “Eudaimonia, in that sense, is a function, not of people’s ideal states, but of what they are able to do and be” (Maboloc, 2007: 229). The capability approach is concerned with the actual freedom the person enjoys rather than on some material belongings that serve only as a means to development. Income and commodity are relevant only for the acquisition of certain modes of functioning, but for the actual development of the person neither can give a substantive description. “Opulence in the form of commodity possession is undoubtedly important in enhancing the standard of living” (Sen, 1987: 15), but conceptions of standards of living are more than just income centered, for quality life, as argued above, is achieved in both the constitutive and instrumental roles of freedom. Functionings and capability are some of the main terms the capability approach uses to further the claim of the centrality of freedom in our conception of development. Such is the case inasmuch as for Sen “the standard of living is a matter of functionings and capabilities, and not a matter directly of opulence, commodities, or utilities” (Sen, 1987: 16).

For Sen, fucntionings refer to the diversified modes of being and doing that individuals may find valuable to do and be. That is the “various living conditions we can and cannot achieve” (Sen, 1987: 16). Functionings, on the one hand, may include some elementary states of being, such as being well-nourished, well-educated, and free from avoidable diseases, to complex modes such as taking part in communal life, appearing in public without shame, and possessing self-respect (Sen, 1987). Capability, on the other hand, refers to the “the alternative combinations of functionings that are feasible for her to achieve. Capability is thus a kind of freedom: the substantive freedom to achieve alternative functioning combinations (less formally put, the freedom to achieve various lifestyles)” (Sen, 1987: 16). Capability refers to the positive freedom an individual possesses to achieve the mode of existence she values. Functionings and capability are both vital for the evaluation of the person’s state of either development or deprivation. The interrelationship between functionings and capability is made clear by looking at the difference between a rich person who chooses to fast and a destitute person who, by her state of abject poverty, is forced to starve. Both may have the same functioning achievements insofar as both are undernourished, but in terms of their capability sets the affluent person who chooses to fast is more able to salvage herself from avoidable death caused primarily by undernourishment. The destitute person in abject poverty, however, does not have the capability to save herself from death caused by starvation (Sen, 1987). Development consists not only of some general modes of existence, i.e. sets of functionings, but also of the capability to achieve certain combinations of states of being and doing that the person may value.

Substantive freedom and positive health

Having the capacity to choose the best alternatives in life presupposes that the person must be free from all possible hindrances that may limit her in obtaining the kind of life she finds reasonable to live. A poor fisherman needs more than just income to sustain his life and family. Being threatened by diseases of the poor, the fisherman should also be guaranteed of standard/quality health care every time he needs it. Health plays a vital role in the development of individual freedom, and so the opportunity for positive health must be open to all. Poor countries must make health care insurance a main priority when crafting policies. Good health necessarily leads to economic development. Development without human beings is an abstraction; it is not possible to conceive development empty of human interventions. And the surest way for a society to achieve full development is to ensure that its members are cared for their elementary capabilities are developed. Christopher Ryan Maboloc argues that: “It is without argument that ensuring the elementary capabilities of people as a matter of public policy is to secure the very basis for their well-being” (Maboloc, 2010: 7).

Although Sen insists on the necessity of developing the individual’s substantive freedom as a basis for developmental evaluations, he also argues for the substantiation of capability development through institutional interventions as forms of instrumental negative freedom. This is because:

Our negative freedom is also of great value if seen from the context of society as a whole since without it, regimes can become abusive. While positive freedom enhances the individual’s ability to be the person she desires to be, our negative freedom protects us from the excesses and manipulative tendencies of other people. (Maboloc, 2010: 7)

In the case of the global poor’s unnecessary suffering, despite advancements in medicine and genetic engineering, what is ultimately needed is that governments of these poorer societies ensure that policies in health care, education, security, infrastructure, and nutrition are prioritized. Failure to secure the proper functioning of the aforementioned basic social structures would mean the non-development of the entire population. Development entails the necessary removal of “major sources of unfreedom: poverty as well as tyranny, poor economic opportunities as well as systemic social deprivation, neglect of public facilities as well as intolerance or overactivity of repressive states” (Sen, 1999: 3). Such is the case insofar as “A life deficient of the capabilities…is bereft of human dignity” (Maboloc, 2007: 233). Individual development is possible only if social institutions are designed to allow poor people to develop their individual substantive freedom. Social institutions are needed to secure wellbeing. The instrumental function that social institutions presuppose rests in the realization of social policies that render individual development possible. For Sen, it is imperative that policies that will serve as social safety nets be promulgated in order to secure the development of individual substantive freedom.