The CA in Brief

The CA can be described very simply in the following way. Human well-being should be conceptualised in terms of what individuals are capable of being and doing in their daily lives in the immediate and long term. For a person to be capable to be or do A, B, or C, there is a good match between their internal features, including biology, knowledge, and skills, and the surrounding external environment, including the physical and social environments, from the local to the global level. The constraints on an individual’s capability/(ties) can be from diverse and multiple sources ranging from internal constraints (e.g., biological impairments) to social practices (e.g., restrictions on the movement of females or non-binary individuals outside the home) to global trade dynamics (e.g., commodity price collapses). The worst social injustices and deprivations occur where many capabilities of individuals are constrained as well as where many factors constrain capabilities.

A person ‘being capable’ to be or do A, B, or C is conceptually distinct from the person actually doing or achieving A, B, or C – which is called a ‘functioning’ in the CA. Capability is a real, practical possibility in contrast to the actual doing or achieving something that is an outcome. The distinction between practical possibility and outcome is conceptually helpful when various kinds of analyses are conducted, and it has important ethical significance. Two people might have the same outcome, such as being malnourished. However, imagine that one person is undertaking a long-term fast for religious or political reasons, whereas another person does not have money to buy any food. How we, as policymakers or problem-solvers, assess and respond to each outcome should differ, and this requires information about the antecedent practical possibilities. Indeed, it may be accepted worldwide that being well nourished is a valuable state of being. However, many harmful consequences follow when this global social value or fact leads to a metric or policy goal that focuses only on nourishment outcomes. Generalising from this example means that only looking at well-being outcomes or being fixated on achieving outcome metrics, rather than seeking information about what people are realistically capable of being or doing, blinds us to important problems and ethical differences in people’s lives. This leads to bad responses. The lesson here is not to ignore outcomes but rather to expand our scope of information gathering and analyses.

The ethical significance of this distinction is that in societies that value human freedoms, the capability space is the best place to assess these freedoms. Rather than looking at only outcomes or even the formal institutions of freedoms (e.g., legal rights, school buildings, functioning press), we should look at what people are actually capable of being and doing in their daily lives. In liberal democratic societies, the purpose of good government and public policies is to ensure that every individual is able to plan, pursue, and revise their diverse plans of life. According to the CA, this ‘ensuring’ is best done through protecting, expanding, mitigating decline, restoring capabilities, and so forth. Importantly, in the CA, freedoms are not only being capable of achieving A, B, or C but also of people choosing which capabilities or bundle of capabilities they want to have (e.g., B, G, L, Y) and choosing which of those capabilities to pursue towards the functioning outcomes. However, any capabilities the person wants are not valuable from the CA perspective, but rather those that are considered central or core to decent work or good quality of life. The societal selection and provision of support for such core capabilities, whether at the national or global level, is where the importance of legitimacy and justification comes in. This will be discussed further in the subsection ‘Proper Justification and Legitimacy’.

While capabilities seem like a simple idea, the CA places great demands or duties on social choice and public policymakers to provide supportive conditions for capabilities and to constantly monitor social conditions and their impact on the daily lives of people. Moreover, monitoring needs to be conducted not only at the group or population level but also at the individual level so that no one is left behind. The ethical obligations to provide such supportive conditions and the need to be concerned with every individual’s well-being are derived from the moral force of the CA and the ‘demands of social justice.’ Academic philosophers of social justice and ethics are accustomed to thinking that strong philosophical arguments should be enough to provide such moral force or adherence, but our modern reality is clearly far removed from that perspective. Different disciplines and professions have different sources that motivate the translation of knowledge into practice or the practice of good ethics. Moreover, moral psychology/social psychology, which is grounded in human biology, plays a significant role in our adherence to some moral principles but not others [Reference Hauser9]. While that research is well beyond the scope of this chapter, it is important to acknowledge in the chapter and book about the application of the CA that there are still open questions about the moral psychology needed for the CA (or any ethics) to be well received by policy implementors or, conversely, the sources that give moral force to the CA. While an accurate understanding of the CA and coherent plans and strategies for integration are important, they are still a few stops short of guaranteeing real-world justice.

Violence of Narrow

In the earlier brief sketch of the CA, the crucial thing to recognise is that the capabilities concept is not just a nice or clever idea but also a militant rejection of the violence tolerated and perpetuated through the informationally narrow, fixed, or dogmatic nature of some other dominant theories, whether in political philosophy, economics, development, or other areas. For example, utilitarian philosophical theories produce and tolerate great amounts of violence against human beings, and other things, such as nature, in the pursuit of maximisation of a narrow, anthrocentric, utility-based outcome or a proxy (happiness, quality-adjusted life years, money, etc.). Violence can range from directly sacrificing one or a large number of people or their freedoms for the greater good all the way to the persistent neglect of ‘few’ people because addressing their well-being needs is not cost-efficient.

Even with the case of John Rawls’s profound and elegant Kantian, social-contract theory and its use of primary goods, there is great violence caused by erasing inherent diversity in human beings and across our life course. While he is highly concerned with well-being equity, the inherent diversity of human beings profoundly affects how well or poorly each of us will be able to transform Rawlsian primary goods into well-being. While Rawls rejects utilitarian violence, the erasure of human diversity and focus on the equity of primary goods leads to causing, tolerating, or obfuscating avoidable inequities in well-being in his ideal just society. On a related point, Rawls, like many other great philosophers, did not benefit from our twenty-first-century knowledge about the causation and distribution of disease and mortality. Rawls thought health/disease was largely a matter of luck and personal behaviours and best dealt with through healthcare, which people can purchase on the basis of their personal preferences. While the majority of people might do well under the Rawls system, there are enormous amounts of preventable well-being deprivation that would be caused or tolerated in Rawls’s ideal just society.

There is also violence that is tolerated or perpetuated in libertarian theories. As Sen discussed in a famous essay, under libertarianism, we would not be able to violate the right to property of one person even if that is the only way to save the life, the right to life, of another person [Reference Sen10]. A system that presents itself as protecting the absolute freedoms of every individual actually produces suboptimal well-being. This specific example shows that while many might recognise Sen’s critiques of various philosophical, economic, and other theories as perceptive and insightful, Sen’s motivation seems to always search for and reveal the real and possible violence being done to human beings through misconceived ideas and poor reasoning. The militant anti-violence perspective in the CA and the related demand for the inclusion of everyone within the scope of justice and equity are often unrecognised or minimised even by CA advocates. The erasing of its militant anti-violence dimension is also what makes it possible for the CA to be misused or cannibalised into other arguments or frameworks. Or, why it is easily dismissed, such as when it is sometimes described as being very simple or essentially an argument for multidimensional well-being.

Proper Justification and Legitimacy

Aside from being vigilant to the violence that various prevailing theories and frameworks can cause or tolerate through informationally narrow, fixed, or dogmatic principles and perspectives, an equally important CA concern is the proper justification and legitimacy of the social and ethical values being endorsed in policies and practice. Sen’s long-standing interest in social choice theory and democracy, his debates on the different development paths of China versus India, first-hand familiarity with the impacts of utilitarian colonial policies in India, and so forth likely inform his strong advocacy for the proper justification and legitimacy of policies and democratic governance more generally. Such concern for legitimacy is also core to the CA. Therefore, while the critique or outright rejection of many theories may be due to their direct cause or toleration of violence, certain other theories are rejected because of their poor ethical justification and illegitimacy. The rejection of the ‘basic needs’ approach to development that was popular in the 1970s is one good example. This approach to basic needs can also be seen in the evolution of discussions on decent work, both within rich countries and in global policy discussions about low- and middle-income countries.

The basic needs approach was well-intentioned, seeking to identify the minimum amount of various goods and services that every human being needs for a minimally decent life [Reference Ghai, Khan, Lee and Alfthan11]. This explicit list (and amounts) of things was aimed at helping or cajoling governments and foreign aid agencies to better focus, rationalise, and prioritise their policies. In the face of mass starvation deaths in various countries, high infant mortality, and other severe deprivations due to pervasive poverty in most countries worldwide in the 1970s, it seems understandable that international policymakers and scholars wanted to identify and establish a minimum threshold or safety net that every human being should be above. If such a line was established, then it might be possible to hold governments accountable to provide individuals and household resources up to that line and cajole governments to make faster progress. (It seems that they also assumed that ethical ideas would be enough to motivate action.)

The ethical problem, however, is that the list of basic needs (or minimally decent work) is derived from a conception of a minimally decent human life. It is not based on purely natural or objective facts about human beings but rather on a conception produced through reasoning about what constitutes a minimally decent human life. However, whose reasoning produced that conception? On what grounds is that conception legitimate to be imposed upon the world, particularly the poorest and most vulnerable people? No matter how well intentioned or urgent, there are real risks that such reasoning is infected with such attitudes as ‘beggars can’t be choosers’, ‘something is better than nothing’, ‘good enough for them but not for us’, and other such pernicious views. Even if basic needs programmes and policies are implemented with sincere virtues, the domination of ethical values by one group over another, particularly domination of those who are vulnerable, is a great moral harm.

Partly in direct response to this kind of ‘benevolent dictator’ approach, the CA restrains from presuming or enforcing an idea of a good human life and proposes ‘only’ the abstract or general concept of basic capabilities. Moreover, Sen has vehemently maintained that the specification of capabilities – which capabilities constitute decent quality of life – should be done by the people being affected by the policies and through public deliberation. The basic needs approach example, hopefully, shows why the CA has clear and minimal core content while also being open to all relevant empirical and ethical information to both avoid violence and engender legitimacy.

There is another ‘high philosophy’ reason to consider. Modern political philosophy in Anglo-Euro America has focused strongly on the conflict of two ethical values, namely liberty and equality. Despite decades of both philosophical and real-world political debates and even violent wars, there is still no widely accepted way to reconcile the conflict between these two important foundational liberal values. This specific value conflict has also led to a large body of twentieth-century philosophical literature that considers more generally the questions of what the rock-bottom or foundational liberal values are and how we may be able to build ethics or theories of social justice with multiple values (‘value pluralism’). Modern thinkers, including John Rawls, Jurgen Habermas, Thomas Scanlon, Bernard Williams, and others, have all sought to provide reasoning for how to reason about and through conflicts of fundamental values. Sen has also engaged in these debates and argued for different ways to address them.

Remember that his initial presentation of the CA focused on redefining the target of equality [Reference Sen1]. He then purposefully frames capabilities as freedoms a decade or two later [Reference Sen12]. Therefore, it is not equality versus freedoms but rather the equality/equity of freedoms. In considering the conflict between different kinds of freedoms or other values, Sen suggested the possibility of ‘partial comparability’ or ‘partial orderings’. That is, rather than full agreement, no agreement, or no optimal agreement, there may still be forward progress through identifying overlap across parts of different orderings or value priorities [Reference Sen13, Reference Sen14]. Aside from showing the possibility of progress during value conflicts, Sen offers a separate and distinct philosophical argument regarding value pluralism, conflicts, and social decision-making.

Sen argues that the process of ‘public reasoning’ itself provides justification and legitimacy for the ideas and values that eventually survive. Rather than one philosopher’s arguments about which values are most important or experts handing down or imposing their wise views involving values, Sen advocates real-world public discussion as the source of justification of value choices. This is why he argues for the CA to be open to specification and ordering of capabilities, which are essentially socio-ethical values. The CA, which specifies which capabilities constitute a decent life for all human beings or even just poor human beings around the world, would risk the same illegitimacy and justification problems of the basic needs approach. However, Sen argues that what survives good public deliberation, whether at the local or global level (e.g., basic human rights), becomes justified. By public reasoning, Sen does not intend to mean that whatever people say goes. There are various requirements for good public deliberation, such as ‘impartiality’ or the ‘impartial spectator’ perspective and the inclusivity of diverse perspectives [Reference Sen12]. A recent assessment of Sen’s understanding of such deliberative processes in modern times was provided by Gasper [Reference Gasper15].

To summarise the discussion thus far, we can identify two significant ethical reasons for informational openness in the CA, which gives it integrative powers and makes it easy to use. First, it aims to avoid the violence that can occur from informationally narrow and fixed concepts and explains why there was rejection of other dominant approaches to social justice as well as theories and paradigms in different fields. Second, openness can ensure legitimacy and proper justification of theories, policies, and practices informed by the CA. Both reasons show how the CA is an open framework for ethical reasons. Importantly, it is also open to diverse ethical values while also holding some core ethical content. Always keeping these two reasons in mind would be prudent in working with the CA either in theoretical work or in trying to integrate the CA into a discipline or practice. Let us move on now to the practicalities of how the CA is integrated through informational openness.

Informational Openness

Sen’s early interest in mathematics and then economics and related areas of social choice theory and social justice philosophy, as well as interest in informing and shaping public policy, likely informed his interest in intertheoretical coherence across disciplines and fields of practice. Aside from important single-discipline contributions, Sen’s work also reflects what is called transdisciplinarity. This certainly shows in the construction and development of the CA. Despite working with different disciplinary paradigms, each with different starting assumptions, methodologies, and basic questions or aims, the core components of the CA were presented in ways that are understandable and relevant to contextual issues and discussions and, importantly, convincing to various disciplines. Other CA scholars have also attempted to explore Sen’s intertheoretic coherence strategies within and across various disciplines and practices. The important anchor or common unit across different discussions is human well-being and related ethical values such as anti-violence, equity, and centring on and prioritising the worst off. As many CA advocates have observed and written, how you use the CA depends on what questions you are asking and what you want to achieve.

One way to engage with CA’s informational openness and understand how it can and has been integrated into various disciplines and policy analyses is to consider its core concepts, aims, and motivations as entry points or points of shared concerns across fields. We have already discussed the anti-violence stance, legitimacy, and justification and identified several core concepts, such as capabilities, functioning, agency, freedoms, multidimensional well-being, social justice, human rights, and equity. These concepts have been mentioned only quickly, and there are many more concepts, such as conversion factors, global justice, comparative justice, and comprehensive consequentialism. One or some of these ideas may look like shared concerns and promising avenues to solve a problem or introduce novel thinking into an existing discipline or practice. Most often, the CA initially interests people because of its basic ideas of multidimensional well-being, capabilities, social justice, rights, and interest in poverty alleviation or more ethical economics. Researchers and policymakers may be searching for ways to expand their existing narrow concept of well-being, understand the causes better, or seek more explicit ethical resources to motivate better or more comprehensive responses to human deprivations (i.e., violence and injustice).

Cause and Effect: Means and Ends

Many disciplines, particularly the natural and social sciences, study cause-and-effect relationships. Various professional practices seek to understand how to produce or improve various outcomes. The CA, as Sen states, asserts that capabilities are both the ends and means of human well-being. That is, human well-being is best understood as being composed of capabilities as well as being created through the development and expansion of capabilities; they are both causes and effects, often iterative, interrelated, and progressive. Therefore, many of the applications/integrations of the CA in various disciplines and practices attempt to align the cause‒effect story in the CA with the cause‒effect story in the user’s domain of interest. For example, as reflected in the focus of this book, many working in economics or other public policy domains are interested in expanding the focus of well-being, or decent work, from a commodity or some other thing (e.g., the effect or outcome) to the broader value space of multiple capabilities and functionings. Similarly, in health policy or well-being at work programmes, we seek to expand focus from only healthcare (often confused as being the cause of health) to the conditions that enable people to be healthy over the life course. We are also seeking to measure, understand the causes, and address the population distribution of health (capability) inequalities. In education, we are interested in expanding our scope from just standardised outcome metrics to helping each individual develop basic capabilities and specific capabilities such as autonomy, critical thinking, problem-solving, self-respect, and aspiration.

For some seeking to apply the CA, the abstract concept of a capability, which is an ethical concept related to well-being, helps to reimagine and elevate the moral nature of the causes and effects of human well-being in their discipline or practice. The CA energises what might be a staid or highly technical discipline (e.g., occupational health, rehabilitation, surgery) with renewed ethical significance. Furthermore, once we accept the use of the capability concept, the CA does not limit the scope of the type of causes or their dynamics when their effects on capabilities/human well-being are examined. It is open to all causes that are natural and social, micro to macro, sociological or political, and so forth. What matters is the context of the human beings that are of concern and the questions being asked to best capture the phenomenon regarding well-being. As a result, we are able to study diverse causes and their dynamics and their impacts on capabilities at the individual and household levels, at the group or national population level, or at the global level. Expanding the scope of causes and effects can have a profound impact on different disciplinary practices and paradigms that are currently limited to narrow informational inputs [Reference Venkatapuram and Marmot16].

By demanding all relevant information regarding capabilities and equity, the CA asserts that addressing human well-being has to be interdisciplinary. The CA inherently contains ethical and philosophical reasoning and, to some extent, economics. Therefore, any use of CA outside philosophy or economics could claim to be doing interdisciplinary work. However, instead of just cannibalising concepts, truly integrating the CA requires understanding and aligning with the ethical concepts, aims, and motivations. The ethical grounding of the CA provides justification or valid reasons for some disciplines to break out of limiting paradigms. The aim of improving human well-being with a focus on equity extends beyond looking at just natural facts or just social causes, expanding well-being outcome concepts, or going below or even above a group-level analysis. While some disciplines, such as development economics, welfare economics, health and healthcare policy, and education, have been amenable to CA applications and analyses, other fields have been more resistant or less interested (see earlier regarding the moral psychology needed).

One important but underrecognised power of the CA’s applications is its ability to help analyse the long causal chain over time and impacts on human well-being/capabilities. This power is because of its open structure but also because of Sen’s many insightful illustrations using the CA to assess historical cause-and-effect relationships. Individuals and disciplines might be interested in the CA for its promise of improving the well-being of people here and now and in their future. However, the CA can also help with the study of historical causes or establish explanations or causal stories of important social problems. This can be of significant consequence and differentiates CA from other social justice theories. One important example is the study of the causes of famines.

Sen and Jean Drèze showed that most famines or mass starvations in modern times did not occur because of the lack of food availability, which was the dominant view [Reference Drèze and Sen17]. Instead, modern mass starvations have occurred because of a variety of social and economic dynamics that constrain people’s ability to purchase food. What was previously thought to be a natural, causal story was fundamentally rejected and changed to a social, political, and economic causal story. Sudden decreases in wages, increases in food prices, grain hoarding, food exports, and other factors better explained mass starvations as a process of capability/entitlement failure than the sudden reduction in food due to natural events or a population size outstripping the food supply. Capability analysis also better explained the distribution patterns of starvation as well as low-level endemic malnutrition (i.e., why some starve while others do not). This study of historical and long-term causes of mass starvation was powerful in changing modern policy approaches to address global hunger. It also overthrew Malthus’s theory of population dynamics, which produced and tolerated enormous violence against human beings (i.e., millions of deaths) worldwide for centuries.

Sen has applied such CA analysis to other historical causal stories, such as in the debates about the relationship between national wealth and health outcomes, the East Asian miracle, India versus China development trajectories, and health and mortality inequalities in the USA and worldwide. Of course, not every analysis Sen has done is about capabilities, but much of it can be understood that way. The possibilities of historical analysis of cause–effect stories via the CA show that it can both be the source of simple ideas and a powerful apparatus that can overthrow paradigms and theories that have held sway for centuries.

Case Studies: Well-Being at Work and Healthcare

To illustrate, two examples are discussed here: reintegration into work and healthcare. Reintegration into work often involves three parties and perspectives: the employer, the health professional, and the worker. For the employer, concern about loss of productivity may be central; for the health professional, the value of social participation, and for the worker, it is meaningful work. In healthcare, disease control or management may be the primary and valued outcome of healthcare professionals, while patients may also value other related aspects, such as duration, experience, and dignity.

When professionals and clients fail to act from a shared value system, this can lead to mutual frustration with each other’s perceived lack of commitment, concern, or understanding. When the process and outcomes of healthcare seem indifferent to patients’ desires, aspirations, and broader well-being, some patients and professionals may seek out additional resources that address these frustrations. However, each person’s value perspective may be valid and legitimate in these two examples; the dissatisfaction with sacrificing, excluding, or deprioritising valued dimensions of the well-being of the primary individual may motivate the seeking out of other resources or starting points. Not addressing the different values means that the primary person suffers violence, the deprivation of well-being.

In such situations, the CA offers a comparatively more robust framework and tools, both conceptually and ethically, than other models do. In the individual case, but also in general, it helps people rethink the means and ends of daily work and healthcare practice generally. The CA also helps validate and motivate the recognition of the multiple dimensions of human well-being, of capabilities versus only outcomes, of freedoms and choice in being the author of one’s own life, and to help agency. From a perspective internal to employee well-being or healthcare professionals, the CA helps motivate and justify expanding the focus from economic productivity and disease management to human well-being. From an external perspective, such as worker or patient group advocacy, the CA motivates and justifies demanding that employers and healthcare professionals recognise patients as active agents who have conceptions of a good life with multiple dimensions.

The CA also opens the possibility of researching which capabilities are important to people. In healthcare, we can ask which capabilities are valuable for people with specific kinds of impairments or disease conditions, which outcomes are valuable, or what is valued in the experience of receiving care and treatment. Building on this, the CA can help identify the diversity of people with the same disease or impairment value across countries as well as even within countries. The use of the CA in this contextual way offers the possibility of healthcare that is more human-centred, not professional and disease-centred. It also helps provide healthcare that reflects local contexts and values rather than providing treatment protocols on the basis of the biology or social values and contexts of a study population from distant countries.

The ease with which the CA can elicit from people what is important to them about their activities, experiences, desires, aims, and aspirations can be powerful in addressing or readdressing the immediate constraints and injustices in people’s lives. In many professions, there is sometimes an active effort to restrict information so as not to become overwhelmed by the scale of injustices that people are experiencing. In the specific cases of both work and healthcare, they are both important places where the basic foundations for well-being, as well as justice claims to well-being, can be realised. Improving work and healthcare via the CA can achieve more justice or repair through rejecting violence, seeking legitimacy, and realising the well-being claims of every person. While these illustrations are largely practical uses of CA in healthcare and well-being at work, the potential for similar use and engagement with contextually specific concerns in the daily practices of other professional practices is enormous and can be productive.

Challenges: Conversion Factors and Commodities

There is a growing body of CA literature on practical applications of the CA in different contexts as well as the development of individual-level capability measurement tools for various contexts. Much of this literature discusses practical efforts to move beyond single-dimensional outcomes, procedures for specifying capabilities, empowering individuals and communities, and so forth. In these practical applications, one aspect is relatively underexamined and is linked to the demand for informational openness: the process where a person’s internal features and external conditions match to create capabilities. See Chapter 10 for examples of practical applications.

In Sen’s early work advocating for focusing on what capabilities individuals have, or their ability to live the kind of lives they want to pursue, he highlights the important economic concept of commodities. While many economists, particularly development economists, focus on the income or commodity holdings of people in assessing poverty or wealth, Sen made the important point – to this audience in particular – that different factors influence a person’s ability to convert commodities into capabilities and functionings. The point being that the concern for economic inequality and deprivation should not be focused on commodity holdings but, more correctly, on capability inequality. Moreover, these influencing factors create capability inequalities, which he termed ‘conversion factors.’ See Chapters 1 and 2 in this book for a short description of conversion factors. In light of the unique diversity of every individual human being’s life context and life path, any assessment of capabilities has to be actively open to all information regarding what is affecting an individual’s capabilities, whether positive or negative. Sen initially focused on examples such as biological diversity (pregnancy, age, disability, etc.), social and cultural practices (female mobility, clothing norms, etc.), and the physical environment (stagnant water pools, etc.). The process of the formalisation of concepts into an approach or theory has led to the categorisation and specification of these diverse conversion factors.

In the Idea of Justice, Sen identifies five categories: personal heterogeneities; environmental diversities; variations in social climate; differences in relational perspectives; and distribution within the family [Reference Sen18]. While one might expect to take these as pillars set forth by the founder of the approach, a closer look shows that there is no clear line between some categories, and some things look odd under the heading being given. For example, Sen suggested that the prevalence of malaria and cholera and the prevalence of HIV/AIDS are environmentally diverse. However, unlike malaria, HIV/AIDS is very much transmitted person to person and falls better under ‘variations in social climate’. In addition, he states that pollution comes under both ‘environmental diversities’ and ‘variations in social climate’. This should not be understood as absentmindedness or mistakes. The error is related to understanding the five categories as a comprehensive and coherent classification of all the conversion factors in the world. Rather, the important thing here is to use the categories as a guide to examine possible conversion factors, from simple to sociological and abstract. See the practical applications described in Chapter 10 of this book as examples.

If a conversion factor is found that does not clearly fall into the five categories, Sen would likely be curious and pleased that we are learning more about constraints on human well-being. The main thing of value is human well-being, which necessitates keeping the concepts of conversion factors open to allow us to be constantly curious for more information about causes as well as possible interventions. To dismiss, obfuscate, ignore, or be wilfully blind to conversion factors because they do not fit the categories tolerates or perpetuates violence and injustice in the form of constrained capabilities. Therefore, a certain kind of grounded-openness – grounded in the theory and open to reality of the context – is important to the CA for both informational reasons and foundational ethical values such as freedom, equity, and justice.

Such reasoning is shown in this book. In the Capability Set for Work Questionnaire (CSWQ), introduced and described in Chapters 1 and 2, clients are presented with seven work values. Each value is rated in three categories: a) the importance of each value; b) whether the client feels empowered by the work environment to achieve the value; and c) whether the client can truly achieve the value. The answers to the b and c categories elicit information on contextual and personal conversion factors and reflect the openness that Sen advocates.

However, there is also another underlying issue. The conversion factors are about converting some commodities into a capability. What commodity is affected by the HIV/AIDS conversion factor, and which capability is that commodity useful for? The underlying issue here is that someone new to the CA could easily think that there are conversion factors affecting every capability, and there is centrality of a commodity to every capability. This is simply not true. Many, but not every, valuable human activity or capability entail a commodity. Or, finding a commodity related to a capability (e.g., healthcare qua health) and making it the centre of analysis may lead us astray. This, indeed, was a mistake of some of the earlier CA and health literature. They thought that every capability had a central commodity, so they focused on healthcare when they thought about health capability. To take a different example, an infant crucially needs food, a commodity. The infant also needs a carer’s love and stimulation for the development of various capabilities. It is misconceived to focus only on food or reframing love and stimulation as commodities to follow the CA model which was initially meant for economics audiences. In the case that commodities are central to capabilities, then the use of conversion factors may be very helpful. However, where there is no commodity but capabilities are constrained by factors such as interpersonal relations or structural oppression (e.g., exploitation, marginalisation, violence), we skip the commodities and conversion factors and focus on the constraints (see the case of Laura in Chapter 10; see also Chapter 12).

To summarise this section on practical integration of the CA, using it in daily practice helps to envision individuals as active agents and authors of their lives and their well-being as being constituted by multiple dimensions, each valuable. This helps to reinforce the idea that freedoms are important to human life. The CA motivates and helps justify expanding narrow and sometimes misguided outcome goals and metrics which can tolerate violence and avoidable deprivations in well-being, or forego better human well-being. The informational openness of the CA has aspects that become more obvious when it is used in daily practice. On the one hand, it allows for the incorporation of different kinds of information, both factual and value-based, to increase well-being. On the other hand, once in use, the CA demands pursuing such information because the person in front of us, here and now, has a moral claim to multidimensional well-being arising from our widely shared fundamental values of freedom and equality.