26. The Health of Nations

For decades, GDP has been the yardstick for measuring living standards around the world. Martha Nussbaum would rather use something that actually works.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Stephen J. Dubner?

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• 0:48Stephen J. Dubner?

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• 1:20Stephen J. Dubner?

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• 2:29Stephen J. Dubner?

  When economists talk about the standard of living in different countries around the world, they often use a single yardstick: GDP. And since economists use it, and they've been using it for decades, we use it too, even if a lot of us don't quite know what it means. G D P. Do you know what it means?

• 2:53Speaker 01

  What's the initials? G B. G P. You got me. Like breakfast cereal necklaces? Am I right? Am I close?

• 3:01Speaker 02

  I'm just a little girl. How am I supposed to know that?

• 3:03Speaker 01

  I honestly have no idea.

• 3:05Speaker 02

  I wouldn't be able to speak intelligently about it.

• 3:07Speaker 03

  Gradual something depth population? No, I don't know what to say. Never heard of it.

• 3:13Speaker 04

  I have no clue what it stands for. Um, government deposit something, something. I don't know. I don't know. Does it have anything to do with, like, economy?

• 3:21Speaker 05

  Yes, the gross domestic product.

• 3:26Speaker 05

  It's the overall amount of stuff that we produce and its correspondent value. Yeah. Okay, good. You're the person who's got it right. Oh, really? Good job. Thanks.

• 3:36Stephen J. Dubner?

  Yeah, that's right. GDP is the total market value of all the goods and services produced within a country over a year. Now, that certainly sounds like a reasonable way to measure a country's wealth, and by extension, its standard of living, right? But let me ask you another question. What does GDP not include? And once you know what it doesn't include, are you sure you still want to use it to measure something as important as living standards? Those are the kind of questions that Martha Nussbaum likes to ask. She is, importantly, not an economist. But for quite a few years, she has been collaborating with an economist, the Nobel laureate Amartya Sen, to find a better, smarter, fairer way to measure living standards around the world.

• 4:20Speaker 06

  Okay. I'm Martha Nussbaum, and I'm a professor of law and philosophy at the University of Chicago. So I teach courses on social justice and sometimes law. But I recently wrote a book about development economics and a kind of philosophical criticism of standard models of development economics. And it's called Creating Capabilities: The Human Development Approach.

• 4:48Stephen J. Dubner?

  Okay. And if you had to give yourself a one-word title, description of what you are, what you do, is it philosopher? What is the one word?

• 4:56Speaker 06

  I would say philosopher, yeah.

• 4:59Stephen J. Dubner?

  Perfect. Okay. And even people who don't know what GDP stands for know that it's the measure that we use to sort of take a country's temperature, to see how well that country is doing. So Martha Nussbaum, what about you? What do you use to take that measure?

• 5:14Speaker 06

  Well, I think GDP is a very obtuse measure. And what I want to look at is what are people really able to do and to be?

• 5:23Stephen J. Dubner?

  Excellent. Now, where do you think, if you had to choose, is the best place in the world to live?

• 5:31Speaker 06

  Hmm. Well, you know, I think in terms of equal distribution of all the good things in life, I personally have thought Finland is a pretty good place. Now, the problem is, they keep out the immigrants. And so, you know, there's that larger issue of global justice they don't do so well on. But in terms of how they get the good things in life to people in a way that enables them to live long, healthy, productive, well-educated lives, they do really a great job.

• 6:02Speaker 07

  From WNYC and American Public Media, this is Freakonomics Radio, a podcast about the hidden side of everything. Here's your host, Stephen Dubner.

• 6:27Stephen J. Dubner?

  Here's why Martha Nussbaum doesn't think GDP is all that helpful in learning how people in different countries are really doing, how they really feel about their lives and their children's lives.

• 6:38Speaker 06

  Okay, well, the first thing is even if you were absolutely determined to have just one number, it wouldn't be the best single number. Average household income would be a much more pertinent number because that's a number about how much money is staying there, doing things for people in that country. The problem with GDP is that the profits of foreign investment often go out of the country, back to the investing country, and so GDP doesn't even tell us what's happening for those people in that country. Now, then, though, there are some more serious problems. Distribution. We want to know how people at the top are doing and how people at the bottom are doing, and what levels of equality that society has attained.

• 7:22Speaker 06

  GDP is an average, so it doesn't tell us whether there's a large number of people who have very miserable lives. In the days when that was used as the main measure, South Africa under apartheid did very well in the development tables because there was a lot of stuff around there in South Africa, but never mind that it didn't go to enrich the lives of a vast majority of the people there. And then, third thing, is that if we think about the different things that are involved in a human being having a good life, those things are plural. There are things like health, education, the quality of race relations. So think about South Africa. All those things are huge, and they were part of the apartheid system, was the inequalities

• 8:07Speaker 06

  in health and education. Now, it turns out that GDP is not very highly correlated with some of those important things. There's a lot of empirical work by now that's been done on whether improving GDP translates into improvements in health and education. And it turns out that it actually doesn't. In the absence of direct government action focusing on those things. So it's just not a very good proxy for a lot of things that are very important to people.

• 8:35Stephen J. Dubner?

  So you're basically saying, wait a minute, wait a minute. For decades, we've gotten it wrong. We've relied primarily on economists who use primarily this one big measurement tool of GDP. And it just doesn't really, and that produces all kinds of negative consequences, including a worship of this metric that just isn't really very valuable for a lot of people, and it doesn't reflect people's true happiness. And you're saying we need to do something very, very different. And you prescribe what's called the capability approach. So in a nutshell, what is it? What is the capability approach?

• 9:09Speaker 06

  Well, the capabilities approach holds that the key question to ask when comparing societies and assessing them for their basic decency or justice is, what is each person able to do and to be? So in other words, this approach takes each person as an end, as a goal of the development process, asking not just about totals or averages, but about the opportunities available to each person. And it is focused on choice or freedom. So the goal is capability or opportunity, not actually having the government dragoon you into behaving in a certain way.

• 9:47Stephen J. Dubner?

  In what I think of as the mission statement, you write that the key question is, what is each person able to do and to be? And within that aim, you focus on a number of important pieces of framing to be done. So a focus on freedom and choice, pluralist values, attacking social injustice and inequality, and that the government must enact all of the above. Now, a lot of this doesn't sound too different, really, from what Milton Friedman has written, which would not be the first person that came to mind when I started to read your book. I'm curious to know what you think of Friedman and how what you have written fits into what

• 10:32Stephen J. Dubner?

  most people have come to think of as the Chicago School of economic freedom to choose?

• 10:39Speaker 06

  Well, of course, I have all these debates with these Chicago School economists all the time. And my colleague, Richard Epstein, likes to say that we agree about ends totally and we disagree about means. Now, I think that might be a little too simple, but I think he's got a lot right. That is to say, Richard just thinks the government doesn't do a very good job at achieving the things that he and I both want, and therefore, we should rely on the market to produce a lot of these things. But I think there's more disagreement than he thinks there is because of the role of law. I mean, I really do think that constitutional law and then other aspects of law play a

• 11:20Speaker 06

  big role in making these opportunities real for people, and that we wouldn't have the religious freedom that we have in the US today if there wasn't a First Amendment and it wasn't enforced through the courts, and a freedom of speech, and so on. And then I think that we wouldn't have meaningful equality and an end to discrimination without law taking a very active hand. Now, Richard has, of course, written a whole book saying that he thinks that the market would solve problems of discrimination. I think that's not realistic. I think people are motivated by hatred and disgust with other people, and, you know, there are a lot of bad motives. My other main area that I work in as a philosopher is the emotions, and I think that the Chicago

• 12:04Speaker 06

  School's big failing is not having a rich enough and deep enough account of human nature and the human emotions. They leave out certain very bad motives that interfere with the competitive market process, and then they also don't give people enough credit for altruism and compassion and so on. So I think that's my main beef with the Chicago School.

• 12:26Speaker 08

  This is a song about being happy. That's right. It's the Happy, Happy, Joy, Joy song.

• 12:35Stephen J. Dubner?

  Coming up, rating countries on a different scale called the Human Development Index, and the philosopher sings, too.

• 13:03Stephen J. Dubner?

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• 14:29Stephen J. Dubner?

  Apply for free at snh.edu/freakonomics. Freakonomics Radio is sponsored by hotels.com. Hotels.com helps you find and book the right stay for work faster. With business preferences, save your travel must-haves, like gym access or breakfast, just once, then get tailored results whenever you search for work travel. Plus, with a free membership, you can save up to 20% on hotels and earn rewards on every stay for future travel. Book now at hotels.com. Visit hotels.com for details.

• 15:13Speaker 07

  From American Public Media and WNYC, this is Freakonomics Radio. Here's your host, Stephen Dubner.

• 15:19Stephen J. Dubner?

  Martha Nussbaum is the author of a new book called Creating Capabilities: The Human Development Approach. She's a philosopher who teaches law at the University of Chicago, although, interestingly, she's not a lawyer. Nussbaum has worked closely with the development economist Amartya Sen on something called the capabilities approach. I asked her about the Human Development Index, which is meant to be a more robust yardstick than GDP at measuring welfare around the world.

• 15:49Speaker 06

  Okay, well, the Human Development Index, which is always on page one of the Human Development Reports of the United Nations Development Program, is a weighted average that factors in GDP, health, and education. There's a mathematical formula that's very complicated, that's been much disputed, and so on. And nations are then ranked, approximately 180 nations are ranked, in accordance with their achievement on this metric. But then, what happens next in the reports, which are often very long, is that then there are other measures that are introduced. Then we see what happens when you adjust it for gender. We see what happens when you focus particularly on the situation of the poorest.

• 16:33Speaker 06

  And then, finally, we break it down. We don't just stop with a single number, but we say, well, let's now look at the health data in themselves. Where are the problems? There's an infant mortality problem, a maternal mortality problem. And so if you want to figure out why the US ranks so relatively low in the index on page one, where it really comes, I mean, different years, different places, but always much lower than one might predict in the list of the developed countries, well, the way it falls down is in areas like infant mortality, an astonishingly high rate of infant mortality in the US, which, of course, there are various explanations you can find for that, such as a lack of available prenatal care to

• 17:18Speaker 06

  People living in inner cities and so on. So there are many things that we would ask after we see the single number. So I think the single number is just a starting point. It's fun. It gets people's attention. But where the action is, is later on, when we really start to break it down into different, different, specific things.

• 17:38Stephen J. Dubner?

  Right. And as you do, as you mentioned, the, the single number is what gets people's attention and gets them talking and paying attention to the issue. And you also mentioned that the US does relatively poorly, all things considered, number one nation in GDP, but last year was only number 12 on the Human Development Index. But then this year, in the new numbers, it, it looks like the US has shot up to number four. Did, did we get so much happier so fast? How did, how did, how did our single number jump up eight places?

• 18:08Speaker 06

  I don't know what happened there. I think, of course, the economic crisis has thrown off these things in a way that's unstable and we may see something completely different the next year. If you go behind it, I'm sure we haven't jumped up to a new level on infant mortality and on all the, the other things that drag us down. So I think it may be a result of a lot of nations cutting back on health and education because of their economic problems or whatever, but we would have to deconstruct it before we would be sure we had the answer to that.

• 18:41Stephen J. Dubner?

  When I look at the top 10 countries in the new HDI, I see Norway, Australia, New Zealand, US, Ireland, Liechtenstein, Netherlands, Canada, Sweden, and Germany. So plainly not uncorrelated with GDP. Shouldn't we expect a little bit more divergence, however?

• 18:59Speaker 06

  Well, it couldn't be uncorrelated because GDP is a part of the number. I mean, so it's a big part of the number, if you look at the formula. So it's set up to be correlated with GDP because the, the belief that I share with the other people who work in this, Sen, among them, is that it's a good thing to increase GDP. It's a very good thing because if there's more money around then, then there's more for politics to do for people. And so, of course, you should do that, among other things. It's just that it doesn't. The correlation doesn't hold up all down the line because then when you look at education, you look at health, there's really not a very good correlation between increases in GDP and improvements in those areas.

• 19:44Speaker 06

  One of the things that Sende did was to do field studies of the different Indian states. And that's really fascinating because it's like a laboratory. Because the Indian constitution leaves health and education to be state managed subjects. And there's tremendous divergence. So some states have gone for a GDP policy. And so Andhra Pradesh, Gujarat have said, well, we're going to improve people's lives just by improving GDP. And you can look and ask, well, did the lives improve? And the answer is, well, some lives, but not others. And certainly rural poverty has not been touched and literacy rates have not risen and so on. Then you look at other states like Kerala particularly, which for a long time has had

• 20:28Speaker 06

  the idea that we really must focus on literacy. And what we want is that every single person should be literate and we want an adequate public system of healthcare, which is basically something that no other Indian state has. Well, the health achievements of Kerala as a state, and it's a very poor state in India, are the same as those of Harlem in New York. Now, that's really shocking when you think of it. That a very poor Indian state should be at the level of a part of the US, which is so much higher, just incomparably higher, in GDP. Well, how did they do that? They did it by distribution, by making sure that healthcare facilities and healthcare

• 21:12Speaker 06

  were available to everyone. On education, Kerala has got 99% male and female literacy in a nation in which 50% of women on average can't read or write, and only 65% of men can read or write. So Kerala has done something extraordinary in the Indian context. How did they do that? Well, that story has actually been told. They did it by having flexible school hours so that working children could go to school. They did it by serving a nutritious midday meal in the school so that parents wanted to send their children to school rather than having them work because it was better for the family income. And actually, the Supreme Court of India by now has ordered all schools in the whole

• 21:52Speaker 06

  nation to serve that midday meal with 350 calories and 18 grams of protein. So that's judicial activism for you. But so that's the kind of thing that makes us think that these are important differences. That GDP does not deliver these other good things. In fact, Kerala did very little for GDP. In fact, they should be criticized for that. They've allowed labor to drive up wages so high that the labor market has fled to other states. And so that's something that they should be criticized for. But on the other hand, it's clear that the states that have done better with GDP have not done better on the things that Kerala does well.

• 22:33Stephen J. Dubner?

  Let's discuss happiness for a moment. So a lot of economists in the last 10 or 15 years have really tried harder to study not just people's financial well-being and so on, but try to get their emotional well-being in some quantifiable way. What's your view of the relationship between wealth and happiness?

• 22:54Speaker 06

  It's all a question of what you think happiness is. And this is a question that philosophers have asked for centuries. And the minute that Jeremy Bentham said that we should look at happiness in terms of pleasure or satisfaction, John Stuart Mill immediately said, now, wait a minute. It's better to be Socrates dissatisfied than a pig satisfied. And so he then insisted that we had to think about happiness as containing many different kinds of experiences, many different kinds of activity. And, well, Mill wasn't the first to say that. He was really getting all that from Aristotle. So I'm with Mill, and I think that the Benthamite approach, where we just think of happiness as a single feeling, has got very little going for it.

• 23:36Speaker 06

  If you just think about a daily experience, the pleasure that I get from writing is very different from the pleasure that I get from going out and buying a nice dress. They're just very different things. And the pleasure that somebody might get from bringing up a child is different again. So I think that's not a good idea. I think we should have a much more Millian, rather than Benthamite, conception of happiness. And if we have that, well, then the question comes, what's the relation of wealth to that? Well, it's certainly a necessary condition. For many parts of it, parents want to be able to give their children the good things in life. They want to be able to give them health care when they're sick. They

• 24:21Speaker 06

  want to take care of their aged parents and so on. So up to a certain threshold level of adequacy, I think wealth is enormously important. Now then, the question is, is it important above that? Are luxury goods important? Now, it's clear that people are envious, that they do feel dissatisfaction when someone else has a better car than they do, or a better house. But that's different from feeling an urgent need for things of basic human importance. And so what I try to say is that we should ask, what is a life that's worthy of human dignity?

• 24:57Stephen J. Dubner?

  Very good. So I realize I've taken up all your time, but just in the last couple of minutes, if I may, I understand you sing, yes?

• 25:06Speaker 06

  Yes, yes, I do.

• 25:07Stephen J. Dubner?

  You sing every night, every day?

• 25:09Speaker 06

  I try to sing every day, yeah. I try to sing at least, you know, forty-five minutes an hour every day.

• 25:14Stephen J. Dubner?

  I see. And what about just at home, when you're alone, puttering around at home? Are you singing?

• 25:19Speaker 06

  Oh, sure. No, that's where I do my practicing. And I, yeah, I mean, I'm always working on a couple of things and, you know, classical music. And I work on, either Handel and Mozart are great favorites. But I'm now working on, actually, some things from Massenay's Verterre. And I'm enjoying that enormously. It's just a very different kind of thing. So, yes, I mean, I'm an old actress. I was a professional actress before I went into the academy. And so I like things that I can interpret musically as an actress.

• 25:48Stephen J. Dubner?

  I see. So since you're a former actress, and since you've got a microphone in front of you, I'm sure you won't mind. Would you sing for us, just a little something?

• 25:56Speaker 06

  Oh, well, gosh.

• 26:09Stephen J. Dubner?

  That was lovely.

• 26:10Speaker 06

  I haven't warmed up, of course. So you're just asking me cold. And I would usually warm up for a half hour before I would do that, but...

• 26:16Stephen J. Dubner?

  That was absolutely lovely. Martha Nussbaum, I thank you so much. It was a pleasure to speak with you.

• 26:20Speaker 06

  Thanks very much, Steve.

• 26:34Speaker 07

  Freakonomics Radio is a co-production of WNYC, American Public Media, and Dubner Productions. This episode was produced by Susie Lechtenberg and mixed by David Herman. Our staff includes Chris Neary, Colin Campbell, and Borey Lam. Subscribe to this podcast on iTunes and you'll get the next episode in your sleep. You can find more audio at FreakonomicsRadio.com. And as always, if you want to read more about the hidden side of everything, go to Freakonomics.com.

• 27:15Stephen J. Dubner?

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• 27:46Stephen J. Dubner?

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