Let's Design an Institution

At this point, we have an account of good reasons. We also know that it applies to reasons for individuals and to reasons for communities. Thus, our guiding questions in taking choices often are how we see our past and who we want to be, as persons but also as a people.

What do these rather abstract conclusions entail for the design of a concrete institution? The best way to bring them to life will be to consider an example in detail. So let's design an institution together.

Suppose, political groups in a given state propose the creation of a new institution, public healthcare. To simplify, we consider a dichotomous choice. Either all pay privately for all their care or all pay collectively for everyone's care. In our private scenario, there hence are no state-funded emergency rooms, no infant vaccination campaigns, nor any of the other basic public health services that, to my knowledge, any contemporary state offers at least in larger cities. Healthcare is fully private. How could the proposed alterna-tive, fully public healthcare, further the public good? More precisely, what would be reasons to create this institution and what do these reasons imply for the institution's design?

In a political debate about the choice between all private versus all public healthcare, a proponent of universal care might see a variety of goods at stake and hence offer a variety of reasons. Table 6.1 lists some reasons and sorts them into Anscombe's three categories. These are mere examples; the list is by no means exhaustive. In the row below, you find the accusations that such a proponent might level against people who fail to see the proposed reasons as reasons. In the bottom row are the goods that, following the reasons in that column, will be realized through public care. Let's go through the details, starting with the reasons.

All three columns seem to offer plausible pro tanto reasons—whether or not you ultimately agree with any given one. Their purpose is neither to show that all states should have universal healthcare nor to evaluate particular reasons, but only to illustrate the form of correct reasoning about institutions.

Appendix 1: Maps of Pukhtunkhwa and Swat

Introduction

The World Health Organization (WHO 2020) characterizes health equity as the absence of unfair and avoidable or remediable differences in health status among groups of people. This can be achieved when those with lower socioeconomic status do not face financial barriers or other obstructions such as language, culture, stigma, distance, and an overall dearth of resources (Orach & Garimoi 2009). People living in poverty are at a greater risk of death than their wealthier counterparts, largely because they lack access to public health initiatives like clean water, sanitation, food security, education, and economic opportunities (Peters et al. 2008). Disease-specific burdens also differ by socioeconomic status as people living in poverty are more likely to die from tuberculosis than those who have higher incomes.

The purpose of this chapter is to inform the readers about the challenges facing Sierra Leone's healthcare system. The chapter examines how the nation is characterized by a severe shortage of healthcare workers and providers in clinical medicine, nursing practice, general practice, and family medicine. It argues that health equity is achieved when everyone in Sierra Leone has access to the same level of healthcare. The chapter also discusses the health trends and debates over the last decade in Sierra Leone. It covers increasing the importance of healthcare systems to meet the population's needs to achieve health equity in the country. According to the World Bank (2019), Sierra Leone has one of the world's lowest life expectancies of 54.8 years, owing to high rates of infectious diseases such as malaria, tuberculosis, and HIV/AIDS. Malaria has historically been endemic in the country, accounting for approximately 40% of hospitalizations of adults and children, while a high prevalence of late diagnosis and undiagnosed tuberculosis cases has further strained the country's healthcare sector. Furthermore, women have been exposed to more health challenges, such as their efforts as primary caregivers during the Ebola pandemic, resulting in higher infections. Maternal and child mortality remain the highest in the world. Additionally, the country's mental healthcare services and rehabilitation are also underdeveloped, owing to the pressure to develop high quality physiological healthcare facilities but also the limited concern for the mental health needs of the society issues that require professional intervention, with many former child soldiers in the civil war turning to drugs and substance abuse as coping mechanisms for their traumatic experiences.

Human beings are political animals because our personal identity and the things that make us happy exist only as part of a political community. That is at least what Aristotle thought, and this book is my attempt to revive his idea for our modern communities.

Constitutivism, the resulting theory, makes five major claims. First, that there are common goods, by which I mean an interest or an aspect of a person's well-being that only exists for several people together. A happy romantic couple, for example, has a happy relationship, and this happiness is one joint good that the spouses have together. In this, two spouses are very different from two business partners, who have synchronized but separate interests, that is, who each pursue their personal good but through a joint venture.

Second, such common goods exist only in conjunction with the personal good of each member of the group. That is, the couples’ happiness is also part of the personal happiness of each spouse and, conversely, we would not speak of a happy couple if one of them were miserable in their relation. In cases where we have common goods, we have such an existential interdependence. The personal good of each member of the group is partly constitutive of the common good they share while this shared good partly constitutes their personal good. We would, after all, also think that an unhappy relationship makes the individual spouses unhappy.

Third, the members of a political community have such a common good. This claim should not be mistaken for political romanticism. My idea is not that we all live happily and harmoniously, even though that would evidently be a desirable state of affairs. As before, my third claim is about certain things only existing in conjunction; it is a metaphysical claim about existential interdependence. Your personal happiness could not exist, that is, the things that a good life necessarily comprises could not be realized outside of a certain social structure that only states provide. To have this kind of structure is to have a state, to form a political community with the structure's other members. Conversely, the good state is one that enables a good life for its citizens, and the state's authority ultimately rests on this.

One instance is the case of Maxim. The story of Maxim will tell much of Russia at war. With its movement, its color, and its pictures it will contain much of the sum total that one can see or feel in the empire of the Czar today. In it there is the theme of the fourth of the four great dramatic facts of this conflict.

The first of these great dramatic facts, I think, is the spirit of Great Britain. No empire has ever been given the free-will service of so many men willing, if need be, to die. I spoke to a Scotland Yard secret-service man in Norway of the millions of British volunteers. “You were in England!” said he. “You saw it.” He spoke as if it were a vision.

And the second is the efficiency of Germany. I have been in five countries, and two of them are Germany's bitterest enemies. But even where anti-Prussianism is almost madness, whether among statesmen and officials, those who fight and those who wait, or those who fear and those who have suffered, there is mingled in one breath hatred and admiration.

And the third is the dignity of France. This, too, is felt everywhere. At the cold, narrow gate of Russia, on the frontier between Finland and Sweden, I met General Pau on his way to visit the Czar's army. This distinguished veteran officer of France, one-armed and not tall of stature, behind his heavy gray brows and white mustache has a countenance filled with a strange combination of power and sadness. That which is firm and resolute and that which is reflective and tender mingle in the expression of his features. I spoke of the dignity of France, and then feared I had taken too great a liberty and had changed too abruptly from some hurried words about the Russian army, whose General Staff headquarters I had just left. He smiled, however, quietly and with pleasure. “France is patient and strong,” he said. “If necessary, she will suffer without complaint, but also she will remain calm after her victories.” The Russian commandant of the frontier station looked at Pau with blinking eyes and wet his own lips with the tip of his tongue. But he said nothing.

Introduction

Young Italian adolescents born in the early years of the twenty-first century – usually identified as ‘Generation Z’ – have grown up amid constant crises. The economic recession generated by the explosion of the subprime mortgage crisis and the failure of major US banks in 2008, the increasingly evident negative effects of climate change, the experience of the pandemic caused by the onset of the SARS-CoV-2 virus and the severe restrictive measures implemented by the government to limit its spread, and recently the geopolitical turbulence linked to Russia's assault on Ukraine and the Israeli reaction to the Hamas terrorist attack: these compose a scenario of uncertainty, and they generate specific forms of anxiety in terms of sensitivity and emotions (Scribano 2021; 2022). Furthermore, the growing pervasiveness of information and communication technology, the importance assumed by social media, the centrality and novelty of the forms and languages of online communication and the transformations that information technology has introduced into daily life in the sphere of work and interpersonal relationships configure a set of experiences that potentially constitute the basis for a new generational identification (Mannheim 1952). Following Karl Mannheim, it is possible to hypothesise the configuration of a specific generational collocation, such as the sharing of unique experiences, which cannot be adequately understood, described and faced by referring to the conceptual and communicative baggage developed by previous generations (Colombo and Rebughini 2019).

Adopting a generational perspective to interpret the experience of contemporary youth requires developing a heuristic tool that makes it possible to highlight the discontinuities with respect to the experience of previous cohorts; discontinuities that entail a search for a new lexicon and new interpretative tools, and the development of a new relationship with oneself, others and reality which involves the tendency to act, think and feel according to specific and recognisable methods or lifestyles.

The chapter analyses how the injunctions to be autonomous, active and creative – characteristic of an individualised society – are internalised and elaborated by young people living in the Milan area of northern Italy. The data presented are based on a nearly 10-year research project, conducted from 2015 to 2023, that involved around 100 young people aged between 18 and 30 (Colombo, Rebughini and Leonini 2017; Colombo, Leonini and Rebughini 2018; Colombo and Rebughini 2021; Colombo Rebughini and Domaneschi 2022).

Ethnography and feminist methodologies and methods have become central in these studies. I acknowledge my personal areas of concern and interest as a researcher. I cannot isolate myself from these studies. I presented myself as a liberal-nationalist feminist, who grew up in an educated family in Pukhtunkhwa, as a daughter who went to school and completed her higher education with the support of her feminist-nationalist Baba (father), who encouraged her to escape the traditional roles of Pukhtun women. My Baba's extreme love and belief in me made me a woman of audacity and nerve. Thus, my research is based on my own life experiences that led me towards gender issues and social justice for Pukhtun women. It is interesting that as an author I share common goals and some common experiences to give voice to the unvoiced, and I positioned myself as an ‘in-between’ researcher:

I further explained the in-between researcher position in this chapter to familiarise my readers with the use of this term in research. However, here I discuss how my story has a place in this book – who I am and where I am coming from – and how it has had a deep impact on the selection and development of my research questions, contexts and participants in both studies. As a researcher, I am well-placed to conduct these studies because of my own personal background, nationality, family heritage and gender. As I men-tioned, I grew up in this area, went to school and completed my MA degree at the University of Peshawar.

Introduction

The first two decades of the twenty-first century can be characterised by the increase in poverty, the massiveness of social programmes (De Sena 2011), the different forms of digitalisation of life and the centrality of consumption (Scribano 2015). Added to this, in 2020, was the COVID-19 pandemic, leaving consequences of different kinds (social, health and economic), among which the increase in global poverty stands out. Although a few years have passed, the geopolitical scenario of the Latin American region has not managed to recover pre-pandemic conditions. Some elements at a global level have also worsened this scenario: the slowdown in economic growth, slow job creation, as well as an inflationary effect on food and energy that worsens the situation of lower-income sectors (CEPAL 2022).

Social policies, as interventions located in space-time and in a particular accumulation regime, are mediations of the state that seek to influence the conditions of production and reproduction of forms of life in society. They are developed from positions and visions of the world, establishing meanings and emotions. Over the last decades, they have been modifying their objectives, population, forms of provision and justifications. In these modifications, the incentive to consume or its increase acquires great mention and importance in the modality with the greatest reach and coverage in the region: cash transfer programmes (CTPs). Added to this is the wealth of interventions created to mitigate the impact of the COVID-19 pandemic.

The scenario mentioned in Argentina assumes its own particularities. Therefore, in this chapter, based on multi-method research carried out in the Municipality of La Matanza (Greater Buenos Aires, Argentina), we will analyse, first, the meaning assigned – by its recipients – to the CTPs – in the pre-pandemic and pandemic context, as well as the emotions about consumption after receiving those interventions. This will allow us to characterise the economic situation of the recipients and the emotions that are organised before, during and after the pandemic and in the face of their consumption practices's restructuration.

The municipality under study is the largest and most densely populated in Greater Buenos Aires. Given that it is the largest urban complex in the country, with an estimated population of just over 11 million inhabitants (INDEC 2022), that is, almost 25 per cent of the total population of Argentina.