This paper proposes a new measure of public expenditure force that policy makers and budget analysts should track in detail over time in routine fiscal monitoring. The paper suggests that adopting the measure will not only warn policy makers of possible impending fiscal pressures, but will help them to differentiate between those budgetary pressures that are temporary and those that may require reforms. The main utility of the expenditure force measure will be in country fiscal analysis. Measuring force across the entire budget allows practitioners to monitor and decompose the micro drivers of public spending pressure, watch out for rapidly expanding spending lines, and identify priorities for reform before these pressures lead to macro fiscal problems. Yet by its construct, spending force is internationally comparable, and independent of expenditure levels or spending types. This could allow global monitoring comparisons and global research into the drivers of public spending force across particular types of country characteristics and economic conditions. In time, and as more data become available, researchers can use the force measure to compare and contrast the dynamics of expenditure types across countries. For example the measure can be used to explore what gives some spending types an initial impulse; whether underlying factors cause different public spending categories to grow faster than average, or to accelerate over time; and what successful countries have done to manage rising force without damaging public services. Since force seems to be a decent predictor of fiscal episodes, it is suggested that "speed limits" for spending might be a feasible component of fiscal rules.
The Fed's much-anticipated new monetary policy framework is now public. Fed Chairman Jerome Powell outlined the policy framework last week in Jackson Hole; you can view his speech here. Overall, I thought Powell's delivery was very good. While there's room for improvement, I think the new framework is a step in the right direction (George Selgin provides a good critique here). There were three things in Powell's speech that stuck out for me. I discuss these below. Shortfalls vs. DeviationsAt the 22:30 mark, Powell reports what may very well be the most substantive change to the monetary policy statement. Here, he states that the FOMC will now interpret important macroeconomic time-series like GDP and unemployment as exhibiting "shortfalls" instead of "deviations" from some ideal or "maximum" level (a frustratingly vague concept). The practical effect of this shift is to remove (or make less prominent) in the minds of FOMC members the idea that the economy is, or will soon be, "overheating" (i.e., embarked on an unsustainable path that can only end in misery for those most vulnerable to economic recession). The idea of "deviation from (some) trend" seems like a plausible description of the postwar U.S. up to the mid-1980s. Severe contractions were usually followed by equally robust recoveries. However, this representation seems to break down since the "great moderation" that began in the mid-1980s. Since then, economic recessions have not been followed by above-average growth. Instead, each recession seems better described as a "growth shortfall." We're not entirely sure what accounts from this cyclical asymmetry, but it seems consistent with Milton Friedman's "plucking model." I think we can expect a stream of research resurrecting this old idea (see here, for example). In any case, the upshot here is that, to the extent that "overheating" is no longer considered a serious threat, the FOMC will be less likely to implement "preemptive" policy rate hikes. This constitutes a tacit acknowledgement that the period leading up to "lift off" and what followed might have been handled better. As I wrote at the time (see my discussion here), standard Phillips Curve logic did not seem to support tightening (unemployment was above the estimated natural rate, inflation was below target, and inflation expectations were declining). But the Committee somehow talked itself into the need to "normalize," to act preemptively and not get caught "behind the curve." In fairness, monetary policy is always about balancing risks (in this case, the perceived risk of overheating). In the near future, less weight will be assigned to the risk of overheating. The Maximum Level of Employment At the 22:30 mark, Powell states "Of course, when employment is below its maximum level, as is so clearly the case now, we will actively seek to minimize that shortfall..." I have a hard time not interpreting "maximum" here as "socially desirable." I think most people would agree that the 2008 financial crisis caused employment to decline below its maximum level. The workers rendered idle in that episode constituted a social waste, and the Fed was right to loosen monetary policy to stimulate economic activity in the face of recessionary headwinds. But the recession induced by the C-19 is very different from standard recessions. This was laid out very clearly by St. Louis Fed President Jim Bullard on March 23, 2020: Expected U.S. Macroeconomic Performance during the Pandemic Adjustment Period. According to Bullard, the temporary removal of some workers from their jobs is not, in this case, a waste of resources. The decline in employment in this case should be viewed as an investment in public health. That is, the maximum level of employment declined and its recovery is driven mostly by the contagion dynamic (as well as improvements in social distancing protocols, masking, testing, treatments, etc.). The role of monetary policy here is to calm financial markets (which the Fed successfully accomplished in March) and to aid the fiscal authority with its income maintenance programs. In short, the primary monetary/fiscal policy objective here is to deliver insurance, not stimulus. Monetary stimulus is appropriate, however, to the extent that demand factors (e.g., individually rational, but a collectively irrational restraint on spending) are inhibiting the recovery dynamic. The evidence for this is usually assumed to be found in falling inflation and inflation expectations, and declining bond yields. And usually, this makes sense, because we usually assume that recessions are caused by collapses in aggregate demand (as in 2008-09). But what if the increase in the demand for money (safe assets in general) is driven by a collectively rational fear? We'd expect to see the exact same inflation and interest rate dynamic, but the role for stimulative monetary policy would be more difficult to justify (though the desirability for insurance remains). So, maybe it is not so clearly the case now that employment is below or, at least, far below its "maximum" level. Note that a significant part of the decline in aggregate employment is coming from the leisure and hospitality sector: Arguably, we do not want, at this stage of the pandemic, to promote the indoor dining experiences people enjoyed earlier this year. This activity will return slowly as economic fundamentals improve. The "full employment" level of employment in this sector is clearly below what it was in Jan 2020. But, to be fair, it is entirely possible, and perhaps even likely, that the level of employment even here is lower than the "full employment" level. It's very hard to tell by how much though. Average Inflation Targeting At the 24:00 mark, Powell explains how AIT will help anchor inflation expectations. Missing the inflation for a prolonged period of time will cause expectations to drift away from target and line up with the historical experience. This view of expectation formation is firmly rooted in the "adaptive expectations" tradition. That is, expectations are assumed to be formed by looking backward instead of forward. People sometimes claim that adaptive expectations are inconsistent with "rational" expectations. But this is not necessarily the case. In fact, it makes sense to use the historical record of inflation realizations to make inferences about the long-run inflation target if people are not sure of the monetary authority's true inflation target; see, for example, here: Monetary Policy Regimes and Beliefs. It's still not entirely clear to me whether FOMC members view AIT as a policy to pursue passively (i.e., let inflation creep up to and beyond target on its own) or actively (i.e., take explicit actions to promote an overshoot of inflation). If it's the former, then I'm on board with the idea. But if it's the latter, I am not. In particular, with the liquidity-trap-like conditions we're presently in, the Fed does not have the tools (or political will) to boost inflation persistently. It is likely to fail, just as the Bank of Japan failed. (I explain here why it's more difficult for a central bank to raise the inflation target than to lower it.) So, as I've advocated many times in the past, why not just declare 2% as a soft-ceiling and let fiscal policy do the rest? My view rests on the belief that missing the inflation target from below by 50bp over the past eight years is not a significant macroeconomic problem (especially given how crudely inflation is measured). The FOMC did view it as a problem, but mainly, it seems, because of the embarrassment associated with missing its target. "We are a central bank. We have an inflation target. Central banks are supposed to hit their inflation targets. We need to hit our inflation target to remain credible." This is why earlier FOMC statements emphasized the Fed's "symmetric" inflation target. That did not work and so now we have AIT which, I'm afraid, might not work either. Happily (for those who want to see higher inflation), Congress seems comfortable with the idea of producing large budget deficits into the foreseeable future. So, if we get higher inflation, it will largely be a fiscal phenomenon. The purpose of AIT is to accommodate any rise in inflation for the purpose of increasing inflation expectations and avoiding the specter of deflation (people often point to Japan as a case to avoid, by Japan seems to be doing fine as far as I can tell). There is the question of how the Fed would react should inflation rise sharply and persistently above 2%. Even if the event is unlikely, it would be good to state a contingency plan. In the past, the Fed could be expected to raise its policy rate sharply. But this event, should it transpire, will almost surely take place during an employment shortfall (since this is now the acknowledged new normal). The only prediction I'll make here is that the FOMC will have a lot of explaining to do in this event.
Sustainable investment (SI) has a strong niche foothold in Sub-Saharan Africa, anchored in the region's largest investment market, South Africa. Yet more work is needed, at policy and portfolio levels, to grow this investment theme. This report recommends measures to expand SI in Sub-Saharan Africa. It forecasts that over the next five years there will be considerable growth of environmental, social, and governance (ESG) considerations applied to investment in South Africa, Kenya, and Nigeria. While these three countries form the basis of the study, the lion's share of data and observations emerged from South Africa, which is home to the continent's most developed capital markets.
An inside joke among economists is that it is very difficult to make predictions, especially regarding the future. However, economists, political scientists, journalists and opinion-makers publish predictions at the beginning of each year. The two most established transatlantic newspapers, the daily Financial Times and the weekly The Economist, have done it again for 2023.To estimate their credibility, we can examine what they predicted for the year 2022. Both FT and TE wavered about the appearance of new variants of Covid-19, which have led to a relative increase in infections and a decrease in deaths. They expected high inflation and the fall of the S&P index, but the reality has been more catastrophic than their figures. They correctly predicted that the climate summit in Egypt would not plan enough to maintain the 1.5o target. Also, that Boris Johnson would be forced to leave Downing Street, but the British weekly now admits having "failed to anticipate the magnitude of the political and economic mess that followed his departure." They were wrong to predict a success of electric cars and an expansion of cryptocurrencies.But the biggest error affected the event with the greatest consequences: Both the FT and TE prophesied that Russia would not invade Ukraine. FT argued that Putin could achieve many of his goals without war: destabilizing Ukraine, deterring military aid from Kyiv's allies, intimidating NATO and forcing more concessions to end the fighting in Donbas.In fact, none of the great crises of this century were foreseen by most forecasters. The 9/11 terrorist attacks were a huge surprise, the Lehmann Brothers bankruptcy had been dismissed, the Trump election was off the table, Covid-19 was just a local plague, and the Ukraine war was off any agenda.The consequences of these unforeseen events have upended the world. They have also revealed the weakness of international institutions in anticipating and dealing with major terrorist attacks, financial crises, the outcome of certain hectic elections, pandemics, and cross-border wars, which are all events of global scope.We live in a world of change, which is a world of uncertainty. Institutions should serve to structure some actions, make others impossible and favor predictable behavior. But currently, the forecasts of results are only reliable in small and simple areas with effective rules of the game.There is a general mismatch between many of the existing public institutions and the ever-expanding territorial scope of complex collective issues. In this context, predictions and decisions are made with limited knowledge or in complete ignorance.On the one hand, limited knowledge allows some actions and events to be estimated with probabilities. For this, we need hypotheses about causes and consequences, as well as well-contrasted data from past events. We may not be sure whether a decision will have or not the desired effects, but we can take risks by deciding based on some probability that it will. In this way, the risks are measurable and can be prevented against. This is how insurance companies, weather forecasts, and some medical treatments work, and this is how governments should work too.On the other hand, we ignore the probabilities of many possible events, which leads to mistaken opinions and self-defeating decisions. A memorable example was secretary of Defense Donald Rumsfeld's explanation after 9/11 that there are things we know we don't know, which carry risks, but there are also things we don't know we don't know, which can be used to justify anything. It's as if the American rulers had thought: we don't know if Iraq has weapons of mass destruction or not, but let's invade the country just in case it does. Willful ignorance also led Brexit promoters to an irresponsible decision that so many regret today. And right now, the central banks seem to be hitting inflation blindly.But even with good institutions and well-founded information, we have to accept that there are surprises. Karl Popper pointed out that our knowledge, that is, the advances of science and technology, cannot be predicted because, if it were, the next inventions would have already been invented. From this he deduced that the future course of human history is largely unpredictable. As Sir John P. Mahaffy once said, "in Ireland the inevitable never happens and the unexpected constantly occurs" –a proposition to which John M. Keynes gave universal value.In its special issue "The World Ahead 2023", The Economist predicts a "permacrisis", one of the words of the year defined as "an extended period of instability and insecurity". It includes a geopolitical crisis due to the widening gap between the West and the rest, a commodity shock that calls for a reshaping of the global energy system, and the consequent inflation and economic recession in developed countries. His forecast is that "2023 will be a grim and potentially dangerous year."All these are probable projections of what is currently happening; but, like last year, the new surprises may be more important, produced by the many things that, for better or for worse, we don't know we don't know.COMMENTSScience is no better at future predictions than social science. No one can predict with any accuracy that helps when the next dangerous asteroid will hit earth. Science cannot predict with enough accuracy next plague will occur, and its predictions about climate change have consistently been wrong (unfortunately wrong in the wrong direction it is happening much faster than they have consistently predicted – look back to articles on it from the early to mid 1980s). What prediction means in science is not future prediction, and it never has. I think as you know (30 things we know) social science is not so bad at scientific prediction.Keith DowdingAustralian National University
Problem statement. Medical tourism, one of new directions of the tourist industry, promptly develops in the world in recent decades. Nowadays, it is already seen the growing number of countries which specialize in providing this type of service, that was caused by economic, social and other advantages. These are not always developed countries, but they are interesting to foreign patients by low-cost of medical care and high quality of providing medical services. Ukrainian medical tourism has recently begun to be the special direction. But there are questions on organization and policy implementation of governmental regulation in this branch of business activity. This is connected with necessity of streamlining of legal framework, economic and organizational basis, infrastructure upgrade, etc.Analysis of last researches and publications. The research of development problems of medical tourism in Ukraine, its influence on the development of countries and its regions, was devoted many scientific works of domestic authors, such as: V. Baiev, T. Bezverkhniuk, M. Bil, O. Bordun, I. Vakhovych, K. Didenko, V. Zhuchenko, V. Malimon, M. Malska, A. Postianyi, A. Romanova and others. But not all answers to questions on governmental regulation of the development of medical tourism are given in these scientific works.Nowadays, opinions on organization of medical tourism in the country are contradictory; methodology of strategic development of destinations of this direction is developed insufficiently. Incomplete means of governmental regulation do not allow to perform practically purposeful planning of sustainable development of medical tourism.The purpose of an article is identification of problems on implementation of the role of the state in the development of medical tourism and definition of necessary changes in regulatory framework, economic and social system in ensuring the regulating influence of the state on this type of business activity.Statement of basic materials. Nowadays, medical tourism is a specific type of the tourist industry which is between, at first, two various spheres - health care and tourism. Medical institutions of its development are medical centres and companies on providing tourist facilities. This type of tourism already brings a considerable part of profit to the budget of touristically developed countries and is extremely perspective for Ukraine in the question of European integration. Development of this industry will cause socio-economic growth of regions and will improve investment image of the country.As the main clause of development of medical tourism and its target point in Ukraine is quantity input of foreign tourists that will promote receipt of considerable financial flows to the country, it is necessary to carry out justification of functions of state authorities and their opportunities of regulation of this sphere.It is noted that medical tourism is the whole system of interrelated main basic and infrastructure institutes of the country which influence on the development of this direction and provide its competitiveness. Special legislation, in many countries, is developed on support of medical tourism, but this sphere practically is outside state policy in Ukraine.There are organizational and legal problems in the country, that have negative effect on development of medical tourism, because of imperfection of available enactments and absence of follow-up. Nowadays, there is no connection between healthcare institutions and travel agencies that considerably complicates the process of arrangement of the medical direction of the tourist industry. Certain slowdown of development of medical tourism in Ukraine is also connected with low-level of services, old infrastructure. The absence of specialized tour operators leads to cooperation with intermediaries that causes excess expenses and treatment process detention. Concerning public health facilities, one of the main problems is outdated plant, underfunding for acquisition of new equipment and insufficiency of highly professional personnel.It is also necessary to note that such fixed assets of regulation and influence of the state on activity of menage entities as licensing, grant of patent, certification, standardization and so forth need details in the context of development of medical tourism.Conclusions. Medical tourism provides outlook of socio-economic development of the country in tourist and medical spheres, creation of workspaces not only in the sphere of health care, but also in other industries. But real development of medical tourism is possible only with the assistance of the state, in particular, during solutions of following questions: 1. Improvement of normative legal documents with accurate distribution of powers, functions, duties and responsibilities of all participants of development process of medical tourism. 2. Ensuring interaction of the Ministry of Health and the Ministry of Economic Development, Trade and Agriculture, in particular the Department of Tourism concerning development of medical tourism. 3. For the purpose to increase the attention of domestic public and private medical institutions to foreign patients, to develop and resolve organizational and technical issues of accreditation by analogy to JCI and ISO 9001. 4. Solutions of questions of issue of «the accelerated medical visa» to foreign citizens who arrive in Ukraine concerning medical tourism. 5. Creation of a system of medical insurance to people, who receive medical services within and beyond Ukraine. This is connected with risks which can arise during treatment and after it. 6. Creation of conditions for ensuring participation of representatives of Ukrainian health sector during international events of medical tourism for promoting of achievements and opportunities of domestic medicine. ; Наукова стаття присвячена теоретичному дослідженню ролі держави щодо розвитку медичного туризму в Україні. В роботі визначені основні передумови та проблеми становлення цієї галузі в нашій країні. Проведено аналіз літератури з питань регулюючого впливу держави на розвиток медичного туризму з погляду спеціалістів економічної та юридичної сфери.
Problem statement. Medical tourism, one of new directions of the tourist industry, promptly develops in the world in recent decades. Nowadays, it is already seen the growing number of countries which specialize in providing this type of service, that was caused by economic, social and other advantages. These are not always developed countries, but they are interesting to foreign patients by low-cost of medical care and high quality of providing medical services. Ukrainian medical tourism has recently begun to be the special direction. But there are questions on organization and policy implementation of governmental regulation in this branch of business activity. This is connected with necessity of streamlining of legal framework, economic and organizational basis, infrastructure upgrade, etc.Analysis of last researches and publications. The research of development problems of medical tourism in Ukraine, its influence on the development of countries and its regions, was devoted many scientific works of domestic authors, such as: V. Baiev, T. Bezverkhniuk, M. Bil, O. Bordun, I. Vakhovych, K. Didenko, V. Zhuchenko, V. Malimon, M. Malska, A. Postianyi, A. Romanova and others. But not all answers to questions on governmental regulation of the development of medical tourism are given in these scientific works.Nowadays, opinions on organization of medical tourism in the country are contradictory; methodology of strategic development of destinations of this direction is developed insufficiently. Incomplete means of governmental regulation do not allow to perform practically purposeful planning of sustainable development of medical tourism.The purpose of an article is identification of problems on implementation of the role of the state in the development of medical tourism and definition of necessary changes in regulatory framework, economic and social system in ensuring the regulating influence of the state on this type of business activity.Statement of basic materials. Nowadays, medical tourism is a specific type of the tourist industry which is between, at first, two various spheres - health care and tourism. Medical institutions of its development are medical centres and companies on providing tourist facilities. This type of tourism already brings a considerable part of profit to the budget of touristically developed countries and is extremely perspective for Ukraine in the question of European integration. Development of this industry will cause socio-economic growth of regions and will improve investment image of the country.As the main clause of development of medical tourism and its target point in Ukraine is quantity input of foreign tourists that will promote receipt of considerable financial flows to the country, it is necessary to carry out justification of functions of state authorities and their opportunities of regulation of this sphere.It is noted that medical tourism is the whole system of interrelated main basic and infrastructure institutes of the country which influence on the development of this direction and provide its competitiveness. Special legislation, in many countries, is developed on support of medical tourism, but this sphere practically is outside state policy in Ukraine.There are organizational and legal problems in the country, that have negative effect on development of medical tourism, because of imperfection of available enactments and absence of follow-up. Nowadays, there is no connection between healthcare institutions and travel agencies that considerably complicates the process of arrangement of the medical direction of the tourist industry. Certain slowdown of development of medical tourism in Ukraine is also connected with low-level of services, old infrastructure. The absence of specialized tour operators leads to cooperation with intermediaries that causes excess expenses and treatment process detention. Concerning public health facilities, one of the main problems is outdated plant, underfunding for acquisition of new equipment and insufficiency of highly professional personnel.It is also necessary to note that such fixed assets of regulation and influence of the state on activity of menage entities as licensing, grant of patent, certification, standardization and so forth need details in the context of development of medical tourism.Conclusions. Medical tourism provides outlook of socio-economic development of the country in tourist and medical spheres, creation of workspaces not only in the sphere of health care, but also in other industries. But real development of medical tourism is possible only with the assistance of the state, in particular, during solutions of following questions: 1. Improvement of normative legal documents with accurate distribution of powers, functions, duties and responsibilities of all participants of development process of medical tourism. 2. Ensuring interaction of the Ministry of Health and the Ministry of Economic Development, Trade and Agriculture, in particular the Department of Tourism concerning development of medical tourism. 3. For the purpose to increase the attention of domestic public and private medical institutions to foreign patients, to develop and resolve organizational and technical issues of accreditation by analogy to JCI and ISO 9001. 4. Solutions of questions of issue of «the accelerated medical visa» to foreign citizens who arrive in Ukraine concerning medical tourism. 5. Creation of a system of medical insurance to people, who receive medical services within and beyond Ukraine. This is connected with risks which can arise during treatment and after it. 6. Creation of conditions for ensuring participation of representatives of Ukrainian health sector during international events of medical tourism for promoting of achievements and opportunities of domestic medicine. ; Наукова стаття присвячена теоретичному дослідженню ролі держави щодо розвитку медичного туризму в Україні. В роботі визначені основні передумови та проблеми становлення цієї галузі в нашій країні. Проведено аналіз літератури з питань регулюючого впливу держави на розвиток медичного туризму з погляду спеціалістів економічної та юридичної сфери.
Palliative care is an appropriate and compassionate response to the needs of patients with life threatening illness. International human rights law establishes palliative care as part of the right to health. But what does this mean in practice? How is palliative care part of the right to health at the country level and in everyday patient experience? This thesis addresses this question with evidence from South Africa. South Africa is important for a number of reasons. The government, despite the country's progressive Constitution (No 108, 1996) which entrenches the right of access to health care has yet to take responsibility for palliative care. Most recently, the South African government co-sponsored the World Health Assembly (2014) resolution on palliative care and thus has a commitment to implementing the resolution. The thesis employs General Comment 14 on the Right to Health to frame the four nested studies that were carried out to address the key research question. General Comment 14 (2000), adopted by the United Nations Committee on Economic, Social and Cultural Right, describes the normative content of the right to health (Article 12 International Covenant on Economic, Social and Cultural Rights) to include four overlapping elements – availability, accessibility acceptability and quality. Aim of the research: to evaluate current provision of palliative care in South Africa in terms of the Human Rights considerations of availability, accessibility and quality. Study One commences the thesis by estimating the need for palliative care in South Africa. Using mortality data for 2010 for conditions determined a priori to require palliative care, approximately 0.52% of the population were estimated to require palliative care, which translates into an average need of 698.5 persons per 100000 or 1 in 143 people every year. While this is a considerable burden, it is also likely to be a significant under-estimate, given limitations to the methods identified in the study. Study Two examines availability of services to meet the need for palliative care. A survey was completed by 131 palliative care organisations between March 2011 and October 2011. Only 3% of services were located within the public sector. The estimated number of patients who received care during the year was 46,347. This is approximately 18% of the need identified earlier in Study One. Availability of morphine, as a marker for palliative care, was found to be dependent on employment of and level of palliative care training of doctors and was especially poorly supplied in the rural areas. Thus, the availability of Palliative Care appears to be limited by health system factors. Study Three investigates access to palliative care in Cape Town, via two pathways 1) referral of patients requiring palliative care and 2) palliative care in their current care settings. A prospective cohort study over six months followed up 162 participants from three groups: 1) patients with metastatic cancer; 2) patients living with HIV with a CD4 count of < 200 cells/mm3 ; and3) patients diagnosed with motor neuron disease (MND). A questionnaire and a validated patient-reported outcome scale, the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS), was administered at first visit. Thereafter participants were followed up telephonically once a month. Few patients (5%)were referred to palliative care services even though a significant number of patients died during the course of the study, indicating a failure to access palliative care when needed. Patient outcomes for people living with HIV improved significantly whereas the majority of patient outcomes in the cancer and MND groups did not improve. Thus, the accessibility of palliative care to patients already in the health system appears to be poor, except when palliative care is integrated into primary care, as is the case for patients with HIV on ARV treatment. Study Four evaluated the quality of care delivered to patients requiring palliative care in accredited hospice and non-hospice non-governmental services in five of the nine provinces of South Africa. A survey was conducted with 459 patient participants and 253 family members who were followed up over a 4-6 week period. Perceptions of quality care were explored through narrative questions and patient-reported outcomes were assessed using the APCA African POS. The results show significant improvement in patient reported outcome measures in both hospice and non-hospice groups, with pain and worry showing the most improvement. Content analysis of the narrative questions identified 5 themes: Quality of Care, Place of care, Staff values and attitudes, Information-sharing and Problems experienced by participants Conclusion: The thesis presents evidence that despite nominal commitment by the state, palliative care is not yet implemented as part of the right to health in South Africa. The need is great but availability of palliative care services is insufficient to meet the need. Access is poor even where palliative care is available but is facilitated by integration of palliative care into primary care services. However, when access is achieved, quality of care is generally good and patient outcomes improve over time with evidence that palliative care values patients as individuals. The study considers concepts relating to dignity and human rights in health as core to both human rights and palliative care. Implications: In South Africa, the planned National Health Insurance Policy lists palliative care as a service in the primary health care setting. In addition, a National Palliative Care Policy has been approved with strategies to integrate palliative care into public health facilities. As General Comment 14 has proved useful for the thesis, for the future, it may also provide a framework to monitor state accountability on the basis of Availability, Accessibility, Acceptability, and Quality of palliative care that can be transferred to other countries.
Die Finanzierung der medizinischen Versorgung ihrer Bevölkerung stellt die meisten Entwicklungs- und viele Schwellenländer vor das Dilemma knapper öffentlicher Ressourcen und konkurrierender Prioritäten. Vielerorts ist die öffentliche Krankenversorgung zwar kostenfrei, aber chronisch unterfinanziert und weder quantitativ noch qualitativ in der Lage, die Nachfrage nach Gesundheitsleistungen zu befriedigen. Auf der Suche nach zusätzlichen oder alternativen Finanzierungsquellen zur Verbesserung der Krankenversorgung entstand die Idee, Patienten stärker an den Kosten ihrer Behandlungen zu beteiligen. Internationale Organisationen wie Weltbank und IWF drängten die Länder Afrikas, Asiens und Lateinamerikas zur Einführung von Nutzergebühren bei Inanspruchnahme von Gesundheitsleistungen. Im Zuge der so genannten Bamako-Initiative führten viele afrikanische Länder generelle Behandlungsgebühren in öffentlichen Gesundheitseinrichtungen ein. Auch in den allermeisten anderen Entwicklungs- und Schwellenländern mussten Patienten in zunehmendem Maße selber für ihre Krankenversorgung aufkommen. Die systematische Einführung von Nutzergebühren im Gesundheitswesen verfolgte im Wesentlichen drei Ziele: Generierung zusätzlicher Mittel zur Verbesserung der Krankenversorgung, Überwindung bestehender Ungerechtigkeiten beim Zugang zu Versorgungsleistungen und Kostendämpfung durch Effizienzsteigerung im Gesundheitswesen. Sie stand im Zeichen der neoklassischen Wirtschaftstheorie, die vornehmlich mikroökonomische Ansätze in der Logik individueller Nutzenmaximierung propagierte und in Entwicklungsländern in Form der Strukturanpassungsprogramme Einzug hielt. In der Gesundheitspolitik verdrängten ökonomische Vorstellungen sozialpolitische Ziele, und es setzte sich das Denken in finanziellen Anreizsystemen zur Steuerung von Anbieter- und Nachfragerverhalten durch. Zugleich bezog sich die Zuzahlungspolitik explizit auf Kernforderungen der Basisgesundheitsbewegung von Alma Ata wie Dezentralisierung, Transparenz, Empowerment und Governance. Mittlerweile liegt eine große Zahl empirischer Untersuchungen über die Auswirkungen von Nutzergebühren im Gesundheitswesen von Entwicklungs- und Schwellenländern vor. Dabei hat sich gezeigt, dass die erwünschten Effekte nur teilweise und in geringem Ausmaß eingetreten sind. Bei aller Heterogenität der vorliegenden Untersuchungen bleibt die Bilanz von Patientenzuzahlungen in Entwicklungsländern in Bezug auf die Systemstärkung und Nachhaltigkeit der Gesundheitsfinanzierung insgesamt hinter den Erwartungen zurück. Dieser Gesamteindruck verstärkt sich, wenn man die Studien jenseits formalwissenschaftlicher Kriterien oder ihres wirtschaftstheoretischen Ansatzes analysiert. So finden grundlegende, nachhaltige Änderungen wie die Kürzung der Regelfinanzierung öffentlicher Leistungserbringer in Folge der Cost-Sharing-Politik ebenso wenig angemessene Berücksichtigung wie weitergehende sozialpolitische bzw. wohlfahrtsstaatliche Konsequenzen primär mikroökonomischer Entwicklungsansätze. Zudem lassen etliche Analysen und Befunde eine unübersehbare Übereinstimmung mit bestimmten entwicklungspolitischen Strategien erkennen, angefangen von weltbanknahen positiven Einschätzungen der meist kurzfristig verbesserten Versorgungsqualität bis zu der unbelegten Annahme, Nutzergebühren wirkten als Vorläufer von Krankenversicherungssystemen. Insgesamt hat die wachsende Erkenntnis eher bedenklicher als positiver Effekte von Behandlungsgebühren sowohl in Entwicklungs- und Schwellenländern als auch bei internationalen Organisationen mittlerweile kritische Positionen gegenüber Patientenzuzahlungen gestärkt. Insbesondere die unerwünschten Auswirkungen auf Arme sowie offenkundige Nachhaltigkeitsprobleme haben die Hürden für die Umsetzung einer Politik der Nutzergebühren erhöht. Die zunehmende Bedeutung von universeller Absicherung im Krankheitsfall als entwicklungspolitisches Ziel hat die Forderung nach Abschaffung von Patientenzuzahlungen zu einem wichtigen Thema in der Entwicklungszusammenarbeit gemacht. ; [User Fees for Health Care in Developing Countries and Countries in Transition: An Instrument of Reform with Predominantly Negative Effects] When it comes to financing health care services for their populations, most developing countries and many newly industrialised countries are faced with the dilemma of scarce public resources and competing priorities. In many places, public health care, while provided free of charge, is chronically underfunded and incapable, in both quantitative and qualitative terms, of satisfying the rising demand for health care services. The search for additional or alternative sources of funding led to the idea of making patients pay a share of the treatment costs. International organisations such as the World Bank and the International Monetary Fund urged African, Asian and Latin American countries to introduce user fees for health care services. In the wake of the so-called Bamako Initiative, most countries in Sub-Saharan Africa introduced user fees at public health care facilities. Likewise, patients in most other developing and newly industrialised countries increasingly had to pay out of their own pockets for medical treatment. The systematic implementation of user fees in health care was intended to achieve three main goals: generating additional revenue for improving health care services, overcoming existing inequalities in access to health care, and reducing costs by increasing efficiency in the health care sector. As a policy, it was guided by neoclassical economics, which primarily called for microeconomic approaches based on the logic of individual maximisation of utility, and which came to developing countries in the form of structural adjustment programmes. In the field of health policy, economic ideas replaced social policy objectives, and health care thinking came to be dominated by systems of financial incentives designed to manage supply and demand. At the same time, cost-sharing policies explicitly referred to some of the core demands of the primary health care movement of Alma Ata: decentralisation, transparency, empowerment, and governance. A wide range of empirical studies on the effects of user fees in the health care systems of developing and newly industrialised countries has become available in recent years. They show the desired effects to have occurred only in part, and only to a small extent. Despite their heterogeneity, these studies reveal the overall outcomes of user fees in developing countries to fall short of expectations with respect to strengthening health care systems and promoting sustainability in health care funding. This overall impression is reinforced if one looks at the studies beyond formal scientific criteria or their underlying economic theory. Fundamental changes with long-term effects, for example, such as cutting the standard budget of public health care providers as a result of cost-sharing policies, are not being addressed appropriately; neither are the social and welfare state consequences of development approaches with a primary focus on microeconomics. What is more, many analyses and findings are in unmistakable agreement with certain development policy strategies, ranging from World Bank-like positive assessments of mostly short-term improvements in the quality of health care provision all the way to the unsubstantiated assumption that user fees act as precursors of health insurance systems. Overall, the growing number of findings that suggest alarming rather than positive effects of user fees in health care has served to strengthen critical points of view regarding direct patient payments, both among policy makers in developing and newly industrialised countries and among international organisations. In particular, undesired effects on poor people as well as obvious shortcomings in terms of sustainability have served to raise the bar for implementing user fee policies. The increasing importance of universal coverage as a goal of development policy has made the call for abolishing user fees a key issue in international development cooperation.
Non-traditional security (NTS) issues continue to threaten the well-being of nations and communities in Asia and around the world. National governments alone cannot solve the multifaceted problems associated with NTS, ranging from climate change and disasters to mass movement of people in search of refuge and safety. Given that traditional multilateralism is in retreat, a more sustainable approach to multilateral cooperation is critically needed, requiring the collaborative participation and engagement of multiple stakeholders from local communities, civil society organisations, the private sector, governments, regional organisations, and other international agencies. The Annual Conference of the Consortium of Non-Traditional Security in Asia (NTS-Asia),1 held in Singapore on 25 and 26 March 2019, examined the relevance of multi-stakeholder collaboration in facilitating efforts to address a number of NTS challenges including, among others, (i) irregular and forced migration; (ii) economic inequality; (iii) environmental degradation; (iv) digital threats; and (v) social friction.
The unprecedented COVID-19 pandemic is the most challenging public health crisis the world has faced in a century. It has overwhelmed global and national health service and disaster management infrastructure and brought economies to a standstill/halt. It serves as both an eye-opener and an impetus to leapfrog reforms to strengthen governance systems and structures. It propels us to innovate and install more forward-looking systems and strategies that will enable us to permanently gain the capacity to survive and win over multiple and complex challenges that we face now and in the future. In the public sector, the pandemic shows the importance of having harmonization and synergy between and among national government agencies and sub-national governments. It has illustrated the importance of investing in digital education, e-commerce, and innovative ways of delivering social protection as well as fostering business innovations to meet fast-changing demand. The literature discusses quite a number of public sector innovations particularly in developed countries and the approaches are combinations of various governance methods, with styles varying depending on the context. Yet on the overall, the public sector has very few models for innovation. This background paper briefly scans the recent literature of public sector innovations and other efforts implemented in the strengthening of governance systems. The goal is to gather insights that may be useful for the Philippines case for enhancing its governance strategies, improving overall performance in service delivery, and building resilience against risks in the long-term.
Policy makers bemoan the lack of research findings to guide urgent decisions, whereas researchers' professional code puts rigor first. This article argues that provisional assessments, produced early in the research cycle, can bridge the gap. Numerous case studies point to the importance of early interaction with policy makers and the delivery of brief, policy-focused papers; but preliminary analyses may be flawed and so increase the chances of a wrong decision. This article demonstrates analytically that a preliminary assessment, supported by the offer of more refined research, provides an option that is superior, on average, to the current practice of submitting a final report at the end of the research cycle. Where practical implementation is concerned, it calls for donor-funded subsidies to promote the use of provisional assessments and for a rapid, independent, professional review process to ensure their quality. While the research-policy exchange in developing countries is a complex, context-specific phenomenon, the proposal offered here holds out some promise of improving decisions in the public sphere under a wide range of circumstances.
The assessment of accounting and auditing (A&A) practices in Sudan is part of the joint initiative of the World Bank and the International Monetary Fund (IMF) to prepare Reports on the Observance of Standards and Codes (ROSC). The ROSC A&A assessment focuses on strengths and weaknesses of the corporate accounting and auditing environment that influence the quality of corporate financial reporting and involves a review of both mandatory requirements and actual practices. It uses International Financial Reporting Standards (IFRS) and International Standards on Auditing (ISA) as benchmarks and draws on recent global experiences and good practice in the field of corporate financial reporting and auditing. This assessment used a diagnostic template developed by the World Bank to facilitate collection of information, which was complemented by findings of a due diligence exercise based on meetings with key stakeholders conducted by World Bank staff. The assessment was carried out ensuring participation from the in-country major stakeholders such as regulators of corporate entities, banks and similar financial institutions, professional accountants, bankers and investment analysts, preparers of financial statements, auditors, academics, and representatives from the leading trade bodies. The main purpose of this ROSC A&A assessment is to assist the Government of Sudan in strengthening the private sector's accounting and auditing practices, along with enhancing financial transparency in the corporate sector.
The definitive reference on the most current economics of development and institutions. The essential role that institutions play in understanding economic development has long been recognized across the social sciences, including in economics. Academic and policy interest in this subject has never been higher. The Handbook of Economic Development and Institutions is the first to bring together in one single volume the most cutting-edge work in this area by the best-known international economists. The volume's editors, themselves leading scholars in the discipline, provide a comprehensive introduction, and the stellar contributors offer up-to-date analysis into institutional change and its interactions with the dynamics of economic development. This book focuses on three critical issues: the definitions of institutions in order to argue for a causal link to development, the complex interplay between formal and informal institutions, and the evolution and coevolution of institutions and their interactions with the political economy of development. Topics examined include the relationship between institutions and growth, educational systems, the role of the media, and the intersection between traditional systems of patronage and political institutions. Each chapter-covering the frontier research in its area and pointing to new areas of research-is the product of extensive workshopping on the part of the contributors. The definitive reference work on this topic, The Handbook of Economic Development and Institutions will be essential for academics, researchers, and professionals working in the field
The Malaysian economy maintained a vigorous pace in the first nine months of 2012 despite external headwinds. Continuing a trend in the past two years, Malaysia's stronger-than-expected Gross Domestic Product, or GDP growth in the first nine months of 2012 was driven by rapid expansion of domestic demand while external demand (and export-oriented industries) stagnated due to continuing global uncertainty. Malaysia's low participation of women in labor markets is linked to a pattern whereby women do not return to work after marriage and childbearing. Education alone is not sufficient to close gender gaps as social norms and formal institutions continue to affect the choices of all women. In the long-term, norms need to evolve for gender gaps to be bridged; in the meantime measures can be put in place to help men and women balance responsibilities. Changing prevailing social norms takes time. In the medium-term, supportive measures at all stages of the life-cycle can be put in place, ranging from flexi-work arrangements and expanded childcare options, to incentives for more female participation in 'non-female' educational fields and job types. While current initiatives to leverage on women's talent are laudable, other policy options must be explored, evaluated, and tailored, to enable Malaysian women to fully contribute to Malaysia's transformation towards a high-income, inclusive and sustainable economy.
A review article devoted to the book of Andrzej Blikle – Doktryna jakości. Rzecz o skutecznym zarządzaniu. As pointed out by the Author, the book is a case of a work rare on the Polish publishing market, written by an outstanding scientist, who successfully runs a business activity. The combination of practical experience with theoretical knowledge gave a result that may be satisfying both for practitioners as well as theorists, and also those who want to get to know the ins and outs of an effective and efficient business management. The Author of the review believes that it is an important voice for shaping an inclusive socio-economic system, which constitutes a value in itself. Although the book is mainly concerned with business management, its message has a much wider dimension and is concerned with real measures of wealth, money and people's lives. The book was awarded The SGH Collegium of Business Administration Award "For the best scientific work in the field of business administration in the years 2014-2015".
Andrzej Jacek Blikle Doktryna jakości. Rzecz o skutecznym zarządzaniu (The Doctrine of Quality. On Effective Management) Gliwice, Helion Publishing Company, 2014, p. 546
Introduction
One of the distinctive features of the contemporary economy and contemporary world is a kind of obsession of quantity which is related to thoughtless consumerism, unfavourable to the care for the quality of the work and the quality of the produced and consumed goods and services. It is accompanied by culture (or rather non-culture) of singleness. Therefore, the book The Doctrine of Quality by Andrzej Blikle is like a breath of fresh air.
It is a different perspective on the economy and the model of operation of enterprises, on the model of work and life of people. A. Blikle proves that it can be done otherwise. He proves it on the basis of careful studies of the source literature – as expected from a professor of mathematics and an economist, but also on the basis of his own experience gained during the scientific and educational work, and most of all through the economic practice. In the world governed by the obsession of quantity, characterised by fragility, shortness of human relationships, including the relationship of the entrepreneur – employee, A. Blikle chooses durability of these relations, creativity, responsibility, quality of work and production, and ethics. The Doctrine of Quality is a rare example of the work on the Polish publishing market, whose author is a prominent scientist, successfully conducting a business activity for more than two decades, which has contributed to the development of the family company – a known confectionery brand "A. Blikle". The combination of practical experience with theoretical knowledge gave a result that may be satisfying both for practitioners as well as theorists, and also those who want to get to know the ins and outs of an effective and efficient business management, or develop the knowledge on this topic. In an attractive, clear narrative form, the author comprehensively presents the complexities of business management, indicating the sources of success, but also the reasons and the foundations of failures.
At the same time, he presents these issues with an interdisciplinary approach, which contributes to thoroughness of the arguments and deeper reflections.
Holism, typical to this book, is also expressed in the focus of A. Blikle not only on the economic, but also on social and ecological issues. Here, the author points to the possibility and need of reconciliation of the economic interests with social interests, and the care for the public good. Analyses of this subject are presented using the achievements of many areas of studies, in addition to economic sciences, including mathematics, sociology, psychology, medicine, and others. This gives a comprehensive picture of the complexity of business management – taking into account its close and distant environment.
There are no longueurs in the book, although extensive (over 500 pages), or lengthy, or even unnecessary reasoning overwhelming the reader, as the text is illustrated with a number of examples from practice, and coloured with anecdotes. At the same time, the author does not avoid using expressions popular in the world of (not only) business. He proves that a motivational system which is not based on the approach of "carrot and stick" and without a devastating competition of a "rat race" is possible. The author supports his arguments with references not only to the interdisciplinary scientific achievements, but also to the economic historical experiences and to a variety of older and newer business models.
There is a clear fascination with the reserves of creativity and productivity in the humanization of work. In fact, the author strongly exposes the potential of productivity and creativity in creating the conditions and atmosphere of work fostering elimination of fear of the future. He shows that such fear destroys creativity. It is not a coincidence that A. Blikle refers to the Fordist principles, including the warning that manufacturing and business do not consist of cheap buying and expensive selling. He reminds that Henry Ford, a legendary creator of the development of the automotive industry in the United States, put serving the public before the profit. The Doctrine of Quality is at the same time a book – proof that one of the most dangerous misconceptions or errors in the contemporary understanding of economics is finding that it is a science of making money, chremastics. Edmund Phelps and others warned against this in the year of the outbreak of the financial crisis in the USA in 2008, reminding that economics is not a science of making money but a science of relations between the economy and social life [Phelps, 2008]. Economics is a science of people in the process of management. Therefore, by definition, it applies to social values and ethos. Ethos is a general set of values, standards and models of proceedings adopted by a particular group of people. In this sense, ethos and economics as a science of people in the process of management are inseparable. Detaching economics from morality is in contradiction to the classical Smithian concept of economics, as Adam Smith combined the idea of the free market with morality. He treated his first work, The Theory of Moral Sentiments, as an inseparable basis for deliberations on the nature and causes of the wealth of nations, which was the subject of the subsequent work of this thinker [Smith, 1989; Smith, 2012]. Identifying economics with chremastics would then mean that all actions are acceptable and desired, if their outcome is earnings, profit, money. The book of A. Blikle denies it. It contains a number of case studies, which also stimulate broader reflections. Therefore, and also due to the features indicated above, it can be a very useful teaching aid in teaching entrepreneurship and management.
The appearance of a book promoting the doctrine of quality and exposing the meaning of ethos of work is especially important because today the phenomenon of product adulteration becomes increasingly widespread, which is ironically referred to in literature as the "gold-plating" of products [Sennett, 2010, pp. 115-118], and the trend as "antifeatures", that is intentionally limiting the efficiency and durability of products of daily use to create demand for new products. A model example of antifeature is a sim-lock installed in some telephones which makes it impossible to use SIM cards of foreign operators [Rohwetter, 2011, p. 48; Miszewski, 2013]. These types of negative phenomena are also promoted by the development of systemic solutions aiming at the diffusion of responsibility [Sennett, 2010]. This issue is presented among others by Nassim N.N. Taleb, in the book with a meaningful title Antifragile: How to Live in a World We Don't Understand? The author proves that the economy and society lose their natural durability as a result of the introduction of numerous tools and methods of insurance against risks, but mostly by shifting the burden of risks on other entities [Taleb, 2012]. N.N. Taleb illustrates his arguments with numerous convincing examples and references to history, recalling, inter alia, that in ancient times there was no building control, but the constructors, e.g. of bridges had to sleep under them for some time after their construction, and the ancient aqueducts are still working well until today. So, he shows that a contemporary world, focused on quantitative effects, does not create a sound base for ethical behaviours and the care for the quality of work and manufacturing.
Andrzej Blikle points to the need and possibility of opposing this, and opposing to what the Noble Price Winner for Economics, Joseph Stiglitz described as avarice triumphs over prudence [Stiglitz, 2015, p. 277]. The phrase emphasised in the book "Live and work with a purpose" is the opposition to the dangerous phenomena listed above, such as for example antifeatures.
convincing that although the business activity is essentially focused on profits, making money, limited to this, it would be led to the syndrome of King Midas, who wanted to turn everything he touched into gold, but he soon realised that he was at risk of dying of starvation, as even the food turned into gold. What distinguishes this book is that almost every part of it forces in-depth reflections on the social and economic relations and brings to mind the works of other authors, but at the same time, creates a new context for them.
So, A. Blikle clearly proves that both the economy and businesses need social rooting. This corresponds to the theses of the Hungarian intellectual Karl Polanyi, who in his renowned work The Great Transformation, already in 1944 argued that the economy is not rooted in the social relations [Polanyi, 2010, p. 70]. He pointed to the risk resulting from commodification of everything, and warned that allowing the market mechanism and competition to control the human life and environment would result in disintegration of society. Although K. Polanyi's warnings were concerned with the industrial civilization, they are still valid, even now – when the digital revolution brings fundamental changes, among others, on the labour market – they strengthen it. The dynamics of these changes is so high that it seems that the thesis of Jeremy Rifkin on the end of work [Rifkin, 2003] becomes more plausible. It is also confirmed by recent analyses included in the book of this author, concerning the society of zero marginal cost and sharing economy [Rifkin, 2016], and the analyses concerning uberisation [Uberworld, 2016].
The book of Andrzej Blikle also evokes one of the basic asymmetries of the contemporary world, which is the inadequacy of the dynamics and sizes of the supply of products and services to the dynamics and sizes of the demand for them. Insufficient demand collides with the rapidly increasing, as a result of technological changes, possibilities of growth of production and services. This leads to overproduction and related therewith large negative implications, with features of wasteful economy of excess [Kornai, 2014]. It is accompanied by phenomena with features of some kind of market bulimia, sick consumerism, detrimental both to people and the environment [Rist, 2015]. One of the more compromising signs of the economy of excess and wasting of resources is wasting of food by rich countries, when simultaneously, there are areas of hunger in some parts of the world [Stuart, 2009].
At the same time, the economy of excess does not translate to the comfort of the buyers of goods – as in theory attributed to the consumer market. It is indicated in the publication of Janos Kornai concerning a comparative analysis of the features of socio-economic systems. While exposing his deep critical evaluation of socialist non-market systems, as economies of constant deficiency, he does not spare critical opinions on the capitalist economy of excess, with its quest for the growth of the gross domestic product (GDP) and profits. As an example of the economy of excess, he indicates the pharmaceutical industry, with strong monopolistic competition, dynamic innovativeness, wide selection for the buyers, flood of advertisements, manipulation of customers, and often bribing the doctors prescribing products [Kornai 2014, p. 202]. This type of abnormalities is not alien to other industries. Although J. Konrai appreciates that in the economy of excess, including the excess of production capacities, the excess is "grease" calming down and soothing clashes that occur in the mechanisms of adaptation, he also sees that those who claim that in the economy of excess (or more generally in the market economy), sovereignty of consumers dominates, exaggerate [Kornai, 2014, pp. 171-172], as the manufacturers, creating the supply, manipulate the consumers. Thus, there is an excess of supply – both of values as well as junk [Kornai, 2014, p. 176]. Analysing the economy of excess, J. Kornai brings this issue to the question of domination and subordination. It corresponds with the opinion of Jerzy Wilkin, according to whom, the free market can also enslave, so take away individual freedom; on the other hand, the lack of the free market can lead to enslavement as well. Economists willingly talk about the free market, and less about the free man [Wilkin, 2014, p. 4].
The economy of excess is one of the consequences of making a fetish of the economic growth and its measure, which is the gross domestic product (GDP) and treating it as the basis of social and economic activity. In such a system, the pressure of growth is created, so you must grow to avoid death! The system is thus comparable to a cyclist, who has to move forwards to keep his balance [Rist, 2015, p. 181]. It corresponds with the known, unflattering to economists, saying of Kenneth E. Boulding [1956], criticising the focus of economics on the economic growth, while ignoring social implications and consequences to the environment: Anyone who believes in indefinite growth in anything physical, on a physically finite planet, is either mad or an economist. [from: Rist, 2015, p. 268].
GDP is a very much needed or even indispensable measure for evaluation of the material level of the economies of individual countries and for comparing their economic health. However, it is insufficient for evaluation of the real level of welfare and quality of life. It requires supplementation with other measures, as it takes into account only the values created by the market purchase and sale transactions. It reflects only the market results of the activity of enterprises and households. Additionally, the GDP account threats the socially desirable and not desirable activities equally. Thus, the market activity related to social pathologies (e.g. functioning of prisons, prostitution, and drug dealing) also increase the GDP. It was accurately expressed already in 1968 by Robert Kennedy, who concluded the discussion on this issue saying that: the gross national product does not allow for the health of our children, the quality of their education or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages, the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country, it measures everything in short, except that which makes life worthwhile [The Guardian, 2012].
While Grzegorz W. Kołodko even states that it should be surprising how it is possible that despite a number of alternative measures of social and economic progress, we are still in the corset of narrow measure of the gross product, which completely omits many significant aspects of the social process of reproduction [Kołodko, 2013, p. 44]. In this context he points to the necessity of triple sustainable growth – economic, social, and ecological [Kołodko, 2013, p. 377]. Transition from the industrial civilisation model to the new model of economy, to the age of information, causes a kind of cultural regression, a phenomenon of cultural anchoring in the old system. This type of lock-in effect - described in the source literature, that is the effect of locking in the existing frames and systemic solutions, is a barrier to development. The practice more and more often and clearer demonstrates that in the conditions of the new economy, the tools and traditional solutions turn out to be not only ineffective, but they even increase the risk of wrong social and economic decisions, made at different institutional levels.
All this proves that new development models must be searched for and implemented, to allow counteraction to dysfunctions of the contemporary economy and wasting the development potential, resulting from a variety of maladjustments generated by the crisis of civilisation. Polish authors who devote much of their work to these issues include G.W. Kołodko, Jerzy Kleer, or Maciej Bałtowski. Studies confirm that there is a need for a new pragmatism, new, proinclusive model of shaping the social and economic reality, a model which is more socially rooted, aiming at reconciling social, economic and ecological objectives, with simultaneous optimisation of the use of the social and economic potential [Kołodko, 2013; Bałtowski, 2016; Kleer, 2015]. There is more and more evidence that the barriers to economic development growing in the global economy are closely related with the rooting of the economy in social relations. The book of A. Blikle becomes a part of this trend in a new and original manner. Although the author concentrates on the analyses of social relations mainly at the level of an enterprise, at the same time, he comments them at a macroeconomic, sociological and ethical level, and interdisciplinary contexts constitute an original value of the book.
Conclusion
I treat the book of Andrzej Blike as an important voice in favour of shaping an inclusive social and economic system, in favour of shaping inclusive enterprises, that is oriented on an optimal absorption of knowledge, innovation and effective reconciliation of the interests of entrepreneurs with the interests of employees and the interests of society. Inclusiveness is indeed a value in itself. It is understood as a mechanism/system limiting wasting of material resources and human capital, and counteracting environmental degradation. An inclusive social and economic system is a system oriented on optimisation of the production resources and reducing the span between the actual and potential level of economic growth and social development [Reforma, 2015]. And this is the system addressed by Andrzej Blikle in his book. At least this is how I see it. Although the book is mainly concerned with business management, its message has a much wider dimension and is concerned with real measures of wealth, money and people's lives.
