URBAN HEALTH CHALLENGE THROUGH THE CAPABILITY LENS : CASE STUDIES IN ACCRA AND BAMAKO

West Africa stands out as the region with some of the worst health and mortality indices. There are nonetheless sharp differentials in health and well-being by urban/rural residence, and individual characteristics such as education and age. Whereas some inequalities are structural in origin, there are, however, inequalities which have a more local origin, depending on household and family level factors that affect, for example, access to health services as well as life styles and behaviour.

After a discussion of some concepts underlying the description of individual and population health states, we use two case studies based on several years of West African field work – women’s health in Accra and the welfare of young people in Bamako – to illustrate how adoption of the capability framework can refine the analysis of unequal access to health. We apply the capability approach developed by Sen and colleagues to distinguish, inter alia, the role of the resources of the context (offer side) from inequalities of individual capacity to use them to improve their well being, due to social, family and individual characteristics. This framework seems especially promising to examine the complex determinants of urban health.