Description
- Abstract:
- In 1988, social movement struggles for re-democratization in Brazil succeeded in enshrining a new constitution that promised universal and equal access to public health care as a right of all citizens. This dissertation offers a comparative-historical analysis of cross-city variation in the extent to which locally-ruling progressive political parties and public health activists from the Sanitary Movement (sanitaristas) transformed this right into expanded state provision of primary public health care after 1988. Drawing on quantitative and spatial analyses, the project finds that the município of Belo Horizonte became a top performer in delivering primary public health care during this period, while Porto Alegre was more moderately effective, and Rio de Janeiro generally under-performed in this regard. Drawing on archival research, original interviews, and fieldwork findings, it then traces differences in primary care delivery to three local, civil society-state regimes of politics – pragmatist, participatory, and clientelist regimes – that were instrumental in building local-level “health developmental states” characterized by sizable numbers of primary public health professionals, clinics, and robust planning capacities for geographically targeting professionals and clinics toward health risks. Within Belo Horizonte’s pragmatist regime, a sizable expansion in primary health care provision occurred as sanitaristas consistently occupied high-level, politically-appointed offices and effectively mobilized locally-ruling Workers Party (PT) governments around the project of building a local-level health developmental state. In Porto Alegre’s participatory regime, primary care expanded more narrowly as sanitaristas occupied such key offices less consistently and struggled to advance their project of building a health developmental state within PT governments that instead prioritized public participation in public service delivery. In Rio de Janeiro’s clientelist regime, primary care provision languished as progressive political parties failed to win power and sanitaristas only rarely occupied key offices within a local state overshadowed by engrained rent-seeking. In sum, alongside other factors, the extent to which sanitaristas and progressive political parties animated local regimes of state-society politics proved consequential for state-building processes and service delivery outcomes in the primary public health sector of these municípios.
- Notes:
- Thesis (Ph.D. -- Brown University (2012)
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Citation
Gibson, Christopher,
"Civilizing the State: Civil Society and the Politics of Primary Public Health Care Provision in Urban Brazil"
(2012).
Sociology Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.7301/Z0FQ9TXS
