Suchergebnisse

Supplementing a traditional focus on economic dimensions of development, sociologists now frequently examine the origins of macro-level growth in human capabilities. One emergent theoretical framework for doing so emphasizes the promise of "twenty-first-century developmental states" for broadening delivery of capability-enhancing public services like health and education. Nevertheless, the configurations of state-society actors that are consistently willing and able to construct such institutions are far from obvious, highlighting a missing-agent problem at the core of the framework. The article addresses this gap by tracing Brazil's historic improvements in social development to what I call "programmatic configurations," or broad-based alliances of civil and political society actors that ameliorate vexing public problems by building democratic institutions and state capacities needed to enact rights-based social policies. It argues that frequent local office-holding by "sanitarista" activists from the country's most important health movement, the Sanitarist Movement, has been essential for constituting the programmatic configurations that maximized social development across urban Brazil in recent decades. More specifically, a brief historical account of the movement and fuzzy-set analysis show that programmatic configurations assembled by sanitaristas in Brazil's largest capitals have generally been a sufficient condition for maximizing improvement over time in three outcomes: infant-mortality reduction, municipal spending on health and sanitation, and municipal delivery of primary public health care. I correspondingly argue for broadening the twenty-first-century developmental state framework to accommodate how programmatic configurations—and the pragmatically inclined civil society activists at their core—can contribute to democratic state-building for social development.

Scholars of the post-neoliberal state in Latin America commonly trace universal social policies to ruling left parties and deepened democracy. Yet, such accounts often overlook how subnational politics in highly decentralized democracies like Brazil's can mediate this relationship. Examining such politics in the Brazilian município of Porto Alegre since 1988 suggests that structural constraints and competing programmatic agendas of Partido dos Trabalhadores (Workers' Party—PT) governments complicated expansion of the public health sector. The município's surprisingly modest delivery of such services is traceable to enduring deemphasis on critical dimensions of state building in this sector by several PT administrations and the integration of civil society actors into multiple participatory governance institutions with little power over this process. Even in such contexts, far-reaching participatory democratic institutions are no panacea for fulfilling the universal social policy ambitions of local post-neoliberal states that depend heavily upon high-level political appointees for their effectiveness.Estudiosos do Estado pós-neoliberal na América Latina frequentemente associam políticas sociais universais aos partidos governantes de esquerda e à solidificação da democracia. Contudo, tais narrativas ignoram como a política subnacional em democracias muito descentralizadas, como a brasileira, mediam esse relacionamento. Um exame dessa dinâmica política no município de Porto Alegre desde 1988 sugere que restrições estruturais e agendas programáticas competitivas de governos do Partido dos Trabalhadores (PT) ampliou a complexidade de expansão do setor de saúde pública. A modesta oferta de serviços de saúde naquele município pode ser atribuída a um esvaziamento contínuo das dimensões criticas da ingerencia do Estado nesse setor por parte de várias administrações petistas e à integração de atores da sociedade civil em múltiplas instituições de governança participatória com pouco poder de decisão sobre tal processo. Mesmo nesses contextos, instituições democráticas com alcance amplo não constituem uma panacéia que realize as ambições sociais universais de Estados locais pós-neoliberais, os quais dependem muito de políticos do alto escalão em cargos comissionados para serem eficientes.

AbstractScholars of Brazil's public health system commonly note the intertwined roles that federal, state, and municipal governments play in delivering care, yet few studies systematically examine varying service performance in areas with overlapping mandates, such as state capitals. This study addresses that gap by developing and analyzing a novel measure of municipal primary care provision that accounts for the proportion of the population without access to private services in 11 large capital cities, then comparing them to the noncapital municipalities in their states. The study finds that capitals generally underperform the noncapital municipalities in primary service delivery. It then draws on a comparative case study in two major capitals, Salvador and Belo Horizonte, and their encompassing states to explore how a history of cooperative or adversarial relations between state and local governments conditions the impact of partisanship, participatory institutions, and public health activists on primary care delivery.