Achieving Access: Professional Movements and the Politics of Health Universalism (The Culture and Politics of Health Care Work)

Why do resource-constrained countries make costly commitments to universal health coverage and AIDS treatment after transitioning to democracy? At a time when the world’s wealthiest nations struggle to make healthcare and medicine available to everyone, this book explores the dynamics that made landmark policies possible in Thailand and Brazil but which have led to prolonged struggle and contestation in South Africa. While conventional wisdom suggests that democratization empowers the masses, this book draws attention to an underappreciated dynamic: that democratization empowers elites from esteemed professions – frequently doctors and lawyers – who forge progressive change on behalf of those in need in the face of broader opposition at home and from abroad. The relative success of professional movements in Thailand and Brazil and failure in South Africa highlights critical differences in the character of political competition. Whereas fierce political competition provided opportunities for professional movements to have surprising influence on the policymaking process in Thailand and Brazil, the unrivaled dominance of the African National Congress allowed the ruling party the luxury of entertaining only limited healthcare reform and charlatan AIDS policy in South Africa. The book offers lessons for the United States and other countries seeking to embark on expansive health reforms.

At a time when the world’s wealthiest nations struggle to make health care and medicine available to everyone, why do resource-constrained countries make costly commitments to universal health coverage and AIDS treatment after transitioning to democracy? Joseph Harris explores the dynamics that made landmark policies possible in Thailand and Brazil but which have led to prolonged struggle and contestation in South Africa. Drawing on firsthand accounts of the people wrestling with these issues, Achieving Access documents efforts to institutionalize universal healthcare and expand access to life-saving medicines in three major industrializing countries.

In comparing two separate but related policy areas, Harris finds that democratization empowers elite professionals, such as doctors and lawyers, to advocate for universal health care and treatment for AIDS. Harris’s analysis is situated at the intersection of sociology, political science, and public health and will speak to scholars with interests in health policy, comparative politics, social policy, and democracy in the developing world. In light of the growing interest in health insurance generated by implementation of the Affordable Care Act (as well as the coming changes poised to be made to it), Achieving Access will also be useful to policymakers in developing countries and officials working on health policy in the United States.

Contents Acknowledgments Abbreviations Introduction 1. DEMOCRATIZATION, ELITES, AND THE EXPANSION OF ACCESS TO HEALTH CARE AND MEDICINE Part I. ACCESS TO HEALTH CARE 2. THAILAND: CHASING THE DREAM OF FREE MEDICAL CARE FOR THE SICK 3. BRAZIL: AGAINST ALL ODDS 4. SOUTH AFRICA: EMBRACING NATIONAL HEALTH INSURANCE –IN NAME ONLY Part II. ACCESS TO AIDS MEDICINE 5. THAILAND: FROM VILLAGE SAFETY TO UNIVERSAL ACCESS 6. BRAZIL: CONSTITUTING RIGHTS, SETTING PRECEDENTS, CHALLENGING NORMS 7. SOUTH AFRICA: CONTESTING THE LUXURY OF AIDS DISSIDENCE Conclusion Notes References Index