Please find below a listing of my journal articles and book chapters. If for some reason you cannot download or obtain a copy of a particular piece, please feel free to email me for it. The following articles are listed in chronological order, with the most recent listed first.
Abstract: This is a case study contribution to a forthcoming book on the issue of Human Rights and Global Health, edited by Benjamin Mason Meier and Larry Gostin (Oxford University Press). This case study discusses the BRICS’ differences in government commitments to healthcare as a human right, the different political and social forces contributing to these differences in government policy beliefs, and how this translated to differences in bilateral aid for healthcare in other developing nations.
Abstract: In this article, we assess the effect that Brazil’s universal healthcare system, SUS (System Único de Saúde), has had on access to organ transplantation services throughout the country. We find that substantial differences in SUS resources and capacity has contributed to inequalities in access to organ transplant services, particularly at the regional level. We conclude by providing policy recommendations for reducing barriers to access to transplantation services and investing in emerging technologies.
Abstract: This article explores the healthcare costs associated with the rising obesity and type-2 diabetes epidemics in Brazil, Mexico, India, and China. I argue that Brazil has outpaced these other emerging economies through innovative policy innovations, the result of favorable — and unique — historical political and social contexts. Findings suggest that these nations should follow Brazil’s lead in building strong political commitment not only to policy reform but also in working closely with civil society to address these new health and wider economic threats.
Abstract: Background: This article conducts a comparative national and sub-national government analysis of the political, economic, and ideational constructivist contextual factors facilitating the adoption of obesity and diabetes policy. Methods: We adopt a nested analytical approach to policy analysis, which combines cross-national statistical analysis with sub-national case study comparisons to examine theoretical prepositions and discover alternative contextual factors; this was combined with an ideational constructivist approach to policy-making. Results: Contrary to the existing literature, we found that with the exception of cross-national statistical differences in access to healthcare infrastructural resources, the growing burden of obesity and diabetes, rising healthcare costs and increased citizens’ knowledge had no predictive affect on the adoption of obesity and diabetes policy. We then turned to a subnational comparative analysis of the states of Mississippi in the US and Rio Grande do Norte in Brazil to further assess the importance of infrastructural resources, at two units of analysis: the state governments versus rural municipal governments. Qualitative evidence suggests that differences in subnational healthcare infrastructural resources were insufficient for explaining policy reform processes, highlighting instead other potentially important factors, such as state-civil societal relationships and policy diffusion in Mississippi, federal policy intervention in Rio Grande do Norte, and politicians’ social construction of obesity and the resulting differences in policy roles assigned to the central government. Conclusion: We conclude by underscoring the complexity of subnational policy responses to obesity and diabetes, the importance of combining resource and constructivist analysis for better understanding the context of policy reform, while underscoring the potential lessons that the US can learn from Brazil.
In this article, I review the current state of political science research in the field of global health policy. I also introduce the themes and arguments made about this topic in our special series of Global Health Governance titled “Political Science in Global Health.”
Abstract: In recent years, several emerging economies have introduced national health insurance programs ensuring access to healthcare while offering financial protection from out-of-pocket (OOP) and catastrophic expenses. Nevertheless, in several nations these expenses continue to increase. While recent research has emphasized the lack of funding, poor policy design and corruption as the main culprits, little is known about the politics of establishing federal regulatory agencies ensuring that state governments adhere to national insurance reimbursement and coverage procedures. This article fills in this lacuna by providing an alternative perspective, one that accounts for differences between nations in the creation of regulatory institutions, with an emphasis instead on governing elite strategies to campaign on access to healthcare during transitions to democracy, civil societal mobilization, constitutional constraints, and the national electoral incentives to overcome ineffective decentralization processes. The cases of Indonesia and China are introduced as examples of how and why their differences in this political process accounted for Indonesia’s success and China’s failure to ensure financial protection.
Abstract: In this article, we analyze the evolution of Brazil’s foreign policy in health. We argue that the Dilma Rouseff administration has not been committed to sustaining prior governments’ efforts to increase foreign aid in health, nor has the government increased the federal budget for those institutions governing this process. A decrease in economic growth, recession, and the Dilma administration’s focus on domestic policy are seen as the main reasons why this transformation has occurred. We consider the long-term impact that this may have on global health diplomacy and Brazil’s position in the world.
Abstract: The BRICS (Brazil, Russia, India, China, and South Africa) have emerged as robust economies with considerable international influence. Nevertheless, essentially all of these nations have fallen short of simultaneously developing strong economies and healthcare systems, in turn contributing to the emergence of healthcare inequalities, such as inadequate access to medicine, out-of-pocket spending, and geographic differences in access to quality healthcare infrastructure and human resources. This is puzzling considering that most of these nations’ economies burgeoned during the 1990s and early-2000s, thus potentially providing additional revenue for healthcare spending, while constitutional guarantees of universal access to healthcare and the presence of democratic electoral institutions in most of these nations should have incentivized governments to successfully address these inequality issues. Nevertheless, with the exception of South Africa, this study finds that waning political commitment to healthcare spending, increased foreign aid assistance and tenuous state-civil societal relationships accounted for these ongoing inequality challenges.
Abstract: During the 1990s, Brazil and Russia diverged in their policy response to AIDS. This is puzzling considering that both nations were globally-integrated emerging economies transitioning to democracy. This article examines to what extent international pressures and partnerships with multilateral donors motivated these governments to increase and sustain federal spending and policy reforms. Contrary to this literature, the cases of Brazil and Russia suggest that these external factors were not important in achieving these outcomes. Furthermore, it is argued that Brazil’s policy response was eventually stronger than Russia’s and that it had more to do with domestic political and social factors: specifically, AIDS officials’ efforts to cultivate a strong partnership with NGOs, the absence of officials’ moral discriminatory outlook towards the AIDS community, and the government’s interest in using policy reform as a means to bolster its international reputation in health.
Abstract: In the United States (US) and Brazil, obesity has emerged as a health epidemic. This article is driven by the following research questions: how did the US and Brazil’s federal institutions respond to obesity? And how did these responses affect policy implementation? The aim of this article is therefore to conduct a comparative case study analysis of how these nations’ institutions responded in order to determine the key lessons learned. Methods: This study uses primary and secondary qualitative data to substantiate causal arguments and factual claims. Results: Brazil shows that converting preexisting federal agencies working in primary healthcare to emphasize the provision of obesity prevention services can facilitate policy implementation, especially in rural areas. Brazil also reveals the importance of targeting federal grant support to the highest obesity prevalence areas and imposing grant conditionalities, while illustrating how the incorporation of social health movements into the bureaucracy facilitates the early adoption of nutrition and obesity policies. None of these reforms were pursued in the US. Conclusions: Brazil’s government has engaged in innovative institutional conversion processes aiding its ability to sustain its centralized influence when implementing obesity policy. The US government’s adoption of Brazil’s institutional innovations may help to strengthen its policy response.
Abstract: The BRICs nations (Brazil, Russia, India, and China) have differed in their government response to health epidemics. It is argued that Brazil eventually outpaced her emerging counterparts in response to AIDS (Acquired Immune Deficiency Syndrome) due to the presence of political institutional, civil societal, and foreign policy strategies that both sustained and encouraged the introduction of innovative policies. The concept of historical policy backlash is introduced in order to explain how the BRICs’ differences in their historic roles as foreign aid donors in health shaped their incentive to either focus on domestic AIDS policy or foreign aid strategies at the expense of domestic policy. This article therefore submits the first attempt to combine comparative political historical, social, and international processes to account for differences in the BRICs willingness and capacity to respond to AIDS.
Abstract: In recent years, several emerging economies, such as India, China, Russia, and Indonesia, have introduced national health insurance programs targeting the poor, safeguarding them from increased out-of-pocket and catastrophic expenses. With the exception of Indonesia, increased government spending for these programs has not helped to safeguard the poor from these expenses. This article introduces an analytical framework combining the importance of constitutional design, federalism and decentralization, and social health movements to account for these differences in policy outcomes. The author’s proposed analytical approach differs from those studies emphasizing financial constraints, the effective targeting of funds, and administrative capacity, suggesting instead that the design of political institutions and the incentives that they create for policy implementation and regulation may provide greater insight into why these targeted health insurance programs are not achieving their goals.
Abstract: New research from the Empowering CSO Networks in an Unequal Multi-polar World programme compares the cases of India, China, Russia and Indonesia in terms of levels and structures of health spending, and the impact on inequality in each of these countries. The report finds that in order to reduce inequality and improve the overall quality of healthcare there is a need to increase public healthcare spending. The research finds clear evidence to show a relationship between increased public provision of healthcare and publically-funded national health insurance programmes, and an overall reduction in inequality. Nevertheless, not all of these four countries are adopting the same path to increase healthcare coverage, and as such the impact on inequality has been mixed. Furthermore, the research highlights a number of ongoing challenges, and suggests that even with political willpower and support to increase public health spending, the detail of how this spending is channelled and monitored is vital in terms of having a positive effect on inequality.
Abstract: In recent years, tripartite partnerships between multilateral health agencies, ministries of health, and civil society have been viewed as important for building and sustaining the creation of national AIDS programs. This article critically examines this argument. In so doing, it uses a new database the author created measuring the presence of these tripartite partnerships and their affects on AIDS program spending. Statistical evidence suggests that these partnerships do not affect AIDS spending. The case of Brazil is then used to further examine various theoretical schools of thought as well as these statistical results at the domestic level, with the usage of qualitative case study evidence. Findings from Brazil further confirms this negative cross-national statistical finding, while highlighting other factors that may account for why governments decide to engage in ongoing AIDS spending, such as the state’s efforts to proactively seek out and strengthen preexisting partnerships with NGOs, while strategically using increased domestic AIDS spending as a means to bolster the government’s foreign policy aspirations.
Abstract: The policy responses to AIDS in the BRICS nations have played out amid radically different political environments that have shaped state-civil society relations in critical ways. In contrasting these different environments, this article offers the first comparison of the policy response to AIDS in the BRICS nations and seeks to understand the way in which political context matters for conditioning the response to a major epidemic. Using a comparative historical approach, we find that while collaborative state-civil society relations have produced an aggressive response and successful outcomes in Brazil, democratic openness and state-civil society engagement has not necessarily correlated with an aggressive response or better outcomes in the other cases. Response to the epidemic has been worst by far in democratic South Africa, followed by Russia, where in the former, denialism and antagonistic state-civil society relations fueled a delayed response and proved extremely costly in terms of human lives. In Russia, a lack of civil societal opportunity for mobilization and NGO growth, political centralization, and the state’s unwillingness to work with NGOs led to an ineffective government response. Top-down bureaucratic rule and a reluctance to fully engage civil society in democratic India substantially delayed the state’s efforts to engage in a successful partnership with NGOs. Nevertheless, China has done surprisingly well, in spite of its repressive approach and narrow engagement with civil society. And in all cases, we find the relationship between state and civil society to be evolving over time in important ways. These findings suggest the need for more research on the links between democratic openness, political repression, and policy responses to epidemics.
Abstract: Why do governments pursue obesity legislation? And is the case of Brazil unique compared
to other nations when considering the politics of policy reform? Using a nested analytic
approach to comparative research, I found that theoretical frameworks accounting for why
nations implement obesity legislation were not supported with cross-national statistical
evidence. I then turned to the case of Brazil’s response to obesity at three levels of
government, the national, urban, and rural levels, to propose alternative hypotheses for why
nations pursue obesity policy. The case of Brazil suggests that the reasons why governments
respond are different at these three levels of government. International forces, historical
institutions, and social health movements were factors that prompted national government
responses. Alternatively, at the urban and rural government levels, receiving federal financial
assistance and human resource support appeared to be more important. The case of Brazil
therefore suggests that the international and domestic politics of responding to obesity are
highly complex, that national and subnational political actors have different perceptions and
interests when pursuing obesity legislation.
Abstract: In recent years, several emerging nations with burgeoning economies and in transition to
democracy have pursued health policy innovations. As these nations have integrated into the
world economy through bilateral trade and diplomacy, they have also become increasingly
exposed to international pressures and norms and focused on more effective, equitable
health care systems. There are several lessons learned from the case studies of Brazil, Ghana,
India, China, Vietnam, and Thailand in this special issue on the global and domestic politics
of health policy in emerging nations. For the countries examined, although sensitive to
international preferences, domestic governments preferred to implement policy on their own
and at their own pace. During the policy-making and implementation process, international
and domestic actors played different roles in health policy making vis-à-vis other reform
actors — at times the state played an intermediary role. In several countries, civil society also
played a central role in designing and implementing policy at all levels of government.
International institutions also have a number of mechanisms and strategies in their toolbox
to influence a country’s domestic health governance, and they use them, particularly in the
context of an uncertain state or internal discordance within the state.
Abstract: The emerging nations of Brazil, China, and India are currently facing the costly epidemics of
obesity and type 2 diabetes. While similar in their pursuit of world prominence, these nations
nevertheless varied in the timing and depth of their policy response. Brazil seemingly
outpaced China and India in the area of prevention and especially with respect to the
universal provision of diabetic medication. Through the introduction of an interdisciplinary
theoretical approach combining different strands of international relations theory, it is
argued that the Brazilian government’s historic interest in simultaneously strengthening its
international reputation in health, as well as the institutionalization of access to medicine as a
human right, facilitated this more aggressive policy response. While China joined Brazil in
having similar geopolitical aspirations, it never institutionalized universal access to medicine
as a human right, thus failing to ensure type 2 diabetics with access to medicine. India, on
the other hand, has never had these geopolitical aspirations or government commitments to
the universal distribution of medication.
This article explains how and why a small group of emerging nations, i.e., Colombia, Mexico,
and Singapore, beat the BRICS (Brazil, Russia, India, China, and South Africa) in
simultaneously reforming their economic and social welfare system
Abstract: This article proposes an approach to comparing and assessing the adaptive capacity of
multilateral health agencies in meeting country and individual healthcare needs. Most studies
comparing multilateral health agencies have failed to clearly propose a method for
conducting agency comparisons. Methods: This study conducted a qualitative case study
methodological approach, such that secondary and primary case study literature was used to
conduct case study comparisons of multilateral health agencies. Results: Through the
proposed Sequential Comparative Analysis (SCA), the author found a more effective way to
justify the selection of cases, compare and assess organizational transformative capacity, and
to learn from agency success in policy sustainability processes. Conclusions: To more
affectively understand and explain why some multilateral health agencies are more capable of
adapting to country and individual healthcare needs, SCA provides a methodological
approach that may help to better understand why these agencies are so different and what
we can learn from successful reform processes. As funding challenges continue to hamper
these agencies’ adaptive capacity, learning from each other will become increasingly
Abstract: Amidst the growing literature on global health, much has been written recently about the
Brazil, Russia, India, China, South Africa (BRICS) countries and their involvement and
potential impact in global health, particularly in relation to development assistance. Rather
less has been said about countries’ motivations for involvement in global health negotiations,
and there is a notable absence of evidence when their motivations are speculated on. This
article uses an existing framework linking engagement in global health to foreign policy to
explore differing levels of engagement by BRICS countries in the global health arena, with a
particular focus on access to medicines. It concludes that countries’ differing and complex
motivations reinforce the need for realistic, pragmatic approaches to global health debates
and their analysis. It also underlines that these analyses should be informed by analysis from
other areas of foreign policy.
Abstract: In this article I explain the international and domestic factors that led to the emergence of
the obesity and diabetes epidemics in Brazil, China, and India. I argue that Brazil outpaced
India and China in the provision of proactive prevention and medical treatment services.
Abstract: The role of multilateral donor agencies in global health is a new area of research, with limited
research on how these agencies differ in terms of their governance arrangements, especially
in relation to transparency, inclusiveness, accountability, and responsiveness to civil society.
We argue that historical analysis of the origins of these agencies and their coalition formation
processes can help to explain these differences. We propose an analytical approach that links
the theoretical literature discussing institutional origins to path dependency and institutional
theory relating to proto institutions in order to illustrate the differences in coalition
formation processes that shape governance within four multilateral agencies involved in
global health. We find that two new multilateral donor agencies that were created by a
diverse coalition of state and non-state actors, such as the Global Fund to Fight AIDS,
Tuberculosis and Malaria and GAVI, what we call proto-institutions, were more adaptive in
strengthening their governance processes. This contrasts with two well-established
multilateral donor agencies, such as the World Bank and the Asian Development Bank, what
we call Bretton Woods (BW) institutions, which were created by nation states alone; and
hence, have different origins and consequently different path dependent processes.
Abstract: This article argues that Brazil’s success in responding to the AIDS epidemic rested in the
government’s pursuit of a reversal of decentralization, which entailed the government’s
delegation of policy-making autonomy, funding, and discretionary fiscal transfers to the
national AIDS program. AIDS bureaucrats achieved this by establishing close partnerships
with social health movements and AIDS nongovernmental organizations advocating policy
ideas with a historically proven track record of success while resembling similar social health
movements in the past. This partnership, in turn, provided AIDS bureaucrats with the
legitimacy and influenced needed for policy reform.
Abstract: The politics of government response to health epidemics is a new area of scholarly research.
Nevertheless, to date scholars have not considered how social science theory can be used
and interdependently linked to provide a more thorough discussion of civil societal and
national government response to different types of health epidemics. Introducing what I call
an interdependent analytic framework of government response to epidemics, this article
illustrates how social science theories can be interdependently linked and applied to help
explain the evolutionary role of interest groups and social movements in response to AIDS
and tuberculosis in Brazil, and when and why the government eventually responded more
aggressively to AIDS but not tuberculosis. Evidence from Brazil suggests that the policy
influence of interest groups and social movements evolves over time and is more influential
after the national government implements new policies; moreover, this response is triggered
by the rise of international pressures and government reputation building, not civil society. I
highlight new areas of research that the framework provides and provide examples of how
this approach can help explain civil societal and biased government responses to different
types of epidemics in other nations.
Abstract: Of recent interest is the capacity of international health agencies to adapt to changes in the
global health environment and country needs. Yet, little is known about the potential
benefits of using social science institutional theory, such as path dependency and
institutional change theory, to explain why some international agencies, such as the WHO
and the Global Fund to Fight AIDS, Tuberculosis and Malaria, fail to adapt, whereas others,
such as the World Bank and UNAIDS, have. This article suggests that these institutional
theories can help to better understand these differences in international agency adaptive
capacity, while highlighting new areas of policy research and analysis.
Abstract: Global Health Diplomacy (GHD) is a new area of scholarly research. While much has been
written on this topic, to date few have analyzed the social and political origins of GHD
processes and their outcomes. Using the case of Brazil as illustration, in this article I carefully
analyze the historical social and institutional conditions motivating nations to engage in
intensive international negotiations for access to essential medicines. Moreover, this article
maintains that scholars have failed to address how praises from the international community
can create incentives for nations to sustain their commitment to not only international
negotiations but also bi- lateral assistance to other nations.
Abstract: The impact of donors, such as national government (bi-lateral), private sector, and individual
financial (philanthropic) contributions, on domestic health policies of developing nations has
been the subject of scholarly discourse. Little is known, however, about the impact of global
financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on
policies and health governance of countries receiving funding from such initiatives. Methods:
This study employs a qualitative methodological design based on a single case study: Brazil.
Analysis at national, inter-governmental and community levels is based on in-depth
interviews with the Global Fund and the Brazilian Ministry of Health and civil societal
activists. Primary research is complemented with information from printed media, reports,
journal articles, and books, which were used to deepen our analysis while providing
supporting evidence. Results: Our analysis suggests that in Brazil, Global Fund financing has
helped to positively transform health governance at three tiers of analysis: the national-level,
inter-governmental-level, and community-level. At the national-level, Global Fund financing
has helped to increased political attention and commitment to relatively neglected diseases,
such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-
governmental-level, Global Fund financing has motivated the National Tuberculosis
Programme to strengthen its ties with state and municipal health departments, and non-
governmental organisations (NGOs); while at the community-level, the Global Fund’s
financing of civil societal institutions has encouraged the emergence of new civic
movements, participation, and the creation of new municipal participatory institutions
designed to monitor the disbursement of funds for Global Fund grants. Conclusions: Global
Fund financing can help deepen health governance at multiple levels. Future work will need
to explore how the financing of civil society by the Global Fund and other donors influence
policy agenda-setting and institutional innovations for increased civic participation in health
governance and accountability to citizens.
Abstract: Contrary to the once-popular notion of the central bureaucracy withering away as an
outcome of decentralization, scholars have shown that in cases of local policy success,
national bureaucrats have instead redefined their roles, strengthening their focus on
monitoring and accountability. Yet building national capacity for effective oversight presents
a challenge within a context of strong subnational autonomy such as Brazil. Comparing the
dynamics of decentralization across two areas of health policy, AIDS and tuberculosis, this
article presents one strategy utilized by federal bureaucrats to increase their regulatory
capacity: seeking resources located outside the formal political arena. Specifically, national
bureaucrats utilize international resources to mobilize local civic groups as policy watchdogs,
thus increasing the accountability of subnational politicians both to the center and to the
Abstract: In recent years, Brazil has been highly revered for its response to HIV/AIDS. Despite the
government’s delayed response, why and how did the national AIDS program eventually
become so successful? This is even further puzzling when one considers the challenges
associated with Brazil’s decentralized response to healthcare needs, lack of subnational
resources and political will to effectively implement AIDS policy. This article maintains that
Brazil’s successful response eventually required the strategic centralization of national AIDS
bureaucratic and policy authority, entailing policies designed to aid local governments while
creating fiscal policies incentivizing sub-national compliance with the national bureaucracy
and more effective policy implementation. Taking advantage of renewed political sup- port,
kindled by international pressures and the president’s reputation- building pursuits, the
sources of AIDS officials’ success, however, resided not in their technical and financial
prowess, but in their ability to forge historically-based partnerships with civic AIDS NGOs
and social movements sharing like-minded ideational beliefs in policy centralization. This
article also discusses how these findings contribute new insights into theories ad- dressing
the reasons for centralization, as well as the ideational sources of gradual institutional
Abstract: This article introduces the benefits of applying social science theories discussing institutional
stasis and change to better measure, explain, and compare elite behavior within health
administration and decentralization processes. A new comparative method based on these
theories is introduced, as well as methods for collecting and analyzing data. Methods: A
literature review of health governance, health system governance, and path dependency and
institutional change theory was conducted to reveal the limitations of health governance
approaches explaining elite behavior. Next, path dependency and institutional change theory
was applied to case studies in order to demonstrate their utility in explaining institutional
stasis and change. Results: Current approaches to analyzing and comparing elite behavior in
the health governance frameworks are limited in their ability to accurately explain the
willingness of elites to pursue more efficient institutional and policy designs. Current
indicators measuring elite behavior are also too static, failing to account for periodic
resistance to change and the conditions for it. Conclusions: By applying path dependency
and institutional change theory, the policy com- munity can obtain greater insight into the
willingness and thus capacity of institutions to pursue innovations while developing
alternative analytic frameworks and databases that better measure and predict this process.
Abstract: In a context of poorly designed health policy decentralization processes and constitutional
commitments to decentralization, what can national governments do to overcome sub-
national policy inefficiencies and respond more effectively to health epidemics, such as
HIV/AIDS? Examining the case of Brazil, this article argues that within these constraining
political contexts, national AIDS programs can devise approaches to what the author calls
“indirect centralization”. That is, by creating new conditional fiscal transfer programs based
on sub-national government adherence to national policy mandates while at the same time
working with local AIDS NGOs to monitor sub-national AIDS policy performance, thus
increasing local government accountability to the center, the national AIDS program can
sustain its centralized influence within a decentralized context. The case of Brazil provides
an example of what other nations can achieve in order to ensure that decentralization
continues to work effectively in response to AIDS and other diseases.
Abstract: Using a temporal approach dividing the reform process into two periods, this article explains
how both Brazil and the United States were slow to respond to AIDS. However, Brazil
eventually outpaced the United States in its response due to international rather than
democratic pressures. Since the early 1990s, Brazil’s success has been attributed to “strategic
internationalization”: the concomitant acceptance and rejection of global pressure for
institutional change and antiretroviral treatment, respectively. The formation of tripartite
partnerships between donors, AIDS officials, and NGOs has allowed Brazil to avoid foreign
aid dependency, while generating ongoing incentives for influential AIDS officials to
incessantly pressure Congress for additional funding. Given the heightened international
media attention, concern about Brazil’s reputation has contributed to a high level of political
commitment. By contrast, the United States’ more isolationist relationship with the
international com- munity, its focus on leading the global financing of AIDS efforts, and the
absence of tripartite partnerships have prevented political leaders from adequately
responding to the ongoing urban AIDS crisis. Thus, Brazil shows that strategically working
with the international health community for domestic rather than international influence is
vital for a sustained and effective response to AIDS.
Abstract: In this paper we examine whether Brazil, Russia and India have similar financing patterns to
those observed globally. We assess how national health allocations compare with
epidemiological estimates for burden of disease. We identify the major causes of burden of
disease in each country, as well as the contribution HIV/AIDS, tuberculosis and malaria
make to the total burden of disease estimates. We then use budgetary allocation information
to assess the alignment of funding with burden of disease data. We focus on central
government allocations through the Ministry of Health or its equivalent. We found that of
the three cases examined, Brazil and India showed the most bias when it came to financing
HIV/AIDS over other diseases. And this occurred despite evidence indicating that
HIV/AIDS (among all three countries) was not the highest burden of disease when
measured in terms of age-standardized DALY rates. We put forth several factors building on
Reich’s (2002) framework on ‘reshaping the state from above, from within and from below’
to help explain this bias in favour of HIV/AIDS in Brazil and India, but not in Russia:
‘above’ influences include the availability of external funding, the impact of the media
coupled with recognition and attention from philanthropic institutions, the government’s
close relationship with UNAIDS (UN Joint Programme on HIV/AIDS), WHO (World
Health Organization) and other UN bodies; ‘within’ influences include political and
bureaucratic incentives to devote resources to certain issues and relationships between
ministries; and ‘below’ influences include civil society activism and relationships with
government. Two additional factors explaining our findings cross-cutting all three levels are
the strength of the private sector in health, specifically the pharmaceutical industry, and the
influence of transnational advocacy movements emanating from the USA and Western
Europe for particular diseases.
Abstract: In this article I discuss Brazil’s commitment to health equality as well as its passion for health
policy innovations and how the United States can learn from Brazil’s success.
Abstract: Contrary to what many may expect, this article argues that Brazil did a better job than the
USA when it came to responding to HIV/AIDS. Because of the Brazilian government’s
concern about its international reputation and the partnerships it has forged with
international donors and civil society, the government has been committed to strengthening
decentralization processes by introducing both formal and informal re-centralization
measures that strengthen health policy devolution, while effectively targeting the biggest at-
risk groups. The US, in contrast, has not achieved these objectives, due to its lack of interest
in increasing its international reputation and its focus on bi-lateral aid rather than investing in
domestic policy. The paper closes by explaining the lessons that Brazil can teach the US and
other large federations seeking to ensure that decentralization and prevention policy work
Abstract: In this article, I explain how Brazil’s unique history and current geopolitical strategy
generates incentives for the government to achieve this, while providing an alternative model
of bilateral aid assistance—one that is premised on knowledge transfer and long-term
partnerships. I close by explaining the lessons that other nations can learn from Brazil and
the model it provides for what other emerging nations— such as India and China—can
achieve in their regions.
Abstract: Little is known about how emerging nations, such as Brazil, Russia, India and China (aka,
B.R.I.C.), strategically use the international health community in order to strengthen their
domestic HIV/AIDS programs. In this article, I introduce a new theoretical framework,
strategic “receptivity” and “resistance,” in order to explain how and why this process occurs.
Brazil emerges as the most successful case of how this process leads to the formation of
international partnerships and domestic policies strengthening its AIDS program, with India
gradually building such a response, followed by China and Russia. This article closes with an
explanation of how this strategic interaction reflects the growing independence and influence
of BRIC while highlighting how this framework applies to other cases.
Abstract: This article introduces a new concept to the study of decentralization processes: policy
dynamism. At its core is the notion that the sequential and temporal process of health
decentralization affect the nature of intergovernmental relationships and municipal
bureaucratic capacity. Examining the case of Brazil, I argue that the rush to decentralize
health services to municipalities has, in the absence of sufficient financial and technical
assistance from the federal and state governments, increased state-municipal conflict over
the management of health policy, limiting municipalities’ ability to increase bureaucratic
capacity. Consequently, some states have attempted to recentralize reforms, generating
further conflict between both subnational levels of government. While some municipalities
have tried to overcome these problems by creating associations and working with
international organizations, several bureaucratic obstacles remain. This article attributes these
outcomes not to federal institutions and economic constraints (the traditional approach in
the literature) but rather to the noninstitutional, temporal policy dynamics of
Abstract: This paper examines the politics of government response to health epidemics in the United
States and Brazil. Using a global structural approach, it explains why, despite their various
similarities, Brazil has been a bit better at responding to both sexually transmitted (STDs),
while the U.S. has been better at responding to non-STDs, such as the specter of avian flu
and bioterrorism. The paper closes with a discussion of why democracies are biased in the
types of epidemics they respond to and what this means for democratic equality and
commitment to its citizenry.
Abstract: The study of decentralization and municipal governance has captured much scholarly
attention. This article highlights the importance of factors that have been generally ignored,
and, in the process, suggests dimensions that facilitate comparison, including at the cross-
regional level. First, regarding the creation and reform of decentralization policy, scholars
may compare cases based on the horizontal and ex-post vertical political processes of reform.
Second, cases can be compared based on the degree of center-state policy fluctuation, i.e., the
institutions and incentives generating continual policy change and delayed outcomes, over
time. Finally, I encourage scholars to scale down to the municipal level, comparing cases
based on the following variables: historical state-municipal fiscal relations, institutional
innovations, and the policy-making process. I close by explaining the various benefits
associated with these approaches and the new research questions and challenges that they
pose for comparative scholars.