Neoliberalism Redux: The Global Health Policy Agenda and the Politics of Cooptation in Latin America and Beyond

Abstract

This article explores the neoliberal cooptation of social justice-oriented global health policies over the last three decades, from primary health care and 'health for all' to various contemporary so-called 'health equity' initiatives, such as Universal Health Coverage and 'health convergence'. The authors illustrate and contextualize the different periods and approaches with examples from a range of Latin American countries, drawing on diverse political experiences and social struggles in the health arena. The analysis concludes with reflections about the region's experiences of resisting and challenging the neoliberal health agenda, in spite of domestic and global environments that have constrained these efforts, past and present. In this sense, the struggle for bona fide equity in health and health policy remains an important and ongoing priority.Our thanks go to Mariajosé Aguilera, Esperanza Krementsova, Ramya Kumar, Devaki Nambiar, the anonymous reviewers and the editors of Development and Change. Development and Change 47(4): 734-759.

Proteção social na América Latina e Caribe: mudanças, contradições e limites

“…Se as experiências de resistência e confronto com a agenda neoliberal na saúde (Cuba, Costa Rica, Brasil e mais recentemente Bolívia, Venezuela e Uruguai) indicam a existência de alternativas para os países da região, elas também revelam sua fraqueza e fragilidade, na medida em que muitos países passaram a adotar a proposta de cobertura universal de saúde. Esse movimento sugere que a arena decisória da saúde na América Latina e Caribe (e no mundo) tem sido fortemente cooptada pela agenda neoliberal 56 , seja pela adoção de inúmeras formas de privatização dos serviços, seja pela apropriação e reenquadramento de valores, saberes e práticas de diversos setores progressistas que atuam no campo da saúde coletiva e que defendem um modelo com mais justiça social e equidade.…”

Inequalities in the Age of Universal Health Coverage: Young Chileans with Diabetes Negotiating for Their Right to Health

“…In contrast, Chile's adoption of neoliberal policies took place in less than a decade during the early years of Pinochet's regime (Birn et al. ; Valdés ).…”

“…However, the term “coverage” has taken on a very specific and narrow meaning, departing from previous claims to achieve health care for all (Birn et al. ; Waitzkin ). For example, the World Bank has stated that achieving UHC means providing people with “access to the health care they need (WHO ), while the UN has narrowed the term down to the provision of “quality essential health‐care” with financial risk protection (WHO ).…”

“…Both approaches reflect a departure from previous more integrated global health calls (e.g., the Alma‐Ata Declaration of 1978) to provide public, unified and comprehensive health care (Birn et al. ; De Vos 2015). Through the case studies, we were able explore the intricacies of the narrow definition for the term coverage in Chile, highlighting issues in access and quality of care within the public and private system.…”

South-South cooperation in health: bringing in theory, politics, history, and social justice

“…While not directly connected to health cooperation, the NIEO both inspired and was invoked by the World Health Organization's (WHO's) call for social justice-oriented primary health care to replace technical disease campaigns at the 1978 Alma-Ata conference -a transformation widely supported in the 1970s but stymied by the neoliberal turn the following decade 79 . By the 1990s, as the debt crisis swept across G-77 countries, the World Bank had not only upstaged WHO in the realm of health "cooperation", but it coopted both primary health care and poverty reduction efforts in the context of the Bamako Initiative's espousal of user fees and, especially, of several waves of structural adjustment loans with conditionalities imposing the downsizing of government health and social programs and the privatization of health services 80 .…”