Confronting Health Inequalities in the BRICS: Political Institutions, Foreign Policy Aspirations and State‐civil Societal Relationships
| DOI | http://doi.org/10.1111/1758-5899.12340 |
| Author | Eduardo J. Gómez |
| Published date | 01 November 2016 |
| Date | 01 November 2016 |
Confronting Health Inequalities in the BRICS:
Political Institutions, Foreign Policy Aspirations
and State-civil Societal Relationships
Eduardo J. G
omez
International Development Institute, King’s College London
Abstract
The BRICS (Brazil, Russia, India, China and South Africa) have emerged as potentially robust economies with considerable inter-
national influence. Nevertheless, essentially all of these nations have fallen short of simultaneously developing strong econo-
mies and health care systems, contributing to the emergence of health care inequalities, such as inadequate access to
medicine, health care treatment and out-of-pocket spending. This is puzzling considering that most of these nations’econo-
mies burgeoned during the 1990s and early-2000s, thus potentially providing additional revenue for health care spending,
while constitutional guarantees of universal access to health care and the presence of democratic electoral institutions in most
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 health care spending, increased foreign aid commitments
and tenuous state-civil societal relationships accounted for these ongoing inequality challenges.
Policy Implications
•Ensuring that all health care inequality issues are addressed prior to creating and implementation health insurance pro-
grams in the BRICS.
•Ensure that governments are fully committed to introducing regulatory institutions that avoid inequality issues, such as
out-of-pocket and catastrophic expenses.
•Ensure that governments are not distracted by foreign policy goals in providing foreign aid in health, at the expense of
over looking ongoing domestic health care needs.
•Ensure that civil society is fully integrated in the health care policy making process, especially on policy interventions that
avoid inequality issues.
Introduction
Scholars interested in understanding the successful develop-
mental prospects of emerging economies have recently
emphasized the importance of simultaneously investing in
health care and other social welfare programs (Haggard and
Kaufman, 2008; Sen, 1999). Several have emphasized the
importance of democratic institutions, electoral accountabil-
ity, centralized public health institutions, and strong state-
civil societal relationships as necessary conditions for devel-
oping equitable and effective health care systems amidst
transitions to democracy and economic reform (Boone and
Batsell, 2001; Gauri and Khaleghian, 2002; McGuire, 2010;
Nathanson, 1996). However, some of the most dynamic
emerging economies have failed to achieve these objectives,
notwithstanding the presence of these institutional and civil
societal preconditions.
A good example is the BRICS (Brazil, Russia, India, China
and South Africa). During the 1990s and early-2000s, these
nations saw the emergence of stable economic growth
rates, rising per capita income alongside increased health
care inequalities. This article primarily concerns itself with
three types of inequalities: universal access to medicine;
out-of-pocket (OOP) expenditures among the poor; and geo-
graphic urban versus rural differences in the quality of
health care infrastructure, e.g., beds and equipment and
human resources: doctors and nurses.
In a context of growth and development, why did these
inequalities emerge? This article claims that these outcomes
were attributed to a lack of government commitment to
increasing government spending for health care, a bypro-
duct of political apathy and conflicting viewpoints within
government. Within the BRICS, South Africa was the only
nation to see an increased government commitment to
reducing inequalities in access to medicine and reduced
OOP, resulting from years of policy neglect, the transition to
democracy and the overwhelming burden of disease. Yet
another challenge, as seen in Russia and China, were politi-
cal leaders being distracted by their efforts to become lead-
ers in providing foreign aid in health, dovetailing with
preexisting ambitions to become geopolitical powers
(Hurrell, 2006); and yet, these ambitions led Russia and
©2016 University of Durham and John Wiley & Sons, Ltd. Global Policy (2016) 7:4 doi: 10.1111/1758-5899.12340
Global Policy Volume 7 . Issue 4 . November 2016
500
Research Article
To continue reading
Request your trial