How does political competition shape institutions that govern the expansion of social policy subnationally? Brazilian states have shown a surprising variation in the design of their public health institutions, which regulate the distribution of health resources and citizen access to public health care. While many states have experienced fragmentation, some have remained highly centralized and discretionary, and only a select few have established a coordinated system based on power sharing and rules‐based distribution. Accounts that link public health care expansion to federal government imposition, the presence of the public health care movement, and leftist parties cannot fully explain this variation. Instead, in the three Brazilian states examined here, the nature of subnational political competition triggered different institution‐building strategies. The findings indicate that plural political competition yielded incentives for limiting state‐level discretion and for sharing power with municipal governments, while political concentration reinforced the attraction to centralized and discretionary policymaking.
One of the most significant recent changes in Brazilian politics is the inroads made by the Workers' Party (Partido dos Trabalhadores, PT) and other leftist parties into state and municipal governments in the country's most conservative region, the Northeast. An important strand of literature argues that this is due to a transformative strategy anchored in institutional growth, which is based on opening local party directorates. In contrast, this analysis shows that the PT has made gains in the region by segmenting its strategy -that is, by focusing on two wellestablished political practices. First, the PT has leveraged executive office at higher levels of government (e.g., federal and state) in order to advance at lower levels (e.g., state and municipal). Second, it has constructed pragmatic alliances with opportunistic parties, thus revealing how the migration of opportunist politicians into allied parties allowed entrenched elites to remain in power. This suggests that the Left's subnational advances are less transformative than they seem and could potentially harm democratic consolidation.
Scholars 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.
BackgroundCoimbra is certainly among the Portuguese university cities with more nightlife-oriented towards students. The CPTTP and IREFREA–Portugal, are investing, in partnership with other organisations of our city (Health, Education, Security Forces, Municipality, Others sectors) in primary, secondary, and tertiary prevention in nightlife settings. This initiative aims to contribute: to identify and eliminate the risk factors associated with (potentially) traumatic situations (intentional and unintentional); to identify and enhance protective factors; to strengthen community resilience.Description of the problemRecreation nightlife plays an important role in students’ lives but also has an intrinsic association to a multitude of risk factors in areas such as sexuality, violence, alcohol and other substances and road driving. According to a survey conducted by IREFREA in Coimbra, in 2014 (sample: 253 men and 184 women, aged between 16 and 43 years old) many of the night goers report that “today” there is more violence and aggression in the night life (60%), more alcohol intoxication (70%) and higher consumption of illegal drugs (43%). 17.6% reported having had road accidents, 21.4% have been hurt by these and 16.9% have had problems with the police. It is also too high a% of individuals who reported having had sex under the influence of alcohol (64.8%).ResultsMore participation, interaction and cooperation between network members; more investment on prevention and investigation; more production and exchange of content; more accession of new “actors” and more interactivity and connectivity.ConclusionsAdopting the ecological model, approaching nightlife in a public health perspective, organising care in a multidisciplinary, multisectoral network has contributed to the promotion of more involvement of the “city” aiming the safety and well-being of their citizens.
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