The notion of "regulatory capture" is typically used to describe the takeover of state agencies by outside interest groups that seek to weaken regulation and advance the agendas of interest groups through control over state policy levers. This concept can be contrasted with that of "developmental capture" of state agencies by networks of reformist bureaucrats within the state who seek to promote inclusive state social and developmental policies of benefit to the broader populace. Building on work that has pointed to instances in which state bureaucrats act autonomously from societal and political pressures, this article argues that existing explanations are insufficient for explaining Thailand's universal health care policy. It points to the critical role played by a network of bureaucrats within the state who strategically mobilized resources in the bureaucracy, political parties, civil society, and international organizations to institutionalize universal health care in the face of broader professional dissent, political uncertainty, and international pressure.
The policy responses to human immunodeficiency virus/acquired immune deficiency syndrome (AIDS) in the Brazil, Russia, India, China and South Africa (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 fuelled a delayed response and proved extremely costly in terms of human lives. In Russia, a lack of civil societal opportunity for mobilization and non-governmental organization (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.
Explanations for the expansion of the welfare state have frequently centered on the importance of left-wing political parties and labor unions. Scholars have even pointed to the rare but growing significance of social democracy in the industrializing world. Yet, in the field of healthcare, labor unions frequently oppose sweeping universalistic reforms that threaten to erode members’ existing benefits, and those most in need of healthcare in rural areas and the informal sector are often the least organized politically. In the absence of mass demands, who then is responsible for universal healthcare programs in the industrializing world, and by what means do they successfully advocate for far-reaching reforms? This article explores the role that “professional movements” played in expanding access to healthcare in an industrializing nation that was engaged in processes of democratization. Mass movements are typically composed of lay people; by contrast, professional movements are made up of elites from esteemed professions who command knowledge, networks, and access to state resources that set them apart from ordinary citizens. The account illustrates how and why professional movements are able to play such a powerful role in health policymaking in the industrializing world, points to the need for more research on professional movements in other cases and policy domains, and discusses their relevance to social change in the industrializing world.
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