“Professional Movements” and the Expansion of Access to Healthcare in the Industrializing World

Abstract

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.

The Politics of Expanding Healthcare Access to the Poor and Informal Sectors

“…While these cases appear to support conventional wisdom that processes of democratic deepening empower the masses who give voice to concerns, they also demonstrate that the dynamics of democratic political competition sometimes enable other well‐positioned elites to set the agenda for major reforms. While other recent work has pointed to the surprising role that “professional movements” in health reforms in the industrializing world (Harris , ), this research illustrates the role that individual public health–minded physicians leading change teams in the ministry of health played in setting the agenda for healthcare reform. Steeped in the language of health sector reform but not tied to broader professional movements, these physicians played a pivotal role in putting reform on their parties’ agenda and driving adoption and implementation.…”

“…However, the cases show that broad‐based civil society groups are far from the only source of agenda setting in the industrializing world. Rather than “professional movements” (Harris , ), physicians leading change teams in Turkey and Mexico played important roles both in setting the agenda for reform and in driving policy adoption and implementation. Although committed public health professionals, these physicians had significant exposure to international organizations, the experience of reform in other contexts, and were steeped in the language of market‐oriented neoliberal reform.…”

Exchange: Explaining the Passage of Universal Healthcare in Thailand

“…Aside from these two critical points raised in my original article (Harris 2015), I raise one other key point in my book: that the agenda for the constitutional reform that led to the necessary electoral rule changes was itself set by the patriarch of the RDM. Prawase Wasi originally wrote to caretaker Prime Minister Anand Panyarachun in 1992, suggesting the need to change the constitution (Wasi 2002).…”

“…Approaching the same question from a different discipline, Joseph Harris, a political sociologist, published an article in the Journal of Health Politics, Policy and Law that pointed 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 (Harris 2015). He contrasted this unusual "developmental capture" of state agencies by reformist bureaucrats who seek to promote broadly inclusive social policies of benefit to the wider populace with more traditional notions of "regulatory capture" involving interest groups who seek to weaken state regulation for private gain.…”

“…He contrasted this unusual "developmental capture" of state agencies by reformist bureaucrats who seek to promote broadly inclusive social policies of benefit to the wider populace with more traditional notions of "regulatory capture" involving interest groups who seek to weaken state regulation for private gain. Harris subsequently refined and rearticulated these arguments in the context of a larger book, Achieving Access: Professional Movements and the Politics of Health Universalism (Harris 2017a) and a related article (Harris 2017b).…”