In 1988, a new health care system, the Sistema Único de Saúde (Unified Health Care System or SUS) was formally established in Brazil. The system was intended, among other goals, to provide universal ...access to health care services and to redefine health as a citizen's right and a duty of the state. A Right to Health explores how these goals have unfolded within an urban peripheral community located on the edges of the northeastern city of Fortaleza. Focusing on the decade 1998–2008 and the impact of health care reforms on one low-income neighborhood, Jessica Jerome documents the tensions that arose between the ideals of the reforms and their entanglement with pervasive socioeconomic inequality, neoliberal economic policy, and generational tension with the community.Using ethnographic and historical research, the book traces the history of political activism in the community, showing that, since the community's formation in the early 1930s, residents have consistently fought for health care services. In so doing, Jerome develops a multilayered portrait of urban peripheral life and suggests that the notion of health care as a right of each citizen plays a major role not only in the way in which health care is allocated, but, perhaps more importantly, in how health care is understood and experienced.
It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS ...represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.
A blueprint for comprehensive, science-based health care system reform.Financial and political pressures on our health care system have negatively impacted individual care and the health system as a ...whole, an issue that has only become more acute because of the COVID-19 pandemic. In Building a Unified American Health Care System, Gilead I Lancaster, MD, lays out a blueprint for comprehensive health care reform, proposing a unified system run by health care professionals—not politicians or commercial health insurance companies—that offers universal coverage and access.Lancaster compares the current arguments for single payer versus commercial health insurance systems with arguments in the early 1900s for a central bank versus regional commercial banks. He then introduces a novel solution: the establishment of a National Medical Board similar to the Federal Reserve System that helped fix the American banking system over a century ago. Along with other innovations, a plan co-created by Lancaster dubbed EMBRACE (Expanding Medical and Behavioral Resources with Access to Care for Everyone) would involve creating a modern, evidence-based health care system, one offering universal coverage for basic needs while allowing for commercial insurance participation. Emphasizing the importance of separating health care from governmental and commercial pressures and incentives, Lancaster explains the need for comprehensive—rather than incremental—reform of the American health care system.
The Amazon, the world's largest rain forest, is the last frontier in Brazil. The settlement of large and small farmers, squatters, miners, and loggers in this frontier during the past thirty years ...has given rise to violent conflicts over land as well as environmental duress. Titles, Conflict, and Land Use examines the institutional development involved in the process of land use and ownership in the Amazon and shows how this phenomenon affects the behavior of the economic actors. It explores the way in which the absence of well-defined property rights in the Amazon has led to both economic and social problems, including lost investment opportunities, high costs in protecting claims, and violence. The relationship between land reform and violence is given special attention. The book offers an important application of the New Institutional Economics by examining a rare instance where institutional change can be empirically observed. This allows the authors to study property rights as they emerge and evolve and to analyze the effects of Amazon development on the economy. In doing so they illustrate well the point that often the evolution of economic institutions will not lead to efficient outcomes. This book will be important not only to economists but also to Latin Americanists, political scientists, anthropologists, and scholars in disciplines concerned with the environment.
How Schools Do Policy Ball, Stephen J; Maguire, Meg; Braun, Annette
Routledge, Taylor & Francis Group,
2012, 20120726, 2011, 2011-12-14, 2012-07-26
eBook, Book
Over the last 20 years, international attempts to raise educational standards and improve opportunities for all children have accelerated and proliferated. This has generated a state of constant ...change and an unrelenting flood of initiatives, changes and reforms that need to be ‘implemented’ by schools. In response to this, a great deal of attention has been given to evaluating ‘how well’ policies are realised in practice – implemented! Less attention has been paid to understanding how schools actually deal with these multiple, and sometimes contradictory, policy demands; creatively working to interpret policy texts and translate these into practices, in real material conditions and varying resources – how they are enacted! Based on a long-term qualitative study of four ‘ordinary’ secondary schools, and working on the interface of theory with data, this book explores how schools enact, rather than implement, policy. It focuses on:
contexts of ‘policy work’ in schools;
teachers as policy subjects;
teachers as policy actors;
policy texts, artefacts and events;
standards, behaviour and learning policies.
This book offers an original and very grounded analysis of how schools and teachers do policy. It will be of interest to undergraduate and postgraduate students of education, education policy and social policy, as well as school leaders, in the UK and beyond.
Stephen J. Ball is the Karl Mannheim Professor of Sociology of Education in the Department of Educational Foundations and Policy Studies at the Institute of Education, University of London, UK.
Meg Maguire is Professor of Sociology of Education in the Department of Education and Professional Studies at King’s College London, UK.
Annette Braun is a Lecturer in Sociology in the Sociology Department of City University, London, UK.
Foreword or Introduction 1. Beyond implementation –Towards a Theory of Policy Enactment 2. Taking Context Seriously 3. Doing Enactment: People, Culture and Policy Work 4. Policy into Practice 5. Whatever happened to... 6. Policy Enactments – In Theory and Practice
Few interventions that succeed in improving healthcare locally end up becoming spread and sustained more widely. This indicates that we need to think differently about spreading improvements in ...practice. Drawing on a focused review of academic and grey literature, the authors outline how spread, scale-up, and sustainability have been defined and operationalised, highlighting areas of ambiguity and contention. Following an overview of relevant frameworks and models, they focus on three specific approaches and unpack their theoretical assumptions and practical implications: the Dynamic Sustainability Framework, the 3S (structure, strategy, supports) infrastructure approach for scale-up, and the NASSS (non-adoption, abandonment, and challenges to scale-up, spread, and sustainability) framework. Key points are illustrated through empirical case narratives and the Element concludes with actionable learning for those engaged in improvement activities and for researchers. This title is also available as Open Access on Cambridge Core.
One Nation, Uninsured offers a vividly written history of America's failed efforts to address the health care needs of its citizens. Covering the entire twentieth century, Jill Quadagno shows how ...each attempt to enact national health insurance was met with fierce attacks by powerful stakeholders, who mobilized their considerable resources to keep the financing of health care out of the government's hands.
Since 1978 when it embarked on sweeping agricultural and industrial reforms, Chinas economic growth has been remarkable. Its success in transforming itself within just three decades from a very poor ...low-income country to a successful middle-income country is unparalleled. During this period, however, and in contrast to the first 30 years of the Peoples Republic, progress in the health sector has been disappointing. For example, during the period 1980-2007, China increased its income per head as a percentage of the OECD average from 3 percent to 15 per cent, but infant mortality fell no faster in China than in the OECD area. Government spending on health grew in real terms, but in contrast to the pattern seen in other countries, the share of GDP allocated to government health spending stayed unchanged in China despite 30 years of economic growth of over 8 per cent per year. Household out-of-pocket spending increased to fill the gap, rising as a share of total health spending from 20 per cent in 1978 to over 60 per cent in 2000. This left many households doing without care when they needed it, and others incurring expenses so large they were driven into poverty. In 2003, as part of its program of balanced development and harmonious society, the government began launching a series of policy reforms in the rural health sector where spending and policy reform had lagged. This book examines the performance and workings of the rural health system leading up to these reforms, outlines the reforms, and presents some early evidence on their impacts. It goes on to outline ideas for building on these reforms to further strengthen Chinas rural health system, covering health financing and health insurance, service delivery, and public health. Health systems often get locked into certain reform paths. The final part of the book therefore uses the
experiences of the OECD countries to gaze into Chinas future; it asks not only what Chinas health system might look like, but also how China might get there from where it is today.
