The Consequences of Movement Office-Holding for Health Policy Implementation and Social Development in Urban Brazil

• Published in: Social forces 2017-12, Vol.96 (2), p.751-778
• Main Author: Gibson, Christopher L.
• Format: Article
• Language: English
• Subjects: Activism; Analysis; Attrition (Research Studies); Brazil; Child mortality; Childhood; Codification; COLLECTIVE BEHAVIOR AND SOCIAL MOVEMENTS; Company business planning; Constitutional rights; Development policy; Economic development; Enactment; Executives; Health care policy; Health policy; Health services; Medical care; Medical care (Private); Medical policy; Mortality; Mortality rates; Planning; Policy implementation; Public health; Social aspects; Social change; Social development; Social movements; Social planning; State building; Urban development
• ISSN: 0037-7732; 1534-7605
• DOI: 10.1093/sf/sox071

Extensive scholarship addresses whether and how social movements can have consequences for outcomes of interest to them. Though divided in its conclusions, existing research generally shares a focus on potential contributions of movements to the codification of rights and adoption of policies, rather than their actual implementation. Often, however, palpable enactment of the crystallized laws and policies that movements demand is far from guaranteed, raising salient questions about whether and how movements can matter for implementation outcomes as well. To address such questions, the article uses a mixed-methods analysis to examine consequences of subnational office-holding by “sanitarista” activists from the Sanitarist Movement—contemporary Brazil’s most important health movement—for rates of primary public health coverage and childhood mortality. Before reviewing existing theories and conceptualizing movement office-holding, it briefly describes the movement’s role in codifying Brazil’s constitutional right to health and demanding new local democratic institutions for enacting that right. Then, Prais-Winsten regression analyses of all major Brazilian capitals between 1995 and 2014 show that sanitarista office-holding atop a key subnational institution was associated with broader health service coverage and lower mortality. Comparative case-study analysis illustrates that office-holding sanitaristas helped generate these improvements by leveraging new democratic offices to marshal support of subnational executives for the movement’s modest but effective state-building project in the municipal health sector. Ultimately, theories of movement consequences benefit from considering how in certain democratic contexts, subnational office-holding can constitute an important standalone outcome with considerable promise to also improve policy implementation and social development.