Explore the vast range of titles available.

This research note assesses participatory health governance practices for HIV and AIDS in Brazil. By extension, we also evaluate municipal democratic governance to public health outcomes. We draw from a unique dataset on municipal HIV/AIDS prevalence and participatory health governance from 2006–17 for all 5,570 Brazilian municipalities. We use negative binomial regression and coarsened exact matching with treatment effects to estimate the influence of community health governance institutions on HIV/AIDS prevalence. Municipalities with participatory health councils experience 14% lower HIV/AIDS prevalence than other municipalities, all else equal. Family Health Program coverage, municipal state capacity, and municipal per capita health spending are also associated with systematically lower HIV/AIDS prevalence. We conclude that participatory health governance may combat HIV and AIDS through municipal spending, education, and community mobilization. Municipal health councils can facilitate these strategies and offer opportunities for improving well-being around the world.

Brazil's constitution (1988) granted municipalities the responsibility of providing social services. Many observers anticipated that this newfound authority would produce policy diversity, as local governments would tailor programs to constituents' needs. Instead, many municipalities chose to replicate programs made famous elsewhere. What explains this diffusion of social policies across Brazil? In particular, what motivates policy makers to emulate \"innovative\" policies? This study compares three approaches that seek to explain political behavior: political self-interest, ideology, and socialized norms. It draws on two policies, Bolsa Escola, an education program, and Programa Saúde da Família, a family health program, in four exemplary cities, to uncover the mechanisms that led to diffusion. Surprisingly, political incentives, such as electoral competition, cannot explain diffusion. Rather, ideology and socialized norms, transmitted through social networks, drive policy emulation. Diffusion occurs when politicians are ideologically compelled to replicate these programs and when policy specialists seek to demonstrate that they follow professional norms. /// La constitución de Brasil (1988) otorgó a las municipalidades la responsabilidad de proveer servicios sociales. Para muchos esta facultad se traduciría en políticas diversas, pues los gobiernos locales diseñarían sus programas en función de las necesidades de sus electores. No obstante muchas municipalidades eligieron replicar programas reconocidos en otros lugares. ¿Qué explica esta difusión de políticas sociales? ¿Qué motiva a los policy makers a emular políticas innovadoras? Este estudio contrasta tres aproximaciones que buscan explicar este comportamiento político: interés político propio, ideología y normas socialmente difundidas. A partir de dos iniciativas, Bolsa Escola, un programa educativo, y Saúde da Familia, un programa de salud para las familias, y con base en cuatro ciudades, se pretende descubrir los mecanismos detrás de la difusión. Sorprendentemente los incentivos políticos, vinculados a la competencia electoral, no explican la difusión, en contraste con la ideología y las normas difundidas a través de redes sociales. La difusión ocurre cuando los políticos están ideológicamente inclinados a replicar programas, y cuando especialistas en la materia buscan demostrar que éstos se ajustan a normas profesionales.

Conditional cash transfer programs (CCTs) have emerged as an important social welfare innovation across the Global South in the last two decades. That poor mothers are typically the primary recipients of the grants renders easy, but not necessarily correct, the notion that CCTs empower women. This article assesses the relationship between the world’s largest CCT, Brazil’s Bolsa Família, and women’s empowerment. To systematize and interpret existing research, including our own, it puts forth a three-part framework that examines the program’s effects on economic independence, physical health, and psychosocial well-being. Findings suggest that women experience some improved status along all three dimensions, but that improvements are far from universal. A core conclusion is that the broader institutional context in which the Bolsa Família is embedded—that is, ancillary services in health and social assistance—is crucial for conditioning the degree of empowerment obtained.

Como a democracia contribui para melhorar o bem-estar? Neste artigo, separamos os componentes da prática democrática – eleições, participação social, expansão dos programas sociais, capacidade administrativa municipal – para identificar sua relação com o bem-estar. Nossa análise de um conjunto de dados original abrangendo mais de 5.550 municípios brasileiros demonstra que eleições competitivas sozinhas não explicam variação nas taxas de mortalidade infantil, um resultado associado ao bem-estar. Vamos além das eleições para mostrar como instituições participativas, programas sociais e capacidade administrativa municipal podem interagir para se apoiar e reduzir as taxas de mortalidade infantil. O resultado é uma nova compreensão de como os diferentes aspectos da democracia trabalham juntos para melhorar uma característica essencial do desenvolvimento humano. DEMOCRACY AR WORK: moving beyond elections to improve well-beingHow does democracy work to improve well-being? In this paper, we disentangle the component parts of democratic practice—elections, civic participation, expansion of social provisioning, local administrative capacity—to identify their relationship with well-being. Our analysis of an original dataset covering over 5,550 Brazilian municipalities demonstrates that competitive elections alone do not explain variation in infant mortality rates, one outcome associated with wellbeing. We move beyond elections to show how participatory institutions, social programs, and local state capacity can interact to buttress one another and reduce infant mortality rates. The result is a new understanding of how different aspects of democracy work together to improve a key feature of human development.Keywords: Democracy, Well-being, Participation, Social programs, Brazil. DÉMOCRATIE EN ACTION: aller au-delà des élections pour améliorer le bien-êtreComment la démocratie contribue-t-elle à améliorer le bien-être? Dans cet article, nous séparons les éléments constitutifs de la pratique démocratique - élections, participation sociale, expansion des programmes sociaux, capacité administrative municipale - pour identifier sa relation avec le bien-être. Notre analyse d’un ensemble de données original couvrant plus de 5 550 municipalités brésiliennes montre que les élections compétitives n’expliquent pas à elles seules la variation des taux de mortalité infantile, résultat lié au bien-être. Nous allons au-delà des élections pour montrer comment les institutions participatives, les programmes sociaux et la capacité administrative municipale peuvent interagir pour se soutenir mutuellement et réduire les taux de mortalité infantile. Le résultat est une nouvelle compréhension de la façon dont différents aspects de la démocratie travaillent ensemble pour améliorer une caractéristique essentielle du développement humain.Mots clés: Démocratie, Bien-être, Participation, Programmes sociaux, Brésil.

One of the most fundamental questions for social scientists involves diffusion events; simply put, how do ideas spread and why do people embrace them? In Diffusion of Good Government: Social Sector Reforms in Brazil, Natasha Borges Sugiyama examines why innovations spread across political territories and what motivates politicians to adopt them. Sugiyama does so from the vantage point of Brazilian politics, a home to innovative social sector reforms intended to provide the poor with access to state resources. Since the late 1980s, the country has undergone major policy transformations as local governments have gained political, fiscal, and administrative autonomy. For the poor and other vulnerable groups, local politics holds special importance: municipal authorities provide essential basic services necessary for their survival, including social assistance, education, and health care. Brazil, with over 5,000 municipalities with a wide variety of political cultures and degrees of poverty, thus provides ample opportunities to examine the spread of innovative programs to assist such groups. Sugiyama delves into the politics of social sector reforms by examining the motivations for emulating well-regarded programs. To uncover the mechanisms of diffusion, her analysis contrasts three paradigmatic models for how individuals choose to allocate resources: by advancing political self-interest to gain electoral victories; by pursuing their ideological commitments for social justice; or by seeking to demonstrate adherence to the professional norms of their fields. Drawing on a mixed-method approach that includes extensive field research and statistical analysis on the spread of model programs in education (especially Bolsa Escola, a school grant program) and health (Programa Saude da Familia, a family health program), she concludes that ideological convictions and professional norms were the main reasons why mayors adopted these programs, with electoral incentives playing a negligible role.

Policy diffusion studies often invoke explanations that draw on the directional pressures for emulation, whether top-down, horizontal, or bottom-up. This article develops a theoretical framework that accounts for the multidirectional features of diffusion, including sub-national, cross-national, and international mechanisms, through the illustrative case of Brazil's federal adoption of Bolsa Escola (School Grant Program), a conditional cash transfer program that preceded the internationally acclaimed poverty alleviation program called Bolsa Familia (Family Grant Program). Using process tracing, I argue that bottom-up pressures, including professional norms and intergovernmental competition, were key for policy emulation. Cross-national competition had little effect on decision-making. Finally, top-down processes, including norms and financing, reinforced adoption decisions and ensured these programs would endure.

How does democracy work to improve well-being? In this article, we disentangle the component parts of democratic practice—elections, civic participation, expansion of social provisioning, local administrative capacity—to identify their relationship with well-being. We draw from the citizenship debates to argue that democratic practices allow citizens to gain access to a wide range of rights, which then serve as the foundation for improving social well-being. Our analysis of an original dataset covering over 5,550 Brazilian municipalities from 2006 to 2013 demonstrates that competitive elections alone do not explain variation in infant mortality rates, one outcome associated with well-being. We move beyond elections to show how participatory institutions, social programs, and local state capacity can interact to buttress one another and reduce infant mortality rates. It is important to note that these relationships are independent of local economic growth, which also influences infant mortality. The result of our thorough analysis offers a new understanding of how different aspects of democracy work together to improve a key feature of human development.

Welfare programs distribute benefits to citizens. Perhaps even more importantly, by conveying powerful messages about how the state views poor people, welfare programs shape people’s views about themselves as subjects or citizens. Theoretical debates on how public policies can enhance democratic citizenship inspire our study of Brazil’s Bolsa Família (Family Grant). Has this conditional cash transfer program, which forms a major point of contact between the state and millions of poor Brazilians, elevated feelings of social inclusion and agency? A prominent perspective in the welfare-state literature would not expect a positive outcome given the strict means testing and behavioral requirements entailed. Yet our focus group research with Bolsa Família recipients suggests that the program does foster a sense of belonging and efficacy. Policy design and government discourse matter. This innovative welfare program yields rich insights on alternative paths to citizenship development for middle- and low-income countries in the third wave of democracy.