A Right to Health? Professional Networks, HIV/AIDS, and the Politics of Universal Healthcare

The neoliberal logic that gained ascendancy in the 1980s emphasized privatization of government services, the weakening of social entitlements, and the liberalization of government regulation. The broadening of state obligations in a costly area like healthcare would therefore seem to run counter to this logic. And yet, contrary to the dominant neoliberal ideological climate, the late 1980s witnessed the beginning of a surprising shift towards more expansive state commitments to healthcare in the developing world. This dissertation explores the expansion of state commitments to healthcare in the developing world, grounded in in-depth case studies of three newly industrializing countries--Thailand, Brazil, and South Africa. Through the 1980s, low-cost programs aimed at health promotion and disease prevention dominated state efforts, revolving around what is often called "primary healthcare." But in the 1990s - coinciding with a formidable new public health threat in the form of the HIV/AIDS epidemic - a number of developing countries began to embrace approaches to healthcare provision that emphasized universal coverage with access to comprehensive care and advanced medical technology. This research explores the relationship between the state, political parties, the medical profession, illness-based social movements, and international actors in three major industrializing countries engaged in processes of democratic deepening. In the context of neoliberalism and a growing role for foreign philanthropy in efforts to address an emerging epidemic, this study gives particular attention to understanding what role the private sector and international actors have played in helping to shape these shifting norms. Through comparative historical analysis, this research seeks to understand variation in the social and political dynamics that prompted newly industrializing states to redefine their obligations to citizens' healthcare.