Limited means for conflict resolution among citizens

Limited means for conflict resolution among citizens

A Closer Look at Three Political Economies: China, Kerala, Chile

Chapter 7












































































Key Ideas

China’s authoritarian government has been impressive in its ability to lift millions out of poverty and quickly implement policies and programs but it does not always choose the right ones to implement.

Kerala has been able to achieve impressive health outcomes and a high quality of living with a long history of public governance aimed at social equality.

Chile has combined support-led social policies with market-oriented economic policies and is attempting to achieve improved health outcomes incrementally.






































National Development

Priorities and ideas that drive nations and governments change over time

United States:

Progressive era during Great Depression

Conservative shift during World War II

Progressive during 1960s and 1970s

Conservative beginning with Reagan Administration







































Great Leap Forward, 1958-1961

Plan to industrialize and collectivize Chinese production of foods and goods

“Struggle sessions” to humiliate the exploiting class, typically higher educated citizens

>25,000 farm communes of about 5,000 families each established between April and December, 1958

Backyard furnaces in every commune were told to produce steel using whatever metal citizens had

Great Chinese Famine

Result of Great Leap Forward

Estimated 40 million deaths







































Cultural Revolution, 1966-1969

Red Guard troops moved violently against people believed to be counter-revolutionaries

Estimated 11 million deaths

Shift from communist to capitalist model in 1979

Decentralization of government to provinces into tiao-kuai (branch-lump) system

Increased rights for rural residents

Continued human rights concerns and censorship, environmental and consumer safety issues








































India gained independence from Great Britain in 1947

World’s largest democracy

Kerala: long history of civic engagement and social mobilization

Anticolonial legacy with prosperity among lower caste and agrarian working class

Post-independence movement was more pragmatic and flexible than other regions

No violence or civil war







































Decentralized governance

People’s Campaign for Decentralized Planning in 1997 aimed to bring power to local areas and incentivize community participation in grama sabhas (municipal assembly meetings)

In a low-income region but has achieved good health outcomes

Growing social and economic inequalities and ongoing problems with trade liberalization

Many households in Kerala have at least one member who has migrated elsewhere for work








































Implemented a version of the “third way”

Independence from Spain in 1810

Copper became a major export

1929 crash impacted copper exports and GDP decreased by 50%

Government-led efforts at import substitution

Agrarian reform and redistribution efforts in 1960s with equity for rural residents








































Limited means for conflict resolution among citizens

1973 coup resulted in violent authoritarian regime, but some social programs were implemented

Transition to democracy in 1990

“Growth with equity” was a goal

Plan AUGE is universal health care program developed based on disease prevalence, cost-effective prevention or treatment, and citizen input

Multiple shifts from left to right over time

Current political economy remains somewhat precarious







































All social policies impact population health

Education, environmental protection, food safety, taxation, trade

Lifting citizens out of poverty through economic reform can result in epidemiologic transition

Can be paradoxical effects, however, depending on implementation strategies

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