Institutions, Policy, and Non-Communicable Diseases (NCDs) in Latin America

Eduardo J Gómez,Claudio A Méndez

doi:10.1177/1866802x20980455

Eduardo J Gómez, Claudio A Méndez

Open Access

https://doi.org/10.1177/1866802x20980455

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Abstract

Research has underscored the agenda-setting and policy implementation advantages associated with the concentration of political and policy-making authority. But to what extent does this concentration of authority within health policy-making institutions determine the early timing and depth of non-communicable disease (NCD) policies? Are other factors within and outside of government more important? Comparing one Latin American country exhibiting a strong concentration of political and policy-making authority, Mexico, to one that does not, Brazil, we find that weaker, fragmented political and policy-making powers in Brazil expedited the creation and implementation of NCD programs. As seen in Brazil, our findings suggest that the factors that account for the earlier adoption of NCD policies and successful implementation are the early institutionalisation of societal interests and pressures within the bureaucracy, the “bottom-up” diffusion of early policy ideas, and international policy recommendations. This institutional, participatory, and ideational approach may provide more important predictors for explaining variation in NCD policies.

Highlights

In the past twenty years, several countries in Latin America have seen the burgeoning growth of non-communicable diseases (NCDs), such as obesity, type-two diabetes, heart disease, and cancer
With respect to depth, we examine if Brazil or Mexico were capable of successfully implementing their NCD policies; we describe this success in implementation, depth, as the national Ministry of Health’s (MoH’s) commitment to working closely with state governments to enforce Journal of Politics in Latin America 13(1)
This study has compared the countries of Brazil and Mexico to assess similarities and differences in the timing and depth of NCD policy reform; it is the first article of its kind

Summary

Introduction

In the past twenty years, several countries in Latin America have seen the burgeoning growth of non-communicable diseases (NCDs), such as obesity, type-two diabetes, heart disease, and cancer. As seen in the more successful case of Brazil, we found that the presence of participatory institutional and ideational factors appear more important in accounting for differences in the early timing and depth of policy reform. The constitutionally-b ased represenation of civil societal actors within government policy- making committees was important, generating a comparatively lower level of bureaucratic autonomy and policy-m aking influence when compared to Mexico While this level of autonomy has remained lower in Brazil, it does not mean that the bureaucracy has not been important; Brazil’s MoH has still played an important role as coordinator of civil societal interests, in turn facilitating civil society's early NCD policy influence. Implementation success in Brazil, a nation that exhibits comparatively weaker and dispersed concentrations of political authority in the area of healthcare policy-m aking

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Conclusion