When compared to some of the world¤s largest nations, Brazil stands out as perhaps the most effective example of how to respond to the HIV/AIDS epidemic. Since Brazil's aggressive campaign against AIDS in the early 1990s, the number of mortality rates and infections has dissipated quickly, highlighting the government and civil society's successful involvement in providing several preventive and medical treatment programs. And yet, when compared to Brazil, several of the world largest nations, such as China, India, Russia, and even the United States, continue to fall short of accomplishing the same objectives? Why is this the case? Why is Brazil so far ahead of its counterparts?
Fernando H. Cardoso, former president of Brazil (19942002), will discuss why Brazil was able to respond so successfully to the AIDS epidemic. Next, researchers from Oxford and Harvard University will respond to Cardoso, highlighting the key contrasts between Brazil, China, Russia, and India, and considering the institutional and social obstacles that these governments continue to face in responding to the AIDs problem.
The roundtable will close with some possibilities of what current and future leaders will need to do in order to contain this problem and what the long-run economic and political ramifications for these nations will be.
Chair: Eduardo J. Gómez, Harvard School of Public Health/Brown University
Gomez is a researcher in the newly formed Politics and Governance Group of the International Health Systems Program t the Harvard School of Public Health. A Ph.D. candidate in the Department of Political Science at Brown, his research focuses on the historical and contemporary politics of government response to health epidemics, theories of decentralization and the politics of economic reform in developing nations.
Discussants (by country):
Brazil
Fernando Henrique Cardoso, Brown University
Cardoso, the former president of Brazil, is a Brown University professor-at-large for a five-year term. He is a renowned scholar in sociology and political science. He also served as member of Brazil's federal senate, foreign affairs minister, and finance minister. Cardoso received his Ph.D. in sociology from the University of São Paulo. His best-known works in English include Dependency and Development in Latin America(with E. Faletto, 1979) and Charting a New Course: The Politics of Globalization and Social Reform (M. Font, editor, 2001). At Brown, he lectures, engages in various symposia, interacts with students, and works with numerous departments on campus. Areas of interest: Analysis of large-scale social change, international development, dependency, democracy, and state reform.
China
Yaunli Liu, Assistant Professor, Harvard School of Public Health
Liu is particularly interested in studying innovative ways to make health systems in developing countries more equitable and efficient. One research project with significant policy impact in China that Liu has been working on since 1994 is "Health Care Financing for China'' Rural Poor.' Initially, this project focused on developing a thorough understanding of the health and poverty problems of 114 poor counties in China. The second phase of this project has been under way since 1997 to field test a community-based system for financing and organizing health care in 10 pilot counties. The project is supported by the UNICEF, IHPP, and World Bank. A related area of research addresses issues pertaining to equity in health and health care. The current research includes an analysis of underlying theories and measurement of equity in health care financing, a study of the impact of market changes on safety-net providers in the US, and a longitudinal study on determinants and socioeconomic consequences of ill health among a cohort of 5,000 families in China. Working with an international team of researchers and policy-makers, Liu has conducted various studies and workshops on health system reforms in developing countries, including Bangladesh, China, Kenya, Tanzania, and Vietnam. Ph.D. University of Minnesota.
India
Ajay Mahal, Assistant Professor, Harvard School of Public Health
Mahal is an assistant professor in the International Health Systems Program t the Harvard School of Public Health. Mahal's research uses economic analyses to influence public health policy in developing countries. He is especially interested in policy issues related to the HIV/AIDS epidemic, ageing, resource allocation in the health sector, decentralization and empowerment, and alcohol consumption. One of his recent projects examined whether public sector health subsidies in India were benefiting the poor and low-caste individuals. A second recent project (sponsored by the United Nations Development Program) exploited variations in state-level alcohol policy in India to explore the effectiveness of alternate policy optionssuch as prohibition, tax policy, and age-limitsin influencing alcohol consumption. More recently, Mahal has begun work on estimating and on developing newer techniques for estimating (and projecting) the health care costs of an ageing population. Ph.D. Columbia University in Economics.
Event Summary
"Learning from Brazil: The Politics of Responding to HIV/AIDS in Brazil and China'October 28, 2004
Participants:
President Fernando Henrique Cardoso, the former President of Brazil and Brown University Professor-at-Large
Professor Yichen Lu Harvard University
Organizer:
Edward Gomez, Graduate Student, Political Science Department, Brown University
On Thursday, October 28, 2004, Fernando Henrique Cardoso, the former president of Brazil and Brown University professor-at-large, participated in a panel discussion at the Watson Institute on the HIV/AIDS epidemic in large countries around the world. He was joined by Professor Yichen Lu of Harvard University, who discussed what China might learn from Brazil's successful campaign against HIV/AIDS in the 1990s.
Cardoso remarked that Brazil has defied expectations in its battle against HIV/AIDS. With its cultural diversity, history of poverty, and relatively new democracy, Brazil was able to bring the HIV/AIDS epidemic under control to the extent that it is now a role model for other nations. Cardoso pointed out that the key to their success is to make the HIV/AIDS patient become a protagonist and to remove the social stigma from the disease. In the early 1990s, the Brazilian government established strong links with civil societies and nongovernmental organizations (NGOs) to cooperate in the effort. Also, Brazil lowered the cost of antiretroviral AIDS medication through local production of generic drugs. Prevention was also an important part of the government initiative. The government utilized the media to communicate to the public the need for safe sex and for disseminating information about HIV/AIDS. Cardoso explained his position that preaching abstinence may give people a false sense of security and actually does not solve any problems. Through sex education, encouragement of condom use c, and affordable and accessible treatment, Brazil has been able to reduce the AIDS death rate by 50 percent in the 1990s.
Professor Yichen Lu described the present situation in China, where it is predicted that 10 to 20 million people will be HIV positive by 2010. Due in part to international pressure and also to the influence of the recent SARS epidemic, policymakers in China have begun to address the HIV/AIDS problem. However, Lu cited several obstacles facing China in its battle against the epidemic. First, its health care system has been hurt by decentralization, and the majority of people in rural areas do not have any health care. Second, from a political perspective, China is still an authoritarian country where civil society is almost nonexistent. Thus, any progress made in the HIV/AIDS campaign is at the mercy of the one-party government, which if directed does have the capability of making sweeping changes and allotting resources in an efficient manner. If the government did make combating HIV/AIDS one of its top initiatives, it would probably succeed. Yet, it does not appear that policymakers in Beijing are ready to address many aspects of this looming problem, such as implementing effective sex education and acknowledging growing risk groups, such as sex workers and gay men.
In the discussion following the panelists' presentation, an audience member questioned how the world can learn from Brazil. Cardoso pointed out that the idea of "learning from Brazil' may be too limiting. For example, because China does not have a vibrant civil society, the link between government and activist groups, which was so important to Brazil's success, is more limited. Therefore, China should probably look to different solutions.
Other fundamental differences in cultures and domestic law must be taken into account. Lu stated that there exists a great tension between health care system and the law enforcement system in China. The people who most need treatment and health care (sex workers and drug users) are also considered criminals, and many in the society do not believe that criminals deserve government-funded treatment and health care. Meanwhile, in Brazil, drug usage is not considered a crime, though it is connected to larger problems of violence and corruption.
Cardoso concluded by saying that HIV/AIDS itself is a preventable and relatively treatable disease, but often it is a part of larger social dilemmas, which are even more complex and more difficult to cure.
Submitted by Peng Wu '05, Watson Student Reporter
***Original title of event was "Learning from Brazil: The Politics of Responding to HIV/AIDS in Brazil, China, and India.' However, the expert on India was not able to attend due to a last minute emergency.