Poverty Reduction and Regional Integration
A comparative analysis of SADC and UNASUR health policies
We are committed to disseminating findings and promoting discussion on the topic of regional integration, poverty reduction, health and wider social development through a wide range of media. Links and information about the project's ongoing dissemination and public/stakeholder engagement activity can be found on this page.
These and a range of other activities over the duration of the project will contribute to ongoing discussion and debate with policy, practitioner, end-beneficiary and policy-facing academic communities working in the intersections of regionalism, poverty and health.
Mariana Farias introduces the importance of PRARI by contextualizing it. There is a pressing issue regarding access to medicines and chronic diseases in an aging population. The journalist asked Mrs. Faria three questions relating to the relevance of her work: the added value of UNASUR in these objectives; the importance of monitoring; and the contributions of PRARI. She explains that the added value of UNASUR is threefold. First, it enables to share best practices and knowledge among UNASUR member states. Second, UNASUR can be a platform for “health diplomacy”, in the sense that voices from the region can be heard at a regional, multilateral and global level. Third, as UNASUR is becoming a global actor, it can influence the national and global level with its member states’ values regarding health.
Mariana argues that the UNASUR region has a poor record on monitoring activity. UNASUR is now at the close of its first 5 year plan and it is important to keep a record of progress and its methods. There are also key opportunities to prepare for the future. PRARI is important in this context, in two ways. UNASUR does not have the capacity to build a database yet and can therefore use data generated by PRARI. UNASUR can also take ownership for the PRARI Toolkit of indicators of regional health policy progress and can use this as a basis to undertake other projects in the future.
Full research articles:
Global Social Policy Forum articles:
Abstract: Poverty reduction and health became central in the agendas of Southern regional organisations in the last two decades. Yet, little is known about how these organisations address poverty, inclusion and social inequality, and how Southern regional formations are engaging in power constellations, institutions, processes, interests and ideological positions within different spheres of governance. This article reviews academic literatures spanning global social policy, regional studies and diplomacy studies, and the state of knowledge and understanding of the ‘place’ of regional actors in health governance as a global political practice therein. It identifies theoretical and thematic points of connection between disparate literatures and how these can be bridged through research focusing on the social policies of regional organisations and regional integration processes. This framework hence locates the contributions of each of the research articles of this Special Issue of Global Social Policy on the regional dimension of health policy and diplomacy in relation to Southern Africa and South America. It also highlights the ways in which the articles bring new evidence about how social relations of welfare are being (re)made over larger scales and how regional actors may initiate new norms to improve health rights in international arenas engaging in new forms of ‘regional’ diplomacy.
Keywords: Health diplomacy, global health governance, regional integration, SADC, UNASUR
Abstract: The Association of Southeast Asian Nations, the European Union, the Southern African Development Community and the Union of South American Nations have increasingly been involved in health diplomacy in the past decade, yet little is known about how they frame health as a foreign policy issue and how this has an impact on their prioritisation of policies. For this, we conducted a review of existing grey and peer-reviewed literature that address regional integration and health, as well as a documentary review according to security, development, trade, human rights, moral/ethical reasonings and global public goods frames identified in the literature. The policy frames identified responded to the challenges these regions currently face. The Association of Southeast Asian Nation’s struggle with re-emerging diseases has led to favouring a securitisation approach to health, the European Union approaches health as a cross-cutting policy issue, the Southern African Development Community presents health as a driver for development, and while the Union of South American Nations emphasises health as a human right and addresses the social determinants of health as an ethical imperative. Overall, these policy frames were useful in analysing the framing of health in foreign policy at the regional level. However, within our analysis, we identified a new frame that approaches health as an intersectoral issue. The impact of regional organisations’ forward will depend on their ability to harness their convening power and speak in a coherent voice on health matters.
Keywords: Foreign policy, health policy, policy frames, regional organisations
Abstract: Since the creation of Union of South American Nations (UNASUR), health policies became a strategic factor in South America to collectively balance the legacy of neoliberal policies in the region. The aim of this article is first to describe the social, political, and economic processes that explain the emergence of UNASUR and its focus on social policy through healthcare. We then analyze how by virtue of UNASUR’s Health Council, healthcare became the spearhead of cooperation giving way to novel forms of diplomacy. In so doing, this article contributes to a broader understanding of the regional health diplomacy and the process of unasurization of health policies as the process of building a new health framework.
Keywords: Global, regional health diplomacy, regional UNASUR, South America, social policy
Abstract: Regional organisations can effectively promote regional health diplomacy and governance through engagement with regional social policy. Regional bodies make decisions about health challenges in the region, for example, the Union of South American Nations (UNASUR) and the World Health Organisation South East Asia Regional Office (WHO-SEARO). The Southern African Development Community (SADC) has a limited health presence as a regional organisation and diplomatic partner in health governance. This article identifies how SADC facilitates and coordinates health policy, arguing that SADC has the potential to promote regional health diplomacy and governance through engagement with regional social policy. The article identifies the role of global health diplomacy and niche diplomacy in health governance. The role of SADC as a regional organisation and the way it functions is then explained, focusing on how SADC engages with health issues in the region. Recommendations are made as to how SADC can play a more decisive role as a regional organisation to implement South–South management of the regional social policy, health governance and health diplomacy agenda.
Keywords: Global South, health diplomacy, health governance, regionalism, SADC, social protection
Abstract: Over the last decade, rapid changes to development models and market rules have led—yet again—to a revision of the meaning of regionalism, bringing to the fore the role of regional organizations in anchoring democracy and supporting progressive social policies. This is particularly the case in South America, where the presence of regional organizations in public policy-making is a subject of increasing scrutiny. This article examines new forms of politically sensitive regional governance in South America, focusing in particular on the case of the Union of South American Nations (UNASUR). It shows how contemporary South American regionalism bypasses the questions of trade and investment that dominated earlier schemes of regionalism in order to focus on shoring up democracy and managing the regional social deficit. The article explores UNASUR's actions in two policy areas: supporting the regional democratic norm and health policy. UNASUR, this article argues, is developing a hybrid form of output-focused legitimacy that rests on a combination of credible commitments to welfare promotion, especially for the poor, and the pursuit of collective public goods, alongside a robust defence of quite minimal but uncontroversial standards of procedural democracy across the region. The analysis challenges the view that regionalism has failed in South America and identifies instead the emergence of a new sort of highly political regionalism. We call for UNASUR to be taken more seriously in the literature on comparative regionalism and, indeed, for a revision of how regionalism more widely is understood in Latin America.
Participatory Action Research (PAR) is a reflective and concerted process of problem-solving where multiple actors collectively define the research problem and objectives and work towards solutions. Given that PAR is generally applied at the community level, there is little evidence of this approach being used at the supra-national level. The Poverty Reduction and Regional integration (PRARI) project, a two year ESRC/DFID-funded study, seeks to do this by using collaborative PAR with identified partners in South America (UNASUR) and Southern Africa (SADC) to build a toolkit of input, process, output and outcome indicators that capture regional policy change and pro-poor regional health policy success. The overall objective of this study is to understand what regional institutional practices and methods of regional policy formation are conducive to the emergence of embedded pro-poor health strategies, and what can national, regional and international actors do to promote these. This seminar will present preliminary results from this ongoing study.
While much has been written about national social policy (and welfare regimes) worldwide, and regionalist economic and security processes, the significance of regional integration as a site and driver of social politics and policy has been rather more neglected within sociological and political science literatures on welfare. This paper is concerned with social policy in processes of region-building and with two inter-related issues: the linkages between regional integration and social policy in practice; and the ability of regional institutions to mobilise collective action in defence of social rights. We argue that regional integration is forging the development of 'new' regional platforms for collective action and contention politics of social policy. We identify three principal ways in which this is happening: (i) by creating normative frameworks structuring inter-governmental and expert networks model of regional social governance and policy; (ii) by facilitating the re-allocation of material and knowledge resources in support of public policy and policy implementation; and (iii) by enabling representation and claims-making of actors in global governance. There are however significant degrees of variance in the extent to which this is evident in practice and this is explored in the paper. Our focus is extensively international in that it goes beyond the experiences of regionalisms in the Global North to also include those in the Global South.
While much has been written about national social policy (and welfare regimes) worldwide, and regionalist economic and security processes, the significance of regional integration as a site and driver of social politics and policy has been rather more neglected within sociological and political science literatures on welfare. This paper is concerned with social policy in processes of region-building, empirically and theoretically. Empirically, it is concerned with two inter-related issues: the linkages between regional integration and social policy in practice; and the ability of regional institutions to mobilise collective action in defence of social rights. It is also concerned with the bases and tenets of a revitalised theoretical understanding of the relationship between regionalisation processes and social policy. Our focus is extensively international in that it goes beyond the experiences of the Global North to also include those of the Global South.
Participatory Action Research as a methodology for achieving pro-poor regional health policy
Keywords: collaborative PAR, health, poverty, policy change
Background: Participatory action research (PAR) is gaining greater attention within conventional policy-facing social sciences research due to the emphasis placed on research uptake for wider public benefit. In affirming stakeholders as agents bringing diverse knowledge and techniques to the research process, it is often claimed that PAR results in a commitment to ownership of research findings and outputs in ways that are more likely to be translated into action (Cornwall & Jewkes 1995; Bergold & Thomas 2012). This paper reflects on this claim by discussing experiences of using an innovative application of PAR among policy-makers working at the interstices of national and regional organisations in Southern Africa and South America.
Methods: The research uses collaborative modes of PAR to construct pro-poor indicators of regional policy success and change with regard to access to health and medicines.
Results: Increased interest in participatory research by funding councils gives rise to significant opportunities for researchers and policy-makers to collaboratively engage in research for wider public benefit, but all actors in the research process need to be sensitive to the tensions, dilemmas, and limits of PAR as a methodology for realising those benefits under conditions of social and political complexity and in the interests of sustainability and inclusivity.
Conclusions: The 'problem' identified in PAR studies of transposing participatory approaches from the project context where they were developed to the policy one presents a challenge for funding councils and researchers alike. Funders and research teams using PAR need to be ever-mindful of the challenges that transposition presents to the non-extractive nature of methodology that PAR seeks to practice and the particular context in which it is practiced, while also ensuring that the connections between policy, power and poverty remain as foreground concerns throughout the collaborative research endeavour.