Charles F. Andrain

Political protest and social change : analyzing politics

At the close of the twentieth century, political protests have erupted throughout the world. While the collapse of communism was certainly one of the most spectacular protest- related events, smaller protests have become ubiquitous. In Los Angeles, labor activists campaign against commercial real estate owners to unionize janitors, mainly Latina immigrants. In the Peoples Republic of China, peasants revolt against tax collectors. Amazonian Indians protest public and economic policies that destroy their culture and rainforest habitat. This book analyzes the reciprocal impact of cultural beliefs, sociopolitical structures, and individual behaviors on protests throughout the world. Why do individuals participate in protest activities? How do cultural beliefs, personal attitudes, and subjective perception influence the potential protester? Addressing the issue of agency in protest, the authors also examine why protestors enlist different tactics to achieve their goals. Why are some protests violent and others nonviolent? When and why do activists conclude that it is better to accommodate than confront? Finally, and crucially, what are the consequences of protest movements?

Comparative Government: Developing New Nations

TEE STUDY OF NEW NATIONS began to take its present form a little over a decade ago in a particularly fortunate intellectual climate. It was a time when new patterns of social science thought in anthropology and sociology were beginning to have an effect on political studies due in large part, to World War II.1 This impact, while it generated antagonism within the field of political science itself, also allowed considerable analytical experimentation, particularly in those cultural and regional areas where little previous work had been done. Although political science orthodoxy reigned supreme in

The Social Democratic Model

Policymakers who advocate the social democratic model of the public health process try to reconcile supposedly conflicting values. Blending individualism with communal cooperation, social democrats support personal freedom in the collective context. For them, public health policies must combine material interests with moral values. Perceiving health as a public good, not a private benefit, they try to ‘decommodify’ health services. Health providers should seek to serve the public in an altruistic way, instead of maximizing their revenues. However great their attachment to moral values, social democrats also pursue material interests. Income redistribution measures become a key policy for expanding equal access to health care services, securing egalitarian health treatments, and realizing similar health outcomes. Social democrats implement health policies that reconcile any tensions between freedom and equality. Assuming that all people share human dignity, they want everyone to gain equal access to health care services, equal treatment by health providers, and equal health status. Progressive methods for raising finances minimize costs to the poor. Physicians retain extensive freedom over diagnoses and treatments. Patients have some choice of their general practitioner.

The Organic Corporatist Model

Whereas liberal entrepreneurs stress individual rights in a market economy, organic corporatists focus on more collectivist principles regulating the market. According to these classical ‘conservative’ values, communal obligations, order, hierarchy, and social differentiation take precedence over individual rationalism, equality, homogeneity, social leveling, and income redistribution. Societies form an organic whole, rather than an aggregate of individual atoms. Communal institutions like the church and family help preserve a society’s historical continuity. Along with the government, they maintain order amid group diversity.

Evaluating Public Health Policies

The motion picture Casablanca takes place at Rick’s Cafe Americain, a chic nightclub adjacent to the airport in the Moroccan city. It is December 1941, just before full-scale warfare erupted between the Allied and Axis powers. Rick Blaine, the American owner of the cafe, gazes at the airport’s beacon light. Captain Louis Renault, a French police prefect appointed by the Vichy regime, sits at a table on the cafe terrace. He asks Rick: ‘And what in heaven’s name brought you to Casablanca?’ Rick replies: ‘My health. I came to Casablanca for the waters.’ Because the Saharan Desert occupies the southern part of Morocco, Renault wonders: ‘Waters? What waters? We’re in the desert.’ Rick counters: ‘I was misinformed.’1

The Entrepreneurial Model

The entrepreneurial model gives the highest policy priority to market principles. The goals of efficiency, increased productivity, and cost containment take precedence over equal access to health services and equal treatment by medical personnel. To attain these goals, entrepreneurs support decentralization, competitive markets, and limited state intervention into the health care market. According to this model, sharp distinctions separate the private from the public sector, with government playing a subordinate role. The market responds to diverse needs and preferences. Purchasers, providers, and consumers enjoy extensive market freedom. Managers in private health insurance corporations make decisions based on cost-benefit analyses. Physicians and hospital personnel have clinical autonomy to treat patients, who choose their health providers from competing plans. The individual assumes personal responsibility for health care needs. Healthy persons finance their medical expenses through private insurance plans. Whereas the healthy pay low insurance premiums, higher-risk sick people must pay more expensive premiums. Means-tests determine eligibility for public health care benefits, which government officials allocate mainly to those with low incomes. These entrepreneurial values reinforce a socially stratified health care system based on extensive income differentiation.1

Political Power and Policy Changes

Novelists highlight the structural conditions that produce illness. Written immediately before World War I, The Ragged Trousered Philanthropists took an egalitarian stance toward programs for workers’ health. Its Irish author Robert Tressell described the working and living conditions of several residential construction workers: house painters, decorators, carpenters, plumbers, plasterers, bricklayers. Laboring in southern England, these men faced long working hours and low wages followed by lengthy periods of unemployment. Poverty, starvation, unhealthy worksites, and dilapidated, crowded, damp residential housing caused sickness, disease, and premature death. A house painter himself, Tressell died at age 40 of tuberculosis. The novel’s hero Frank Owen suffered from lung disease. Yet he had the energy to proclaim egalitarian socialist ideals to his workmates, most of whom failed to view the world through a working-class consciousness. Unlike Owen, they accepted the dominant fatalist, hierarchical, and individualist worldviews. Holding fatalistic values, several perceived their world as unchangeable. God and evil human nature, not structural conditions, brought sickness, poverty, and joblessness.

Public Policies and Health

In his novel The Plague, Albert Camus viewed health as a public good and disease as a public evil. Written immediately after World War II, the novel portrays the diverse reactions to the plague that struck the Algerian port city of Oran. Perceiving the pestilence as inevitable, fatalists resigned themselves to suffering and eventual death. Roman Catholics who deferred to ecclesiastical authority sought solace in prayer. Although Father Paneloux regarded God’s will as incomprehensible, he urged his parishioners to ‘remain faithful and agree to rely on God’, even when they could not understand the reasons for children’s deaths.1 Individualists who doubted the efficacy of prayer tried to escape the city. Those with greater optimism mobilized sanitary squads to improve public hygiene in the more congested areas of Oran. These egalitarian activists helped the official sanitary service disinfect the attics and cellars, so that rats could no longer infest residences with the bacteria that spread bubonic plague. Public policymakers, including the prefect and his subordinates, quarantined the city, fumigated houses, administered social services, and tried to maintain public order. The plague produced contradictory effects. Both solidarity and anomie resulted.

Introduction: Politics and Health

Henrik Ibsen sketched a close linkage between politics and health. Published in 1882, his play An Enemy of the People highlighted the dependence of doctors on government policies. Purists and pragmatists battled over the safety of the local water supply in a town along the Norwegian coast. Dr Thomas Stockman uncovered poisonous bacteria polluting the water works (‘Baths’) and endangering the community with typhoid fever. Dr Stockman urged his older brother Peter, who served as town mayor, chief of police, and chairman of the Board of the Baths, to rebuild the water pipes and sewage system. Yet this policy would entail higher taxes, greater unemployment, and lower profits for businessmen, mainly because the town operated as a resort area. Mayor Peter Stockman rejected his brother’s demands to close the Baths. A public meeting occurred to discuss this issue. As a purist, Dr Stockman championed the cause of public health. Challenging government authorities with justifications based on moral right, civic virtue, and ultimate ends, he viewed the dispute over the water supply as a conflict between good and evil. For him, bacteria polluted the water. Lies, opportunism, and eagerness to compromise polluted the spiritual values of the community.

Political Culture and the Meaning of Health

George Bernard Shaw viewed medicine as a new form of salvation. Written during the early twentieth century, his essays on Doctors’ Delusions sketched an analogy between health care and religion. Physicians and priests articulated meaning to health. They perceived health as wholeness, as freedom from sin or viruses and bacteria. Physicians functioned through the General Medical Council (GMC), which resembled the College of Cardinals. Authorized by the state, the GMC cemented the union of church and government. Challenges to medical orthodoxy represented blasphemy and heresy. Just as the Church excommunicated heretics, so the General Medical Council upheld scientific medical standards by banning unorthodox practitioners (osteopaths) and new medical techniques. Physicians wielded the power of life and death over their patients, who assumed the same passive role occupied by the laity. Doctors extracted malignant cells from patients’ bodies, in a similar way that priests exorcised demons from parishioners. Faith in scientific medical expertise paralleled faith in divine wisdom. Medical cures resembled spiritual miracles.