Confronting Health Inequalities in the BRICS: Political Institutions, Foreign Policy Aspirations and State-civil Societal Relationships

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The BRICS (Brazil, Russia, India, China and South Africa) have emerged as potentially robust economies with considerable international influence. Nevertheless, essentially all of these nations have fallen short of simultaneously developing strong economies and health care systems, contributing to the emergence of health care inequalities, such as inadequate access to medicine, health care treatment and out-of-pocket spending. This is puzzling considering that most of these nations’ economies burgeoned during the 1990s and early-2000s, thus potentially providing additional revenue for health care spending, while constitutional guarantees of universal access to health care and the presence of democratic electoral institutions in most nations should have incentivized governments to successfully address these inequality issues. Nevertheless, with the exception of South Africa, this study finds that waning political commitment to health care spending, increased foreign aid commitments and tenuous state-civil societal relationships accounted for these ongoing inequality challenges.

Ensuring that all health care inequality issues are addressed prior to creating and implementation health insurance programs in the BRICS.
Ensure that governments are fully committed to introducing regulatory institutions that avoid inequality issues, such as out-of-pocket and catastrophic expenses.
Ensure that governments are not distracted by foreign policy goals in providing foreign aid in health, at the expense of over looking ongoing domestic health care needs.
Ensure that civil society is fully integrated in the health care policy making process, especially on policy interventions that avoid inequality issues.