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Putting Ideals to the Test: Health Councils in Brazil

Darshana Patel's picture

My last post on this blog discussed public deliberation as a political ideal and what happens when that ideal is tested in an actual decision-making space.   In a paper about municipal health councils in Brazil, Andrea Cornwall gives a blow-by-blow description of what happens when deliberative spaces stop being polite and start getting real.  

Health councils were established in Brazil’s 1988 ‘Citizens’ Constitution’ and empowered citizens with the right to review and approve executive-level budgets, accounts and spending plans on health programs. Although overshadowed by the participatory budgeting process, Brazilian health councils can also provide some important lessons on how to deepen citizen engagement and decision-making.   Through the example of these health councils, Cornwall argues that three elements in particular are often “under-theorized” by deliberative democratic theorists.  First, understanding political culture is important. Second, how do party politics infiltrate and impact these spaces?  And last, how is power challenged in these spaces?  (She describes discussions in this deliberative space more as confrontational rather than reasonable.)

Cornwall narrates conversations in these meetings that are all too familiar: 

"Mimicking conduct in the municipal assembly, debates in the health council often tend to consist of speeches given by a vocal few, with speakers being heckled and interrupted. Speakers need to be assertive enough to carry on speaking over the interruptions of others; some stumble and give up as they are shouted over, others rise to the challenge and persist. When things get particularly heated, many voices are raised at once in a fast-paced jumble of arguments and counter-arguments. From what I had observed, decisions in the council were rarely reached by consensus. Voting was used as a way of settling a matter if things became particularly heated, with the open recognition that the government position would always end up in the majority. A show of hands was just that: showing whose side you were on, and some would only show that they supported the government, fearful of losing contracts or falling out of favor. This did not discourage people from debate, however; indeed, those who were able to make and mount positions had an evident relish of the opportunity for a really good argument. "

But despite all of these dynamics, these spaces do not represent old wine in new bottles.   There really are some radical shifts from the status quo.   For example, citizens who may otherwise lack the technical knowledge are given a legitimate role in the process.   

The main message from this paper and other similar accounts of deliberative spaces is that however much we may want to keep it neat; it is inherently a messy and chaotic process.  
Rather than try to minimize the messiness, it is important to pay attention to it. 

Photo credit: Flickr user kate.gardiner

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