FROM APARTHEID TO NEOLIBERALISM: HEALTH EQUITY IN POST-APARTHEID SOUTH AFRICA
FROM APARTHEID TO NEOLIBERALISM: HEALTH EQUITY IN POST-APARTHEID SOUTH AFRICA
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DOI：
10.2190/hs.40.1.e
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发表时间：
2010-01-01
影响因子：
3.4
通讯作者：
Baker, Peter A.
中科院分区：
文献类型：
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作者：
Baker, Peter A.
1994年，非洲人国民大会（ANC）赢得南非首次民主选举。它继承了一种带有种族隔离时代不平等烙印的医疗服务，高度私有化，并且扭曲了城市白人的医院需求。 ANC 的宣言承诺做出重大改进，但这项研究发现只有两个显着的健康公平改善：(1) 初级保健的资金增加了 83%，并且配备了更好的人员； (2) 卫生保健工作者在人口中的种族代表性明显增强。然而，这些改善被不断恶化的公私组合中的股权损失所抵消。对精英参与者的政策分析将这种失败归因于财政部新自由主义宏观经济政策（GEAR）的主导地位，该政策严重限制了公共支出的增长。 ANC 的民族主义意识形态是 GEAR 和许多健康公平决策的基础。它联合了非国大、国际资本、非洲精英和白人资本，共同实现非洲经济复兴的愿望。它也随之席卷了民众，成为新的霸权意识形态。正如本研究发现的那样，成功的政策是那些可以成为这种积极的霸权改革的一部分，象征性地庆祝非洲民族主义，并且不挑战主要参与者的利益的政策。
In 1994, the African National Congress (ANC) won South Africa's first ever democratic election. It inherited a health service that was indelibly marked with the inequities of the apartheid era, highly privatized and distorted toward the hospital needs of urban Whites. The ANC's manifesto promised major improvements, but this study finds only two significant health equity improvements: (1) primary care had funding increased by 83 percent and was better staffed; and (2) health care workers became significantly more race-representative of the population. These improvements, however, were outweighed by equity losses in the deteriorating public-private mix. Policy analysis of the elite actors attributes this failure to the dominance of the Treasury's neoliberal macroeconomic policy (GEAR), which severely limited any increases in public spending. The ANC's nationalist ideology underpinned GEAR and many of the health equity decisions. It united the ANC, international capital, African elites, and White capital in a desire for an African economic renaissance. And it swept the population along with it, becoming the new hegemonic ideology. As this study finds, the successful policies were those that could be made a part of this active hegemonic reformation, symbolically celebrating African nationalism, and did not challenge the interests of the major actors.