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Why does the supply of mental health care vary across countries? Moreover, why would the state supply services to those who cannot demand them? This chapter introduces how a comparative, political-economic, and historical perspective can explain mental health care outcomes, as well as how studying mental health can inform comparative political economy. It then turns to the theoretical argument, explaining why and how public sector managers and workers – the “strange bedfellows” of the “welfare workforce” – shape the supply of public social services. The chapter closes with a sketch of the book’s research design and how it structures the following chapters
This concluding chapter reviews the core findings about psychiatric deinstitutionalization and mental health care and lays out the argument’s theoretical implications for social policy scholarship more generally. It highlights that the political logic of social services (e.g., health, education, and care) is distinct from that of cash transfers (e.g., pensions, unemployment, and disability benefits). The key difference: the welfare workforce. I also discuss the complex policy implications of this trend (especially as the contours of the welfare workforce become less clear) and close by considering how to harness the power of welfare workers in contemporary welfare capitalism.
The Welfare Workforce is a thought-provoking exploration of mental health care in the United States and beyond. Although all the affluent democracies pursued deinstitutionalization, some failed to provide adequate services, while others overcame challenges of stigma and limited resources and successfully expanded care. Isabel M. Perera examines the role of the “welfare workforce” in providing social services to those who cannot demand them. Drawing on extensive research in four countries – the United States, France, Norway, and Sweden – Perera sheds light on post-industrial politics and the critical part played by those who work for the welfare state. A must-read for anyone interested in mental health care, social services, and the politics of welfare, The Welfare Workforce challenges conventional wisdom and offers new insights into the complex factors that contribute to the success or failure of mental health care systems. This title is also available as Open Access on Cambridge Core.
This article considers a significant but overlooked set of policy developments in the latter half of the twentieth century: the extension of collective bargaining rights to most health care workers, many of whom were formally excluded for three decades under the 1947 Taft-Hartley amendments. Drawing on primary sources including archival records, an exhaustive review of congressional testimony, and rulings from the quasijudicial agency governing private sector industrial relations, this article shows that health care workers did so in two interrelated processes. First, in coordination with the civil rights movement, workers mobilized and used both disruptive and legal social movement tactics. Second, in doing so they drew the state into and revealed its position in the collective bargaining process between workers and health institutions, facilitating what is conceptualized as cross-domain policy feedback. Cross-domain policy feedback occurs when a policy in one domain (e.g., public health spending) influences the politics of a policy in a seemingly separate one (e.g., labor and employment relations). Such effects, this article suggests, are likely to occur when a policy is relatively large in scale, implicates actors with a diverse set of interests, and offers significant ambiguity and discretion in its implementation. Empirically, this article is the first to chart the institutionalization of collective bargaining rights for health care workers, among the largest group of private sector employees in the postindustrial economy. It also offers a new theoretical and conceptual framework through which to study the ways by which public policies reshape political dynamics—an enduring research agenda for students of American politics and policy.
As Latin America's flagship 'racial democracy,' Brazil is famous for its history of race mixture and fluid racial boundaries. Traditionally, scholars have emphasized that this fluidity has often led to whitening, where individuals seek classification in white, or lighter, racial categories. Yet, Back to Black documents a sudden reversal in this trend, showing instead that individuals are increasingly opting to identify with darker, and especially black, racial categories. Drawing on a wealth of quantitative and qualitative data, David De Micheli attributes this sudden reversal to the state's efforts at expanding access to education for the lower classes. By unleashing waves of upward mobility, greater education increased individuals' personal exposure to racial hierarchies and inequalities and led many to develop racial consciousness, further encouraging black identification. The book highlights how social citizenship institutions and social structures can work together to affect processes of identity politicization and the contestation of inequalities.
Unilateral presidential action is thought to be limited by the ability of successors to easily reverse past decisions. Yet, most executive actions are never formally revoked. We argue that because of presidents’ unique position as chief executive, some actions create outcomes that make policy reversal more difficult or even infeasible. We develop a novel measure of policies with more immutable consequences and analyze the revocation of executive orders issued between 1937 and 2021. We find the degree of outcome immutability reduces the influence of political conditions on policy revocation. We further examine these dynamics in three cases in which presidents have substantial discretion – diplomacy, non-combatant detention, and police militarization. Scholarship has long highlighted the president’s first-mover status relative to other institutional actors as a key source of their power. Collectively, our argument and evidence demonstrate this applies to their relationship with successors.
In light of ongoing debates about income targeting in the welfare state, this article explores how the design and outcomes of income targeting policies are related to popular targeting preferences. Based on the unique combination of fine-grained opinion and policy indicators in a multilevel analysis, the results show that targeting preferences are indeed empirically related to targeting policies. However, whether these preferences are affected more by the de jure targeting design or the de facto targeting outcome seems to vary between two very different policy domains. In the case of unemployment benefits, the results suggest positive policy feedback: support for high-income targeting increases when unemployment benefits are designed to benefit those with previously higher incomes. For income taxation, by contrast, the results suggest negative policy feedback. In that case, it is not so much the de jure design but rather the de facto outcome that matters: the more taxes effectively work to the advantage of higher-income earners, the less support there is for a tax that levies the same amount on everyone, regardless of income.
Previous scholarship has shown that experience with public policies can affect citizens’ willingness to participate in politics. However, few studies have examined whether the effect of experience with policy is moderated by existing policy environments. We focus on the impact of Deferred Action for Childhood Arrivals (DACA) and examine how it affects foreign-born Latinos’ political orientation and behavior. We find a relationship between enrollment in DACA and political orientation and that the effect on participation is moderated by the intensity of enforcement in an immigrant’s county of residence.
We assess how change to gender equality might be achieved from the top down. Policymakers in the context of college sports are athletic department administrators. They can directly affect policy via the NCAA rulemaking committees and must implement policy at individual schools. We also explore the role of coaches; while they have less direct policy control, they still make hiring decisions within their team staffs and serve as important intermediaries between student-athletes and administrators. We build on work on organizational culture to predict that as women move into higher leadership roles (i.e., head coach or administrative department head), they become less supportive of gender equity initiatives. We show that is indeed the case; moreover, we find that, more generally, female coaches and athletic administrators exhibit less support for equity initiatives than female student-athletes. This suggests that organizational culture – where women administrators and coaches remain in the clear minority – is a hurdle to equality. It shows that marginalized groups pursuing change from the top down must contend with organizational cultures that are at odds with such transformation.
We offer details of our empirical approach. Our method involved multiple distinct representative surveys of key college athletic stakeholders (i.e., student-athletes, coaches, athletic administrators, and the American public including nonfans and fans). Our surveys measure opinions on a set of gender equity policy proposals (e.g., equal spending, requiring schools to interview at least one woman for athletic director jobs, etc.). We also include an exercise that requires respondents to confront inevitable policy tradeoffs. Respondents are asked to allocate a fixed budget to fund gender equity initiatives or benefit initiatives (e.g., paying college student-athletes versus guaranteed scholarships). Our measures allow us to explore the empirical evidence for our argument while making generalizable statements about the relevant stakeholders. The chapter provides details of our measurement approach and samples, as well as how we connect our theory to our analyses. Our data allow us to excavate important dynamics within and across group that have interests in college athletics.
In this article, we study how political parties located on the right of the political spectrum adapt to changing electoral and political constraints. Drawing on the concept of policy feedback, we turn to the politics of social policy in the province of Quebec to show that the Coalition Avenir Québec (CAQ), a right-wing party, embraced a more centrist strategy than the preferences of its electoral base would suggest. The CAQ has rejected the austerity policies associated with the previous government and has favoured social policy expansion rather than tax cuts or a quicker return to balanced budgets. We then explore the reasons for this move toward the centre. Our evidence suggests that self-reinforcing feedback effects from existing policies shape public opinion and electoral strategies, which contribute to moderating the actions of this right-wing governing party.
We investigated both the direct and indirect political dividends of public policies by examining Minha Casa, Minha Vida, a housing programme in Brazil that selects its beneficiaries by lottery. We surveyed the lottery participants and found that the winners were not more likely to support the incumbent politicians. Non-beneficiaries, a much larger group, were aware of the programme and thought well of it while the beneficiaries' responses to the programme were sometimes underwhelming. However, politicians considered the programme to be an electoral asset, and a difference-in-differences analysis of electoral results leveraging the roll-out of the programme across municipalities found that presidential and mayoral incumbent candidates performed better in localities that had implemented MCMV. Overall, when the beneficiaries formed a relatively small group, the benefits were conspicuous and the programme's objectives were widely supported. Government programmes can create electoral payoffs independently of how programmes are perceived or experienced by beneficiaries.
We explore the policy feedback process and describe how state policies have evolved or devolved in the specific issue area of firearm laws and domestic violence. This chapter demonstrates how and when states respond to the need to reform their domestic violence laws and shows how key actors in that process, including legislators and interest groups, affect the content of the policy that is adopted. The chapter includes examples of states whose definition and scope of domestic violence laws vary and contrast them with each other and with federal law. We present six studies of states that differ in their legislative histories on domestic violence laws to identify key factors that can explain this variation; we test these factors in the quantitative analysis presented in Chapter 4.
Three reforms each appealing to a different logic of (re)distribution are strongly politicized in contemporary welfare states: means-tested benefits, demanding activation policies and basic income schemes. While the policy design of means-tested benefits relies on the distributive justice principle of need, demanding activation policies are intrinsically related to the principle of equity and basic income schemes depend on equality. Based on the moral economy and policy feedback literatures, which assume that public opinion adapts to the normative conceptions of justice encapsulated by institutions, attitudes towards these welfare reforms are expected to be grounded on these distributive logics. However, as these reforms are weakly institutionalized and their underlying principles are politically contested, the normative foundation of their public support remains unclear. This study investigates how distributive justice preferences shape support for these proposals by applying structural equation modelling on data from the CRONOS panel linked to the European Social Survey round 8 (2016/2017). Results indicate that only basic income schemes and demanding activation policies are to some extent connected to each of the justice principles. Overall, this study nevertheless indicates that the justice principles have limited explanatory power, which confirms that attitudes towards contemporary welfare reforms rely weakly on justice norms.
The Introduction outlines the main premise of the book: the mass closure of public schools has serious consequences for American democracy. It begins with one mother’s – Ms. Leanne Woods’ – fight to save Steel Elementary School in Philadelphia. Using the example of Steel elementary, it argues that citizens learn about politics through the institutions they interact with the most, and that for many Americans, schools are those institutions. Accordingly, when schools close en masse, these blunt policy instruments play a significant role in shaping citizens’ – specifically African Americans and Latinx – relationship with government, politics, and political participation. And yet, despite the direct consequences of these policies on the lives of these Americans, the connection between educational policy experiences and democracy remain understudied in political science. In the impending chapters, Closed for Democracy takes on this investigation and demonstrates how affected citizens come to win policy battles to save schools but lose their faith in government.
Chapter 9 concludes the book by outlining its contributions to scholarship in comparative politics, development and public administration. The theoretical framework centered on bureaucratic norms brings institutionalist perspectives on the state and social policy together with insights on street-level bureaucracy and local collective action. The conceptual interweaving of meso-level state institutions with the micro-politics of frontline service delivery gives rise to a new understanding of bureaucracy and its relationship to human development. The chapter also explores the study's policy implications for the reform of bureaucracy, public services and primary education in developing countries.
Chapter 2 presents the book’s theory connecting differences in bureaucratic norms to variation in the implementation of primary schooling. I first define implementation and operationalize it for the primary education domain. I then present comparative education indicators, showcasing differences in performance across four Indian states. Next, I develop a theory anchored around the ideal types of legalistic and deliberative bureaucracy. I argue that deliberative bureaucracies, which promote flexibility and problem-solving, are more effective since they can adapt policies to local needs and activate participation from marginalized communities. By contrast, legalistic states, which adhere strictly to rules and procedures, implement policies unevenly and tend to benefit privileged groups in society, weakening the engagement of poor communities. I elucidate two mechanisms: collective understanding and behavior of state officials, and societal feedback, which together yield varied mentation patterns and outcomes. I explore the political origins behind the differences in bureaucratic norms. I scope conditions of my theory and contrast it with alternative political explanations for the implementation of public services.
Workplace automation fueled by technological innovations has been generating social policy implications. Defying the prevalent argument that automation risk triggers employment insecurity and prompts individuals to favour redistribution, this study doesn’t find empirical evidence in the Chinese context. Analysing national survey data, this study reveals a very strong association between automation risk and popular preference for government responsibility in old-age support. Further analysis suggests that more generous local welfare systems generate a reinforcing effect between automation risk and individuals’ support for government involvement in old-age support. In a welfare system in which major redistributive policies are not employment-dependent, automation risk may not necessarily trigger stronger preferences for short-term immediate protection through redistributive programmes, but may stimulate individuals to project their need for social protection towards middle- or longer-term and employment-related policies. The generosity of subnational welfare systems moderates the formation of individuals’ social policy preferences through policy feedback.
Although the idea that existing policies can have major effects on politics and policy development is hardly new, the last three decades witnessed a major expansion of policy feedback scholarship, which focuses on the mechanisms through which existing policies shape politics and policy development. Starting with a discussion of the origins of the concept of policy feedback, this element explores early and more recent contributions of the policy feedback literature to clarify the meaning of this concept and its contribution to both political science and policy studies. After exploring the rapidly expanding scholarship on policy feedback and mass politics, this element also puts forward new research agendas that stress several ways forward, including the need to explain both institutional and policy continuity and change. Finally, the element discusses the practical implications of policy feedback research through a discussion of its potential impact on policy design.This title is also available as Open Access on Cambridge Core.
We use the case of education interest groups to examine how and when policy changes lead interest groups to polarize in their support for political parties. Using over 145,000 campaign contributions from all 50 states from 2000 to 2017, we test whether the passage of private school choice, charter laws, and labor retrenchment policies led to the polarization of education interest groups over time. In 2000, teachers unions were the dominant group and mostly aligned with Democrats. Meanwhile, Republicans lacked support from any education groups. This pattern was consistent across states. Over time, coalitions in some states became polarized, meaning unions grew even more aligned with Democrats and reform groups with Republicans, while other states did not experience such polarization. We show that private school choice programs, but not labor retrenchment or charter laws, contributed to this changing partisan alignment. Our findings demonstrate that policy feedback can shape both the electoral mobilization and party alignments of interest groups.