Christopher L. Gibson

Despite the constitutional right of all Brazilian citizens to universal public health care, some municipio governments of large captial cities expanded provision and equalized access to basic health services during the last 20 years, while others did not. This variation emerged from three distinct regimes of state-society actors that initiated, consolidated, or obstructed the rise of municipio-level developmental states for the public health sector called “healthy states.” Spatial and quantitative analyses demonstrate cross-municipio variation in the weakening or expanding magnitude and spatial inequality of basic health service delivery within Brazil’s largest cities. Qualitative analyses of interview an archival data produced during fieldwork then traces these variable trajectories to “pragmatist regimes” of state-society actors that built and consolidated healthy states in Brazil's top performing municipios, “radical regimes” that built but struggled to consolidate healthy states in medium-performing municipios, and “rent-seeking regimes” that impeded the construction of healthy states in poorly-performing municipios.