The Pharmaceuticalization and Judicialization of Health

Abstract

A major player in the political economy of pharmaceuticals in the Global South, and boasting a universal health care system, Brazil offers fertile ground for exploring the unanticipated ways people have mobilized for treatment access in contexts of stark inequality. In this article, I place the ever-evolving twin phenomena of the pharmaceuticalization and judicialization of health in a multilayered historical context: the post–World War II push for states to embrace the idea that their citizenry had a right to health, and Brazil’s particular embrace of a constitutional right to health in 1988; the turn of the World Health Organization (WHO) to essential medicines in the 1970s, and the responses of both governments and pharmaceutical companies in the ensuing decades; the advent of neoliberal forces as they swept the globe, landing in Brazil in the early 1990s; and the HIV/AIDS pandemic in Brazil with the government’s precedent-setting provision of lifesaving antiretroviral therapies in the late 1990s. This dynamic context sheds light on a bottom-up ethnographic inquiry of the ways the poor in Brazil have turned in increasing numbers over the last two decades to the courts to litigate access to medicines. Through their collective trust in the judiciary and their willingness to be a frontline force against the ill effects of neoliberalism, citizen-litigants are instantiating a kind of magical legalism, opening up new possibilities for the state to live up to its human rights and medical commitments. People’s quests for accountability reveal an ambitious vision of justice at a local scale and a distinct sense of politics in-the-making, even alongside a resurgent authoritarianism.