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Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico.

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dc.contributor.author Knaul, Felicia Marie
dc.contributor.author Touchton, Michael
dc.contributor.author Arreola-Ornelas, Héctor
dc.contributor.author Atun, Rifat
dc.contributor.author Anyosa, Renzo Jc Calderon
dc.contributor.author Frenk, Julio
dc.contributor.author Martínez-Valle, Adolfo
dc.contributor.author McDonald, Tim
dc.contributor.author Porteny, Thalia
dc.contributor.author Sánchez-Talanquer, Mariano
dc.contributor.author Victora, Cesar
dc.date.accessioned 2021-12-12T20:25:00Z
dc.date.available 2021-12-12T20:25:00Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/10314
dc.description.abstract We present a new concept, Punt Politics, and apply it to the COVID-19 non-pharmaceutical interventions (NPI) in two epicenters of the pandemic: Mexico and Brazil. Punt Politics refers to national leaders in federal systems deferring or deflecting responsibility for health systems decision-making to sub-national entities without evidence or coordination. The fragmentation of authority and overlapping functions in federal, decentralized political systems make them more susceptible to coordination problems than centralized, unitary systems. We apply the concept to pandemics, which require national health system stewardship, using sub-national NPI data that we developed and curated through the Observatory for the Containment of COVID-19 in the Americas to illustrate Punt Politics in Mexico and Brazil. Both countries suffer from protracted, high levels of COVID-19 mortality and inadequate pandemic responses, including little testing and disregard for scientific evidence. We illustrate how populist leadership drove Punt Politics and how partisan politics contributed to disabling an evidence-based response in Mexico and Brazil. These cases illustrate the combination of decentralization and populist leadership that is most conducive to punting responsibility. We discuss how Punt Politics reduces health system functionality, providing lessons for other countries and future pandemic responses, including vaccine rollout en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet Regional Health. Americas
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Brazil en_US
dc.subject Mexico en_US
dc.subject Covid-19 en_US
dc.subject Health Systems en_US
dc.subject Stewardship en_US
dc.title Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.lana.2021.100086
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.05
dc.relation.issn 2667-193X


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