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1 Introduction The Geopolitics of Public Health in the BRICS Nations In recent years, po­ liti­ cal leaders in Brazil, Rus­ sia, India, China, and South Africa , a group of nations known as the BRICS, have aspired to become world leaders in po­ liti­ cal and economic development. Their growing economies, cultural influence, and heightened participation in foreign affairs have earned the re­ spect of the international community. This exclusive group of countries has worked together to reformulate international discussions and policies on issues ranging from fair and ­ free trade to ­ human rights, while defending the interests of less developed nations. The BRICS, empathizing with countries perceived as being controlled and manipulated by international creditors such as the International Monetary Fund (IMF) and the World Bank, have gone so far as to create their own regional development bank as a counterweight to­ these institutions (Pilling, 2014). And the ­ tables have turned. In 2011, the IMF asked the BRICS for their assistance in helping save Greece, Portugal, and Spain, all on the brink of financial collapse (Soto and Murphy, 2011). Ironically, in 2003, it was Brazil that approached the IMF for help in rejuvenating its flagging economy (BBC, 2003). In short, the BRICS have aligned with one another based on their similar interests and success in reforming their foreign policies and achieving global prominence. When it comes to health policy, however, the BRICS nations have not behaved as similarly, nor have their policy achievements been as impressive. As figure 1.1 illustrates, ­ these governments have differed considerably in their commitment to healthcare spending, highlighting key differences in their approaches to improving the health and wellbeing of their citizens. Furthermore, 2   Geopolitics in Health the BRICS have failed to prioritize the strengthening of the institutions and policies that undergird their healthcare systems, not only by ensuring that policies are effectively implemented, but also by ensuring that federal and state funding is allocated efficiently, that health officials are held accountable, and that every­ one—­ especially ­ women and minorities—is treated equally with re­ spect to healthcare needs (Gómez, 2015b). But ­ were the BRICS as dif­ fer­ ent when it came to responding to public health crises, such as epidemics? One could easily assume that, given the BRICS’ increased prominence on the world stage and striving for greater po­ liti­ cal and economic influence, they would similarly take an interest in aggressively responding to diseases that threaten their economic per­ for­ mance and growth potential. One could further assume that such potentially devastating threats would increase po­ liti­ cal interest in responding through immediate and aggressive bureaucratic and policy reforms—­ especially when compared with responses to diseases perceived as less severe and catastrophic, such as diabetes , hypertension, and cancer, and broader health systems challenges. However, even when faced with disease epidemics, none of ­ these nations immediately responded. By the early 1990s, the HIV/AIDS epidemic was sweeping across the BRICS nations, generating fear, discrimination, and social instability and contributing to thousands of deaths in a short period of time. A foreign-­ born virus, HIV/ AIDS had several modes of transmission, ranging from sexual relations and poorly managed blood transfusion pro­ cesses to the sharing of ­ needles in intravenous drug use. Tuberculosis (TB) resurfaced shortly thereafter ­ because of the im0 2 4 6 8 Percent 10 12 14 16 1995 2000 2005 2012 Brazil Russia India China South Africa Figure 1.1. BRICS general government expenditure on health (as percentage of total government expenditure), 1995–2012. Source: WHO, 2015. Introduction  3 mune system deficiencies caused by HIV and ­ because of increased poverty and urbanization. And as a consequence of accelerated economic growth, international trade, and changes in daily lifestyle—in essence, the very products of the BRICS’ success as emerging economies—­ obesity emerged as a serious public health threat by the turn of the twenty-­ first ­ century, contributing to a host of related diseases such as hypertension, diabetes, and cancer. The BRICS differed in how they responded to ­ these epidemics, highlighting impor­ tant differences in their po­ liti­ cal commitment to meeting healthcare needs and safeguarding their socie­ ties. The BRICS’ responses ranged from the limited introduction of prevention and treatment policies, mainly during the early 1990s, to a stronger policy response by the mid-1990s, which entailed a rise in administrative and policy spending on prevention and treatment programs . By the mid-2000s, the BRICS differed in the key outcome of interest in this book: developing a centrist policy response. This response, as...