Conceptual and operational framework on exclusion in social protection for health

Transcription

1 Pan American Health Organization Conceptual and operational framework on exclusion in social protection for health Sulamis Dain 1 1 Full Professor of Economics, Institute of Social Medicine, State University of Rio de Janeiro.

2 1 Sumary Executive Summary... 2 Objectives... 2 Political and Ideological Matrices of Social Protection Models: Origins, Evolution and Perspectives... 3 Policies against Poverty from a Social Protection Perspective... 4 From poverty to social exclus ion Policies against Social Exclusion, Marginality and Poverty: a Latin American Perspective... 6 Objectives... 9 I. Political and Ideological Matrices of Social Protection Models: Origins, Evolution and Perspectives... 9 I.1 Models of Social Protection...10 I.2. Crisis of Welfare States and its effects on policies against poverty and social exclusion...13 V.1The World Bank: A New Perspective on Policies against Poverty...23 VI Health Policies and Welfare State Crisis VII The Extension of social protection in health (ESPH) BIBLIOGRAPHY...31

3 2 Conceptual and operational framework on exclusion in social protection for health Sulamis Dain Executive Summary Objectives This paper aims to compare theoretical-conceptual and political ideological framework of present strategies to combat poverty and social exclusion in less developed countries, mainly in Latin American countries, emphasizing exclusion from social protection in health. The purpose of this comparison is to relate them to present initiatives on the subject, referring to World Bank (poverty reduction), to the Inter American Bank (social risk management) and to PAHO (equity and extension of Social Protection in Health). The starting point of this analysis is the historical background and evolution of the concept of social exclusion and the means to overcome it, as suggested by other institutional actors such as CEPAL and ILO, and academic authors from various political and ideological orientations. Economic and political foundations behind different conceptions on the subject of exclusion and social protection for health will be stressed. Therefore, it is necessary, as a first approach, to identify the roots of current differences among leading models of social protection which express themselves in social security, health and social assistance policies, in order to stress their degree of coherence and integration to strategies analyzed. This general background will allow tracing main developments and perspectives referring to policies to combat poverty in the developed world, as well as their successive changes to cope with social, economic and demographic realities in rapid and intense process of transformation. This perspective takes into account conceptual, political and legal transformation of poverty into social exclusion, as the basis for new social protection policies. There is often a weak correlation between the model of social protection, for which Social Security and Social Assistance are good proxies and health policies adopted in different countries, as for example in Canada and England. As social security is growingly

4 3 based on the occupational structure and on individual capacity to finance pensions and retirement schemes, health policies in both countries has kept its universalistic and collective nature, being financed by state general revenue. 2 The assessment of Latin American policies brings up new aspects to the developed countries common ground, related to new direction of causality among poverty, exclusion and marginality, inherent to the constitution of mode of development in the region. Local pre conditions allied to conservative reform hegemony and unfavorable insertion on the globalization process frustrate, even in the better scenarios, the full development of conditions and characteristics of welfare states. In view of that, our main challenge is to take these determinants and the restrictions to be faced both by social and health policies in the region into local assessment of strategies and recommendations for their improvement Political and Ideological Matrices of Social Protection Models: Origins, Evolution and Perspectives Esping-Andersen has distinguished among three welfare-state regimes: `liberal', `corporatist' and `social-democratic', which in Western Europe may characterize Anglo- Saxon, `continental' or central-european, and Scandinavian countries (Esping-Andersen The distinction among welfare regimes is based on differences in the degree of decommodification, meaning the entitlement to rights, independently of market merit categories. Western European systems of social protection have been frequently categorized as either `Bismarckian' (funded by contributions and with entitlement based on employment status), or as closer to a `Beveridge' model (funded by taxes with entitlement based on citizenship or residence status). In the European Union, the majority of systems are primarily contributions-based, but there has never been a `pure' system of either type. This is even less the case today; nevertheless continental northern Europe has in general been 2 Although poverty and social exclusion are aspects or stages of a process of desagregation or lack of socio economic basis to give consistancy and stability to social protection policy, not always social exclusion in health derives exclusively from these factors US health policy illustrates the consequences of a radical view of market regulation and of state subsidiarity on social policies. There are about 40 million people excluded from public or private health schemes, because on one side they are not poor enough to benefit from public programs, nor forma lly employed to benefit from group insurance nor rich enough to cover for the costs referring to adverse selection of risk

5 4 closer to the Bismarckian model, whereas Scandinavia and the Br itish Isles have been closer to a `Beveridge' model. Southern European systems have been less well developed in terms of risks covered and extent of coverage 3. To ensure the resources to enable the state to fulfill its universalistic guarantee, Beveridgian and state-socialist systems were committed to full employment; in the former case through Keynesian demand management, and a very strong moral climate of work subsidiarity (especially in Scandinavia); in the latter case, through central planning and legal obligation. A generalized universalistic means-tested social assistance safety net is available in most European Union countries, but, implemented alongside social insurance systems; it reinforces the primary inequality attributable to the operation of the labor market. A variation from pure Beveridgian approach, the liberal model also provides a means tested social assistance safety net, implying market hegemony and state subsidiarity, and limiting state policies to care for the poor, through low range, means tested social assistance programs. There has been very recently an optimistic perception on advances in social protection regimes ( Esping Andersen, 2002), based on European efforts to establish a common protocol for social protection, emphasizing state policies based on citizenship which guarantee higher dynamism in countries with higher levels of decommodification. However, it is also true that some meaningful aspects of solidarity are disappearing in many countries, and that differentiation among social protection in developed countries after the seventies has been increasing. US economy illustrates the fact that the increase in national wealth is not enough to outgrow inequality, social exclusion and segmentation. On the other hand, it is clear by now that social protection in less developed countries is an unfulfilled dream, and that previous inequality and heterogeneity creates social, economic, political and ideological constraints, refraining redistribution and social inclusion. Policies against Poverty from a Social Protection Perspective From a European point of view, corporatist model of social inclusion guarantees access to social rights, assuring group cohesion through occupation, and extending benefits through social assistance to those not included a priori. On the other extreme, social

6 5 democrat model is based on the reinforcement of citizenship rights to attain cohesion and social inclusion, through wide access to goods, services and cash benefits, related to the perfectioning of social protection policies. Liberal model, on the contrary, defines the market as the dividing instrument between those included and excluded, based on the assumption that every individual whose access to the market is limited by the lack of material means must obtain some kind of compensation through redistribution, in harmony with market incentives. Based on these principles, liberal tradition in England and the U.S. has privileged policies aiming the development and multiplication of systems of income maintenance (safety nets, food stamps, negative income tax credit, etc), which guarantee market functioning. Liberal model is the origin of a new theoretical approach on institutional focus on poverty, that of «social obligations of citizenship» meaning a set of reciprocity relations among participants in a political system which is market oriented. This paradigm reduces the scope of social rights and imposes conditions on those assisted. Individual responsibility increases as a consequence of economic situation and other external factors determining poverty and exclusion. The permanence of poverty and the amplitude of exclusion processes has lead to growing polarization of the debate between right or entitlements and duties, increasing conditionality to the access of social assistance of any kind.workfare model, as opposed to welfare, has been on the centre of policies against poverty in many countries, increasing controls, selectivity, obligations, labor enforcement, disciplinary mechanism. All of these picture a distinctive pattern of social integration- compulsory inclusion, via acceptance of jobs or any other kind of participation imposed by the community. From poverty to social exclus ion. Changes in concept express growing difficulties not only in diagnosing situations of social fragility but also in giving adequate answers through social policies, thus denying essential citizenship rights to an increasing number of individuals. Along the sixties, poverty was often associated to a concept of non satisfied needs, which implied previous definition of minimum standards of living. Necessity was institutionalized as a social right, to be attended through sustainable compensatory policies.

7 6 During the seventies, the concept of relative poverty stands up as a measure to identify «social position» of the poor vis-à-vis average pattern of consumption of the population as a whole. Someone was defined as poor, relatively to the whole population, if they lacked behind this average pattern of consumption, both from the perspective of their insufficiency of income, and from the non access to goods and services. Therefore, poverty incorporated the idea of inequality. During the eighties, the concept of exclusion was adopted to express social status of individuals in the lower stratus of social hierarchy and their difficulty in integration to the market and citizenship circuits. Where social protection does not depend on the market, this kind of hierarchy does not exist, since there is unrestricted access to goods, services and income financed by state general revenue. In all other countries, the tonic of social exclusion depends on the impoverishment of social relations and solidarity networks. Social exclusion is the very denial of fundamental rights, being excluded those groups of persons which are partial or totally out of range of effective application of human rights. Policies against Social Exclusion, Marginality and Poverty: a Latin American Perspective In Latin America, social exclusion, perceived as the denial to fundamental rights, is associated to the lack of entitlement to jobs for all citizens, as well as to lack of access to basic goods and services. Latin American poverty results from extreme inequality derived from labor market conditions, through non qualified jobs and low wages, bellow subsistence level. For the vast majority of the working class work was always flexibilized, badly paid and unqualified, thus leading to poverty. The concept of poverty in Latin America is often related to other categories, such as exclusion, marginality, inequality, vulnerability and state of risk. Conceptual debate has been neglected in favor of operational views, spread through international institutions such as The World Bank and ECLAC which adopt images or perspectives of poverty. For that reason, poverty is defined as a frontier, that of permanent income insufficiency which results in the non satisfaction of basic needs. This perspective on poverty lead to a decomposition of the poor and socially excluded category in groups, and to the establishment of a hierarchy of situations in order to focus on selective emergency intervention, using urgency as a priority criteria.. Policies

8 7 against poverty become a sum of programs, denying the very notion of citizenship, which implies permanent state responsibility in the guarantee of rights, in richness as in poverty. Latin American social protection system, though inspired in the European model, never came close to a welfare state. Its system of social security, health and social assistance becomes one of the main issues for structural conservative reforms in the continent. As economic crises developed, during the nineties, traditional social assistance policies, already limited to a few countries in the region, became even more restricted, limiting themselves to the implementation of a minimal safety net which aims to ensure a minimal level of social reproduction to mitigate devastating effects of adjustment policies, reproducing safety nets programs implemented everywhere by the World Bank with the support of other institutions. Most Latin American countries are against this kind of focused and temporary actions, based on low range, means tested social assistance programs. Even in the latest World Bank versions on policies against poverty, or Inter American Bank on the management of social risk, where poverty is finally seen as multi causal and interdependent phenomena, policies for the poor are dissociated from a long range, wider approach policy of social protection. The central role of state in social protection and social inclusion policies finds little recognition in these agencies, where subsidiarity of the state is the rule, even if dependent and stagnated markets have for a long time made evident their incapacity and lack of interest to deal with sustained combat against poverty. Even the State, by not assuming social dimension as part of every policy, contributes to increase the dichotomy between economic and social aspects of growth. Policies concerning extension of social protection in health, when conceived as a broad and inclusive welfare policy, guarantees to society, through state action, that individuals can satisfy their needs and demand through adequate access to health services, on its various institutional form, independently of their ability to pay.(paho, 2003). However, since exclusion in health is a multi causal phenomenon, it must be stressed that, on top of guaranteeing adequate financing, good conditions of access and service utilization, effective social protection in health requires the reinforcement of the welfare state.extension of social protection in health (ESPH) takes into account and in ample

9 8 perspective multiple dimensions of the problem of exclusion and ill health, going well beyond conventional wisdom related to actions recommended by other Latin American institutions which measure inequity by inequality in income and health conditions, and do not take into consideration the territorial dimension of inequity or the unequal distribution of health services in the territory. Even with its broader concepts, ESPH is only a necessary, but not sufficient condition, to the entitlements of full citizenship in the fight against poverty and social exclusion. Regional poverty goes against singling out health policies for universalistic access and publicly financed provision of services, as in Canada or UK, in spite of growin g liberal frame for social protection. Here, the relative autonomy of health policies encounters many more difficulties and less support. Putting it in other words, one can say that ESPH is in itself a big departure from social assistance policies for the poor, spread all over the continent, which could give enormous coherence to Latin-American welfare policies, in a real context of decommodification. In absence of this general framework, it retains its dimension of sector policy, surely with more potential and consistency than alternative strategies referring to health policies. However, in view of restrictions and absence of pre conditions for social inclusion in the region, it does not look possible it will be able to overcome, in its own jurisdiction, the limited character of health and social protection policies. Conceptual and operational framework on exclusion in social protection for health

10 9 Sulamis Dain Objectives This paper aims to compare theoretical-conceptual and political ideological framework of present strategies to combat poverty and social exclusion in less developed countries, mainly in Latin American countries, emphasizing exclusion from social protection in health. The purpose of this comparison is to relate them to present initiatives on the subject, referring to World Bank (poverty reduction), to the Inter American Bank (social risk management) and to PAHO (equity and extension of Social Protection in Health). The starting point of this analysis is the historical background and evolution of the concept of social exclusion and the means to overcome it, as suggested by other institutional actors such as CEPAL and ILO, and academic authors from various political and ideological orientations. Economic and political foundations behind different conceptions on the subject of exclusion and social protection for health will be stressed. Therefore, it is necessary, as a first approach, to identify the roots of current differences among leading models of social protection which express themselves in social security, health and social assistance policies, in order to stress their degree of coherence and integration to strategies analyzed. This general background will allow tracing main developments and perspectives referring to policies to combat poverty in the developed world, as well as their successive changes to cope with social, economic and demographic realities in rapid and intense process of transformation. This perspective takes into account conceptual, political and legal transformation of poverty into social exclusion, as the basis for new social protection policies. I. Political and Ideological Matrices of Social Protection Models: Origins, Evolution and Perspectives In developed countries, from the beginning of the fifties to middle seventies, growing state intervention in social policies, as well as the increase in tax burden and social expenditures, made it possible to integrate on the same program of social protection both the demands of capitalism and of democracy (Myles, 1984). The combination of universalistic policies directed to citizenship and social security policies directed to protect

11 10 contributors (workers and their dependants) from social risks of old age, incapacity, illness, death and unemployment guaranteed a wide coverage of the whole population. Structural financing requirements associated to universalistic policies and coverage of non individualized expenditure in health and education programs, added general revenue as a permanent source of financing in addition to social security financing, based on direct contribution from employers and employees. General revenue also financed redistribution associated to the guarantee of minimum levels of welfare, through cash allowances to the poorest (ILO, 1983). Till mid seventies, this redistribution was only a conjuncture element of stable economies, where growth and full employment were presented for more than two decades. Even then, differences among welfare states were already pointed by Titmuss 3 (1959), whose typology of welfare states made analytical distinction among the model of industrial models, institutional redistributive model and residual welfare model, referring the first to occupational structure, the second to universalistic concept of citizenship, and the third to actions of income complementation. Titmuss, directly involved in the conception and the development of the National Health System (NHS), was a source of inspiration for Esping Andersen. I.1 Models of Social Protection Esping Andersen (1990) taxonomy of the welfare state is based on their distinctive degree of participation in the production and distribution of goods, services and cash benefits, related to social rights, which he named as decommodification 4. The degree of decommodification depends on the intensity of combination among three basic types and conceptions of social protection. 3 Richard Titmuss s suggests a distinction between residual and institutional welfare states: under the residual model of welfare provision, social services are provided to people who are unable to help themselves. They form a temporary safety net around individuals when the natural channels of welfare the private market and the family break down. The State limits its commitments to marginal and deserving social groups On the other hand, under the institutional-redistributitive model, services are provided on a universal basis and social welfare as an integrated institution in society, providing universalistic services outside the market on the principle of need (Richard Titmuss (1958)(Social Policy. An Introduction; Brian Abel-Smith/Kay Titmuss (Eds.); London 1974: 4 ~De-commodification occurs when a service is rendered as a matter of right and when a person can maintain a livelihood without reliance on the market~.

12 11 The corporatist regime, first created in Germany under Bismark, is essentially an encapsulation of conservative continental European ideals, and in its extreme forms appears nearly feudal. A goal of this regime is to maintain a particular class structure in society, which is in contrast with the social democratic agenda of removing class structure in favor of egalitarianism. In the corporatist regimes, the family provides the first level of welfare support for its members. The principle of subsidiarity dictates that only when family support fails can an individual seek assistance from the state. Conservative tradition does not include women in the workforce, and the policy of the corporatist states correspondingly discourages dual-income families. Joint taxation of income is one economic incentive towards single-income families, but there are others as well; the unavailability of such services as day-care for children or grocery stores open late makes it logistically difficult to manage a family in which both parents hold jobs. The church also plays an influential role. In liberal regimes, the market is responsible for providing welfare services. State instituted welfare assistance only exists for those who cannot participate in the market economy, for reasons of being destitute, disabled, or elderly. Benefits are nearly always means-tested. As welfare programs such as pension and insurance programs are market based, participation is often optional. It is generally left to the market to decide how social programs (eg, insurance) will be implemented. Esping-Andersen describes the social democratic regime as ``a peculiar fusion of liberalism and socialism,'' one which acts to empower the individual via heavy state involvement in welfare service provision. Here, it is the state that provides basic welfare guarantees, and these guarantees are targeted at individuals. By acting on the basis of individuals, the Social Democratic system aims to promote equality, with the hope that egalitarian principles will result in a stable, consensus-based society. An important characteristic of the social democratic regime is that social rights are tied not to participation in the labor market, but to ``social citizenship,'' and the right to welfare is considered basic and stable. Esping-Anderson states that one goal of the welfare state is to decommodify labor, such that ``citizens can freely, and without potential loss of job, income, or general welfare, opt out of work when they themselves consider it necessary.'' (Esping-Andersen, 1990).

13 Means testing versus Universalism Esping-Andersen, summarizing Titmuss (1958), writes that in the liberal (residual) welfare state, ``the state assumes responsibility only when the family or the market fails; it seeks to limit its commitments to marginal and deserving social groups.'' This is unquestionably true of the American system, where citizens only receive financial assistance from the government on a exceptional and usually temporary basis. Welfare benefits, such as unemployment money from the state, free or subsidized school meals or day-care for children, and government-issued ``food stamps'' are only available to the poor. In contrast, social democracy dictates a policy of ``universalism'' readily apparent in Sweden, where all parents receive child allowances, all students receive government stipends, etc Market versus State Swedish and American policy entrust the state and the market, respectively, with the provision of welfare services. The U.S., true to the liberal ideal, relies on the market to develop social services. Services such as insurance, pensions, health care, and child care, are for the most part privately operated. As to child care, in the U.S you get the childcare you pay for, and the types and costs of childcare as well as its quality differ between families according to their incomes. State influences the market-based provision of social services through various economic policies, for example tax credits. Through tax credits, the government can make social services affordable and thus create a demand which will be met by the market. It assumes that the market is able to provide a significant range of choice beyond what the government would be able to provide itself, and is, so goes the theory, able to find efficient mechanisms to meet demand. In Sweden, true to the social democratic model, social services are often provided by the state directly. Child care, medical care (ie, hospitals), schools, and pensions are enterprises of the Swedish state. It is possible that Sweden's relative homogeneity makes this scheme particularly appropriate. Between these extreme experiences, there appears to be significant national differences as to the degree of decommodification of income and services related to social protection, with state participation being more intense in Scandinavia and European

14 13 countries as a whole, and less significant in U.S., as well as in Canada and Australia The scheme behind presents models of social protection according to features pointed out by Esping Andersen. Type of welfare Regime Liberal Conservative/Corporatist Social Democratic Values Work ethic stigma Rights according to class and status Equality, universalism of high standards Instruments Means tested assistance Private insurance backed by state State is first line of support; high level of benefits Aims Strengthen the market Strengthen civil society, limit Fusion welfare and market work, full employment Decommodification Low Medium High Class implications Middle class suspicious of Class maintained but Middle class wooed state stabilized from market to state Country example USA, Canada, Austrália, UK Austria, France, Germany Scandinavia I.2. Crisis of Welfare States and its effects on policies against poverty and social exclusion Many are the economic, demographic, social, family and labor market factors on the root of welfare crisis that manifests itself in developed countries from the mid seventies onwards. This crisis demands the adoption of a new social architecture for social protection which, in the most favorable cases involves a whole new conception of the welfare state, in the sense of facing these challenges and finding adequate and innovative solutions From Esping-Andersen 5 optimistic perspective, it is possible that the redesign national European systems of welfare will bring around a common European strategy, based upon the interaction of the three pillars of social protection market, family and state to reinforce universal social rights, in an active and dynamic way. In this process, it will be necessary to take into consideration poverty new concepts, as well as actions to overcome it A whole new formulation of new social risks will be part of social protection policies, remodelling its conventional arsenal. 5 Esping-Andersen G. (2002) Towards the Good Society, Once Again? In Esping-Andersen G. (org). Why We Need a New Welfare State Oxford University Press.

15 14 Even taking into account the relatively more favorable social conditions in Europe, and bigger capacity to keep and transform in a favorable way, values and policies of the welfare state, it must me reminded that poverty causes such as strucutural unemployment,, precarization of jobs, were not eliminated, affecting both the young and the older in the active population. To that it must be added the precarization of family arrangements and networking, due to changes in demography that affect patterns of family reproduction, reducing private protection, with considerable negative impact on child poverty. There is also an increase in unequality, due to a new pattern of income distribution, that favors income concentration in the last decile. Elsewhere, social policies strongly reflect poverty evolution towards social exclusion and the dominance of a focalization strategy of social policies, centered on the very poor or excluded, as opposed to former strategies, based on universalization of social rights and on a wide perception of social citizenship. Strategies to fight poverty and exclusion have very often lead to the upspring of local regimes for poverty regulation 6, through the development of diversified and focused programs, taylored for each type of situation. Social Security Bill Jordan 7 recognizes two distinct and opposite political matrices in the building of the European debate about poverty, derived from the previously mentioned current theories. In one side, the anglo-saxon or liberal matrix (derived from the minimization of the original Beveridgian line), which has its basis on the tradition of economic individualism. In the other extreme, the so-called continental or Bismarkian matrix, which has its support on the compulsory or corporate collectivism, where the relationship of belonging to a social category or group prevails, with representative strength to negotiate personal interests in the scope of a broader system of social protection. The liberal matrix presumes that every individual whose participation in the market is hindered by the lack of material resources essentially a low income -, is considered 6 See Mingione E. e Oberti M. (2002). The Struggle Against Social Exclusion at the Local Level: diversity and convergence in European cities. Eletronic version of the article printed from European Journal of Spatial Development. 7 Jordan B. (1996). A Theory of Poverty and Social Exclusion. UK: Polity Press.

16 15 poor and consequently should obtain some sort of reparation that would allow, through measures of redistribution, to compensate this deficiency. Consonant with these principles, the liberal tradition recurrent in England and in the United States favors interventions directed towards the development and multiplication of income safeguarding systems (safety nets, food stamps, negative income tax credit, etc), which guarantee the market s good functioning. In a methodological plan, this has led to the establishment of income levels or poverty lines that allow the identification of the target-population for the countless programs against poverty. As asserted by Jordan, all efforts made towards the association of certain income levels to certain forms of social exclusion or poverty reflect, in the liberal tradition, the unavoidable premise: without poverty verification 2 nothing justifies a redistribution. In continental Europe, on the other hand, (the Bismarkian focus), the belonging to a social group or corps in other words, the inclusion guarantees the access to a number of rights, which primary aim consists exactly in assuring the group s cohesion through the maintenance of solidarity. In the continental tradition, what matters is not the individual s level of resources, independence, autonomy, prudence or competence. The first thing that matters is the relationship of the destitute with his family, his community and the State. Poverty becomes a social problem when people, due to their economic situation, cease to belong, cease to be represented and, as a consequence, are excluded from the corporate life of his community and of the State, says Jordan. Therefore, it is the State s duty, through its social policies, to figure and regulate these relationships, avoiding the slackening of social ties. Jordan summarizes well the cleavage between these two models of intervention, affirming that, in the countries with a liberal tradition, social policies are not necessarily aimed to promote social integration, their purpose is to guarantee individual rights through minimal levels of redistribution (what matters is the efficiency of the system of social protection in the battle against destitution, through income transfer based on rigorous criteria of eligibility). 2 Jordan B. (1996). Op. Cit. Page 95.

17 16 In the countries of continental Europe, the paradigm of inclusion and sense of belonging to a community or society prevails (in this case, the important is the social relations that such social protection systems create and regulate through the concession of benefits for the less privileged). It is important to remember that in the 90 s, chiefly by influence of Meads works 3 social citizenship was defined based on a set of universal principles of justice that everybody shares because it is in the best interest of all -, a new theoretical focus on the institutional treatment of poverty appears, that of social obligations of citizenship. Justified by the principle of rights and duties as a set of reciprocity relations between members of a political system oriented by the market s logic, this paradigm reduces the scope of rights while enforcing conditions to those assisted. The individual responsibility increases in detriment of the economic scene and other external factors that determine poverty and exclusion. Even in the countries where the model of solidarity and inclusion prevails, the social discomfort derived from the permanence of poverty and of the amplitude of exclusion processes have led to a growing polarization of right x duties debates 4, in favor of the extension of conditionalities. That way, the model of workfare, as opposed to welfare, has oriented the reformulation of policies against poverty, increasing the control, the selectivity, the compensations, enforcing obligations in the acceptance of every kind of work, the application of disciplinary mechanisms, which reflect a different pattern of social integration the compulsory inclusion, through the work or other type of participation imposed by the community. This is the focus for the formulation of welfare policies in England, the Netherlands and the United States. III From poverty to exclusion: Evolution of the legal/political focus on poverty in Europe According to Thomas 5, the analysis of the battle against poverty policies leaves out an aspect of great importance, which is the reconceptualization of poverty, 3 Meads L.M. (1986). Beyond Entitlement: The Social Obligations of Citizenship. New York: Basic Books. 4 See National Observatory of Poverty and Social Exclusion. Report Paris: La Documentation Française. - 5 Thomas H. (1999) Les Inclus. Paris: PUF

18 17 through the 60 s and 90 s, which demands a reformulation of the social policy and of the strategies associated to it. Throughout the 60 s, poverty was associated to a concept of unfulfilled needs that presupposes the definition of a minimal pattern of life conditions. The wanting is thus established as a right. In absolute poverty or destitution live all those whose pattern of expenditure is situated below the vital minimal due to their deficit in income. The European and North-American studies dedicated to the identification of the poor in this phase take the family or the domicile as their observation unit. Changes in the families composition are very frequent, due to changes in the work market (periods of recession or expansion), redefining poverty s scope. In the 70 s, the concept of relative poverty becomes the measure to identify the social position of the poor vis-a-vis the average pattern of expenditure of the population as a whole. It is poor, in relation to the population, he who is situated below the average pattern of expenditure, not only from the standpoint of low income, but also by the inaccessibility to goods and services. We pass from an approach centered exclusively on income to a broader focus, that of lack of resources. The hiatus or differential that separates the poor from this medium pattern expresses the intensity of poverty, the degree of privation that must be attenuated through compensatory policies and programs capable of assur ing the necessary resources for a dignified life. Being the group of the poor an heterogeneous set, with some living below the vital minimal, others in a perhaps less critical situation but still very unfavorable and fragile, we must identify the hiatus that separate each one of the average expenditure Poverty (poverty s intensity) is now calculated with basis on an inequality measure. Parting from this understanding of the poverty phenomenon, the CEE begins to consider as poor, as early as 1976, all individual and families whose resources are so scarce that exclude them from the ways of life, habits and normal activities of the State where they live. The calculation for the identification of the poor is established with basis on an indicator of relative poverty. The individuals whose per capita income is inferior to that limit qualify, therefore, as potential target-public of welfare policies. Whether one is looking for the estimation of absolute poverty or adopts a relative approach that deals with the degree of inequality, the employed methodology

19 18 supports itself on the elaboration of lines of poverty or income levels that separate the universe of the poor from that of the non-poor. The demarcation line between these two universes is made based on the definition of need levels, on their turn stipulated with basis on a consensual interpretation, by each society, of what is its pattern of well-being. Thomas emphasizes with propriety that the concept adopted by the CEE introduces, at the end of the 70 s, the category of the excluded, around which the theoretical and methodological debate on poverty will be reformulated from the beginning of the 80 s. Thus, in the 80 s, a new category is born the exclusion. Different from absolute poverty, which is based on objective criteria, such as low income, homelessness, lack of human capital, to talk about exclusion implies also the consideration of subjective aspects, which may cause rejection feelings, loss of identity, the break of social and community ties, resulting in a retraction of sociability nets and disruption of solidarity and reciprocity mechanisms. Exclusion is less a need state than a path, a road along which, to the deficit in income and lack of various resources, are added almost constant accumulated disadvantages, de -socialization processes due to ruptures, situations of social depreciation coming from the loss of social status and of the drastic reduction of opportunities, and the chances of re - socialize tend to decrease. Exclusion, like poverty, has a negative connotation, for it means bad or deficient integration, be it by the productive system, be it by the expenditure pattern. The key element of exclusion is given by the impoverishment of social relations and solidarity nets. For this reason, the notion of exclusion also means failure. Paugam 6 calls attention to the loss of social status 7 and to the stigma currently associated to all the populations that find themselves in a situation of great socio-economic precariousness. This condition would not be a direct result of poverty, but of acceptance, by the poor or populations that live in a risk situation, of a devaluated social status that of a potential client of welfare policies and programs. The processes of identification, eligibility and qualification that substantiate and legitimate the right to assistance are designated as 6 Paugam S (1991). La Disqualification Sociale. Essai sur la Nouvelle Pauvreté. Paris: PUF, Page Translated in Brazil in some works as social unqualification. See Paugam S (1999) op. Cit.

20 19 part of the ritual of degradation of the needy population s social status. To be assisted is to be stigmatized, thus excluded. In Castel s point of view 8, in lieu of exclusion, it is better to refer to processes of social unfiliation equally referent to the loss of status, with devaluation of the individual, by the rupture of the links of institutional filiation derived from the crisis in the wage society. Suc h processes express, through the loss of jobs, the growing precariousness of contractual relationships, the existence reiterated by economic instability and the progressive inadequacy of social protection systems, the loss of a productive and social identity that isolates the individual (the unfiliated ) leading to the rupture of solidarity ties. Finally, one should point out the designation of the European Observatory of National Policies for the Battle against Exclusion which, together with some NGOs and the important adhesion of France 9, interprets social exclusion as the denial of fundamental rights 10. In 1994, the European Council adopted the following definition: are excluded the groups of people that are partially or integrally out of the field of effective application of human rights 11. Here, exclusion is the opposite of citizenship 12 IV The Latin American Debate: Exclusion, Marginality and Poverty In Latin America, the evolution of the two categories poverty and exclusion seem to have followed its own trajectory. Initially, the poor were associated to the vagrant, to those who refused to work, that remained out of the productive universe, poverty being thus a synonym of resistance to the wage system. Though strongly idealized, this concept of poor is revealing of its non-place in the world of work, for every productive insertion outside the limits of the new world s predominant relationship of capitalistic production implies exclusion. To be poor, therefore, is practically to self -exclude of the dominant 8 Castel R (1995) Les Métamorphoses de la Question Sociale em Europe. Une chronique du salariat. Paris: Fayard. 9 Law of 1998 relatite to the fight against social exclusion. England refused to adopt this definition, maintaining its adhesion to the notion of equality of opportunities. 10 Exclusion Sociale et Pauvreté em Europe (2001). Ministère de l Emploi et de la Solidarité. Paris: La Documentation Française. 11 Blandine B and Salama P. (2002). Apud Strobel P. (1996). De la pauvreté à l exclusion: société salariale ou société des droits de l homme? In Revue Internationale dês Sciences Sociales, june, nº Aldaíza Sposati writes about this understanding of exclusion in Social Exclusion below the Line of the Equator, in Véras et alii (1999) op. Cit.

21 20 pattern of inclusion, as if the choice were given to all. We identify here one of the dimensions inherent to the notion of exclusion, that is, the non-belonging. The second phase, in the 50 s and 60 s, refers to the time when poverty, as a social issue, reappears in the mass of excluded, marginal people, inserted in the periphery of the economic system, with a right of participation at most restrict to the sub-employment 13. At this point, marginality is recognized as inherent to the capitalist system and, above all, to dependent societies which, in adopting the model of import substitutes, give way to the constitution of a dual work market, formed by two different sectors. Poverty is pictured by the expansion of population surplus, by marginal groups that do not find work in the formal and modern sector of the economy and who usually live in slums. Again, poverty is understood as a form of exclusion: to not belong to the new working class bearer of the project of social modernity. The insufficient income or the nonfulfillment of basic needs two ways of accounting the poor do not constitute, right off, the factor of identification and delimitation of poverty. Somehow, the poverty category is built based on a discrimination to not belong that is, it is based on a stigmatizing register, instead of forging itself from the evidence of income penury and resources that should be assured as a citizen right. Two strong ideas marginality and duality -, intimately linked to the dynamics of the work market in the dependent peripheral societies will, then, inform the debate about poverty in Latin America, under the influence of Cepal s thought (a late industrialization, strongly excluding, propitiatory to marginality, as proposed by the dependence theory). Such matrix will remain until the 70 s. In it, the poor are those who remain in the informal market, where traditional and backward sectors prevail, at the margin of the economy s modern sector, and, for this reason, are unable to break with the poverty culture and adopt the new urban-industrial values of the developed capitalist societies. The now classic work of Francisco de Oliveira, Economia Brasileira: Crítica à Razão Dualista (Brazilian Economy: a Critique of the Dualistic Thought), clarifies the mistake of this interpretation, demonstrating that the exclusion was not caused by the 13 Valladares L. Op. Cit. Page 98.

22 21 inadequate and disfunctional form of the workers productive integration, but by their exclusion from the production gains, from the profits of the economic growth:...the capitalist expansion of the Brazilian economy has deepened, after 1964, the exclusion that was already a characteristic that had been gaining strength over the others and, moreover, turned exclusion into a vital element for its dynamism 14. Exclusion appears thus as structurally inherent to the building of Latin-American societies. Like Oliveira, Castells 15 also recognizes that it is idealistic to marginality what is really the reflex of a situation of tension between two social and interpenetrating societies. This form of articulation is a characteristic trait, and not a pathology in Latin American. So, while in the developed countries the exclusion appears in the mid-70 s, with the workers unfiliation, the long term unemployment and the growth of the new poor category, in Latin America, and particularly in Brazil, the excluding pattern is constitutive of the accumulation model, in all its phases and not only by force of market flexibilization and globalization. This is the pattern of extreme inequality, understood as exclusion from an expressive contingent of the working class, to whom economic and social citizenship is denied. Poverty is a consequence of exclusion. This new concept of the poverty determinants leads to the understanding, in the second half of the 70 s and all through the next decade, that poverty is not a reflex of exclusion from the work market, but an expression of a certain kind of bond, of a precarious, fragile and unstable insertion. In this third phase, the poor is transformed into the worker whose income does not allow him to lead a dignified life, whose worker status is constantly questioned. Again, it is evident that, in the Latin American picture, exclusion and poverty constitute two intimately associated and recurrently present categories, although distinct. At this point, exclusion means not to be outside, but not to be legitimately and fully integrated. Exclusion is the opposite of social integration, which is given by two axes: professional insertion and insertion in the sociability and reciprocity nets. The counting of the poor reveals an important inflection in the debate on poverty in Latin America, up to here excessively marked by the marginality paradigm. In fact, the 14 Oliveira F. (1975). Economia Brasileira. Crítica à Razão Dualista. São Paulo: Brasiliense CEBRAP, page Castells M. (1971). Problemas de Investigación em Sociologia Urbana, México: Siglo XXI.

23 22 approach to poverty uses methods to calculate and classify the unprivileged groups, aiming to focus the Government s social action in the fight against poverty. This suggests that the State s regulation of poverty changes of axe, the discourse on exclusion gives way to that on poverty. The poor are no longer described as vagrants or marginal, instead as workers expropriated from the fruits of economic development and social well-being. Poverty is the picture of inequality, and the periphery of the big cities are the expression of the daily segregation. According to Ziccardi, CEPAL statistics prove that a high proportion of the poor works, and that, among these, a good part is linked with the formal sector of the economy, employed either in the private or the public sectors. That is, not only the workers of the informal sector, the independent or the non-declared pay workers that are poor. Poverty in Latin America is the result of an extreme inequality imposed by the labor market through low qualified jobs and, above all, extremely low pay levels, established beneath subsistence levels. With the deterioration of employment conditions of the 90 s, we observe a significant fall in salaries, especially in the second half of the decade, even if bubbles of recuperation have been registered here and there, due to the victory against inflation. And although poverty has decreased as a result, inequality in general was aggravated. In the United States, welfare programs like the EITC (Earned-Income Tax Credit) were created to complement the income of poor workers, maintaining the incentive to work. In Europe, the universal benefits, of a redistribution character, aiming to support families and children, promoting well-being in general (housing and transportation subsidies, minima sociaux) also supplemented, but in a legitimate and regular way, without discontinuity, insufficient pay levels, fighting poverty. In Latin America, though, the fight against poverty was never a priority in the scope of social policies and much less a justification for the adoption of redistribution mechanisms of protection of destitute groups. For the ILO 16, what distinguishes the notion of social exclusion, such as employed in the 90 s in Latin America, from the old concept of marginality, is that it is caused by modern processes, like globalization and the State s role in the new liberal order. 16 International Labour Organization Ford Foundation (1999). La Exclusión Social en el Mercado de Trabajo. El Caso del Mercosur y Chile. Síntesis Ejecutiva, Santiago.