In the last decade, several leftist countries in Latin America, including Venezuela, Bolivia, Ecuador, Brazil, Argentina, Nicaragua, and El Salvador, among others, have retooled national and regional political, economic, and social governance to push against the constraints of deeply ingrained neoliberalism. This so-called post/neoliberal era is an attempt to move beyond neoliberalism, which was forced upon and adopted by Latin American governments beginning in the 1970s, and its failures, including privatization of State enterprises, persistent poverty and increasing social inequality, and widespread environmental destruction. This dissertation uses the term “post/neoliberal” to acknowledge that post/neoliberal governance models exist alongside neoliberal models. To date, much focus has been paid to post/neoliberal macroeconomic policies and State-civil society relations. The aim of this dissertation, therefore, is to examine the influence of post/neoliberalism on the governance—that is, the discourses, policies, institutions, programs, and practices that manage, direct, and conduct everyday life—of public health, environmental health, and well-being.
My conceptual framing draws from Foucauldian governmentalities, urban political ecology, and neoliberalism as governmentality and as policy. Together, these literatures provoke new questions concerning the dialectic relationship among health, environment, and development amid changing political economic governance in Latin America. The empirical basis of this dissertation draws from qualitative (discourse analysis, interviews, and participant observation) and quantitative (household survey questionnaires) fieldwork conducted in Managua, Nicaragua.
This dissertation is comprised of three body chapters to be submitted to academic journals for peer review. In the first body chapter I argue that contemporary public health governance in Venezuela, Bolivia, and Ecuador, three countries where post/neoliberalism is most pronounced, is characterized by social medicine and neoliberal and post-neoliberal values, strategies, and practices. Importantly, I find that in emphasizing interculturality and “collective well-being,” post-neoliberal governance pushes the boundaries of current understandings of social medicine, though strong ties to neoliberalism are maintained. In the second body chapter I examine the themes of solidarity participation and living well in Nicaragua. I focus attention on the discourses and strategies of the “Live Clean, Live Healthy, Live Nice, Live Well…!” national campaign (hereafter “Live Nice, Live Well”). I situate the campaign in relation to the revolutionary Sandinista and neoliberal periods to analyze how environmental health governance in the contemporary period is politicized, responsibilized, and aligned with indigeneity. Survey data reveal that lay perceptions of Live Nice, Live Well deviate from government discourses, and I argue that the campaign contributes to the production of a normalized form of post/neoliberal citizenship that reflects the diverse antecedents of contemporary governance in the country. The third body chapter slightly deviates from the others in that it examines the social and economic effects of a neoliberal municipal waste site development project on waste pickers. I find that the project does little to improve waste pickers’ socio-economic marginalization, which contributes to neighborhood-wide environmental degradation, thereby preventing them from “living well.” Further, the development project highlights the disjuncture between State discourses focused on moving beyond neoliberalism and persistent neoliberal practices. Broadly, this dissertation argues that examination of post/neoliberal governance, including its tensions, contradictions, and paradoxes, is critical to understanding public and environmental health in contemporary Latin America.