Democratic governments in all developing countries today face the daunting challenge of extending social welfare in an age of global free trade and mobile capital while simultaneously balancing the books. In Latin America, they have the added burden of ameliorating inequalities generated recently by the market's expanded role in the provision of goods and services, as well as those inherited from a development model that unequally distributed economic resources, opportunities, and basic rights of citizenship. Unlike the experience in East Asia, where the model of export-oriented industrialization once critiqued for its exploitation of cheap labor eventually resulted in better-educated labor forces and greater equality, children of the rural and urban informal poor in Latin America often died before they stepped foot in school.

The two books under review, while focusing on quite different questions—episodes of mass contention against neoliberal reform in Latin America and health-care outcomes in several countries of Latin American and East Asia—both engage enduring questions about the sorts of governments, strategies of economic development, and particular features of economic and social policy that are best equipped to provide public goods to their citizens. They allow us to entertain the possibility that state and market reforms need not always be exclusionary, just as they alert us to the political fallout and disastrous consequences in human terms when they are.

Challenging Neoliberalism in Latin America seeks to explain why waves of mass protests swept four countries that experienced such reform—Argentina, Bolivia, Ecuador, and Venezuela—to the point that they forced elected presidents out of office. Drawing from rich ethnographic accounts that include testimonies from participants, the book impressively traces the roots of protests that many, blinded by a singleminded focus on a traditional labor movement weakened by soaring unemployment and deindustrialization, did not see coming. Contentious politics among the unemployed, landless, and the just plain poor in far corners of national territories was initially made possible because declining unions adapted, embraced informal sector workers, and lent their knowledge of organizing to new groups. But it was only when protests shifted from the workplace into urban neighborhoods and rural communities that unemployed miners and oil workers, retirees, teachers, displaced coca growers, and mothers struggling to feed their families could find common cause and contention could become so widespread. Moreover, protesters that could not stop production developed new tactics to disrupt commerce—pickets of the unemployed flown in, roadblocks of key ground transport routes, and the turnout of entire towns to back up those on the front lines of antigovernment protest.

Episodes of contention had multiple triggers and targets. Some protests were clear reactions to the injustice of rates of unemployment that reached 45% in some areas, but others—like protests against spikes in food and gasoline prices that resulted from cuts in government subsidies—have a long tradition in Latin American politics. Still others, such as demands for rights to indigenous language, customs, and control of natural resources and land and against coca eradication, were not necessarily motivated by neoliberal reform. Although the reader may have wished that Eduardo Silva had not labeled all varieties of protest in all countries as anti-neoliberal and that he had parsed his explanation for the disparate origins of protest, he crucially draws our attention to the transformation of these diverse protests, whatever their origins, to broader movements opposing privatizations and International Monetary Fund and free-trade agreements; to their relocation from the provinces to the capitals; and to the shift of their targets from neoliberal economic policies to the governments that implemented them.

What accounts for such impressive outpourings of public anger? Invoking Karl Polanyi's (The Great Transformation, 1944) classic notion of collective defense against market society, Silva treats the mobilization of protest against state and market reforms as a natural response to neoliberal policies that impoverished the population in the service of international capital. Yet as we know from decades of theoretical and empirical advances in the field of contentious politics, deprivation and genuine grievances do not inevitably lead to protest. His welcome use of divergent cases where protest failed to materialize in the 1990s—Peru because of repression and Chile because of remedial government action to expand social protection—moves us in the right direction but does not really settle the questions of when and why specific grievances became powerful waves of contention. It suggests, that barring repression and remediation, a steady accumulation of citizen frustration over economic exclusion, political betrayal, and repeated violations of electoral mandates by arrogant governments under pressure from international creditors will eventually boil over.

Yet the historical record does not confirm such a linear progression. In Argentina, for example, Carlos Menem resoundingly won his reelection bid in 1995 despite 17% unemployment and a neoliberal surprise implemented largely by decree. Why was neoliberalism tolerated in 1995 but not in 1999? Possibly, as Susan Stokes contended in Mandates and Democracy (2001), citizens forgave mandate violations when economic outcomes were good, at least in the sense that prices were stabilized, but not when the economy tanked. Or perhaps public tolerance for mandate violations wore thin when governments were repeat offenders, and the people, fooled once by price stability, were not apt to be fooled twice. There is a third possibility. Although Challenging Neoliberalism implies that all protest against neoliberal reform—even that with the explicit goal of removing elected presidents before the end of their terms in office—is legitimate, governments may also have fallen victim to disloyal oppositions.

Indeed, is any state and market reform admissible? While most readers of goodwill join Silva in objecting to shredding social safety nets for the most vulnerable, reasonable people might disagree about the desirability of providing free university education for the elite, investing state resources in antipoverty programs rather than modernizing steel mills, and reducing the privileges of upper- and upper-middle-class public sector employees in order to extend the provision of basic education, health, and human services to the rural and informal poor. Is it ever possible to do the latter without the former?

Wealth, Health, and Democracy in East Asia and Latin America zeroes in on precisely this possibility in the context of the provision of public health and, specifically, lowering infant mortality rates and raising life expectancy. By means of statistical analysis and eight careful case studies, James McGuire contends persuasively that wealth alone does not determine mortality rates, but that public policy plays a critical role through the provision of basic health care, one of the most fundamental of human rights. The book rigorously analyzes four Latin American and four East Asian cases, with an ideological objectivity that is as refreshing as it is rare, and that guarantees the book will be an essential reference in the comparative literature on social policy in developing countries.

Contrary to the long-standing assumption that the best way to reduce poverty is first to grow, McGuire's study finds that the best way to keep children alive is not to give all priority to economic growth. While economic wealth does tend to determine the level of infant mortality, the causal relationship between faster growth and steeper rates of decline is weaker. Some of the periods of sharpest decline in infant mortality, moreover, came during decades of anemic growth when inexpensive programs that included health education, family planning, and water and sanitation services were made available to the very poor. Once having definitively demonstrated the critical role of the targeted public provision of basic health care to the needy, McGuire tackles the question of where the impetus to public provision comes from, especially since not all of the success stories showcased in the book were democracies. More important than regime type, the author contends, is the “habit” of democracy, and the inculcation over the long term of what citizens could come to expect of their states. Even dictators worried about their base of support and international reputation, taking care to cultivate their reputations.

McGuire chose his cases to highlight different democratic traditions and growth rates—his variables of primary interest. But they are also instructive for what they say about the possibilities and pitfalls of neoliberal economic reform. Paradoxically, in the most ruthless of neoliberal experiments the world has perhaps ever known—the bloody dictatorship of Augusto Pinochet in Chile—infant mortality rates fell precipitously. After leveling off, they fell again impressively after a democratically elected center-left coalition assumed the presidency in 1990, but that government, which invested more resources in health-care provision, did not dismantle Pinochet-era neoliberalism. In Brazil, economic reform inspired episodic protests against IMF agreements, privatizations of state-owned enterprises, and the restructuring of state commitments to public sector workers, but it also enabled successive governments, beginning in the mid-1990s, to transform Brazil from a “laggard” to a “leader” in the provision of basic health care to vulnerable populations. In East Asia, the impressive decline in infant mortality rates in Taiwan is attributable not to the introduction of universal health insurance in the mid-1990s but to “shared growth”—a rapid rise in GDP per capita coupled with the most equitable distribution of income outside of Europe—and the effective public provision of basic health-care services to the poor in earlier decades. South Korea, which first had to recover from the ravages of war in the 1950s, also dramatically reduced infant mortality with rapid growth and low income equality, as well as the provision of family planning, water and sanitation, and maternal and infant health care and nutrition.

McGuire's conclusions are unambiguously hopeful. While shared growth and long democratic traditions are most propitious, it would seem that any government that sets its mind to it can scare up the resources to keep children alive, make them healthier, lay the foundation for them to lead productive lives, and serve the cause of social justice. Hope can turn to heartbreak and rage, however, when his account is juxtaposed to Silva's. The reader of both books will inevitably ask, given McGuire's powerful conclusions: What level of ideological blindness or sheer greed would allow any government to stand by while children die of preventable diseases? It is to be hoped that these works will contribute to ensuring that citizens demand that governments apply these lessons to the improvement of the human condition.