Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name





Ruth Milkman

Committee Members

Charles Post

Janet Gornick

Jeff Webber

Paula Varela

Subject Categories

Comparative Politics | Health Policy | Inequality and Stratification | Politics and Social Change | Quantitative, Qualitative, Comparative, and Historical Methodologies | Social Policy | Social Welfare


Social Policy, Latin America, Social Welfare, Political Economy, Comparative Historical Analysis, Public Policy, Health Policy


In the first decade and half of the 21st century, most Latin American countries experienced a long-overdue reduction in income inequalities and significant social policy expansion. While this welfare expansion has been widely documented, scholars have paid less attention to the persistent or increasing segmentation: inequalities in transfers and in the quality of services across population groups continued unabated. This dissertation employs mixed-methods to respond to the following questions: have governments in Latin America, and Left governments in particular, made significant progress toward universal social policy?

For 17 Latin American countries in the period 2000-2020, I measure three dimensions of welfare policy (inclusion, generosity, and equity) in four policy areas: health care, transfers, education, and family policies. Following a welfare-regime framework, I determine the degree of decommodification for each country over time. The results show that most countries made significant improvements in inclusion and generosity in social policy, but not in terms of equity: inequities in transfers and in the quality of services across sectors of the population slightly increased. Left governments made larger strides in decommodification, but they also failed to make improvements in equity. At the same time, an across-the-board growing reliance on targeted, social-assistance programs marks a general shift toward a more liberal type of welfare regime. A cluster analysis provides an accurate classification of welfare regimes for Latin America in 2002 and 2017, and depicts the emergence of new regimes: advanced and dual compensatory states.

Building on both neo-Marxian and institutionalist theories of the state and welfare development, my comparative historical analysis of pension and health policy in Uruguay, Argentina and Chile highlights the importance of crises of legitimacy in bringing progressive structural reforms onto the agenda. In addition, policy legacies, the balance of forces between classes, and the character of the party in power are key variables explaining the diverse outcomes across cases. Capital’s structural power and elected officials’ structurally-determined interest in maintaining business confidence explain the increased penetration of the market in social policy across cases.

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