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From issue: The Environment (Fall 2009)

Policy Updates

A snapshot of policy trends and successes in the region.

In this issue:

Drug Decriminalization: A Trend Takes Shape

Coletta A. Youngers and John M. Walsh

Latin American frustration with the “war on drugs” is growing. Harsh anti-drug laws have failed to stem apparently rising drug use, and incarceration rates are climbing—up 40 percent on average in Mexico and South America over the last decade—with more drug users and low-level dealers behind bars. But high-level drug traffickers carry on with impunity.

Increasingly, many countries are leaning toward decriminalization as an alternative approach, hoping that it will be effective both in reducing consumption and dealing with associated health problems. This approach treats drug abuse as a public health and social policy issue rather than as a criminal justice problem. The goal is to encourage addicts to seek help, reduce prison overcrowding and free law enforcement to focus on dismantling drug-trafficking organizations.

Decriminalization proposals often spark fears that drug use will rise, but experts such as the University of Maryland’s Peter Reuter find no evidence of this in the case of personal marijuana consumption.

On August 25, the Argentine Supreme Court ruled that it was unconstitutional to impose criminal sanctions for the personal possession of drugs. Although narrowly written, the judgment paves the way for legislation that would decriminalize the possession of illicit drugs for personal consumption.

Just days before the Argentine ruling, Mexico followed a similar path with a law decriminalizing possession of small quantities of drugs and mandating increased prevention and treatment programs. Those apprehended with a minimal amount of drugs—for example, 0.17 ounces (5 grams) of marijuana or 0.02 ounces (500 milligrams) of cocaine—will be encouraged to seek treatment, which becomes mandatory after the third arrest. The rationale: allow law enforcement to instead target small-scale dealers and criminal networks. However, the new law sets a low threshold in differentiating between a consumer and a seller and applies harsher penalties for small-scale dealing. It may also send more recreational drug users to jail.

Uruguay, which never criminalized drug possession for personal use, takes a more holistic approach. Instead of a quantitative cut-off between what is considered consuming and dealing, judges—in accordance with a 1974 law—evaluate the specific circumstances and assess why the individual possessed the drugs. Some legal analysts view this as arbitrary, but such discretion can prevent consumers from ending up in jail.

In Brazil, legislative changes in 2002 and 2006 led to the partial decriminalization of possession for personal use, replacing prison sentences with mandatory treatment and community service. Discussion is underway on further reforms that would fully decriminalize consumption and ensure proportionality of sentences for convicted drug dealers.

Some of the most far-reaching reforms are set to be implemented in Ecuador, where the Ministry of Justice is completing draft legislation that would decriminalize consumption and ensure proportionality of sentences in drug cases. Ecuador’s new constitution, approved in September 2008, states that “addictions are a public health problem” and mandates government agencies to develop prevention and treatment programs.

Ecuador is known for having one of the region’s harshest anti-drug regimes. A small-time trafficker faces a 10 to 25-year sentence but a convicted murderer can only be sentenced up to 16 years. As a stop-gap measure until the new legislation is approved, the government of President Rafael Correa pardoned more than 2,000 drug “mules”—those carrying small amounts of drugs—who fulfilled three criteria: first-time offenders, those caught with a maximum of 4.4 pounds (2 kilograms) of any drug and those who completed 10 percent of the sentence (or a minimum of one year).

Despite the trend toward decriminalization and the lack of evidence that changes in personal possession laws make any difference in drug-use rates, skeptics worry that decriminalization sends the wrong message. They argue that such policies legitimize drug use, encourage young people to experiment with illegal drugs and could lead to increased drug-related crime.

Such is the case in Colombia. President Álvaro Uribe has proposed recriminalizing consumption in an attempt to reverse a 1994 decision by the Colombian Constitutional Court that declared it unconstitutional to punish drug possession for personal use. Colombian adults can possess up to 0.7 ounces (20 grams) of marijuana and 0.03 ounces (1 gram) of cocaine, among other substances, for consumption in their own homes and not face criminal sanctions. But the president sees this as inconsistent with efforts to curtail drug trafficking.

Since 2003, the Colombian President has unsuccessfully tried five times to overturn the court’s ruling and amend the constitution. Another proposed constitutional amendment is working its way through the Colombian Congress simply stating: “The possession and consumption of narcotic or psychotropic substances is prohibited.” But the Colombian Supreme Court recently reaffirmed the 1994 Constitutional Court ruling.

As many Latin American countries opt for some form of drug decriminalization, the U.S., long a promoter of criminal sanctions to rein in drug abuse, has largely kept quiet. Although the reaction, or lack thereof, from the administration of President Barack Obama should not be confused with agreeing with decriminalization, the Latin American reforms come at a time when the drug war is coming under question in the U.S. as well.

A federal Sentencing Commission initiative allows more than 19,000 drug offenders to apply for early release over the next 30 years. Numerous state governments, many facing fiscal crises, have moved to scale back harsh drug sentencing statutes that helped fuel the incarceration boom in recent decades. But, it appears that many countries in Latin America are already charting a different course.

Health and Equity in Latin America

Antonio Ugalde and Núria Homedes

The debate over health care reform in the United States has echoes in Latin America. But across the region, a variety of attempts to improve health care delivery—with Chile, Cuba and Colombia offering starkly different approaches—has resulted in quality care still being largely inaccessible. Some Latin Americans benefit from access to good local and international health care, but the majority struggle to obtain basic care.

Until the middle of the twentieth century, Latin American health care systems were quite similar. Typically, health care was offered to employees in the formal labor market through public health insurance plans paid for by a combination of employer, worker and government contributions. The poor had access to publicly delivered services of variable quality, while the wealthy relied on private services. Private charity organizations—mostly religious groups—attempted to fill the gap. But the result was fragmented and inequitable systems.

In 1952 Chile became one of the first countries to break the traditional Latin American model. The governing Christian Democratic Party organized a single-payer national health system similar to many European systems where the public sector financed health care and all citizens could receive free care. But under the rule of General Augusto Pinochet (1974–1990) the national system was replaced with a public-private approach, opening medical care delivery to the private sector and decentralizing it to the municipal level. This system—criticized for benefiting the wealthy at the expense of other social groups—continues despite changes introduced since the country’s return to democracy.

In Cuba, a government-run health system provides free, universal coverage, which has brought major improvements in the quality of care. But it lacks productivity and efficiency and needed management improvements.

Colombia’s health reform, launched in 1993, offers yet a third model. It dismantled the social security and public-sector services system common throughout much of the region, and replaced it with a system based on neoliberal principles, in which private and public providers compete for clients. Insurance premiums are paid by employers, with the government covering those for the needy. But high co-payments have prevented the poor from gaining access to the system. The results are typically unimpressive: skyrocketing total health expenditures without visible improvements in equity. Studies also indicate that efficiency and quality have deteriorated. On the delivery side, insurance companies report large profits and high administrative expenditures while many hospitals have gone bankrupt.

The Costa Rican Alternative

A fourth, and more promising, model of care has existed in Costa Rica since 1974. It involves integration of the social security program—the Caja Costarricense de Séguro Social (CCSS or Caja)—with the medical services offered by the Ministry of Health. In effect, it is a single-payer model managed by Caja and financed by the employers, employees and the government, with the government subsidizing care for the poor.

The results have been impressive: 86 percent of the population has equal access to quality, comprehensive care. Medical services, including transplants, are free as are prescribed pharmaceuticals. The 14 percent not served by Caja are mostly the wealthy and the self-employed who prefer to pay as you go. According to the World Health Organization, life expectancy is now the longest in Latin America: 75 years for men and 80 for women.

But Costa Rica didn’t get to this point without some trial and error.

In the 1980s Caja organized a handful of health cooperatives and a capitation system (where a set amount is paid for each person in a health plan assigned to a specific provider) that failed to improve the efficiency or coverage of health care. Other experiments have proved to be more successful. In 1974 factories were permitted to hire physicians to work on-site, providing workers with easier access to care. Lab and diagnostic tests, hospitalization, specialty care, and drug provision continue at Caja locations. A similar program has allowed patients to pay low fees and be treated by private physicians of their choosing while still receiving other Caja services.

There is no perfect health system, and Costa Rica has experienced its share of problems. There has been corruption at high administrative levels, and physicians have found ways to take advantage of the system by reducing work load or using public resources for personal gain. But overall many experts consider Costa Rica to have the region’s most efficient, comprehensive, equitable, and affordable health system.

Education: Three Years After Chile's Penguin Revolution

Jorge Fábrega

In 2006, high-school students in Chile took to the streets to protest the country’s education system, sparking President Michelle Bachelet’s first major crisis. Known as the Penguin Revolution (a term that refers to the students’ white and black uniforms), the protests accomplished what decades of public debate had failed to do: force a political agreement to reform institutional practices in place since the 1980s. The student movement—perhaps the most successful in the country’s history—responded to widespread complaints that despite public education funding, the system’s guiding principles perpetuate socioeconomic differences.

As a result, needed change has come to Chilean education. But there is still much work to be done.

In practice, Chilean schools are segregated by socioeconomic levels. The Education Ministry classifies them into five groups using a methodology that combines information about household income, parents’ educational level and characteristics of the particular educational institution. Gaps in the educational outputs of these groups increase with years of schooling. For example, upon completion of their fourth year, the gap between students belonging to the high and low ends of this segregated system reaches 26 percent in reading comprehension and 36 percent in mathematics. By the tenth year, these differences increase to 36 percent and 55 percent, respectively.

Although formal education is compulsory up to middle school, this gap in quality severely limits the ability of students in the lower socioeconomic classes to compete for admission to higher education institutions—the grand prize where human capital investment returns are most concentrated. A recent study by Claudio Sapelli of the Pontificia Universidad Católica de Chile shows that as of 2006 students who completed middle school earned between 9 percent and 12 percent more than those who did not. The economic returns of a technical or professional degree were higher, with graduates earning 20 percent more than non-graduates. And for those who possessed a college or university degree this number increases to 24 percent.

Moreover, public higher education spending is concentrated on the 25 universities in existence when the current legal framework was created, though more than 200 universities and technical institutes operate today. This has led to a shortfall in financial aid for middle- and low-income students. Unlike wealthier youth, a financially struggling student who achieves a competitive but not outstanding score on the university entry exam can only apply to limited universities. The result: 67 percent of students in the highest socioeconomic groups enter a college or university, a sharp contrast with the 20 percent for lower-socioeconomic class students.
This means that the grand prize of the Chilean educational system—higher education—is obtained by only a fraction of those who should be reaching this goal. Penguins were right when they pointed to the structural inequalities of the system as the cause of Chile’s educational failures.

Beyond the Penguin Revolution

The Penguin Revolution accelerated the changes needed to eliminate these gaps. For example, in 2008 a new system was established for primary and middle-school subsidies that allocates more funds for schools catering to the less fortunate. This subsidy is estimated to inject an additional $900 million into the educational system, doubling the resources destined to priority students. Last year the Education Ministry also launched a program called INICIA (or, in English, START) to improve training for primary- and secondary-school teachers. As of December 2008, 80 percent of teacher-training schools were enrolled in this program.

Another initiative has focused on merit-based scholarships. The Education Ministry’s Milenio (Millennium) scholarship covers a portion of the annual tuition at a technical school for low- and middle-income students with a grade-point average above 5 (on a scale of 1 to 7). Through 2005, it had annually awarded fewer than 10,000 of these scholarships; this year the ministry will grant 50,000 of them. Scholarships for domestic postgraduate work have also increased by 65 percent since 2005, while foreign postgraduate awards gained momentum through a new program called Becas Chile (Scholarships for Chile). This year Becas Chile will reach 2,500 fellows and next year another 3,500—a notable advancement considering that up until 2007 only 200 of the 5,815 Chileans studying abroad received public funding.

Although none of these initiatives is a direct result of the students´ demands, the Penguin protests unlocked energy needed to put these programs into effect. The protests created a sense of urgency that produced an unexpected consensus over a sweeping new general education law last August.
The new general education law extends middle school from four to six years, and reduces elementary school from eight to six years. It also prohibits private schools from pre-selecting students before the sixth grade. Significantly, the law prevents private schools from siphoning off the best students (which the private schools have a financial incentive to do under the voucher system).

The new law also creates the Agencia de Calidad de la Educación (Education Quality Agency) responsible for monitoring the overall quality of the education. Schools will then be sanctioned for poor performance—a process that could result in closing a school.

Unfortunately, the consensus has not been sufficient to introduce urgent higher-education reforms.

Nevertheless, the Chilean education system has come a long way. since the first reform debates held even prior to the Penguin Revolution. It wouldn’t be far-fetched to say that today’s reforms are the result of battles fought by teenage students three years ago.

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