Democratization of Brazilian Health Councils: The Paradox of Bringing the Other Side into the Tent


Contemporary discussions of ‘democratic innovation experiences’ have evolved into a heated debate about how effective these ‘new spaces’ are in including ordinary citizens, particularly those traditionally marginalized and excluded. This article focuses on the Brazilian experience with Health Councils and begins by discussing the conditions that have been pointed out by previous studies as favouring the inclusion of these groups in these ‘new spaces’. On the basis of these studies, one question that remains is about the democratic legitimacy of these experiences, as it seems that there is a bias towards the inclusion of those that already have political ties with the traditional political system. The local Health Councils in 31 subprefeituras(new administrative subdivisions) of the city of São Paulo were researched and a continuum was observed: ranging from a small number of one or two sectors that have historical ties with political parties included in the council to a far more diversified composition, including up to seven sectors with autonomous representatives and various types of association. Using these results as their starting‐point, the analyses conclude with a discussion of the relative significance of the factors previously identified as central in establishing the democratic legitimacy of these ‘new democratic spaces’.