Regional governance and legitimacy in South America: the meaning of UNASUR
PIA RIGGIROZZI AND JEAN GRUGEL*
Claims that South American regionalism has failed have been common for a decade or more.1 Despite the fact that regional initiatives have proliferated since at least the 1960s,2 issues of sovereignty, the absence of economic complementarity and rapid shifts in global economic power have acted as a brake on the creation of an effective South American common market and on 'open' regionalism, or integration through market opening. The result, according to Malamud, is the 'segmented proliferation' of weak and unstable models of region-building, leading some to conclude that regionalism in South America should be understood as little more than a series of disappointments.3 This conclusion would hold good if regionalism were only about economics. But, as Börzel has pithily put it, when it comes to regionalism, 'it's not only the economy, stupid'.4
In fact, regionalism in South America is far from being consigned to the scrapheap. Instead it is in a process of dramatic, but quiet, transformation. In contradiction to the economic projects of the 1990s and the early years of the millennium, contemporary region-building in South America is firmly political and intergovernmental in character. It bypasses questions of trade and investment in order to focus on shoring up democracy, managing the social deficit and buttressing regional security. The key idea underpinning regionalism now is to provide a space above the state for debate, knowledge-sharing and the promotion of new practices and methods of regional policy formation, and to provide democratically elected governments with some external support mechanism to which they can turn when faced with internal and external critics. In this new register, regional governance is taking shape in a less spectacular way than in the
* This article draws on a combination of documentary analysis, newspapers and interview data. Some of the research was carried out in the context of a research project supported by the Economic and Social Research Council (ESRC), grant ref. ES/L005336/1. The article does not necessarily reflect the opinions of the ESRC.
1 Nicola Phillips, 'Hemispheric integration and subregionalism in the Americas', International Affairs 79: 2, March 2003, pp. 327—49; Andres Malamud, 'Overlapping regionalism, no integration: conceptual issues and the Latin American experiences', EUI working paper, RSCAS 2013/20 (Florence: European University Institute, 2013).
2 Andres Rivarola Puntigliano and Jose Briceno Ruiz, 'Regional integration: linking past and present', in Andres Rivarola Puntigliano and Jose Briceno Ruiz, eds, Resilience of regionalism in Latin America and the Caribbean: development and autonomy (New York: Palgrave Macmillan, 2013), pp. 1—18.
3 Malamud, 'Overlapping regionalism, no integration', p. 8.
4 Tanja Börzel, 'Comparative regionalism: a new research agenda', KFG working paper series no. 28 (Berlin: Kolleg-Forschergruppe, Freie Universität, Aug. 2011), p. 16.
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Pia Riggirozzi and Jean Grugel
past and it is proceeding in parts, rather than in response to a comprehensive road map set out in advance.
As Riggirozzi and Tussie argue, contemporary regionalism in South America is shaped by the changed geopolitics of the Americas.5 The relative decline of the United States and the fact that Washington is focused on domestic concerns and international crises outside the hemisphere, combined with Brazil's foreign policy dilemmas, mean that there is no undisputed regional hegemon.6 UNASUR, the most significant of the new 'post-hegemonic'7 forms of regional governance schemes, was created in 2008. Its Constitutive Charter establishes as its main goals 'to address social development, deepen democracy and establish economic complementarities between the member states for the purpose of poverty reduction'.8 In some ways, it picks up where the earlier idea of the Common Market of the South (MERCOSUR), which dates from 1991, left off. But while MERCOSUR represents only five South American countries (Argentina, Brazil, Paraguay, Uruguay and Venezuela), UNASUR, with twelve, unites the southern hemisphere. Just as importantly, UNASUR set aside any attempt at economic integration—precisely the area where MERCOSUR has floundered—in order to focus on developing a deeply political badge of identity.
There is certainly some doubt as to how much UNASUR can actually deliver, even with this more limited mandate. UNASUR needs to build its legitimacy and show its worth. With this in mind, we explore in this article some key aspects of how UNASUR is seeking to build its legitimacy as a regional actor through the protection of democracy and the promotion of welfare, with a focus on the provision and sharing of information in support of rights-based social policy delivery.
As with all supranational organizations, there are questions to be asked about UNASUR's democratic mandate. There are no mechanisms for direct inputs from civil society or South American electorates into UNASUR. Yet we would argue that UNASUR is nonetheless more directly concerned with the state of democracy in South America than other attempts at integration in the region's recent past. With regard to welfare and the social deficit, UNASUR is making efforts to effectively link policy-making with the rights-based approaches that address the needs of the region's poor and most vulnerable citizens; and with regard to diplomacy, UNASUR is developing a profile as an energetic defender of regional democracy. We conclude that UNASUR is developing a hybrid form of legitimacy: output-focused and based on a normative vision of its role in the provision of regional public goods, namely democracy, human rights and the eradication of poverty.
5  Pia Riggirozzi and Diana Tussie, eds, The rise of post-hegemonic regionalism: the case of Latin America (Dordrecht: Springer, 2012).
Christopher Layne, 'This time it's real: the end of unipolarity and the pax Americana', International Studies Quarterly 56: 1, 2012, pp. 1—11.
7 Riggirozzi and Tussie, The rise of post-hegemonic regionalism.
8 UNASUR constitutional treaty (Tratado Constitutivo de la Union de Naciones Sudamericanas), art. 3.1, http://www.comunidadandina.org/unasur/tratado_constitutivo.htm, accessed 27 May 2015.
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Regional governance and legitimacy in South America
Legitimacy and democracy in regional governance
All governance projects require legitimacy, understood as a process of validation of action taken by political leaders.9 Without legitimacy, governance is fragile, even dysfunctional.10 Yet it is also the case that all forms of governance above the state suffer from a legitimacy deficit to a greater or lesser degree. The legitimacy of international organizations is questionable precisely because there is no 'people' able to hold them to account and no direct evidence, therefore, that their actions are supported by a democratic mandate. For this reason there is considerable debate as to how—indeed whether—international governance can be justified.11
Broadly, for state-centric International Relations scholars, democratic states can confer legitimacy on supranational organizations, especially if those organizations explicitly 'promote the key values that underlie demands for democracy'.12 Critical theorists, however, do not accept either the methodological nationalism implicit in this view or its elitism. Instead, they argue that international governance should be directly accountable to citizens in some way and point to the range of organizations, from social movements to transnational non-governmental organizations, that seek to influence the decisions of international bodies.13 Regional governance institutions can present even more acute problems of legitimacy since they are sometimes designed to take on day-to-day regulatory functions and intervene directly in the lives of citizens.14 For this reason, the EU responded to its democratic deficit by creating an elected parliament and seeking to include civil society networks in its governance structure, a process MERCOSUR explicitly sought to emulate.15 Nonetheless, the debate about legitimacy in regional organizations, particularly lively in EU studies, continues, tending to highlight the constitutional deficit related to legal and procedural aspects of representation, accountability and democratic allocation of political authority.16
If legitimacy through democracy is traditionally regarded as 'input' legitimacy, supranational organizations also justify their existence through 'output' or efficiency legitimacy.17 Risse suggests that if governance above the state level contributes to 'better' outcomes, that is through interventions that effectively
9 Christian Reus-Smit, 'International crises of legitimacy', International Politics 44: 2, pp. 157—74 at p. 158.
10 Andrea Ribeiro Hoffmann and Anna van der Vleuten, eds, Closing or widening the gap? Legitimacy and democracy in regional integration organizations (Aldershot: Ashgate, 2007).
11 For an interesting review of the legitimacy of international organizations from the perspective of international law, see Daniel Bodansky, 'The legitimacy of international governance: a coming challenge for international environmental law', American Journal of International Law 7: 1, 1999, pp. 583—624.
12 Allan Buchanan and Robert Keohane, 'The legitimacy of global governance institutions', Ethics and International Affairs 20: 4, 2006, pp. 405—37 at p. 417.
13 Jan Aart Schölte, 'Civil society and democratically accountable global governance', Government and Opposition 39: 2, 2004, pp. 211-33.
14 Arthur Benz and Yoannis Papadopoulos, 'Actors, institutions and democratic governance: comparing across levels', in Arthur Benz and Yoannis Papadopoulos, eds, Governance and democracy: comparing national, European, and international experiences (London: Routledge, 2006), pp. 273—95.
15 The EU's weaknesses in this respect are captured by Kalypso Nicolaidis and Richard Youngs, 'Europe's democratic trilemma', International Affairs 90: 6, Nov. 2014, pp. 1403—19.
1 Juha Jokela and Bart Gaens, 'Interregional relations and legitimacy in global governance: the EU in ASEM',
Asia Europe Journal 10: 2, 2012, pp. 145—64. 17 Fritz Scharpf, Governing in Europe: effective and democratic? (Oxford: Oxford University Press, 1999).
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tackle common problems and provide public goods, this can compensate for the absence of democratic control.18 Steffek goes further, suggesting that effective institutions above the state have a kind of democratic legitimacy, despite an absence of democratic process, if it can be shown that outputs are of benefit to the 'public interest'.19 He argues: 'Democratic output legitimacy is present when government delivers results that are in the public interest of the respective community; based on encompassing knowledge pertinent to the issue; and that do not violate the human and civil rights of any member of the community.'20
There are risks with this approach, however, not least the separation of democracy from process and citizenship, and the reduction of democracy to the absence of rights violations. Nevertheless, caveats aside, both Steffek and Risse make a convincing case that an absolute distinction between input and output legitimacy (or, put differently, democracy versus efficiency) does not always make sense. Both point to the emergence of forms of international and regional governance that are not directly democratic, but that nevertheless uphold democratic values and consciously seek to act for the collective good. In the process, they raise the prospect that regional governance can actively enable more and better democratic governance within national states even when it is not itself democratic in form. It could be argued, for example, that regional organizations promote democracy in member states if they support national governments in achieving democratically mandated goals, 'lock in' democratic reforms and defend democratic practices.21 They can do so through negative action—excluding states that contravene established democratic standards—and in positive ways, by embedding democratic or human rights-based legislation, or supporting capacity-building, the provision and sharing of information, standard-setting and regulation, policy creation and debate, and research and development, provided those policies promote deeper democracy and/ or enhance and extend human rights, well-being and welfare. Following Majone's theorizing about European and regional integration more generally, we propose that regional organizations can significantly address market failures and produce policy outcomes that are redistributive and efficient, supporting the identification of policy gaps and suitable decision-making, and improving existing policies in member states—what Majone identified as 'Pareto optimal' solutions.22 From this perspective, the discussion of legitimacy moves away from deliberative issues of democratic input to a focus on efficient responses and credible policy-making.
These debates have generated many thought-provoking contributions concerning the EU and its democratic credentials, while suggesting the importance of being alert to the possibility that regionalism might derive its legitimacy
18 Thomas Risse, 'Transnational governance and legitimacy', in Benz and Papadopoulos, eds, Governance and democracy, pp. 179—99.
19 Jens Steffek, 'The democratic output legitimacy of international organizations', discussion paper SP IV 2014— 101 (Social Science Research Centre, Technische Universität Darmstadt, Berlin, Feb. 2014).
20 Steffek, 'The democratic output legitimacy', p. 8.
21 Jon Pevehouse, Democracy from above: regional organizations and democratization (Cambridge: Cambridge University Press, 2005); also Ribeiro Hoffmann and van der Vleuten, eds, Closing or widening the gap?
22 Giandomenico Majone, Regulating Europe (London: Routledge, 1996) and Dilemmas of European integration: the ambiguities and pitfalls of integration by stealth (Oxford: Oxford University Press, 2005).
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Regional governance and legitimacy in South America
in quite different ways. In comparative perspective, this is particularly relevant in the global South, where there is a need to compensate for limited state capacity. The analysis also suggests the possibility that post-hegemonic regionalism in South America, and UNASUR in particular, might draw legitimacy from quite different sources from either the EU or earlier region-building projects in South America. As the following sections explain, knowledge creation, knowledge-sharing and support for welfare delivery are at the heart of UNASUR's mission; one measure of UNASUR's success, therefore, is its capacity to deliver expertise and support national-level welfare policy-making, working directly with governments. Another will be its capacity to serve as a regional protector of the transitions to democracy, which still periodically come under strain and which are vital for the international reputation and standing of the region as a whole. This new phase of regional governance is less headline-grabbing and dramatic than previous projects of integration in South America; it is, after all, chiefly about embedding and extending programmes and norms associated with national-level governance. Precisely for this reason, however, this more limited project seems to be more legitimate within South America than earlier, and sometimes highly controversial, region-building schemes.
Renewing South American regionalism: addressing the credibility gap
UNASUR is taking shape in a context of scepticism about the value of deep integration, in sharp contrast to the 1990s. Expectations, on the part of policymakers and citizens alike, are relatively low. UNASUR follows on from two quite intense decades of region-building based chiefly on the principles of inter-regional/interhemispheric trade and market opening. 'New' regionalism, as it was known, comprised the various attempts to make regionalism fit the realities of a neo-liberal, post-communist global political economy in the 1990s, and is the topic of a vast and still growing literature.23 To recap a now well-known debate, the point of new regionalism was to 'lock in' neo-liberal economics and trade reforms. The Free Trade Area of the Americas (FTAA) was meant to stabilize market opening in South America and refashion hemispheric politics and economics in ways that suited the interests of transnational capital and US power. It was a radical and controversial project, precisely because it meant the subordination of South America to North American economic interests. A reassertion of South America followed, in the shape of the Common Market of the South or MERCOSUR, under the (unacknowledged) leadership of Brazil.24 By the mid-1990s, then, there were two distinct integration models in play. Both were
23 Jean Grugel and Will Hout, eds, Regionalism across the North—South divide: state strategies and globalisation (London: Routledge, 1999); Louise Fawcett and Helene Gandois, 'Regionalism in Africa and the Middle East: implications for EU studies'', Journal ofEuropean Integration 32: 6, 2010, pp. 617—36; Fredrik Soderbaum and Timothy M. Shaw, Theories of new regionalism (Basingstoke: Palgrave Macmillan, 2003); Louise Fawcett and Monica Serrano, eds, Regionalism and governance in the Americas: continental drift (Basingstoke: Palgrave Macmillan, 2005).
24 Phillips, 'Hemispheric integration and subregionalism in the Americas'; also Bjorn Hettne, 'Globalization and the new regionalism: the second great transformation', in Bjorn Hettne, Andras Inotai and Osvaldo Sunkel, eds, Globalism and the new regionalism (London: Macmillan, 1999), pp. 1—24.
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ambitious. The FTAA aimed for hemispheric integration through the imposition of neo-liberal economic rules, while MERCOSUR sought to build a common market committed to phased market opening, complemented by a set of political institutions along the lines of the European model.
By the early 2000s, it was evident that the FTAA, the US-led model of hub-and-spoke regionalism with Washington at the centre of a vast network of trade arrangements across the hemisphere, would prove unacceptable in South America. The Mar del Plata Summit of the Americas in 2005 effectively signalled the close of the project.25 So spectacular a failure requires explanation. Some of the principal difficulties, at least on the South American side, resided in a widespread belief in state sovereignty (and therefore hostility to what came to be seen as policies leveraged from Washington), combined with hyper-presidential powers that allow elected heads of state to reverse decisions taken by their predecessors.26 The FTAA sparked intense mass popular opposition, in which the rejection of the idea of leadership by North America combined with widespread protest brought on by exhaustion with neo-liberalism itself. Attempts at elite civil society inclusion in regionalism through formal but somewhat meaningless consultations were dismissed by most social movements in the region as no more than invited participation.27 Mass mobilization to oppose the FTAA led to the formation of national and transnational social movement coalitions and fed into the World Social Forum in 2001, where activists came together to debate alternatives to global neo-liberalism. The return of grassroots politics to centre stage in South America through the protests against the FTAA, in fact, marked the beginning of the region's electoral shift to the left.
MERCOSUR, meanwhile, though it offered a far more modulated engagement with markets and certainly did not excite the same kind or degree of opprobrium as the FTAA, was far too ambitious in view of the limited capacity of most member states and their relatively weak commitment to it, a fact that was generally acknowledged by policy-makers in private although rarely in public. At the same time, MERCOSUR offered very little to regional electorates whose main concerns lay with domestic politics. So, as Brazil focused its attention on playing a role globally through the BRICS, MERCOSUR simply stalled.
As Malamud rightly points out, the overall achievements from this period, especially when set in the context of its ambition in terms of economic integration, are quite low.28 Institutionally, decision-making processes in regional governance have been captured by a strong form of 'presidentialism', reinforcing the power of executives at the expense of other voices. In terms of delivering social protection, welfare and human development, these continued to be seen as the subject of (seriously constrained) domestic spending choices, often to mitigate
25 Mario Carranza, 'Clinging together: Mercosur's ambitious external agenda, its internal crisis, and the future of regional integration in South America', Review of International Political Economy 13 : 5, 2006, pp. 802—29.
2 Andres Malamud, 'Mercosur turns 15: between rising rhetoric and declining achievement', Cambridge Review of International Affairs 18: 3, 2005, pp. 421—36.
27 Rosalba Icaza, Peter Newell and Marcelo Saguier, 'Citizenship and trade governance in the Americas', in John Gaventa and Rajesh Tandon, eds, Globalizing citizen: new dynamics of inclusion and exclusion (London: Zed, 2010).
2  Malamud, 'Overlapping regionalism, no integration'.
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the effects of market reforms or to secure trie political support of citizens.29 Trie fact is that, in the end, regionalism played a much smaller role than had been imagined in the political economy of South America; in turn, this means that there is now something of a credibility gap in South America as to the democratic legitimacy and the worth of regional governance itself. But as the United States signalled sharply diminished interest in the region with the failure of the FTAA and the demands of its own concerns elsewhere, the question was never whether regionalism would be abandoned so much as how it would be reimagined. The strong sense of 'regionness' within South America and the longstanding tradition of cooperation among its constituent states made abandonment an option not to be contemplated.30
UNASUR—or the reimagined model of regionalism—has as its chief strength its close fit, or at least its capacity to engage, with the new architecture of centre-left democracy in South America. As Acharya notes, changes to the form of national democracies profoundly affect the nature of regional governance.31 UNASUR fits the paradigm shift that began in South America in the early 2000s, as the conservative politics of the early years of democratic transition in the region gave way to the range of left and centre-left governments that dominate the region today. Part of the so-called 'post-neo-liberal' shift in South America is a fresh articulation of the nation and a more plural engagement with ideas about development than neo-liberalism would permit.32 The new left governments that took office across the region—in Venezuela (1998), Brazil (2002), Argentina (2003), Uruguay (2004), Bolivia (2005), Ecuador (2006), Paraguay (2008) and Peru (2011)—promise mixed economies and a generally pragmatic combination of welfare and populist policies.
Not surprisingly, then, the combined demands that national differences be respected, new forms of regional cooperation be strictly intergovernmental and responsibility for economic decision-making be recognized as sitting squarely with national governments have shaped the debate about the purpose and future of regionalism in South America. At the First Summit of South American Presidents in 2000, which was to give rise to UNASUR a few years later, discussions turned on how to support regional democracies and encourage development by deepening contacts and flows—of ideas, as well as material goods—across the
29 Manuel Riesco, 'Binding material for a young giant? Regional social policies in Latin America', in Bob Deacon, Maria Macovei, Luke Van Langenhove and Nicola Yeates, eds, World-regional social policy and global governance: new research and policy agendas in Africa, Asia, Europe and Latin America (London: Routledge, 2010), pp. 108-39.
30 For reasons of space, we have put any discussion of ALBA (the Bolivarian Alliance for the Peoples of Our America) to one side in this article, but clearly the fact of its existence is significant in respect of the emergence of UNASUR. For a discussion, see Pia Riggirozzi, 'Region, regionness and regionalism in Latin America: towards a new synthesis', New Political Economy 7: 4, 2012, pp. 421—43; also Rivarola Puntigliano and Briceno Ruiz, 'Regional integration'.
31 Amitav Acharya, 'Democratization and the prospects for participatory regionalism in Southeast Asia', Third World Quarterly 24: 2, 2003, pp. 375-90.
32 See Jean Grugel and Pia Riggirozzi, 'Post-neoliberalism in Latin America: rebuilding and reclaiming the state after crisis', Development and Change 43 : 1, 2012, pp. 1—21; Mark Goodale and Nancy Postero, eds, Neoliheralism interrupted: social change and contested governance in contemporary Latin America (Stanford, CA: Stanford University Press, 2013).
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region.33 The South American Union of Nations was established in 2004 at Cuzco, Peru, and set out three principal goals. Two were fairly standard: the promise to reinvigorate interregional cooperation and the commitment to the creation of physical infrastructure (roads, energy and communications) to support better regional development. But alongside these was a promise of greater political cooperation in eradicating poverty and, particularly, in improving health.34 UNASUR's Constitutive Treaty explicitly declared the need to foster integration in ways that would support social inclusion and poverty eradication in ways that were based on the realization of rights.35 Supporting rights-based social policy, delivered through member states, came to be framed as a 'regional' responsibility. Moreover, a democratic clause was added to the Constitutive Treaty in 2010, allowing for measures to be taken against a member state if the democratic process were put in danger. In short, UNASUR became a 'space for political action',36 and it moved towards articulating a programme of action and a claim for legitimacy based on strongly political terms.
Seeking legitimacy through welfare policy
Since its formation, UNASUR has committed itself to supporting more effective social policy in member states, and official documents place a strong rhetorical emphasis on 'rights'. These priorities have come together, above all, in a commitment to welfare through rights-based health care; in marked contrast to the emphasis on trade and investment in earlier phases of region-building, health has become one of UNASUR's primary areas in its 'space for political action'. That health was a defining feature in the new regional agenda did not come about by chance. South America was fertile ground for the reignition of a regionalism incorporating the normative dimensions of a new era, at odds with the neo-liberal core and defiant of US mentoring, redirecting integration projects to respond to the legacies of poverty and Latin America's social debt.37 The scale of health needs in South America is immense, despite a fall in poverty rates of more than 14 per cent between 2000 and 2013.38 The region's poor are still at risk from the (re-) emergence of infectious diseases such as dengue and chagas, and parasitic diseases. In parts of the region, such as Bolivia, Paraguay and Peru, communicable diseases still determine the quality of life and life expectancy, while only limited access to basic medicines is still common.39 This bleak situation is exacerbated by the lack
33 Jose Antonio Sanahuja, 'Post-liberal regionalism in South America: the case of UNASUR', EUI working paper RSCAS 2012/05 (Florence: Robert Schuman Centre for Advanced Studies, European University Institute, 2012).
34 Riggirozzi and Tussie, eds, The rise of post-hegemonic regionalism.
35 UNASUR Constitutive Treaty, http://www.unasursg.org/documentos-normativos-unasur, accessed 29 May 2015.
36 Pia Riggirozzi, 'Regionalism through social policy: collective action and health diplomacy in South America', Economy and Society 43: 3, 2014, pp. 432—54.
37 Riggirozzi, 'Regionalism through social policy'.
38 Economic Commission for Latin America and the Caribbean (ECLAC/CEPAL), Social panorama of Latin America (Santiago de Chile, 2014).
39 John C. Holveck, John P. Ehrenberg, Steven K. Ault, Rocio Rojas, Javier Vasquez, Maria Teresa Cerqueira,
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of technical expertise and efficient national health regulatory structures, which in turn inhibit accessibility, quality and equity in the delivery of health services. Not surprisingly, government failures to deliver decent health care figured as part of the anti-neo-liberal protest across the region through the 1990s and the first years of the new millennium, when spending on public health plummeted as a consequence of neo-liberal reforms, and budgetary cutbacks and the privatization of health insurance directly reduced access to health care on the basis of rights.40
Tackling health policy signals quiet ambition within UNASUR. But addressing health deficits through regional cooperation is also a shrewd move in South America, since this is a policy area where there is considerable expert knowledge and where local and regional expertise is genuinely valued. The region, moreover, has some experience of successful cooperation in primary health care to build on, not only through the longstanding Pan American Health Organization (PAHO), but through the work undertaken by MERCOSUR and the Andean Community to put in place cross-border epidemiological control and surveillance in response to, and support of, increased movement of goods and people.41 The focus on health also means that there is a potential tangible 'deliverable' that can be attached to region-building in the form of measurably better health outcomes. Finally, better and more effective health policies feature among the demands of the new left, meaning that UNASUR can act in concert with national regimes in the region. The shift to the left in South America has put rights-based ideas about health on the political agenda as part of the concept of buen vivir (well-being), which has found a place in the new constitutions of Bolivia and Ecuador; discussions are also opening up about what 'universal' health care might look like in South America. In short, health is clearly an issue area where UNASUR can make a difference and connect strongly with current debates in the region. UNASUR has been careful to link the focus on health to the idea of democratically responsive regionalism: raising regional health standards is defined as a way to capture 'the energetic force of the people in the process for South American integration' and as a vehicle for inclusion and citizenship.42
Moreover, unlike other social areas, health has a history of social activism in the region. Decent health care has been part of the social justice agenda in South America since the mid-1950s, and in some cases the right to health was embedded within the agenda of democratization.43 In Brazil, the movimiento sanitarista (health
Josefa Ippolito-Shepherd, Miguel A. Genovese, and Mirta Roses Periago, 'Prevention, control and elimination of neglected diseases in the Americas: pathways to integrated, inter-programmatic, intersectoral action for health and development', BMC Public Health 7, 2007, http://www.biomedcentral.eom/1471-2458/7/6, accessed 29 May 2015.
40 See Nancy Birdsall and Jose L. Londono, No tradeoff: efficient growth via more equal human capital accumulation in Latin America (Washington DC: Banco InterAmericano de Desarrollo, 1998); Alejandro Portes and Kelly Hoffman, 'Latin American class structures: their composition and change during the neoliberal era', Latin American Research Review 38: 1, 2003, pp. 41—82.
41 Sistema Economico Latinoamericano (SELA), Bulletin 150 on the integration in Latin America and the Caribbean,
http://www.sela.org/attach/258/EDOCS/SRed/2010/07/T023600004239-0-Boletin_150__MAYO_20io_
Ingles_.pdf, accessed 27 May 2015, p. 56.
42 UNASUR Constitutive Treaty, p. 14.
43 Anne-Emanuelle Birn and Laura Nervi, 'Political roots of the struggle for health justice in Latin America', The Lancet, 2014, http://www.thelancet.com/journals/lancet/article/PIISoi40-6736(i4)6i844-4/fulltext, accessed 27 May 2015.
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movement) was part of the social movements that organized to demand democratization in the 1970s and early 1980s. It also played a role in the constitutional reform in 1988 that led to the introduction of a universal public health system in Brazil.44 Grassroots social movements have campaigned in the region around the slogan salud es democracia ('health is democracy'), promoting the idea that the right to health care is a central element of meaningful citizenship. Brazil—here again regional leader—also pioneered a form of health diplomacy and led international demands for access to medicines in response to the escalation of HIV and for price reductions in the procurement of pharmaceuticals for national health programmes.45 UNASUR's adoption of health as a key policy area therefore reflects both the demands of activist health professionals in the region and the organization's own wish to be seen as responsive to its societies.
The South American Health Council was created in 2009 to map out the broad parameters of UNASUR's health policy and take political responsibility for it. An intergovernmental body, it is made up of the ministers of health of the twelve member states. The role of the Council is to set policy priorities, working in conjunction with technical groups set up around some health themes and networks to help policy delivery. In 2009 the UNASUR Health Council approved a Five Year Plan, which outlined five areas for action:
• surveillance, prevention and control of diseases;
• development of universal health systems for South American countries;
• information for implementation and monitoring health policies;
• strategies to increase access to medicines and foster production and commercialization of generic drugs;
• capacity-building directed at health practitioners and policy-makers for the formulation, management and negotiation of health policies at domestic and international levels.46
Needless to say, the themes were not chosen at random. They make sense both epidemiologically, including areas where cooperation would be of direct benefit to the region's population (disease control, for example, or the prospect of greater availability of generic drugs), and politically, in corresponding to the demands of post-neo-liberal governments and their grassroots supporters for such measures as the development of universal health systems. In taking up health, then, UNASUR is directly connecting itself with the social struggles for access to health and health equity that have unfolded in the continent over many years.
44 Patricia De Mendonca, Mario Aquino Alves and Luiz Campos, 'Empreendedorismo institucional na emergen-cia do campo de politicas püblicas em HIV/AIDS no Brasil', 2010, Fundacion Getulio Vargas, http://rae.fgv.br/ rae-eletronica/vol9-numi-20io/empreendedorismo-institucional-na-emergencia-campo-politicas-publicas-, accessed 29 May 2015; Andrea Cornwall and Celestine Nyamu-Musembi, 'Putting the "rights-based approach" to development into perspective', Third World Quarterly 25: 8, 2004, pp. 1415—37.
45 Amy Nunn, Elize Da Fonseca and Sofia Gruskin, 'Changing global essential medicines norms to improve access to AIDS treatment: lessons from Brazil', Global Public Health: An International Journalfor Research, Policy and Practice 4: 2, 2009, pp. 131—49.
46 UNASUR SALUD, Plan Quinquenal, 2010—2015, July 2010, http://www.ins.gob.pe/repositorioaps/o/o/jer/ rins_documentosunasur/PQ%2oUNASUR%2oSalud.pdf, accessed 27 May 2015.
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One issue that quickly became apparent is that, in order to tackle health inequalities within the region, more than cross-border cooperation and surveillance by governments would be required; the region would also have to develop some shared mechanisms to address the fact that the policy capacity to respond to health emergencies or build primary care was highly unequal across South America. That is, UNASUR's championing of the right to health also created a need for knowledge-sharing about how this might be delivered through coordination, technical expertise and standards. This led in turn to the creation of a regional health think-tank, the South American Institute of Health Governance (Instituto Sudamericano de Gobierno en Salud or ISAGS), under the auspices of the Health Council and reporting directly to it. ISAGS' tasks are to provide policy-oriented and informative research, training and capacity-building for member states.47 Its main functions are to:
• identify needs, develop programmes and undertake capacity-building for human resources and leadership in health;
• organize existing knowledge and carry out research on health policies and health governance as requested by the South American Health Council or member states;
• systematize, organize and disseminate technical and scientific information on regional and global health, with the intention of supporting decision-making processes and advocacy;
• support the formulation of UNASUR's common external policies to back up negotiations in global and international agendas; and
• provide technical support to national health institutions.48
ISAGS has emerged as the most active level of health governance within UNASUR and the key tier of regional health governance. The Health Council, and ministries of health, benefit from its activities in a number of ways, from being more effectively briefed at international meetings to having regional expertise to call on to support national health targets. Located in Rio, ISAGS is able to capitalize on the leadership of Brazilian diplomats and health experts in international negotiations on the provision of medicines and the right to health and on the historic movimiento sanitarista,49 and to draw on other Brazilian health research institutions such as the Oswaldo Cruz Foundation.50
ISAGS is, almost inevitably, more radical than the Health Council itself. Its core philosophy is that health provision cannot be left to the market and its position within the governance structure in UNASUR means that it has been able to infuse policy-making with a rhetoric about rights and universalism. It not only gives UNASUR an aura of technical know-how and expertise, much in the
47 For information about UNASUR thematic groups, networks and ISAGS, see http://isags-unasul.org/isags. php?lg=3, accessed 29 May 2015.
48 Resolution CSS 05/2009 Sede y creation ISAGS, Apr. 2009.
49 Paulo Buss and Maria do Carmo Leal, 'Global health and health diplomacy', Cadernos da Saude Puhlica 25: 12, 2009, pp. 2541—51.
50 Authors' interviews with ISAGS chief of cabinet, 10 Nov. 2014, and with former Officer at the Pan-American Health Organization, 12 June 2012.
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manner of PAHO, but conveys the message, through new normative frameworks and practice, that health is a matter of politics and rights as well as part of a more comprehensive approach to social determinants of well-being and democratic standards. In many ways, being a new institution, tied to the new regional political economic coordinates in South America and being genuinely South American, UNASUR/ISAGS is in a better position to deliver effective health governance than PAHO, a Washington-based institution with more than a century of history and with a mandate that focuses on 'health coverage' rather than 'universal access to health' as supported by IS AGS/UN ASUR. These are different ways of addressing how health care reaches societies, and ultimately speak of different conceptions of entitlement and equality.51
I SAGS rapidly became active in strengthening health governance capacity, advocating the right to health and supporting policy-making and policy reforms towards universalization of health care across the region.52 I SAGS has already trained policy-makers and practitioners by setting up UNASUR-sponsored public health schools in Bolivia, Guyana, Peru and Uruguay, and the UNASUR network of public health schools supports training across the region.53 ISAGS has also provided support directly to ministries of health in Guyana and Paraguay on primary care and the preparation of clinical protocols, and has supported reforms aimed to move towards universalization of health sector provision in Bolivia, Colombia and Peru.54 ISAGS is involved in the diffusion of information on combating HIV/AIDS, influenza and dengue fever across the region,55 and has developed mapping techniques to coordinate shared policies for the production of some key medicines. Policy advances of this sort—concrete, modest, focused and cheap to deliver—taken in a relatively short timeframe and below the radar of political commentary—are unusual in the context of previous projects of South American regionalism, and they stand as evidence of UNASUR's grounded approach.
ISAGS has begun to scale up its level of activity on behalf of UNASUR, once again with relatively little attendant publicity. ISAGS has been quietly targeting global health governance forums and is trying to establish a joint bargaining position for South American negotiators vis-a-vis pharmaceutical companies and in the World Health Organization.50 ISAGS now holds meetings prior to each annual gathering of the WHO, so that UNASUR is increasingly able to coordinate its actions at the WHO and is beginning to speak out on behalf of developing countries more widely. UNASUR has begun to campaign on access to medicines,
51 Authors' interviews with ISAGS chief of cabinet, 10 Nov. 2014, and with former Officer at the Pan-American Health Organization, 12 June 2012; also UNASUR SALUD, Plan Quinquenal.
52 UNASUR SALUD, Plan Quinquenal; also Pia Riggirozzi, 'Regionalism, activism, and rights: new opportunities for health diplomacy in South America', Review of International Studies 41: 2, 2015, pp. 407—28.
53 See Network of Public Health Schools, 'Unasur promotes health systems in South American nations', http:// andromeda.ensp.fiocruz.br/resp/?q=en/node/i88, accessed 29 May 2015.
54 ISAGS Report, Jan. 2013, http://issuu.com/isagsunasur/docs/informe_ing, accessed 27 May 2015.
55 'UNASUR's role in the vaccination against pandemic influenza', Pan-American Health Organisation Immunisation Newsletter 32: 4, 2010, pp. 1—8; Eduardo Hage Carmo, André Gemal and Suelen Oliveira, Health surveillance in South America: epidemiological, sanitary and environmental (Rio de Janeiro: ISAGS, 2013).
56 Riggirozzi, 'Regionalism through social policy'.
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and is keen to coordinate active resistance to the dominance of pharmaceutical companies as part of its campaign for rights-based access to health.57
What are we to make, then, of UNASUR's activity in the health field in terms of understanding South American regionalism? Certainly, this is far from representing a comprehensive programme of welfare delivered through the region or indeed a citizen-based governance model of health. But it does suggest that UNASUR is acting as a regional space for health policy coordination, innovation and collective action, allowing practitioners, academics and policy-makers to come together to collaborate and create a network that encompasses civil society and member states, in support of better access to health care, services and medicines. Meanwhile, from the perspective of UNASUR itself, health is part of the process of legitimacy-building; and its health-related activities stand as evidence of this new phase of regionalism that is profoundly concerned with the issues faced by 'ordinary' people.
Upholding the democratic norm in South America
The right to democratic governance in South America has gradually been incorporated into national regimes across the hemisphere, and is also set out in in South American regional institutions. As early as 1997, the Organization of American States (OAS) agreed the Protocol of Washington, which allows for a member state in violation of democracy to be expelled from the organization.58 MERCOSUR, which was born from broadly contemporaneous and equally fragile transitions to democracy in Argentina and Brazil, also took up democratization as a theme of integration. As Gardini points out, democracy was established as a 'foundational idea' uniting the MERCOSUR group of countries.59 But if democracy conferred legitimacy on the presidential politics that characterized MERCOSUR in practice, the institutional matrix that emerged acted chiefly as an obstacle to direct citizen engagement.60 Moreover, although MERCOSUR agreed the Ushuaia Protocol on democracy in 1998, how exactly it could act to shore up democracy in South America more widely in cases where it was threatened was not clear, especially given its limited membership. MERCOSUR's capacity as an active pro-democracy actor in the region was always more limited in practice than the rhetoric promised.
UNASUR has inherited and built on these commitments to supporting the democratic norm in the region and may have learned something from MERCOSUR's limitations. Steps were taken quickly to establish a legal basis for pro-democracy action via a democracy clause attached to UNASUR's constitution in
57 Authors' interviews with international cooperation officer at the Ministry of Health in Ecuador, 30 July 2012; former UNASUR Health Council delegate from Ecuador, 6 Aug. 2012; and former coordinator of Technical Group for Access to Medicines, 2 Aug. 2012.
58 Ellen Lutz and Katherine Sikkink, 'International human rights law and practice in Latin America', International Organization 54: 3, 2000, pp. 633—59.
59 Gian Luca Gardini, The origins of Mercosur democratization and regionalism in South America (Basingstoke: Palgrave Macmillan, 2010).
60 Jean Grugel, 'Regionalist governance and transnational collective action in Latin America', Economy and Society 35: 2, 2006, pp. 209-31.
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2010. The 'Additional Protocol on Commitment to Democracy', as it is formally called, allows for rapid response consultations and the deployment of diplomatic missions if democracy is thought to be threatened, and the adoption of sanctions, including suspension from participation in the organization, trade sanctions and even the closing of borders.61 The clause was designed to be effective once ratifications reached nine, and it came into force in March 2014 with ratifications in Ecuador and Colombia.
The clause was always intended as a tool to be deployed rather than simply a paper provision. It had come about as UNASUR struggled to respond to events in Ecuador in 2010, when attempts were made to overthrow the elected President, Rafael Correa, in a police mutiny. UNASUR did not even wait for the clause to be ratified before acting in 2012 in defence of democracy in Paraguay, when the left-wing President Fernando Lugo was removed from office following a congressional impeachment process of dubious legitimacy.62 Lugo, a former bishop of the centre left, became president after the 2008 elections on a platform of far-reaching and long-overdue social reforms. However, once in office his reform programme, especially land and tax reform, was vehemently opposed by powerful vested interests represented in the major opposition parties and lobby groups such as the Rural Association of Paraguay, and by the agro-export business.63 The result was political competition and increasing polarization, social discontent and in turn a crisis of governance leading to the congressional impeachment on counts of 'poor performance'.64 With Brazil in the forefront, UNASUR countries quickly condemned the impeachment as undemocratic and proposed the suspension of Paraguay from UNASUR (and MERCOSUR), while Venezuela went even further and cut off oil supplies to Paraguay.65 A team of high-level regional diplomats was organized to monitor the situation (along the lines envisaged by the democracy clause) and to encourage a peaceful end to the crisis. UNASUR's actions in relation to the Paraguayan crisis stood in marked contrast to those of the OAS, which insisted that the removal of Lugo was legal.66 Lugo himself unwillingly accepted the outcome of the congressional proceedings, despite questioning their legitimacy, and chose to stand for election to the Senate, in which he was successful. This partial resolution allowed Paraguay to re-enter UNASUR. But it had nonetheless been made clear that UNASUR would act robustly where it could to protect democratic institutions in the region.67
61 Additional Protocol to the Constitutive Treaty of UNASUR on Commitment to democracy, http://www. sela.org/attach/258/EDOCS/SRed/20n/06/T023600004782-0-PROTOCOL_TO_THE_CONSTITU-TIVE_TREATY_OF_UNASUR_ON_COMMITMENT_TO_DEMOCRACY.pdf, accessed 27 May 2015.
62 Javier El-Hage, 'Should Paraguay be expelled from the OAS, Mercosur and Unasur?', Americas Quarterly, 25 June 2012, http://www.americasquarterly.org/should-paraguay-be-expelled-from-the-oas-mercosur-and-unasur, accessed 27 May 2015.
63 Peter Lambert, 'The lightning impeachment of Paraguay's President Lugo', Berfrois, 27 Aug. 2012, http:// www.berfrois.com/2012/08/a-very-paraguayan-afFair, accessed 27 May 2015.
64 Odeen Ishmael, 'UNASUR applies "democracy clause" on Paraguay', Council on Hemispheric Affairs, 17 Sept. 2012, http://www.coha.org/unasur-applies-democracy-clause-on-paraguay/, accessed 27 May 2015.
65 Ishmael, 'UNASUR applies "democracy clause'". Lambert, 'The lightning impeachment'.
67 UNASUR/ISAGS, 'Unasur meeting settles the return of Paraguay and the transmission of PTP to Surinam', 27 Aug. 2013, http://www.isags-unasur.org/it_materia.php?ev=7i9&lg=3, accessed 27 May 2015.
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UNASUR benefited from the Paraguayan crisis in that it became clear that it was willing not only to act but also to pursue an independent line from the United States in terms of democracy protection. Its independence is, in fact, part of why its criticisms carry weight in the region. Unlike the OAS, which can easily look as if it has been unduly influenced by the United States, UNASUR is evidence that South American countries will police the preservation of democracy for themselves.
The differences between North and South America in relation to regional democracy are further illustrated in relation to Venezuela. South American countries regarded Venezuela's controversial President Hugo Chavez as a legitimate and democratically elected head of state and government, whatever their views about his policies, while Washington sided strongly with the Venezuelan opposition, both before and after Chavez's death in 2013. In February 2014, not long after Nicolas Maduro, Chavez's successor, took office, Venezuela embarked on a dangerous path of social protest and repression.68 Continuous violent street protests focused on inflation, shortages and crime, while opposition leaders launched a campaign to oust Maduro and his socialist government. Political tensions are embedded in the structure of this deeply polarized society, riven by partisan and class-anchored social divisions.69 This politically sensitive scenario was promptly addressed by UNASUR, which immediately took a leading role, stepping in to try to mediate. A UNASUR delegation was formed in an attempt to broker peace talks between the Venezuelan government and opposition leaders, a proposal that was accepted by both parties and led to a process that is still under way.70 The United States, by contrast, increased its support for the Venezuelan opposition. President Obama called on Brazil and other South American countries to condemn President Maduro for human rights violations; the request was met with a clear refusal. UNASUR has preferred instead to call for all parties in Venezuela to respect human rights and find a negotiated way forward.71 Moreover, and marking the distance between North and South American approaches even more clearly, UNASUR decided in February 2015 to set up a commission, at the request of the Venezuelan government, to investigate possible US interventions to destabilize democracy in Venezuela.72
Democratic promotion and protection are generally an elitist affair, carried out by politicians, diplomats, international bureaucrats and civil servants; and,
68 Seumas Milne and Jonathan Watts, 'Venezuela protests are sign that US wants our oil, says Nicolas Maduro', http://www.theguardian.com/world/2014/apr/08/venezuela-protests-sign-us-wants-oil-says-nicolas-maduro, 8 April 2014, accessed 29 May 2015.
69 See Julia Buxton, 'Venezuela's opposition has played into Nicolas Maduro's hands', Guardian, 4 March 2014, http://www. theguardian .com/commentisfree/2014/mar/ 04/venezuela-opposition-nicolas-maduro-chavez-poor-outreach, accessed 27 May 2015; also Barry Cannon, 'As clear as MUD: characteristics, objectives, and strategies of the opposition in Bolivarian Venezuela', Latin American Politics and Society 56:4, 2014, pp. 49—70.
70 'UNASUR proposes mediated talks in Venezuela', 28 March 2014, http://www.thepanamericanpost. com/2014/03/unasur-proposes-mediated-talks-in.html, accessed 27 May 2015.
71 'Bloque sudamericano Unasur procura dialogo entre Venezuela y EEUU para disminuir tension', Reuters Latin America, 9 Feb. 2015, http://lta.reuters.com/article/topNews/idLTAKBN0LD2AI20150209, accessed 27 May 2015.
72 Frederick Mills, 'Latin America unites against US attack on Venezuelan democracy', Council on Hemispheric Affairs, 9 Feb. 2015, http://www.coha.org/latin-america-unites-against-u-s-attack-on-venezuelan-democracy/, accessed 27 May 2015.
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at trie regional level, can act as a way to shore up presidential authority. But in a region where democracy is not yet entirely assured, it can play an important role in moments of crisis by signalling that interrupting the democratic process will carry a heavy diplomatic price. UNASUR's actions in this area are not, therefore, without significance. Of course, the fact that South American countries use UNASUR to defend democracy is not evidence—and should not be taken to imply—that UNASUR is part of a project of deep democratization or citizenship governance. UNASUR is willing to act to stop elected governments being overthrown, but it is not pushing for mechanisms to ensure citizen voice or representation—indeed, such measures would be regarded as undue interference in member-state affairs. Still, UNASUR is willing to stake out a firm defence of regional democracy, understood as respect for democratically elected presidents, even when doing so means some disagreement with the United States. And this is precisely one of the key characteristics of UNASUR as a regional governance body: it self-consciously represents a democratic South America. This combination of inclusiveness (all South American countries can join) along with a firm defence of minimal democratic standards, even in defiance of the United States, allows it to claim the right to speak for the region in ways that other regional organizations could not.
Conclusion
UNASUR is a new experience for South America. It is a regional governance project based not on economic integration but on social policies, political cooperation and a defence of democracy; its aspirations are limited, but there are realistic plans in place for delivery; and there appears to be a preference within it for creating a team of professional specialists to take charge of a policy area rather than having politicians making grand (and unrealistic) statements of policy intent. Moreover, UNASUR is willing to disagree publicly with the United States. This is neither insulated, sealed-off governance, where decisions that affect the future development of the region are taken unaccountably, nor citizenship-centred governance. Instead, it is a hybrid form of politically sensitive governance, in which technical capacity is mixed with institutional commitment to limited intervention in ways that respect sovereignty but promote democracy. Its claim to legitimacy rests on a combination of a commitment to welfare promotion for the poor and the pursuit of collective public goods, alongside a robust defence of quite minimal but uncon-troversial standards of procedural democracy across the region.
To be clear, UNASUR is not about creating deep democratic engagement in South America. There are no citizenship inputs and no plans for any. But neither is UNASUR entirely divorced from the democratic process in South America; and it has established for itself a role in supporting democracy in the region at moments of crisis. UNASUR has emerged through intergovernmental negotiations between governments all of which are committed to democratic processes and to strengthening democracy regionally. Many of those governments, moreover—including
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those of Bolivia, Brazil and Ecuador—have explicitly sought to introduce new forms of democratic innovation. And, for all the member states, UNASUR's agenda, and in particular its support for a regional health agenda, is about reducing the social deficit in ways that not only respect rights but also create conditions for people to act more effectively as citizens.
Perhaps surprisingly, UNASUR has not yet been paid the attention it deserves in the comparative literature on regional governance. Certainly, it is something of a suigeneris case. It does not fit the idea of regionalism either as a neo-liberal enterprise or as embodied in the radical citizenship-centred projects that motivated protests and put an end to the FTAA itself. But it is precisely because it is a hybrid project that it is so interesting, based as it is on a combination of firm—but conventional—support for democracy and a more innovative package of welfare support. It may even turn out to be an example in fact of what Scharpf would have called 'positive integration'.73
Fritz Scharpf, 'Negative and positive integration in the political economy of European welfare states', in Gary Marks, Fritz Scharpf, Philippe Schmitter and Wolfgang Streeck, Governance in the European Union (London: Sage, 1996), pp. 15—39.
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