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Beginning in the late 1970s, activists from the favelas of Rio de Janeiro challenged the conditions—such as limited access to security, sanitation, public education, and formal employment—that separated favela residents from Rio's other citizens. The activists built a movement that helped to push the nation toward redemocratization. They joined with political allies in an effort to institute an ambitious slate of municipal reforms. Those measures ultimately fell short of aspirations, and soon the reformers were struggling to hold together a fraying coalition. Rio was bankrupted by natural disasters and hyperinflation and ravaged by drug wars. Well-armed drug traffickers had become the new lords of the favelas, protecting their turf through violence and patronage. By the early 1990s, the promise of the favela residents' mobilization of the late 1970s and early 1980s seemed out of reach. Yet the aspirations that fueled that mobilization have endured, and its legacy continues to shape favela politics in Rio de Janeiro.

This important collection of essays, originating in a 1989 conference on the disadvantaged in American health care, provides incisive commentary on U.S. health care policy and politics. Examining public responses to health crises and analyzing the political logic of the American community, this volume charts the immobility of U.S. health policy in recent years and points to its disastrous consequences for the 1990s.
Focusing on the particular needs of disadvantaged groups—the elderly, children, people with AIDS, the mentally ill, the chemically dependent, the homeless, the hungry, the medically uninsured—these essays develop strong policy statements. The authors describe the growth in U.S. health care programs, from Kerr-Mills to Medicare, Medicaid, and subsequent revisions, and stress the serious omissions resulting from incremental policy expansion, both in identifying disadvantaged groups and in implementing programs. They report the weakness of the U.S. health care system compared to systems of other technologically developed countries.

Contributors. Deborah A. Stone and Theodore R. Marmor, Judith Feder, Alice Sardell, Bruce C. Vladeck, Michael Lipsky and Marc A. Thibodeau, Daniel M. Fox, William E. McAuliffe, M. Gregg Bloche and Francine Cournos, Lawrence D. Brown, James A. Morrone

During the 1990s, growing demands to end chronic welfare dependency culminated in the 1996 federal "welfare-to-work" reforms. But regardless of welfare reform, the United States has always been home to a large population of working poor—people who remain poor even when they work and do not receive welfare. In a concentrated effort to address the problems of the working poor, a coalition of community activists and business leaders in Milwaukee, Wisconsin, launched New Hope, an experimental program that boosted employment among the city's poor while reducing poverty and improving children's lives. In Higher Ground, Greg Duncan, Aletha Huston, and Thomas Weisner provide a compelling look at how New Hope can serve as a model for national anti-poverty policies. New Hope was a social contract—not a welfare program—in which participants were required to work a minimum of thirty hours a week in order to be eligible for earnings supplements and health and child care subsidies. All participants had access to career counseling and temporary community service jobs. Drawing on evidence from surveys, public records of employment and earnings, in-depth interviews, and ethnographic observation, Higher Ground tells the story of this ambitious three-year social experiment and evaluates how participants fared relative to a control group. The results were highly encouraging. Poverty rates declined among families that participated in the program. Employment and earnings increased among participants who were not initially working full-time, relative to their counterparts in a control group. For those who had faced just one significant barrier to employment (such as a lack of access to child care or a spotty employment history), these gains lasted years after the program ended. Increased income, combined with New Hope's subsidies for child care and health care, brought marked improvements to the well-being and development of participants' children. Enrollment in child care centers increased, and fewer medical needs went unmet. Children performed better in school and exhibited fewer behavioral problems, and gains were particularly dramatic for boys, who are at the greatest risk for poor academic performance and behavioral disorders. As America takes stock of the successes and shortcomings of the Clinton-era welfare reforms, the authors convincingly demonstrate why New Hope could be a model for state and national policies to assist the working poor. Evidence based and insightfully written, Higher Ground illuminates how policymakers can make work pay for families struggling to escape poverty.