Democracy and Population Health: Lessons from the BRICs

• In Event: Comparative Politics of Health: Popular Demands, Institutional Legacies

Abstract

What is the relationship between democracy and population health? There is a large theoretical and empirical literature in political science and public health that explores this question. There are a number of reasons to believe that democratic political systems are more likely to improve population health than are non-democratic regimes. First, because representative democracy leads to competition for popular support among elected officials, these regimes are more likely to be responsive to the needs of their populations. Amartya Sen argues that political freedom helps to avoid public health disasters by raising public awareness and pressuring public officials to respond. In contrast, non-democratic regimes do not face the same incentive to be responsive to their citizens. Furthermore, non-democratic regimes may wish to limit human capital development, because improved health, may empower citizens to mobilize and place pressure on the regime for greater political power. A number of studies offer empirical evidence that there is a correlation between democratic political institutions and broad measures of population health, including infant mortality and life expectancy. Other studies, however, suggest that the relationship may be more complicated. Michael Ross, for example, argues that, although democracies spend more on health and social programs, the benefits of such spending accrue to middle and higher income citizens. As a result, he finds that democracy has no effect on population health. In this paper, I will critically review the literature on the relationship between population health and democracy. In addition, I will compare data from BRIC (Brazil, Russian, Indian and China) countries during the first decade of the 21st Century to illustrate the complexity of the relationship between democracy and health.

Author

• Michael K. Gusmano, The Hastings Center