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The rise of democracy over the globe raises the question of how effective democratic regimes are in maintaining the welfare of its citizens. Many well established democracies have high rates of positive population health, however, it is unclear whether the two factors are causally connected. My research question is: does democracy have an effect on population health? The dependent variable is population health and the independent variable is the level of democracy. To measure the relationship, I will be looking at the effect that democracy has on life expectancy. This essay will first explore the relevance of this research question, then offer data to explain the relationship, before evaluating such data and drawing a conclusion from it.
Scholarship which proposes the causal relationship between democracy and good health first distinguishes the importance of competitive executive recruitment. Democratic elections create a competitive struggle between elites for support from the electorate (Wigley and Akkoyunlu-Wigley, 2011). Consequently, representatives have greater motivation to widen their public support: in this case through advocating for policies which will improve public health. Accountability to the people ensures governments are directly responsible for improving population health. Second, the openness of the electoral system allows for the government to be scrutinised by interest groups, the media and the wider population, with democratic governments being more likely to respond to such criticism (Bollyky et al., 2019). Third, democracies generally allow greater access to information due to larger political and social freedoms, allowing populations to be better informed on healthcare matters. Finally, democratic regimes are more likely to increase spending on social programs which improve population health, due to the competitive nature of politics and the inclusion of the working class into the decision making process, who politicians assume rank health care high on their own political agenda (Brown and Hunter, 1999).
However, the relationship between these two variables is not comprehensively agreed upon. Ross (2006) highlights that often democratic societies fall in line with their autocratic counterparts when it comes to the distribution of health services to the poorest areas of the population. Even democratic countries are able to distort their successes by improving overall population health without targeting the most disadvantaged societies, weakening the link between democracy and good health. This highlights the importance in further investigating the relationship between democracy and health.
The data was collected from the Polity IV Project and the World Bank organization.
I chose to use a democracy index as my measure of democracy over factors such as voter turn out as it is arguably a more valid measure. The Polity IV index collects data on multiple attributes of democracy, focusing on the constraints of the executive, political participation and political competitiveness. Taking account of these attributes the index then creates an ordinal scale in which states are ranked from -10 (strongly autocratic) to 10 (strongly democratic), which allows for a straightforward comparison of regime type. However, the measure is not entirely valid. The Polity index focuses narrowly on the electoral properties of political participation and does not account for factors such as suffrage or civil liberties, which are essential when assessing the definition of democracy. In terms of reliability, the Polity index is largely reliable. The accumulation of electoral data is easily accessed, as well as the level of citizen participation in the political process. This can be measured through electoral turnout, the number of candidates up for election, party membership or active contestation against the government through protests and petitions.
I chose to use life expectancy as an indicator for good health, unlike other indicators of health such as infant mortality rates, life expectancy summarises mortality risks across a spectrum of age groups, allowing for easier tracking of health improvements in populations. However, increases in life expectancy can be attributed to a range of factors, including improved living standards, education or healthcare, which although could be indirect consequences of democracy, do not directly correspond to democracy as an institution itself, limiting its validity. The World Bank data is mostly reliable, however its reliability could be reduced due to the nature of census data collection, where factors such as homelessness, poor literacy rates or under-registration can mean large sections of the population are unaccounted for.
The data shows there is an interdependence between the level of democracy within a country and how healthy its population is. However, it is difficult to conclude that it is democracy itself which is causing greater population health. In addition, the data shows that there are exceptions to this trend, with some countries exhibiting high levels of life expectancy despite living in less democratic regimes.
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