If democracy really is good for health, then the countries of central and eastern Europe are obvious places to look for an effect. These countries were part of the Soviet bloc for several decades of the 20th century before adopting, to various degrees, democratic governments in the 1990s. Their experience provides a wealth of natural experiments.

Between the 1920s and '50s the communist system achieved much. In 1917, the Bolsheviks inherited a health situation from imperial Russia that was appalling. Faced with epidemic typhus, Lenin noted that “if communism does not destroy the louse, the louse will destroy communism.”1 One clear political commitment was to improve the health of the population, and in many ways this was successful. Basic health services were provided to a widely dispersed population, endemic diseases were controlled or eradicated, and health outcomes improved noticeably. All of these gains took place in the absence of a semblance of democracy. Yet they could not be sustained. By the 1960s, the financial demands placed by …