Editor's Choice

Please Santa, bring me freedom

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7480.0-g (Published 16 December 2004) Cite this as: BMJ 2004;329:0-g
  1. Kamran Abbasi, acting editor (kabbasi{at}bmj.com)

    Freedom has become the political buzzword of the 21st century. George Bush's agenda is to bring democracy and freedom to the rest of the peoples of the world, while his own are slaves to work, crippled by personal debt, and trapped in loneliness or loveless relationships—the shackles of the rich. Now that the surviving Afghanis and Iraqis are enjoying the benefits of Western freedoms, what will this mean for their health? No empirical studies have explored the relation between the extent of freedom allowed by political regimes and the effect on a nation's health—until now.

    Carlos Alvarez-Dardet and colleagues use freedom as a proxy for democracy in their ecological study that covers 98% of the world's population (p 1421). One hundred and seventy countries are classified as free, partially free, or not free, according to a freedom rating devised by Freedom House, a non-profit making, independent organisation promoting democracy. The freedom rating is informed by two main components, political rights and civil liberties. Democracy, conclude the authors, is independently associated with health, and this association remains after adjustment for a country's wealth, level of inequality, and size of public sector.

    Christopher Martyn, in an accompanying commentary (p 1423), warns that ecological surveys are “notoriously vulnerable to confounding,” and asks if the BMJ would have published the study if it had shown a positive association between political repression and health. My answer, of course, is yes. George Davey Smith describes health promotion in Nazi Germany, part of the racial hygiene movement and a cover up for the deterioration of public health (p 1424). Dan Ncayinana reports that South Africa's inability to deal with poverty and HIV/AIDS means that democracy may become “a pyrrhic victory” (p 1425). Therese Hesketh and Wei Xing Zhu rue the irony that as China has become freer some of the advances in health—achieved under communism—have been reversed (p 1427). Europe's transitional countries, however, do offer support for the hypothesis that democracy is good for health (p 1429).

    Experts have considerable freedom, but they can also be dangerous (“I am an expert in electricity,” said W C Fields. “My father occupied the chair of applied electricity at the state prison.”) Andrew Oxman and others offer a guide to the essentials of artifexology—the study of experts (p 1460). Are you a noisy expert who is often wrong (a crow)? A vainly self conscious expert who spends enormous amounts of time at grand rounds (a peacock)? Or a plump, boring, cooing expert who craps over everything (a pigeon)?

    And why not take the advice of an expert chef? Raymond Blanc makes a gourmet recipe out of our polymeal paper (see bmj.com); take once a day from age 50 and kiss goodbye to tablets and an early death (p 1447). Might doctors do better by retraining as polymeal chefs? For 2005, resolve to expel experts from your lives, and let in freedom and cooking (p 1413).


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