Effect of democracy on health: ecological study
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7480.1421 (Published 16 December 2004) Cite this as: BMJ 2004;329:1421
- Álvaro Franco, professor1,
- Carlos Álvarez-Dardet, professor (carlos.alvarez@ua.es)1,
- Maria Teresa Ruiz, professor1
- 1 Observatory of Public Policies and Health, Departamento de Salud Pública, Universidad de Alicante, Edificio de Ciencias Sociales, APDO 99, 03080 Alicante, Spain
- Correspondence to: C Álvarez-Dardet
Although the influence of democracy in preventing famines has been reported,1 there have been no empirical studies on the relation between the extent of freedom allowed by political regimes and the effect on a nation's health. We explored the effect of democracy on life expectancy and maternal and infant mortality in most countries, taking into account a country's wealth, its level of inequality, and the size of its public sector.
Politics and health
Since Virchow's seminal work, in which medicine was first proposed as a political science,2 politics has often been referred to in the medical literature, although mostly at a rhetorical level.3 Studies of political epidemiology are therefore needed, with research focusing on the effects on health of the institutions derived from political power.
Some authors have tried to determine empirically whether governments can have an effect on the incidence of specific health problems. Studies in the United Kingdom and elsewhere have measured the effect of Labour and Conservative governments on suicide rates.4 More recently, welfare state policies have been associated with health benefits in people from countries belonging to the Organisation for Economic Cooperation and Development.5
Data are now available to enable the measurement of the global impact on health of a wide range of political and economic variables. As a result the World Health Organization commission on macroeconomics and health has produced valuable information on associations between health and wealth.6 Yet information is still lacking on the relation between the extent of freedom of a particular country and the health of its people. Each year, Freedom House, a non-profit making, independent …