Sixty seconds on . . . democracy
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1225 (Published 18 March 2019) Cite this as: BMJ 2019;364:l1225
The Brexit debate has made me ill
On the contrary, it’s democracy in action and that’s good for your health.
Oh yes? Says who?
The authors of a paper in the Lancet1 which looks at countries that have embraced democracy since 1980 and concludes that their health outcomes are significantly better than they would otherwise have been. Over 20 years, democratic experience cut heart mortality, for example, by 9.64% (95% confidence interval, 6.38 to 12.90).
It would be nice to believe it
You mean you don’t? Shame. Granted, the statistical techniques are pretty opaque, and it’s an observational study that can’t determine cause and effect. But it’s plausible, if one accepts that people with meaningful votes force governments to pay more attention to health.
So what did they do?
They took life expectancy figures (recalculated to exclude the effects of the HIV pandemic) and compared them with information on the type of regime in each country. They also looked at gross domestic product per capita, domestic health spending, and foreign aid directed at health. They processed the data using four statistical techniques.
What did it show?
That life expectancy at age 15 was 3% better after 10 years in countries that had gone democratic. Thomas Bollyky, of the US Council on Foreign Relations and lead author of the paper, said: “This is good news at a time when the news around democracy has been fairly depressing.”
Why depressing?
The authors say: “With the political turmoil in the US and Europe, the case for democracy has never seemed dimmer.” Presumably that’s code for saying that the authors like democracy best when they approve of its outcomes.
Why did they exclude HIV?
This is not adequately explained, and might have skewed the findings.
What are the implications?
International health assistance might be more effective if it focused on promoting democracy and an open society as well as on technical matters.