Intended for healthcare professionals

Democracy and Health

The coronavirus pandemic is not an advertisement for the healthy effects of democracy. As of October 2020, 9 of the 10 nations with the highest cumulative cases of covid-19 are democracies. The mixed performance of democracies represents a departure from their success in confronting other health challenges, relative to other forms of governments.

Democracy remains the preferred form of government on all continents, but this vision of democracy works in a crisis only if it is promoted in normal times.

This collection takes a closer look at the progress of different political systems achieving universal health coverage, explanations for the links between democracy and health, and what measures must be undertaken to better “pandemic proof” this political system.


Preparing democracies for pandemics
Tackling inequalities is essential for justice, security, and preparedness, say Thomas Bollyky and Ilona Kickbusch

Autocratisation and universal health coverage: synthetic control study
A special paper from Simon Wigley and colleagues finds that countries that move away from democratic principles perform poorly on life expectancy, effective health coverage, and levels of out-of-pocket spending

Social justice as a foundation for democracy and health
Jennifer Prah Ruger uses the covid-19 pandemic to show the importance of countries implementing a justice framework for health and equality

Social media and vaccine hesitancy
New research by Wilson and Wiysonge shows that use of social media to organise offline action is linked to doubts about vaccine safety, and that disinformation campaigns contribute to declines in vaccination coverage

Is health politically irrelevant? Experimental evidence during a global pandemic
Arnab Acharya and colleagues investigate the electoral impact on politicians of their failures or successes in managing covid-19. Their survey of three large democracies suggests voting intentions will be unaffected

Investing in civil society for better democracy and better health
Roopa Dhatt and colleagues recommend a three-pronged call to action asking that civil society is engaged, funded, and protected in global health governance


This collection was launched at the World Health Summit, 25-27 October 2020, Berlin, Germany. Funding for the articles, including open access fees, was provided by a grant from Bloomberg Philanthropies to the Council on Foreign Relations, support from the Konrad-Adenauer-Stiftung to the Graduate Institute of International and Development Studies, and the Institute for Health Metrics and Evaluation.

The BMJ commissioned, peer reviewed, edited, and made the decision to publish these articles. Ilona Kickbusch and Thomas Bollyky were the guest editors for this special collection. Kamran Abbasi was the lead editor for The BMJ.