Democracy is linked with decreases in mortality caused by cardiovascular disease and road deaths, as well as increases in government health spending.
The global study published in international journal The Lancet found that democracy appears to play a bigger part in health outcomes than a country’s GDP.
Democratic governance accounted for about 25% of the reductions in deaths from cardiovascular disease (CVD) and transport injuries over time.
Life expectancy improved faster in countries that transitioned to democracy between 1970 and 2015 compared to those that did not, increasing by an average of 3% after 10 years. As levels of democracy increased, governments spent more on health, irrespective of a country’s economic wellbeing (GDP), the research showed.
The findings are from the first comprehensive assessment of the impact of democracy on adult health and cause-specific mortality using detailed political, economic and population health information for 170 countries over the past 46 years (1970-2016).
The causes of mortality that appeared to be most affected by democratic experience – CVD, tuberculosis (TB), transport injuries, and several other non-communicable diseases (NCDs) – were responsible for over a quarter of all the death and disability in individuals aged 70 years and younger in low and middle income countries.
The average country’s increase in democracy, such as increased government spending and economic growth reduced CVD disease deaths and other NCDs by about 9%, and TB by roughly 8% between 1995 and 2015.
The results potentially represented a major change to tackle global health challenges, US Institute for Health Metrics and Evaluation and co-author Dr Joseph Dieieman said.
“Efforts to improve the health of adults might benefit from funding programs that help countries to strengthen their democratic processes and build more accountable institutions. So would directing more of the scarce development assistance for health to causes where democratic performance has the most effect on health, such as cardiovascular diseases.”
Increasing funding for development agency-led programs promoting open and accountable democratic institutions and processes may help improve health and increase investment in high-quality, accessible healthcare.
The past decade has seen falling levels of democracy around the world, with an estimated 2.5 billion people, about one third of the world’s population living in countries where democratic qualities such as the right to vote and freedom of association are in decline.
The link between democracy and population health is difficult to measure because of other contributing factors, such as country income or total health expenditure. Previous studies have been unable to determine whether the democratic process itself affects health or if factors such as country income, or the quality of government institutions, might be responsible.
Democratic rule enforced by regular free and fair elections appears to make an important contribution to adult health by increasing government spending on health and potentially reducing deaths from several NCDs and transport injuries, according to the researchers. Autocracies do not have the same external pressures or support from global health donors to tackle NCDs and injuries and may have less incentive to finance their prevention and treatment.
“Without the same pressure or validation from voters or foreign aid agencies, autocratic leaders have less incentive than their democratic counterparts to finance the more expensive prevention and treatment of heart diseases, cancers and other chronic illnesses,” US Council on Foreign Relations and lead researcher Thomas Bollyky said.
“Despite being responsible for an estimated 58% of the death and disability in low and middle income countries, just 2% of development assistance for health was devoted to non-communicable diseases in 2016.”
Democracy had less effect on the declines in mortality for some of the leading communicable causes of death such as HIV and malaria which are more heavily targeted by international aid. Democracy also did not appear to have substantial effects on mortality from all NCDs.