Effect of democracy on health: ecological study.
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ABSTRACT:
SUBMITTER: Franco A
PROVIDER: S-EPMC535957 | biostudies-literature | 2004 Dec
REPOSITORIES: biostudies-literature
Publications
Effect of democracy on health: ecological study.
Franco Alvaro A Alvarez-Dardet Carlos C Ruiz Maria Teresa MT
BMJ (Clinical research ed.) 20041201 7480
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Project description:Due to increasing demand and scarce financial resources for healthcare, health system efficiency has become a major topic in political and scientific debates. While previous studies investigating determinants of health system efficiency focused primarily on economic and social influence factors, the role of the political regime has been neglected. In addition, there is a lack of formal theoretical work on this specific topic, which ensures transparency and logical consistency of arguments and implications. Using a public choice approach, this paper provides a rigorous theoretical and empirical investigation of the relationships between health system efficiency and political institutions. We develop a simple principal-agent model describing the behavior of a government with respect to investments in population health under different political regimes. The main implication of the theoretical model is that governments under more democratic regimes put more effort in reducing embezzlement of health expenditure than non-democratic regimes. Accordingly, democratic countries are predicted to have more efficient health systems than non-democratic countries. We test this hypothesis based on a broad dataset including 158 countries over the period 1995-2015. The empirical results clearly support the implications of the theoretical model and withstand several robustness checks, including the use of alternative indicators for population health and democracy and estimations accounting for endogeneity. The empirical results also indicate that the effect of democracy on health system efficiency is more pronounced in countries with higher income levels. From a policy perspective, we discuss the implications of our findings in the context of health development assistance.
| S-EPMC8423257 | biostudies-literature
Project description: Not available
| S-EPMC535960 | biostudies-literature
Project description:BackgroundWinning funding for health and medical research usually involves a lengthy application process. With success rates under 20%, much of the time spent by 80% of applicants could have been better used on actual research. An alternative funding system that could save time is using democracy to award the most deserving researchers based on votes from the research community. We aimed to pilot how such a system could work and examine some potential biases.MethodsWe used an online survey with a convenience sample of Australian researchers. Researchers were asked to name the 10 scientists currently working in Australia that they thought most deserved funding for future research. For comparison, we used recent winners from large national fellowship schemes that used traditional peer review.ResultsVoting took a median of 5 min (inter-quartile range 3 to 10 min). Extrapolating to a national voting scheme, we estimate 599 working days of voting time (95% CI 490 to 728), compared with 827 working days for the current peer review system for fellowships. The gender ratio in the votes was a more equal 45:55 (female to male) compared with 34:66 in recent fellowship winners, although this could be explained by Simpson's paradox. Voters were biased towards their own institution, with an additional 1.6 votes per ballot (inter-quartile range 0.8 to 2.2) above the expected number. Respondents raised many concerns about the idea of using democracy to fund research, including vote rigging, lobbying and it becoming a popularity contest.ConclusionsThis is a preliminary study of using voting that does not investigate many of the concerns about how a voting system would work. We were able to show that voting would take less time than traditional peer review and would spread the workload over many more reviewers. Further studies of alternative funding systems are needed as well as a wide discussion with the research community about potential changes.
| S-EPMC5803583 | biostudies-literature
Project description:AimsThe COVID-19 pandemic has led to a spate of studies showing a close connection between inequitable access to health care, welfare services and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question by asking whether more 'egalitarian' forms of democracy matter, given that they contain more equitable health-care access and societal infrastructure, such as social capital and trust.MethodsWe use standard regression techniques, including instrumental variables analysis addressing endogeneity on COVID-19 testing and deaths data as of the end of May and beginning of September. We use novel data from the Varieties of Democracy Project on health-system equity and egalitarian democracy.ResultsOur results suggest that more equitable access to health care increases testing rates and lowers the death rate from COVID-19. Broader egalitarian governance, measured as egalitarian democracy, however, shows the opposite effect. Thus, factors associated with health-care capacity to reach and treat matter more than broader societal factors associated with social capital and trust. The results are robust to alternative testing procedures, including instrumental variable technique for addressing potential endogeneity.ConclusionsDespite a great deal of public health focus on how equitable governance helps fight the adverse effects of so-called neoliberal pandemics, we find that broadly egalitarian factors have had the opposite effect on fighting COVID-19, especially when an equitable health system has been taken into account. Fighting disease, thus, might be more about the capacity of health systems rather than societal factors, such as trust in government and social capital.
| S-EPMC7797351 | biostudies-literature
Project description:Tobacco control advocates began to use ballot initiatives to enact tobacco control measures in the late 1970s. In response, the tobacco industry worked for over two decades to change laws governing initiative and referendum processes to prevent passage of such measures. In 1981 the tobacco industry's political lobbying arm, the Tobacco Institute, created a front group that presented itself as a neutral initiative research clearinghouse to effect changes in state initiative and referenda laws. In 1990 the Tobacco Institute began creating an in-house team and worked with third-party groups to try to change state initiative laws. While the industry ultimately abandoned both efforts when neither achieved immediate success, over time the industry's goals have penetrated legitimate discourse on the initiative and referendum process in the United States, and many specific ideas it advocated have garnered mainstream support. Direct democracy advocates, as well as public health advocates and policy makers, need to understand the tobacco industry's goals (which other industries adopted) of limiting the direct democracy process to ensure that any changes do not inadvertently increase the power of the special interests that direct democracy was developed to counterbalance.
| S-EPMC4040295 | biostudies-literature
Project description:More democratic countries are often expected to fail at providing a fast, strong, and effective response when facing a crisis such as COVID-19. This could result in higher infections and more negative health effects, but hard evidence to prove this claim is missing for the new disease. Studying the association with five different democracy measures, this study shows that while the infection rates of the disease do indeed appear to be higher for more democratic countries so far, their observed case fatality rates are lower. There is also a negative association between case fatality rates and government attempts to censor media. However, such censorship relates positively to the infection rate.
| S-EPMC7997903 | biostudies-literature
Project description:What kind of economic development curtails clientelistic politics? Most of the literature addressing this relationship focuses narrowly on vote buying, resulting in theories that emphasize the importance of declining poverty rates and a growing middle class. This article employs a combination of ethnographic fieldwork and an expert survey to engage in a first-ever, more comprehensive comparative study of within-country variation of clientelistic politics. I find a pattern that poorly matches these dominant theories: Clientelism is perceived to be less intense in rural, poverty-prone Java, while scores are high in relatively wealthy yet state-dependent provincial capitals. On the basis of these findings, I develop an alternative perspective on the relationship between economic development and clientelism. Emphasizing the importance of societal constraints, I argue that the concentration of control over economic activities fosters clientelism because it stifles the public sphere and inhibits effective scrutiny and disciplining of politico-business elites.
| S-EPMC6187067 | biostudies-literature
Project description:Revising public health policy based on new data does not happen automatically. This is acutely relevant to the now undeniable evidence that many diseases develop differently between the sexes and may also be affected by gender. Current health and medical practices across the globe generally fail to cater for sex and gender effects in common diseases. Inadequate policy frameworks to guide the comprehensive inclusion of sex and gender in research jeopardises scientific rigour and ultimately the practices they underpin. To ensure that Australian health and medical research is fit-for-purpose, we realised that potent initiatives would be necessary to expedite strategic reframing of thought and behaviour. Here we report on our innovative engagement of end-users for democratic self-determined policy reform to guide health and medical research, based on robust data. We draw upon our specific study to outline seven key steps that can be adopted to accelerate effective change, across a breadth of evidence-based initiatives to reform health policies.
| S-EPMC11861193 | biostudies-literature
