Public Health Efficiency in a Democratic v. Nondemocratic State
Malachi C. Nkosi writes:
In March 1994, Ramesh Govindaraj and Ravindra Rannan-Eliya published research in comparing public health in respect to democratic and nondemocratic states. Their conclusion, after monitoring child mortality and life expectancy in response to differing governmental structures and income, yielded results in favor of those living in democratic states. They found that living in a democratic stated yielded lower child mortalities and higher life expectancies than those in nondemocratic states. However, with the definitions outlined in Ramesh Govindaraj and Ravindra Rannan-Eliya’s work, it was found that some socially-democratic states could be misclassified as nondemocratic states. These socially-democratic states with high levels of social programs tended to affect the lower class, which generated better living results in that state. Ramesh Govindaraj and Ravindra Rannan-Eliya failed to address the presence of democratic states that leaned toward the left (more social democracies) than those that leaned more toward the right (less social democracies). In doing this study, Govindaraj and Rannan-Eliya theorized that the change in income and political regime was what dictated the state’s public health system and effectiveness. However, when doing this experiment, Govindaraj and Rannan-Eliya failed to compare the left-leaning and right-leaning regimes to nondemocratic regimes, no longer verifying that these democracies are in fact doing better than these nondemocratic states. It appears clear that when comparing the effectiveness of these states’ public health systems that it should not only be the regime and income, but also the political polarity in the state as well.
Does the political spectrum of the democracy affect the effectiveness of its public health systems? This is the question I want to engage, monitoring the left-leaning or right-leaning democracies and comparing them to the nondemocratic states. In addition, I seek to challenge the initial post of if “democracies” truly have an advantage in public health. Govindaraj and Rannan-Eliya’s “democracy” is based on Robert Dahl’s definition, in which a government can be voted out of power through the people. But there are several nondemocratic examples of this: the former Soviet Union/Russia, China, North Korea, etc. In addition, Govindaraj and Rannan-Eliya define a nondemocratic state as those guided by Marxism or Leninism. If that was the case, Germany would be considered a nondemocratic state. In addition, many democracies that take in social guides (left-leaning) could be mistakenly taken for nondemocratic in this study. This needs to be highlighted.
From preemptive research and readings from Govindaraj and Rannan-Eliya’s study, World Bank articles, and data from the United Nations, I can hypothesize that some high-income, nondemocratic states can be just as effective if not better that those in low-income, right-leaning democracies. In this study, I seek to monitor child mortality rates and life expectancy as a measure of the dependent variable. The independent variable will be the political regime and, if it is democracy, if the political polarity of the state affects the dependant variable. I will also develop a more unambiguous definition and distinction between democracies and nondemocratic states.
The areas of investigation will be in the following trials:
- India vs. Pakistan
- India vs. China
- N. Korea vs. S. Korea
- Jamaica vs. Cuba
- Brazil vs. Venezuela
- Guyana vs. Venezuela
Within these countries (depending on the comparisons), I will control for population, income, region, and relationship with the United States and its allies (the relationship with the developed world).
This is truly a good topic, and I think that the challenging part of it will be the definition of democracy.
First of all, are you going to do study of several years or for only one? It is hard to define a country as democratic or not since some have a past of dictatorship. As an example, Uruguay had a civic-military dictatorship for 1973-1985, and now it is a non-communist democracy (to use the terms used by Ramesh Govindaraj and Ravindra Rannan-Eliya.
As in your blog post, it is important to address that the idea of classifying a country as a democracy on the sole criteria that the population can take a state head out of their position through voting could lead to mislabeling. As an example, Peru and Venezuela had Fujimori and Chavez respectively. Both countries could voted them out, but manipulations in the electoral system and frauds kept them in power. Therefore, both of these countries could have been considered democracies when they weren’t.
In addition, it is possible that some of these countries with a dictatorial regime in the recent past could get good results such as low infant mortality rates due to the good policies of the dictator (example, Pakistan) and not for the more recent democracy.
I particularly like the fact that you identify a major problem with the Govindraj and Eliya study about their relatively superficial definition of democracy. In the 19 years since the study, development has accelerated in regions across the world. The 1994 study would not have touched Rwanda (with the genocide being a recent memory) and yet Rwanda today has some of the highest development indicators in Africa.
An interesting case to look at here might also be how development indicators jump once a country shifts from an undemocratic regime to a democratic one. For instance, this has happened in South Africa with the elimination of the apartheid regime.
This research is very interesting and reminds me of work done by economist Amartya Sen on famines in democratic and nondemocratic states. Sen’s basic argument was that because most actual instances of famine often do not involve disruptions or reduction in food supplies, famine is better explained as being primarily caused by increases in inequality. For example, Sen argued that the Bengal famine that he witnessed firsthand as a child could best be explained by rising inequality between urban and rural workers (an urban economic boom raised food prices above what rural workers with stagnant wages could afford). Sen therefore argues that democracy plays an important role in preventing famines because it places limits on the types of economic inequality that can develop. Sen argued that because nondemocratic regimes have few incentives to fight inequality, they tend to experience famines at a much higher rate than democracies. One modern example that comes to mind is famine in North Korea, which is caused by poor economic management but exacerbated by inequality between the favored military class and the rural working class in the countryside.