Life expectancy grew faster for countries that have switched to democracy since 1970

This article is more than 1 year old

This article is more than 1 year old

Democracy is good for your heart, health and longevity, a major study of 170 countries has concluded, in a boost to a form of government that has faced significant setbacks around the world in recent years.

Life expectancy improved more quickly in countries that switched to democracy over the past 50 years, the researchers discovered, and there were fewer deaths from cardiovascular disease, diseases such as cancer and cirrhosis, and even road traffic accidents.

The study, published in the Lancet, said it was not just that democracies tended to be richer: the “democracy effect” was far stronger than any GDP effect.

“Free and fair elections appear important for improving adult health … most likely by increasing government accountability and responsiveness,” the study said. “Democracies are more likely than autocracies to lead to health gains.”

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The report comes at a time when democracy is being challenged perhaps as never before. A majority of the world’s population lives in democracies, but more than 2 billion people live in countries where democracy has been on the back foot in recent years, such as India, Turkey, Brazil and the US.

The rise of populism attests to disillusionment in much of the democratic world, and the relative success of autocracies from China to Rwanda, and Vietnam to Singapore, has raised questions as to whether political freedom is the best system of government for everyone.

The study concludes that, as far as health is concerned, it is.

Thomas Bollyky, the lead author, from the US Council on Foreign Relations, said: “This is good news at a time when the news around democracy has been fairly depressing. Health and elections are inevitably linked.”

Researchers used existing measures of democratic experience compiled in the V-Dem database and plotted them against a range of metrics such as government health spending and disease outcomes.

They then compared trends in countries that had transitioned from autocracy to democracy since 1970 with 55 states that had not. The impact of HIV was factored out, because the huge amount of foreign aid devoted to the virus would have skewed the findings.

The conclusions were stark. Life expectancy at age 15 was 3% higher in countries 10 years after their transition to democracy than in counterparts that had not changed government type. Cardiovascular disease, tuberculosis, transport injuries and non-communicable diseases also fell as democracy bedded in.

These four health dangers cause a quarter of the total death and disability in people under 70 in low and middle-income countries. The implication for further democratisation across the autocratic world is clear.

“We estimate that, between 1994 and 2014, the increases in democratic experience resulted in 16 million fewer deaths from cardiovascular disease globally,” said Bollyky.

He added that if China had experienced the same democratic transition that a country such as Poland achieved over that period, it would have saved 10 million lives of people who died from that one illness.

Researchers believe free societies achieve better outcomes not because of prosperity but public pressure. “Countries where government is not subject to free and fair democracy doesn’t have the same pressure from voters” to deliver better health services, Bollyky said.

Dr Joseph Dieleman, a co-author of the paper, from the Institute for Health Metrics and Evaluation, said: “Efforts to improve the health of adults might benefit from funding programmes that help countries to strengthen their democratic processes.”

The study is the biggest of its kind to make such a broad correlation between democracy and adult health: others have focused more narrowly on democracy’s impact on early years health.

The work was conducted by the US Council on Foreign Relations and the Institute for Health Metrics and Evaluation. It was funded by Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

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