Backsliding among indicators of democratic stability relevant to public health: Risks in OECD nations

Abstract

Oppression and inequality, as critical social and structural determinants of health, are key threats to public health. Democratic stability provides institutional measures to mitigate oppression and inequality. We investigate trends in democratic backsliding in the Organization for Economic Co‐operation and Development (OECD) nations, overall, and compare trends in backsliding among specific indicators of democracy relevant to public health based on protections against oppression and inequality. We leverage a comprehensive, longitudinal, data set (V‐DEM), capturing key indicators of democracy in OECD nations from 2010 to 2020. Indicators were selected from the scholarly literature on democracy and health for their effects on oppression and inequality. We observe trends over time in democratic stability among OECD nations, overall, and then compare trends in democratic stability or backsliding across OECD nations within categories of democratic indicators established to mitigate oppression and inequality. Democracy is declining across all OECD nations. Broad democratic declines are shown between types of OECD member states. Country income is not necessarily protective for democratic stability. We find specific declines in two measures with immediate implications for public health—Civil Liberties and Integrity of the Courts—across at least half of all OECD nations and a particularly alarming level of change in the United States. Politics shape and limit public health. Declining components of democracy can have both short‐ and long‐term consequences for population health by increasing inequality and reducing mechanisms to protect against oppressive tactics. Public health can play an important role in improving democracy by strengthening accountability.

Electoral Democracy and Working‐Age Mortality

“…The role of democratic governance-in particular, its erosion-as a cause of the troubling trends in working-age mortality in recent decades has largely been absent from scientific studies and the public narrative. 9 Yet, this is precisely what the historical record would predict. According to historians such as Szreter 64,65 and Colgrove, 66 real improvements in population health in the mid-to late 1800s in industrializing countries such as England came about largely because of increased voting power of the public and, partly as a consequence, the rise of government interventions such as sanitation and clean water systems to improve social conditions for everyone.…”

“…The degree of erosion of democracy in general and electoral democracy in particular in the United States in recent decades is striking and unusual compared with most other high-income countries. 9 In 2021, more than 150 scholars of US democracy signed a document imploring Congress to pass the Freedom to Vote Act and, if necessary, suspend the Senate filibuster so that a simple majority would be necessary to pass it. 10 The signatories warned that failure to pass it would "undermine the minimum condition for electoral democracy-free and fair elections-[and] have grave consequences not only for our democracy, but for political order, economic prosperity, and the national security of the United States as well."…”

“…Taken together, our findings shine a light on a critical yet understudied determinant of population health in the United States—democracy. The degree of erosion of democracy in general and electoral democracy in particular in the United States in recent decades is striking and unusual compared with most other high‐income countries 9 . In 2021, more than 150 scholars of US democracy signed a document imploring Congress to pass the Freedom to Vote Act and, if necessary, suspend the Senate filibuster so that a simple majority would be necessary to pass it 10 .…”

“…Our findings underscore the role of governance as a determinant of population health. The role of democratic governance—in particular, its erosion—as a cause of the troubling trends in working‐age mortality in recent decades has largely been absent from scientific studies and the public narrative 9 . Yet, this is precisely what the historical record would predict.…”

“…One macro‐level factor that has been largely overlooked as a potential explanation is democracy. Despite alarm bells from scientists 6–10 and journalists 11,12 about democratic backsliding in the United States and its pernicious consequences, the role of democracy has been largely absent from studies of the high and rising working‐age mortality. Democratic backsliding refers to “the processes through which elected rulers weaken checks on executive power, curtail political and civil liberties, and undermine the integrity of the electoral system.” 13 Several events in recent decades have greased the wheels of the backsliding, such as the 2013 Supreme Court decision in Shelby County v. Holder to eliminate a key provision of the Voting Rights Act and the Court's 2010 decision in Citizens United v. Federal Election Commission to remove spending limits on elections from corporations and special interest groups.…”