Health and historical levels of freedom

Abstract

BackgroundThe link between political freedom and health is unclear. We aimed to determine the association by exploring the relationship of historical and cumulative freedom levels with important health outcomes.MethodsWe obtained countrywide health indicators for life expectancy, infant mortality, maternal mortality ratio, % low birth weight babies, Gini coefficient (a measure of wealth inequality) and various markers of freedom based on political rights and civil liberties. We applied multivariable logistic regression to examine the association between health indicators and within-country years of freedom as determined by Freedom House rankings.ResultsThe total proportion of free years from 1972-2005, the duration of current freedom level, and the Gini coefficient show independent positive associations with health indicators, which remain after the adjustment for national wealth, total government expenditure, and spending on health. Countries identified as having high total proportion of free years demonstrated significantly better health outcomes than countries with low levels of freedom (life expectancy, Odds Ratio [OR] 7.2, 95% Confidence Interval [CI], 2.3-22.6, infant mortality OR 19.6, 95% CI, 5.6-67.7, maternal mortality ratio, OR 24.3, 95% CI, 6.2-94.9, and % low birth weight babies OR 3.8, 95% CI, 1.4-10.8). This was also the case for infant mortality (OR 3.4, 95% CI, 1.0-8.4), maternal mortality ratio (OR 4.0, 95% CI, 1.2-12.8), and % low birth weight babies (OR 2.6, 95% CI, 1.0-6.6) among countries considered as having medium levels of freedom.InterpretationWe found strong associations between country-level freedom and important health outcomes. The cumulative level of freedom over time shows stronger associations with all health indicators than the duration of current freedom level.

Guns and Butter: Child Mortality and the Mediators of Militarization

“…Autocratic regimes generally appear to concern themselves only with the more powerful segments of the population (see Zweifel & Navia, 2000). Countries with more democratic governments (vs. more authoritarian governments) tend to have lower infant or child mortality rates (e.g., Biggs et al, 2010; McGuire, 2013).…”

Welfare States, Labor Markets, Political Dynamics, and Population Health

“…Our conceptualization of these two indicators as health determinants is consistent with existing studies that have found increases in political freedom are associated with improvements in population health. 23,24…”

“…Our conceptualization of these two indicators as health determinants is consistent with existing studies that have found increases in political freedom are associated with improvements in population health. 23,24 GDP per capita is added in adjusted models to factor out different levels of economic development of East and Southeast Asian nations for a given year. Data are in constant 2005 U.S. dollars and retrieved from the World Bank.…”