Studies of health have recognized the influence of socioeconomic position on health outcomes. People with higher socioeconomic ranking, in general, tend to be healthier than those with lower socioeconomic rankings. The effect of political environment on population health has not been adequately researched, however. This study investigates the effect of democracy (or lack thereof) along with socioeconomic factors on population health. It is maintained that democracy may have an impact on health independent of the effects of socioeconomic factors. Such impact is considered as the direct effect of democracy on health. Democracy may also affect population health indirectly by affecting socioeconomic position. To investigate these theoretical links, some broad measures of population health (e.g., mortality rates and life expectancies) are empirically examined across a spectrum of countries categorized as autocratic, incoherent, and democratic polities. The regression findings support the positive influence of democracy on population health. Incoherent polities, however, do not seem to have any significant health advantage over autocratic polities as the reference category. More rigorous tests of the links between democracy and health should await data from multi-country population health surveys that include specific measures of mental and physical morbidity.
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References
1.
AntonovskyA.Social class, life expectancy and overall mortality. Milbank Mem. Fund Q.45:37–73, 1976.
2.
KitagawaE. M., and HauserP. M.Differential Mortality in the United States: A Study in Socio-economic Epidemiology.Harvard University Press, Cambridge, 1973.
3.
TownsendP., and DavidsonN.Inequalities in Health: The Black Report.Penguin Books, Harmondsworth, U.K., 1982.
4.
MarmotM.KogevinasM., and ElstomM. A.Social/economic status and disease. Annu. Rev. Public Health8:111–135, 1987.
5.
FoxJ. (ed.). Health Inequalities in European Countries.Gower, Aldershot, U.K., 1989.
6.
KaplanG. A., and KeilJ. E.Socioeconomic factors and cardiovascular disease: A review of the literature. Circulation88(4, pt. 1):1973–1998, 1993.
7.
FeinsteinJ. S.The relationship between socioeconomic status and health: A review of the literature. Milbank Q.71:279–322, 1993.
8.
KunstA. E., and MackenbachJ. P.The size of mortality differences associated with educational level in nine industrial countries. Am. J. Public Health84:932–937, 1994.
9.
LynchJ. W.Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction?Am. J. Epidemiol.144:934–942, 1996.
10.
DerverF., and WhiteheadM. (eds.). Health Inequalities.Stationery Office, London, 1997.
11.
MarmotM., and WilkinsonR. (eds.). Social Determinants of Health.Oxford University Press, Oxford, 1999.
12.
ElstadJ. I.Social Inequalities in Health and Their Explanations. Rapport9/00. NOVA, Oslo, 2000.
13.
WildmanJ.Income related inequalities in mental health in Great Britain: Analysing the causes of health inequality over time. J. Health Econ.22:295–312, 2003.
14.
NavarroV. (ed.). Political and Economic Determinants of Population Health and Well-Being—Controversies and Developments.Baywood, Amityville, NY, 2004.
15.
RaphaelD. (ed.). Social Determinants of Health—Canadian Perspectives.Canadian Scholars' Publishing, Toronto, 2004.
16.
WilkinsonR. G.Income distribution and life expectancy. BMJ304:165–168, 1992.
17.
WildmanJ.The impact of income inequality on individual and societal health: Absolute income, relative income, and statistical artifacts. Health Econ.10:357–361, 2001.
18.
SiegristJ., and MarmotM.Health inequalities and the psychosocial environment—Two scientific challenges. Soc. Sci. Med.58:1463–1473, 2004.
19.
HadleyJ., and OseiA.Does income affect mortality? An analysis of the effects of different types of income on age/sex/race-specific mortality rates in the United States. Med. Care20(9):901–914, 1982.
20.
DuleepH. O.Measuring the effect of income on adult mortality using longitudinal administrative record data. J. Hum. Resources21(1):238–251, 1986.
21.
EttnerS. L.New evidence on the relationship between income and health. J. Health Econ.15:67–85, 1996.
22.
KakwaniN.WagstaffA., and van DoorslaerE.Socio-economic inequalities in health: Measurement, computation, and statistical inference. J. Econometr.77:87–103, 1997.
23.
KawachiI.WilkinsonR. G., and KennedyB. P. (eds.). Income Distribution and Health: A Reader.New Press, New York, 1999.
24.
MeerJ.MillerD. L., and RosenH. S.Exploring the health-wealth nexus. J. Health Econ.22:713–730, 2003.
25.
AdamsP.Healthy, wealthy, and wise? Tests for direct causal paths between health and socioeconomic status. J. Econometr.112:3–56, 2003.
26.
SilventoinenK., and LahelmaE.Health inequalities by education and age in four Nordic countries, 1986 and 1994. J. Epidemiol. Community Health56(4):253–258, 2002.
27.
KunstA. E.Occupational class and cause specific mortality in middle aged men in 11 European countries: Comparison of population based studies. BMJ316:1636–1642, 1998.
28.
HallqvistJ.Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program. Soc. Sci. Med.58:1555–1562, 2004.
29.
FoxA.GoldblattP., and JonesD.Social class mortality differentials: Artifact, selection, or life circumstances?J. Epidemiol. Community Health39:1–8, 1985.
30.
PekkanenJ.Social class, health behaviour, and mortality among men and women in eastern Finland. BMJ311:589–593, 1995.
31.
PicusT.Social conditions and self-management are more powerful determinants of health than access to care. Ann. Intern. Med.129(5):406–411, 1998.
32.
TaylorR., and RiegerA.Medicine as social science: Rudolf Virchow on the typhus epidemic in Upper Silesia. Int. J. Health Serv.15(4):547–559, 1985.
33.
WaitzkinH.One and a half centuries of forgetting and rediscovering: Virchow's lasting contributions to social medicine. Soc. Med.1(1):5–10, 2006.
34.
CeresetoS., and WaitzkinH.Economic development, political-economic system, and the physical quality of life. Am. J. Public Health76(6):661–666, 1986.
35.
LenaH. F., and LondonB.The political and economic determinants of health outcomes: A cross-national analysis. Int. J. Health Serv.23(3):585–602, 1993.
36.
NavarroV.Has socialism failed? Health indicators under capitalism and socialism. Sci. Society57(1), 1993.
37.
NavarroV., and ShiL.The political contexts of social inequalities and health. Soc. Sci. Med.52:481–491, 2001.
38.
NavarroV.The importance of the political and the social in explaining mortality differentials among the countries of the OECD, 1950–1998. In The Political and Social Contexts of Health, ed. NavarroV.. Baywood, Amityville, NY, 2004.
39.
CoburnD.Beyond the income inequality hypothesis: Class, neo-liberalism, and health inequalities. Soc. Sci. Med.58:41–56, 2004.
40.
NavarroV.Special report on the political and social contexts of health, Part I. Introduction: Objectives and purposes of the study. Int. J. Health Serv.33(3):407–417, 2003.
41.
NavarroV. (ed.). The Political and Social Contexts of Health.Baywood, Amityville, NY, 2004.
42.
BambraC.FoxD., and Scott-SamuelA.Towards a politics of health. Health Promotion Int.20(2):187–193, 2005.
43.
ShandraJ. M.Dependency, democracy, and infant mortality: A quantitative, cross-national analysis of less developed countries. Soc. Sci. Med.59:321–333, 2004.
44.
BollenK.World system position, dependency, and democracy: A cross-national analysis. Am. Sociol. Rev.48:468–479, 1983.
45.
FrancoA.Alvarez-DardetC., and RuizM. T.Effects of democracy on health: Ecological study. BMJ329:1421–1423, 2004.
MarshallM. G., and JaggersK.Polity IV Project: Political Regime Characteristics and Transitions, 1800–2002: Dataset Users' Manual.Integrated Network for Societal Conflict Research Program, Center for International Development and Conflict Management, University of Maryland, 2002. www.cidcm.umd.edu/inscr/polity.
49.
RoyJ.-P.Socioeconomic status and health: A neurobiological perspective. Med. Hypotheses62:222–227, 2004.
50.
StrikeP. C. and SteptoeA.Psychosocial factors in the development of coronary artery disease. Prog. Cardiovasc. Dis.46(4):337–347, 2004.
51.
KuhD., and Ben-ShimoY. (eds.). A Life Course Approach to Chronic Disease Epidemiology.Oxford University Press, Oxford, 1997.
52.
KristensonM.Psychobiological mechanisms of socioeconomic differences in health. Soc. Sci. Med.58(8):1511–1522, 2004.
53.
WilkinsonR.Unhealthy Societies: The Afflictions of Inequality.Routledge, New York, 1996.
54.
KawachiI. R., and KennedyB.The Health of Nations: Why Inequality Is Harmful to Your Health.New Press, New York, 2002.
55.
HofrichterR. (ed.). Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease.Jossey-Bass, San Francisco, 2003.
56.
VageroD.Inequality in health: Some theoretical and empirical problems. Soc. Sci. Med.32:367–371, 1991.
