Opinion

Safeguarding Democracy for Better Health Policies

Ana Rita Gonzalez*

Policy Wisdom LLC, Miami, FL, USA

Submission: November 22, 2024; Published: December 02, 2024

*Corresponding author: Ana Rita Gonzalez, Policy Wisdom LLC, Miami, FL, USA

How to cite this article: Ana Rita G. Safeguarding Democracy for Better Health Policies. JOJ Pub Health. 2024; 9(3): 555763. DOI: 10.19080/JOJPH.2024.09.555763

Keywords

Keywords: Democracy; Health Policy; Governance; Health Outcomes.

Abbreviations: WHO: World Health Organization; SDH: Social Determinants of Health

Opinion

Democracy is essential for peace, development and ensuring human rights including health are protected. [1] Providing access to quality healthcare at an affordable cost is the responsibility of the governments towards its citizens and WHO supports this and calls on all governments to progress towards universal health coverage. [2] Despite this, inequities in health have been noted across regions, countries, and within countries. Several studies have highlighted a set of factors that leads to it - workforce shortages, lack of sustainable funding, and social determinants of health amongst others. One of the lesser-studied and talked about factors is democracy or lack thereof. Democracy ensures that citizens’ voices are heard and that the Government which is the decision maker represents people’s voices as their mandate. This includes health, education, social protection, livelihood, and quality of life which are collectively labelled as the social determinants of health (SDH). Along with this, the provision of quality comprehensive healthcare which includes preventive and curative health services is also the responsibility of the government. For all of this to happen, it is imperative that policies are in place to address the SDH, provide quality and affordable healthcare, and that sufficient resources are allocated for their implementation. Since health policies are the blueprint for long-term interventions.

Recent Trends in Democracy

Recent trends indicate a notable decline in levels of democracy globally, often referred to as democratic backsliding. Over the past two decades, numerous countries have experienced significant erosion of democratic norms and institutions, characterized by the weakening of civil liberties, restrictions on media freedom, and the centralization of executive power. For instance, analyses from various democracy indices reveal that while the aggregate level of democracy has not advanced since around 2005, many nations have seen a regression in key democratic elements. [3,4] This decline has been attributed to several factors, including the rise of authoritarian populism, increased political polarization, and external pressures from nondemocratic regimes. [3,5] For example, India has exemplified this trend, where legal mechanisms have been employed to undermine opposition and limit freedoms, reflecting a pattern of incremental democratic erosion rather than overt authoritarianism. [6] Similarly, the recent US election result raises concerns over the stability of democracy. [7,8] As a result, the global landscape of democracy appears increasingly precarious, prompting calls for efforts to reinforce democratic institutions and practices. [9,10]

Democracy and health outcomes

The relationship between democracy and health outcomes is increasingly recognized as significant, with evidence suggesting that democratic governance is associated with improved population health, particularly in the context of non-communicable diseases, including cancer, and injuries. Studies indicate that democracies tend to allocate more resources to healthcare leading to better health indicators such as increased life expectancy and reduced mortality rates from conditions like cardiovascular diseases and tuberculosis. [11-14] However, despite the growing body of literature highlighting these correlations, there remains a notable lack of comprehensive studies explicitly connecting democratic governance to specific health policies and their implementation. Some scholars do argue that democratic institutions enhance the adoption of pro-health policies and democracies tend to be more effective than non-democracies in selecting representative and leaders, transparent with their intentions, which could lead to improved implementation of health policies and, consequently, better overall health outcomes for the population. [14] Moreover, conversations in non-academic spaces around democracy leading to better health policies are also limited. This is a loss since policies are a blueprint for sustained action and can act as advocacy tools and offer monitoring and evaluation frameworks for continuous improvement.

Democracy and Health Policies

In well-functioning democracy health policies are made and shaped in a way that addresses the needs of the people, are informed by evidence, and are formulated in consultation and inputs from a wide variety of stakeholders including patients. Moreover, people have the power to choose their representatives who can raise health problems on the political agenda, hence ensuring that resources are allocated, and policy implementation is effective. The declining trend in democracy should concern everyone. Public health professionals, patient advocates, healthcare providers, and all other stakeholders should be aware that health policies are not made in isolation but negotiations for health happen in the political realm and the extant regime affects their capacity to shape health policies. While conversations around social, commercial, and behavioural determinants of health are prevalent. Political determinants are often not the focus of attention and discourse. It may be argued that it is one of the most upstream determinants which affects social and commercial determinants and health services. Hence, further empirical investigations are necessary to elucidate the pathways through which democracy influences health policy decisions and the subsequent impacts on public health.

Conclusion

The interplay between democracy and public health policy is critical to understanding in shaping effective responses to contemporary health challenges. By prioritizing evidencebased decision-making, fostering public trust, and addressing the political dynamics at play, democracies can effectively address current and future public health problems. As we move forward, all stakeholders including policymakers and public health professionals must embrace a collaborative approach that integrates scientific expertise with support for democratic values to achieve optimal health outcomes for all citizens..

References

1. Universal Declaration on Democracy (2024) Inter-Parliamentary Union.
2. Universal Health Coverage (2024) World Health Organization.
3. Understanding and responding to Global Democratic Backsliding (2024) Carnegie Endowment for International Peace.
4. Little AT, Meng (2024) A Measuring Democratic Backsliding. PS Polit Sci Polit 57(2):149-161.
5. Grillo E, Prato C (2020) Reference Points and Democratic Backsliding. American Journal of Political Science 67(1): 71-88.
6. Maya Tudor (2023) Why India’s Democracy Is Dying. Journal of Democracy 34(3): 121-132.
7. (2024) After the elections, what’s next for democracy?
8. (2024) US: Second Trump Term a Threat to Rights in US, World Human Rights.
9. Grillo E, Luo Z, Nalepa M, Prato C (2024) Theories of Democratic Backsliding. Annual Review of Political Science 27(1): 381-400.
10. Nancy Bermeo (2016) On Democratic Backsliding. Journal of Democracy 27(1): 5-19.
11. Democracy Matters in Global Health (2024) Council on Foreign Relations.
12. Bollyky TJ, Templin T, Cohen M, Schoder D, Dieleman JL et al. (2019) The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis. Lancet 393(10181): 1628-1640.
13. (2024) Does democracy lead to better health? Our World in Data.
14. Vu TV (2024) Revisiting the effect of democracy on population health. Oxf Econ Pap Pp: 1-27.