Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis.

AIMS: The COVID-19 pandemic has led to a spate of studies showing a close connection between inequitable access to health care, welfare services and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question by asking whether more 'egalitarian' forms of democracy matter, given that they contain more equitable health-care access and societal infrastructure, such as social capital and trust. METHODS: We use standard regression techniques, including instrumental variables analysis addressing endogeneity on COVID-19 testing and deaths data as of the end of May and beginning of September. We use novel data from the Varieties of Democracy Project on health-system equity and egalitarian democracy. RESULTS: Our results suggest that more equitable access to health care increases testing rates and lowers the death rate from COVID-19. Broader egalitarian governance, measured as egalitarian democracy, however, shows the opposite effect. Thus, factors associated with health-care capacity to reach and treat matter more than broader societal factors associated with social capital and trust. The results are robust to alternative testing procedures, including instrumental variable technique for addressing potential endogeneity. CONCLUSIONS: Despite a great deal of public health focus on how equitable governance helps fight the adverse effects of so-called neoliberal pandemics, we find that broadly egalitarian factors have had the opposite effect on fighting COVID-19, especially when an equitable health system has been taken into account. Fighting disease, thus, might be more about the capacity of health systems rather than societal factors, such as trust in government and social capital.

Does social diversity impede sound economic management? An empirical analysis, 1980-2012.

Several celebrated scholars argue that diverse preferences and coordination failure due to ethnic and cultural diversity hamper the social cohesion necessary for good economic management, leading to development failure. Using several measures of diversity, we find that higher levels of ethno-linguistic and cultural fractionalization are conditioned positively on higher economic growth by an index of economic freedom, which is often heralded as a good measure of sound economic management. High diversity in turn is associated with higher levels of economic freedom. We do not find any evidence to suggest that high diversity hampers change towards greater economic freedom and institutions supporting liberal policies. The effect of diversity, moreover, is conditioned positively by higher democracy. Our results raise serious doubt about the centrality of social diversity for explaining economic failure, nor is there evidence to suggest that autocratic measures are required under conditions of social diversity to implement growth-promoting policies. This is good news because history and culture seem to matter less than rational agency for ensuring sound economic management.

Does free-market capitalism drive unequal access to health? An empirical analysis, 1970-2015.

Many scholars, particularly in public health, argue that neoliberal capitalist economic forces adversely affect communities by increasing inequalities, ultimately affecting health. Apparently, corporate capitalism affects health and communitarian concerns because governments place corporate profits over the publics interests. Using unique data collected by the Varieties of Democracy (VDEM) project that capture the degree of access of the poorest segments of society to health services comparable with those available to the richest segments, this study finds that an index of economic freedom robustly reduces inequality of access to health. We argue that these results obtain because greater exposure to global markets increases the premium on the productivity of labour, increasing incentives for political elites to invest in productivity-enhancing public goods. Our results are robust to a number of alternative models and data, and robust to instrumental variables analyses addressing potential endogeneity. Rather than free-market capitalism increasing health-related neglect of society, our data suggest that free-market capitalist conditions promote equitable access to health. This is good news for governments wishing to grow their economies, reform broken health systems for gaining advantages in a competitive global economy, and serve communitarian interests, such as shared good health.