More corrupt countries have fewer doctors: Here’s why there’s a link between democracy and health

Democracy isn’t just about free elections, human rights, and equality, a new study has found – it’s also about the health workforce.

It’s long been known that people in wealthier countries with more robust public services tend to live longer and have stronger health systems. But as it turns out, democracy and corruption are also key factors, according to the study of 134 countries published in the journal PLOS Global Public Health journal.

Countries considered highly democratic – meaning they had trustworthy elections, civil liberties, and a functional government – and were viewed as less corrupt tended to also have more doctors available, the study found.

The availability of doctors offers clues about the kind of medical care people can expect to receive.

For every 10 per cent increase in physician density, healthcare access and quality improves by 2.3 per cent, other research has shown.

The link between democracy, corruption, and the health workforce held up regardless of how much money the countries spent on healthcare relative to the size of their economies, the study found.

“Governance quality – through both democracy and corruption – plays a critical role in shaping healthcare workforce capacity,” said Dr Amrit Kirpalani, the study’s lead author and an assistant professor in the paediatrics department of Western University’s medical school in Canada.

Which countries in Europe had the strongest health workforces?

In Europe, Finland, Sweden, and Austria led the pack, with high democracy scores, low levels of corruption, and strong physician workforces, Kirpalani told Euronews Health.

However, there were some exceptions. While Bulgaria and Romania are also democratic countries, they have problems with corruption that could undermine their health workforces, he added.

“A country can be highly democratic yet struggle with corruption, or vice versa,” Kirpalani said.

The results add some nuance to a growing body of evidence that shows that as democracy spreads around the world, health outcomes improve.

An analysis of 115 countries between 1960 and 2015, for example, found that as the level of democracy rose in a country, its overall death rates, including child and infant mortality, declined.

Compared with people living under dictatorships, those in democracies are also less likely to die from cardiovascular diseases or accidents involving cars or other modes of transportation, according to another study published in the Lancet medical journal.

Growing up in an autocratic system could impact health

In dictatorships and other autocratic systems, “for well-connected people in the inner circle of power, there may be really good facilities available, but for the general population at large, in remote areas, people without any political power, they may be left on their own,” Dominic Rohner, an international economics professor at the Geneva Graduate Institute, told Euronews Health.

“You tend to have more accountability, less corruption, better health access in democracy”.

Yet living in a democracy isn’t enough to confer health benefits, Rohner discovered earlier this year in a global analysis with colleagues from the University of Bologna. It also matters where people grow up.

Regardless of where they lived as adults, people who spent the first 20 years of their lives in a democracy had a life expectancy that was 2.8 years longer than those who spent their first two decades under an authoritarian regime, the study found.

Child mortality was also 3.28 per cent lower.

“Even if you grow up in an autocracy and then you move to a democracy, the lost years are lost and the damage is done forever,” Rohner said.

Of course, dictators are hardly ready to give up their power in the name of people’s health. But Rohner said findings like his have important implications as voters around the world consider which candidates to put in power.

The public’s health, it turns out, might be on the ballot as well.

Voters “should keep in mind that statistically, if you go for autocracy, life will be less good for the average citizen,” Rohner said. “The way back to democracy is a hard one”.