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.
Highlights
The link between political freedom and health is unclear
We created a database of 181 countries for life expectancy, infant mortality, maternal mortality ratio, % low birth weight babies, Gini coefficient, total government expenditure (USD), Gross National Income/capita, % total GDP spent on health, and historical level of freedom
We obtained data on life expectancy for 176 countries, infant mortality for 181 countries, maternal mortality ratio for 166 countries, % low birth weight babies for 173 countries, Gini coefficient for 156 countries, total government expenditure for 173 countries, GNI/capita for 162 countries, and % of total GDP spent on health for 180 countries
Summary
We aimed to determine the association by exploring the relationship of historical and cumulative freedom levels with important health outcomes. With various organizations providing data on political and health indicators from all over the world, large-scale global comparisons are possible[3]. In this analysis, we explore the relationship of historical and cumulative freedom levels, based on political rights and civil liberties, using various health indicators. The authors found that higher levels of democracy were associated with better health outcomes. Since they compared Freedom House ratings to
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