Download Document

Wealth, Health, and Democracy
in East Asia and Latin America
James W. McGuire
Department of Government
Wesleyan University
Middletown, CT
[email protected]
Seminar
United Nations Development Programme
New York, NY
October 30, 2009
1
Main Question
Why do some societies do better than others at reducing infant mortality?
Method Used to Answer Question
Nested analysis
• Quantitative analysis of 105 developing countries in 1990 predicting
infant mortality from democracy, public health spending, social service
utilization, and economic, demographic, cultural, and geographic
variables (Ch. 2).
• Eight case studies of the pattern and pace of infant mortality decline
from 1960 to 2005 (Chs. 3-10).
• Latin America: Argentina, Brazil, Chile, Costa Rica
• East Asia: South Korea, Taiwan, Indonesia, Thailand
• A comparison of the eight cases to explore the impact of democracy on
pro-poor health campaigns, and of pro-poor health campaigns on infant
mortality (Ch. 11).
2
Main Findings
•
Public health: Good public provision of public social services can do as much
to reduce infant mortality as fast economic growth or low income inequality,
and is often easier to achieve.
•
Political Science: Long-term democratic experience, and to a lesser extent
short-term democratic practice, promotes the provision and utilization of
mortality-reducing social services, but less, and more complexly, than most
previous research suggests.
•
What public social services are especially effective?
• Primary health care (focus of the book and of this seminar)
• Primary and secondary education
• Family planning
• Provision of safe water and adequate sanitation
•
What encourages governments to provide these services?
• Bureaucratic initiative
• International influence
• Democracy (focus of the book and of this seminar)
• Civil society involvement
3
4
5
6
GDP per capita and Income Inequality
in Eight Latin American and East Asian Societies
Mean
GDP per GDP per
Gini Gini index Change in
annual rise capita, PPP capita, PPP index of of income Gini index
in GDP per
income inequality of income
capita
inequality
inequality
19602003
1960
2003
Taiwan, Ch.
Korea, Rep.
6.3%
6.0%
1,444
1,458
19,885
17,597
29.9
33.3
33.9
37.2
4.0
3.9
Thailand
Indonesia
4.6%
3.2%
1,059
1,071
7,274
4,122
43.8
43.3†
44.8
39.6†
1.0
-3.7
Brazil
Chile
2.4%
2.0%
2,644
5,086
7,205
12,141
59.0
46.0
57.6
54.6
-1.4
8.6
Costa Rica
Argentina
1.5%
0.6%
4,513
7,838
8,586
10,170
43.0
36.4*
49.0
52.9*
6.0
16.5
Indonesia: 1976 and 1995. * Argentina: Metropolitan areas only.
GDP per capita: Penn World Table 6.2.
Gini: WIDER income inequality database.
c. 1970 c. 2003
19702003
†
7
Life Expectancy and Infant Mortality
in Eight Latin American and East Asian Societies
Life
Life
Infant
Infant Infant
Life
expectancy expectancy expectancy mortality mortality mortality
level
level
decline, avg. level
level
rise, %
ann. %
Chile
Costa Rica
1960-2005
76%
72%
1960
57.3
61.9
2005
78.2
78.5
1960-2005 1960
5.9%
120
4.3%
68
2005
8
10
Korea, Rep.
Taiwan, Ch.
79%
64%
54.2
64.4
78.4
77.6
6.4%
4.9%
82
54
5
6
Indonesia
Thailand
61%
50%
41.5
52.6
67.8
69.9
3.3%
5.6%
128
103
28
8
Brazil
Argentina
56%
49%
54.8
65.2
71.8
74.8
3.8%
3.4%
115
63
20
13
Source: World Bank, World Development Indicators, 2 Aug 2008.
8
9
10
Determinants of Primary Health Care Policies
1. Bureaucratic initiative
•
•
Political leaders
Health ministry, social security, etc. officials
2. International factors
•
•
•
•
•
•
•
•
•
•
Missionaries
Colonization/occupation
Multinational corporations
Multilateral organizations
Migration
International norms and ideological diffusion
Foreign aid
Foreign study/training
National prestige
Foreign models
•
•
•
•
•
Electoral incentives
Intra-party competition
Freedom of information
Freedom to organize
Sense of equality, entitlement (if democratic a long time)
3. Democracy
4. Civil society involvement
•
•
•
Interest groups
Social movements
Issue networks (drawn from knowledge communities)
11
Is Wealthier Healthier?
1.
2.
Don’t oversell economic factors as causes of mortality decline.
Public education, family planning, water and sanitation, and basic health
services are crucial to mortality decline. Good public provision of usually
inexpensive social services can often make up for slow economic growth, high
income inequality, and high income poverty.
Does Democracy Promote Mortality-Reducing Social Services?
1.
Democracy can contribute to the provision and utilization of mortalityreducing social services not only via electoral incentives, but also via intraparty competition, freedom of information, freedom to organize, and (in
countries with long democratic experience) a sense of equality/entitlement.
2.
Civil society involvement, including by labor unions, can discourage as well
as encourage mortality-reducing social services.
3.
Democracy does not have a unique, invariable, automatic, or massive
beneficial effect on mortality-reducing social services in every case.
4.
Democracy can be justified on intrinsic and constructive grounds, not just on
instrumental grounds. Also, citizens and political leaders have to seize the
opportunities that democracy provides.
12
Thank you
For inviting me!
Jim McGuire
13