McGuire Studies the Relationship Between Democracy and Public Health

Professor of Government James McGuire is a political scientist with expertise in the association between democracy and public health.

You study the relationship between democracy and population health. Does the literature find that democracy is good for population health?

As a political scientist I’ve long been interested in democracy, and especially in its possible impact on other aspects of well-being. Many other political scientists have studied democracy’s impact on economic growth and income inequality. My interest has been in democracy’s impact on the risk of early death, and particularly on child mortality in developing countries. For Amartya Sen and Martha Nussbaum, whose capabilities approach I endorse, the end of human development is to enable each of us to lead a thoughtfully chosen life. To live the life one has reason to choose, however, one has to be alive.

For my forthcoming book Democracy and Population Health, I reviewed more than 200 quantitative studies of the association between the two phenomena. On balance, these studies find that democracy is usually, but not invariably, beneficial for population health. One can certainly dredge up examples of authoritarian countries that have done well. China, Saudi Arabia, and Cuba have reduced infant mortality quite steeply over the past 30 years, but for every such case there is a North Korea, Venezuela, or Zimbabwe—authoritarian countries where infant mortality has declined only at a glacial pace.

Given the temptation to cherry-pick case studies that support one’s previous conjectures, I thought that the time was ripe for a survey of systematic cross-case analyses, most of which have been carried out cross-nationally.

Besides establishing that democracy on balance is good for population health, the studies I reviewed found that electoral contestation, although important as a determinant of population health, is not the only aspect of democracy that reduces the risk of early death. Long-term democratic experience appears to be important as well, as does decentralization, high voter turnout, proportional representation, and left-party strength. Surprisingly, freedom of expression is usually found to be unrelated to population health, possibly because there haven’t been many studies of the association, but also possibly because, until the coronavirus outbreak, population health has not been particularly “newsworthy,” measured as it usually is by slow-changing indicators like national infant mortality rates and life expectancy measures.

The current coronavirus outbreak is happening during election season in the United States. How does social science research indicate that the pandemic might affect the election results?

On Feb. 26, President Trump held a news conference in which he stated, “we could be at just one or two people [infected with the coronavirus] over the next short period of time.” On that date, the fivethirtyeight.com polling average put his approval rating at 43.4%. Almost a month later, on March 20, when the number of identified cases in the United States had soared to 18,980 with 256 deaths, the same polling average put the president’s approval rating at a statistically identical 43.2%. The question is what will happen over the next few months.

No one doubts that the coronavirus outbreak will have devastating effects on the US economy. By this route, the coronavirus outbreak could jeopardize President Trump’s reelection prospects. But if the president succeeds in sweeping under the rug his initial dismissal of the seriousness of the outbreak, which has already cost us dearly, and in remarketing himself as a “war president” (despite his initial hesitancy, not for the first time, to go to war), and if the worst-case scenarios for the pandemic are somehow avoided, Trump could even end up benefiting from the crisis.

Is there a historical precedent for something like a pandemic having an impact on psychological dispositions and election results?

In the past, the fear of infectious disease, or “parasite stress,” has been found to encourage authoritarian attitudes. Murray, Schaller, and Suedfeld studied 90 pre-industrial societies, as well as individual respondents across 31 countries, and found that parasite stress was a strong predictor of authoritarian values and practices. To explain this association, they argued that “because many disease-causing parasites are invisible, and their actions mysterious, disease control has historically depended substantially on adherence to ritualized behavioral practices that reduced infection risk,” leading to the exaltation of “group loyalty, obedience, and respect for authority.” Corroborating this finding from another perspective, Thornhill, Fincher, and Aran found that a decline in parasite stress is associated with more liberalized attitudes and values embracing traditionally disenfranchised groups. Similarly, Tybur and colleagues found that, across 11,501 respondents in 30 countries, lower parasite stress was related to less prejudice against persons who violate traditional social norms.

In a twist on the parasite stress hypothesis, which suggests that the threat of infectious disease encourages authoritarian attitudes, Beall, Hofer, and Schaller found that a threat of this sort encourages a propensity to vote conservative. In October 2014, a case of Ebola was reported in the United States. Over the next several weeks, polling data showed a significant shift in voting intentions from the Democrats to the Republicans. Likewise, Jost and colleagues found in a meta-analysis of eight studies that experimentally-induced mortality salience (fear of death) was strongly associated with “attitudes and behaviors that are generally associated with conservative and right-wing ideological positions.”

What would be the implications for democracy in the United States if the coronavirus helps Trump get reelected?

In the United States, reports of coronavirus infections could undermine democracy, not only by providing an excuse for widely-reported verbal and physical attacks against people perceived to be of East Asian descent, but also by advantaging the Republican party in the November 2020 elections … assuming that these elections occur. According to the major democracy-rating indices, the Republican President Donald Trump has presided over prodigious democratic erosion. Would democratic backsliding accelerate during a second Trump term? There is no way to be sure, but based on the experiences of other countries, the answer is likely yes. As Kaufman and Haggard point out, “a second term for Trump would not only increase the president’s control over the other branches of government, but would enhance his capacity to deploy tax, regulatory, and even police powers against political opponents.” Drawing on evidence from Hungary, India, Poland, Turkey, and Venezuela, Yascha Mounk has argued that when an illiberal populist first takes office, “many key institutions, including courts and electoral commissions, are still dominated by independent-minded professionals who do not owe their appointment to the new regime.” As soon as such leaders are reelected, however, “these constraints begin to fall away. As the independent-minded judges and civil servants depart, populist leaders feel emboldened to pursue their illiberal dreams.”

Does our form of government in the United States make us more or less well-equipped to respond to the outbreak, compared to a country like China?

China’s authoritarian regime made it initially quite poorly equipped to respond to the outbreak, and contributed heavily to the spread of the coronavirus within the city of Wuhan, Hubei, where it originated, and later around the world. In December 2019, Chinese authorities arrested several health professionals on charges of spreading “rumors,” which later proved to be correct, that an unknown but potentially serious virus was causing respiratory infections in the city of Wuhan. One of those arrested was Dr. Li Wenliang, who contracted the virus and died of the disease on Feb. 7, 2020. Thus, initially, authoritarianism prevented the free flow of information needed to mobilize the government and the public to take action to counter the impending threat.

By imposing a complete quarantine on Wuhan, and later on Hubei province, and by imposing travel restrictions on the whole country and even more stringent restrictions on many cities, China appears to have been able to slow the spread of the virus—for the moment. Was authoritarianism a necessary condition for this (possibly fleeting) success? I would characterize it as a supportive condition, but not as a necessary condition. Enforcement of the quarantine and travel ban by party committees probably helped subsequently to reduce transmission, as did an intrusive surveillance regime that would be hard to implement in most Western democracies. However, the United States mobilized the population effectively after Pearl Harbor was bombed in 1941, and democratic Japan, South Korea, and Taiwan have been at least as successful as China, so far, in stopping the spread of the virus. The main problems with the U.S. response so far have been deadly delays in the distribution of testing kits, protective equipment for health workers, ventilators for intensive care units, and social distancing measures. These delays were not caused by our political regime. Democracy produces electoral incentives, but it’s up to incumbents how to respond to them. In a time of crisis, a public-spirited and competent incumbent will ignore electoral incentives and act expeditiously to secure the public good. A narcissistic and incompetent incumbent is more likely to minimize the threat until that stance is no longer tenable, wasting precious time in the single-minded pursuit of personal glory.