Wealth, Health, and Democracyin East Asia and Latin America

James W. McGuire

Department of GovernmentWesleyan University

Middletown, CTjmcguire@wesleyan.edu

Seminar

United Nations Development Programme

New York, NY

October 30, 2009

James W. McGuire

Department of GovernmentWesleyan University

Middletown, CTjmcguire@wesleyan.edu

Seminar

United Nations Development Programme

New York, NY

October 30, 2009

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Main QuestionWhy do some societies do better than others at reducing infant mortality?

Method Used to Answer QuestionNested 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).

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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

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GDP per capita and Income Inequalityin Eight Latin American and East Asian Societies

Meanannual risein GDP per

capita

GDP percapita, PPP

GDP percapita, PPP

Giniindex ofincome

inequality

Gini indexof incomeinequality

Change inGini indexof incomeinequality

1960-2003

1960 2003 c. 1970 c. 2003 1970-2003

Taiwan, Ch. 6.3% 1,444 19,885 29.9 33.9 4.0Korea, Rep. 6.0% 1,458 17,597 33.3 37.2 3.9

Thailand 4.6% 1,059 7,274 43.8 44.8 1.0Indonesia 3.2% 1,071 4,122 43.3† 39.6† -3.7

Brazil 2.4% 2,644 7,205 59.0 57.6 -1.4Chile 2.0% 5,086 12,141 46.0 54.6 8.6

Costa Rica 1.5% 4,513 8,586 43.0 49.0 6.0Argentina 0.6% 7,838 10,170 36.4* 52.9* 16.5

† Indonesia: 1976 and 1995. * Argentina: Metropolitan areas only.GDP per capita: Penn World Table 6.2.Gini: WIDER income inequality database.

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Life Expectancy and Infant Mortalityin Eight Latin American and East Asian Societies

Lifeexpectancy

rise, %

Lifeexpectancy

level

Lifeexpectancy

level

Infantmortality

decline, avg.ann. %

Infantmortality

level

Infantmortality

level

1960-2005 1960 2005 1960-2005 1960 2005

Chile 76% 57.3 78.2 5.9% 120 8Costa Rica 72% 61.9 78.5 4.3% 68 10

Korea, Rep. 79% 54.2 78.4 6.4% 82 5Taiwan, Ch. 64% 64.4 77.6 4.9% 54 6

Indonesia 61% 41.5 67.8 3.3% 128 28Thailand 50% 52.6 69.9 5.6% 103 8

Brazil 56% 54.8 71.8 3.8% 115 20Argentina 49% 65.2 74.8 3.4% 63 13

Source: World Bank, World Development Indicators, 2 Aug 2008.

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Determinants of Primary Health Care Policies1. 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

3. Democracy• Electoral incentives• Intra-party competition• Freedom of information• Freedom to organize• Sense of equality, entitlement (if democratic a long time)

4. Civil society involvement

• Interest groups• Social movements• Issue networks (drawn from knowledge communities)

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Is Wealthier Healthier?

1. Don’t oversell economic factors as causes of mortality decline.2. 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 mortality-

reducing social services not only via electoral incentives, but also via intra-party 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.

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Thank you

For inviting me!

Jim McGuire

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