Wealth, Health, and Democracy in East Asia and Latin America

1. Wealth, Health, and Democracyin East Asia and Latin America James W. McGuire Department of Government Wesleyan University Middletown, CT jmcguire@wesleyan.edu Seminar United Nations Development Programme New York, NY October 30, 2009

2. 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).

3. 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

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

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

11. 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 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)

12. Is Wealthier Healthier? • 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? • 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. • Civil society involvement, including by labor unions, can discourage as well as encourage mortality-reducing social services. • Democracy does not have a unique, invariable, automatic, or massive beneficial effect on mortality-reducing social services in every case. • 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.

13. Thank you For inviting me! Jim McGuire