Is democracy good for your health?

This is the authors' abstract. We don't add key points for this paper.

Democracy is a system where citizens choose leaders through free and fair elections, founded on the principle of equality and aimed at prioritizing public health and well-being.1 When done properly, democracy can benefit population health through multiple mechanisms such as prioritizing public health, holding leaders accountable and fostering competent governance.2 Nevertheless, research on the relationship between democracy and health presents a puzzling picture. First, evidence is mixed regarding whether democracy is associated with improved health.3 On one hand, many studies suggest democracy has a positive impact on a wide range of population health outcomes, including life expectancy, infant and child mortality, self-rated health.2 On the other hand, a growing literature has also raised doubts and found democracy has little to no impact on health outcomes.4 Furthermore, the significant increase in democratic governance around the world has also been accompanied by the persistence and widening of health disparities, which is regarded as ‘one of the great disappointments in public health’.5, (page 761) In Canada, for example, the paradox is that, despite significant gains in life and health expectancy—ranking the country among the world’s healthiest—inequalities in these measures persist and have even widened over time.6 In fact, there is a well-documented public health puzzle. That is, in highly developed social democratic and welfare states such as Denmark, Finland, Norway and Sweden health inequalities, both relative and absolute, are not necessarily smaller and, in some instances, may even be more pronounced.5,7