Democracy, Equality and Good Public Health: A Fuzzy Set Analysis of Latin America

Our goal is to answer one crucial question: what are the core conditions that explain high levels of public health in Latin America? We offer a key contribution to the empirical literature on the policy impact of democracy, by claiming that democracy interacts with other factors to help public health: differences in public health levels in Latin America can be better explained by the interplay of these factors, rather than as the net effect of single institutional conditions. Political regimes have direct and indirect effects on public health. Political oppression is clinically related to mental oppression, which converts into depression and illnesses. Political freedom is often related to mutual respect and self-worth which breed mental satisfaction and health. Indirect effects are based on politicians’ responsiveness to popular needs and accountability mechanisms, which are missing in authoritarian settings. Economic well-being and public expenditures, as well as a more equal income distribution, finally, favor better funded and more efficient health systems. We find that there are at least four different ‘models’ thorough which political and socio-economic conditions exerted an impact on health in different groups of Latin American countries, through varying combinations of factors as democratic governments, prosperity, social equality and generous public health outlays. Yet, one specific combination of factors appears particularly effective: in conjunction with democracy, socio-economic equality represents the most promising arrangement for securing good health results in the area.