Health Security, Quality of Life and Democracy during the COVID-19 Pandemic: Comparative Approach in the EU-27 Countries.

The aim of this paper is to emphasize the role played by the social, economic and political variables in shaping models of sustainable healthcare systems and strategies able to support and improve the quality of life during and after the COVID-19 pandemic. The context of our research is represented by the medical and socioeconomic crises generated by the COVID-19 pandemic. The current pandemic negatively affects healthcare systems, quality of life and the global economy. In this respect, this paper aims to thoroughly scrutinize the effects of the COVID-19 pandemic on the social and healthcare systems of EU countries, to analyze the impact of human development in the field of the Global Health Security Index and to estimate the relation between resilience and quality of life during the COVID-19 pandemic. The research design is quantitative, resorting to the use of both descriptive and inferential statistics, against the background of a long-term comparative approach to the respective situations in the EU-27 countries. Empirical findings are relevant for emphasizing the fact that human development and social progress are predictors for the dynamics of health security measures. Moreover, the quality of the political regime, particularly in the case of full and flawed democracies, is strongly related to a high level of resilience and could influence the perception of quality of life. All of these empirical results could prove valuable for scholars interested in understanding the relationships between democracy, healthcare systems and quality of life, and for political decision makers involved in the effort of reducing the negative effects of COVID-19 in EU-27 countries.

The value conflict between freedom and security: Explaining the variation of COVID-19 policies in democracies and autocracies.

In the name of health security, individual freedoms were constrained in an unprecedented way in many countries, democratic or authoritarian, all over the world during the COVID-19 pandemic. Yet the constraints have not been consistent across countries, which motivates this paper to examine the relevance of value preferences towards freedom or security in the society for COVID-19 policies. Based on data for 40 democratic and authoritarian countries, the analyses show that the variation in the stringency of COVID-19 policies can be explained by value preferences of the population only in autocracies. In democracies, however, we do not find such a relationship. Governments in democratic political systems, we argue, are responsive to their constitutions and face prosecution by the judiciary if they violate the law or provisions of the constitution, limiting their capacity to implement strong COVID-19 policies. Nevertheless, their COVID-19 policies restricted citizens' freedoms and liberties, which means that these policies were rather not responsive to citizens' preferences for freedom, democratic rights and liberties. By highlighting how autocracies respond to their citizens' value preferences for security, this paper contributes to a better understanding of how autocracies might gain legitimacy in times of crises.

Political ideology predicts preventative behaviors and infections amid COVID-19 in democracies.

Can one's political ideology predict his or her testing positive for COVID-19 and how? The present study leveraged a recent (April-May 2020) survey of 27,260 individuals across 27 democracies to investigate the associations between political ideology and coronavirus infections. Our individual-level data and mediation analyses allow us to tease out different correlational paths according to which one's political ideology affects his or her infection. We found a more right-leaning attitude to be associated with a higher probability of testing positive both directly and indirectly through conspiracy theory beliefs and physical distancing. Moreover, our cross-national investigation also found that becoming more right-leaning in ideology was associated with a higher level of perceived risk of COVID-19 infection, which made one less likely to test positive. Combined, we provide a more nuanced understanding of the role played by political ideology in the current pandemic, on which the design of a more effective risk communication strategy can be based.

Trust in the Police during the Pro-Democracy Movement in Hong Kong: Psychosocial Factors of Perceived Procedural and Distributive Justice.

Hong Kong has experienced social unrest in response to the proposed anti-extradition bill since early June 2019. Demonstrations and rallies have often ended in violent clashes between protestors and the police. Based on a sample of 1024 Hong Kong adults, this study explored the psychosocial factors underlying public perceptions of police procedural and distributive justice among Hong Kongers. Testing the propositions of several criminological theories (i.e., neutralization theory, the general aggression model, general strain theory, and self-control theory), the findings indicated that men reported significantly more positive general perceptions of police procedural and distributive justice, better general mental health, and more negative attitudes toward violence than women did. Young adults perceived significantly higher levels of police general, procedural, and distributive justice than did their middle-aged and older counterparts, who reported significantly better general mental health and greater self-control. Multivariate analyses indicated that across all age groups, better general mental health, greater self-control, and more negative attitudes toward violence were significantly associated with positive perceptions of police general, procedural, and distributive justice. This study concludes with practical guidance for enhancing public perceptions of police procedural and distributive fairness.

Improving preparedness for next pandemics: Max level of COVID-19 vaccinations without social impositions to design effective health policy and avoid flawed democracies.

In the presence of pandemic threats, such as Coronavirus Disease 2019 (COVID-19) crisis, vaccination is one of the fundamental strategies to cope with negative effects of new viral agents in society. The rollout of vast vaccination campaigns also generates the main issue of hesitancy and resistance to vaccines in a share of people. Many studies have investigated how to reduce the social resistance to vaccinations, however the maximum level of vaccinable people against COVID-19 (and in general against pandemic diseases), without coercion in countries, is unknown. The goal of this study is to solve the problem here by developing an empirical analysis, based on global data, to estimate the max share of people vaccinable in relation to socioeconomic wellbeing of nations. Results, based on 150 countries, reveal that vaccinations increase with the income per capita, achieving the maximum share of about 70% of total population, without coercion. This information can provide new knowledge to establish the appropriate goal of vaccination campaigns and in general of health policies to cope with next pandemic impacts, without restrictions that create socioeconomic problems. Overall, then, nations have a natural level of max vaccinable people (70% of population), but strict policies and mandates to achieve 90% of vaccinated population can reduce the quality of democracy and generate socioeconomic issues higher than (pandemic) crisis.

Does democracy protect? The United Kingdom, the United States, and Covid-19.

The Covid-19 crises in the United Kingdom and the United States show how democracies may struggle to confront disasters that are increasingly impinging on the Global North. This paper highlights the extent to which disasters are now 'coming home' to Western democracies and it looks at some of the principal reasons why democracy has not been especially protective, at least in the case of the UK and the US. These include: reconceptualising disaster as a good thing (via 'herd immunity'); the influence of neoliberalism; and the limitations in the circulation of information. A key pandemic-related danger is the conclusion that democracy itself is discredited. Disasters, though, call for a reinvigoration of democracy, not a knee-jerk invocation of autocratic 'emergency' rule. A fundamental problem in the UK and US is that these countries were not democratic enough. The paper underlines the risk of a move towards a disaster-producing system that is self-reinforcing rather than self-correcting.

When election expectations fail: Polarized perceptions of election legitimacy increase with accumulating evidence of election outcomes and with polarized media.

The present study, conducted immediately after the 2020 presidential election in the United States, examined whether Democrats' and Republicans' polarized assessments of election legitimacy increased over time. In a naturalistic survey experiment, people (N = 1,236) were randomly surveyed either during the week following Election Day, with votes cast but the outcome unknown, or during the following week, after President Joseph Biden was widely declared the winner. The design unconfounded the election outcome announcement from the vote itself, allowing more precise testing of predictions derived from cognitive dissonance theory. As predicted, perceived election legitimacy increased among Democrats, from the first to the second week following Election Day, as their expected Biden win was confirmed, whereas perceived election legitimacy decreased among Republicans as their expected President Trump win was disconfirmed. From the first to the second week following Election Day, Republicans reported stronger negative emotions and weaker positive emotions while Democrats reported stronger positive emotions and weaker negative emotions. The polarized perceptions of election legitimacy were correlated with the tendencies to trust and consume polarized media. Consumption of Fox News was associated with lowered perceptions of election legitimacy over time whereas consumption of other outlets was associated with higher perceptions of election legitimacy over time. Discussion centers on the role of the media in the experience of cognitive dissonance and the implications of polarized perceptions of election legitimacy for psychology, political science, and the future of democratic society.

Prepare developed democracies for long-run economic slowdowns.

Developed democracies proliferated over the past two centuries during an unprecedented era of economic growth, which may be ending. Macroeconomic forecasts predict slowing growth throughout the twenty-first century for structural reasons such as ageing populations, shifts from goods to services, slowing innovation, and debt. Long-run effects of COVID-19 and climate change could further slow growth. Some sustainability scientists assert that slower growth, stagnation or de-growth is an environmental imperative, especially in developed countries. Whether slow growth is inevitable or planned, we argue that developed democracies should prepare for additional fiscal and social stress, some of which is already apparent. We call for a 'guided civic revival', including government and civic efforts aimed at reducing inequality, socially integrating diverse populations and building shared identities, increasing economic opportunity for youth, improving return on investment in taxation and public spending, strengthening formal democratic institutions and investing to improve non-economic drivers of subjective well-being.

When Covid-19 first struck: Analysis of the influence of structural characteristics of countries - technocracy is strengthened by open democracy.

CONTEXT: The Covid-19 pandemic hit the developed world differentially due to accidental factors, and countries had to respond rapidly within existing resources, structures, and processes to manage totally new health challenges. This study aimed to identify which pre-existing structural factors facilitated better outcomes despite different starting points, as understanding of the relative impact of structural aspects should facilitate achieving optimal forward progress. METHODS: Desk study, based on selecting and collecting a range of measures for 48 representative characteristics of 42 countries' demography, society, health system, and policy-making profiles, matched to three pandemic time points. Different analytic approaches were employed including correlation, multiple regression, and cluster analysis in order to seek triangulation. FINDINGS: Population structure (except country size), and volume and nature of health resources, had only minor links to Covid impact. Depth of social inequality, poverty, population age structure, and strength of preventive health measures unexpectedly had no moderating effect. Strongest measured influences were population current enrolment in tertiary education, and country leaders' strength of seeking scientific evidence. The representativeness, and by interpretation the empathy, of government leadership also had positive effects. CONCLUSION: Strength of therapeutic health system, and indeed of preventive health services, surprisingly had little correlation with impact of the pandemic in the first nine months measured in death- or case-rates. However, specific political system features, including proportional representation electoral systems, and absence of a strong single party majority, were consistent features of the most successful national responses, as was being of a small or moderate population size, and with tertiary education facilitated. It can be interpreted that the way a country was lead, and whether leadership sought evidence and shared the reasoning behind resultant policies, had notable effects. This has significant implications within health system development and in promoting the population's health.

Empathy and its associations with age and sociodemographic characteristics in a large UK population sample.

OBJECTIVES: Empathy is fundamental to social cognition, driving prosocial behaviour and mental health but associations with aging and other socio-demographic characteristics are unclear. We therefore aimed to characterise associations of these characteristics with two main self-reported components of empathy, namely empathic-concern (feeling compassion) and perspective-taking (understanding others' perspective). METHODS: We asked participants in an internet-based survey of UK-dwelling adults aged ≥18 years to complete the Interpersonal Reactivity Index subscales measuring empathic concern and perspective taking, and sociodemographic and personality questionnaires. We weighted the sample to be UK population representative and employed multivariable weighted linear regression models. RESULTS: In 30,033 respondents, mean empathic concern score was 3.86 (95% confidence interval 3.85, 3.88) and perspective taking was 3.57 (3.56. 3.59); the correlation between these sub-scores was 0.45 (p < 0.001). Empathic concern and perspective taking followed an inverse-u shape trajectory in women with peak between 40 and 50 years whereas in men, perspective taking declines with age but empathic concern increases. In fully adjusted models, greater empathic concern was associated with female gender, non-white ethnicity, having more education, working in health, social-care, or childcare professions, and having higher neuroticism, extroversion, openness to experience and agreeableness traits. Perspective taking was associated with younger age, female gender, more education, employment in health or social-care, neuroticism, openness, and agreeableness. CONCLUSIONS: Empathic compassion and understanding are distinct dimensions of empathy with differential demographic associations. Perspective taking may decline due to cognitive inflexibility with older age whereas empathic concern increases in older men suggesting it is socially-driven.

Democracy and case fatality rate of COVID-19 at early stage of pandemic: a multicountry study.

Many studies have evaluated factors that influence the course of the COVID-19 pandemic in different countries. This multicountry study assessed the influence of democracy and other factors on the case fatality rate of COVID-19 during the early stage of the pandemic. We accessed the World Health Organization, World Bank, and the Democracy Index 2019 databases for data from the 148 countries. Multiple analyses were conducted to examine the association between the Democracy Index and case fatality rate of COVID-19. Within 148 countries, the percentage of the population aged 65 years and above (p = 0.0193), and health expenditure as a percentage of GDP (p = 0.0237) were positively associated with countries' case fatality rates. By contrast, hospital beds per capita helped to reduce the case fatality rates. In particular, the Democracy Index was positively associated with case fatality rates in a subgroup of 47 high-income countries. This study suggests that enhancing the health system with increased hospital beds and healthcare workforce per capita should reduce case fatality rate. The findings suggest that a higher Democracy Index is associated with more deaths from COVID-19 at the early stage of the pandemic, possibly due to the decreased ability of the government.

Democracies Linked To Greater Universal Health Coverage Compared With Autocracies, Even In An Economic Recession.

Despite widespread recognition that universal health coverage is a political choice, the roles that a country's political system plays in ensuring essential health services and minimizing financial risk remain poorly understood. Identifying the political determinants of universal health coverage is important for continued progress, and understanding the roles of political systems is particularly valuable in a global economic recession, which tests the continued commitment of nations to protecting their health of its citizens and to shielding them from financial risk. We measured the associations that democracy has with universal health coverage and government health spending in 170 countries during the period 1990-2019. We assessed how economic recessions affect those associations (using synthetic control methods) and the mechanisms connecting democracy with government health spending and universal health coverage (using machine learning methods). Our results show that democracy is positively associated with universal health coverage and government health spending and that this association is greatest for low-income countries. Free and fair elections were the mechanism primarily responsible for those positive associations. Democracies are more likely than autocracies to maintain universal health coverage, even amid economic recessions, when access to affordable, effective health services matters most.