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Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis.
Vadlamannati, Krishna Chaitanya; Cooray, Arusha; de Soysa, Indra.
  • Vadlamannati KC; School of Politics and International Relations (SPIRe), University College Dublin (UCD), Ireland.
  • Cooray A; Former Ambassador of Sri Lanka to Norway, United Nations University, Finland.
  • de Soysa I; Center for Poverty Analysis (CEPA), Sri Lanka.
Scand J Public Health ; 49(1): 104-113, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1207571
ABSTRACT

AIMS:

The COVID-19 pandemic has led to a spate of studies showing a close connection between inequitable access to health care, welfare services and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question by asking whether more 'egalitarian' forms of democracy matter, given that they contain more equitable health-care access and societal infrastructure, such as social capital and trust.

METHODS:

We use standard regression techniques, including instrumental variables analysis addressing endogeneity on COVID-19 testing and deaths data as of the end of May and beginning of September. We use novel data from the Varieties of Democracy Project on health-system equity and egalitarian democracy.

RESULTS:

Our results suggest that more equitable access to health care increases testing rates and lowers the death rate from COVID-19. Broader egalitarian governance, measured as egalitarian democracy, however, shows the opposite effect. Thus, factors associated with health-care capacity to reach and treat matter more than broader societal factors associated with social capital and trust. The results are robust to alternative testing procedures, including instrumental variable technique for addressing potential endogeneity.

CONCLUSIONS:

Despite a great deal of public health focus on how equitable governance helps fight the adverse effects of so-called neoliberal pandemics, we find that broadly egalitarian factors have had the opposite effect on fighting COVID-19, especially when an equitable health system has been taken into account. Fighting disease, thus, might be more about the capacity of health systems rather than societal factors, such as trust in government and social capital.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Equity / Delivery of Health Care / Democracy / COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: Scand J Public Health Journal subject: Social Medicine / Public Health Year: 2021 Document Type: Article Affiliation country: 1403494820982106

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Equity / Delivery of Health Care / Democracy / COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: Scand J Public Health Journal subject: Social Medicine / Public Health Year: 2021 Document Type: Article Affiliation country: 1403494820982106