Austerity by Design Comment on "Ensuring Global Health Equity in a Post-pandemic Economy".

Several scholars across many disciplines argue that neoliberal, free-market economic conditions drive inequalities, generating poverty and misery due to unfair austerity, ultimately affecting human health. Professor Labonté's prescription is that we jettison these policies targeting economic growth and development for generating greater fairness for the world's poor. This rejoinder argues contrarily that the criticism of neoliberal policies are misplaced, and that degrowth is really "self-imposed austerity," which will not benefit the poor. This rejoinder scrutinizes some simple stylized fact and assesses the soundness of the broader arguments. The evidence suggests clearly that becoming wealthy and following prudent economic policies is the best path to improving population health, equity, and other progressive outcomes. Badly required growth for the poor comes from free markets and good governance, and equity for the sake of fairness neither results in better health outcomes, nor an improved environment.

Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis.

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.

Does free-market capitalism drive unequal access to health? An empirical analysis, 1970-2015.

Many scholars, particularly in public health, argue that neoliberal capitalist economic forces adversely affect communities by increasing inequalities, ultimately affecting health. Apparently, corporate capitalism affects health and communitarian concerns because governments place corporate profits over the publics interests. Using unique data collected by the Varieties of Democracy (VDEM) project that capture the degree of access of the poorest segments of society to health services comparable with those available to the richest segments, this study finds that an index of economic freedom robustly reduces inequality of access to health. We argue that these results obtain because greater exposure to global markets increases the premium on the productivity of labour, increasing incentives for political elites to invest in productivity-enhancing public goods. Our results are robust to a number of alternative models and data, and robust to instrumental variables analyses addressing potential endogeneity. Rather than free-market capitalism increasing health-related neglect of society, our data suggest that free-market capitalist conditions promote equitable access to health. This is good news for governments wishing to grow their economies, reform broken health systems for gaining advantages in a competitive global economy, and serve communitarian interests, such as shared good health.

Does social globalisation through access to information communication technologies drive obesity among youth? An empirical analysis, 1990-2013.

Scholars debate the effects of globalisation on obesity. Using the latest data on access to ICTs and the Global Burden of Disease data on excess weight gain and obesity, we find that both social globalisation and access to ICTs lower the overweight and obese share among the global youth cohort aged 15-19. Previous studies report mixed results, which are hard to evaluate because of the use of different data, sample sizes, and estimating strategies. Using fixed-effects analyses on a global sample of over 160 countries spanning 24 years, we show that 'social globalization' reduces the obesity share of youth when fixed effects are estimated. Greater access to ICTs also independently lowers youth obesity rates. We speculate that greater access to information and knowledge about current trends, the benefits of physical activity and diet, and trends in healthy consumption spreading through ICTs might be a boon despite risks associated with greater consumption from increasing wealth and political freedoms. These results are robust to several estimating methods, including instrumental variables analysis. Our results suggest that increased access to ICTs does not increase obesity and that policy might even usefully target youth via ICTs for encouraging better health.

Gender empowerment, inequalities and the prevalence of adult female obesity: An empirical analysis using new data, 1990-2013.

Aims: Do gender inequality and gender discrimination explain female obesity? Discrimination denies access to choose and constrains agency. Scope: Using the Global Burden of Disease data on overweight and obesity share of the adult female population for almost 160 countries over a 24-year period, we find that female empowerment has no effect on the population share that is overweight, but it reduces the obese share of women. The substantive impact is, however, slight and the results are not robust to testing a sample of only developing countries. Political freedoms for women in general, however, show positive effects on the prevalence of obesity, results that are again substantively meagre. Higher levels of income inequality and a measure of health inequality predict lower levels of female obesity independently of the controls, which raises some doubt about large arguments linking generalized inequality to obesogenic environments. Results: In so far as our measures of female empowerment capture greater access to rights and agency, they are poor predictors of the prevalence of obesity. The results suggest that local-level idiosyncrasies matter a lot more than do macro-level factors. Conclusions: Any conclusion should be treated tentatively given the short temporal domain examined here and uncertainties in the data. While promoting rights and equity for women are still intrinsically valuable and moral, the task of reducing obesity per se may require more targeted public action promoting healthier lifestyles and consumption among vulnerable groups.

Does social diversity impede sound economic management? An empirical analysis, 1980-2012.

Several celebrated scholars argue that diverse preferences and coordination failure due to ethnic and cultural diversity hamper the social cohesion necessary for good economic management, leading to development failure. Using several measures of diversity, we find that higher levels of ethno-linguistic and cultural fractionalization are conditioned positively on higher economic growth by an index of economic freedom, which is often heralded as a good measure of sound economic management. High diversity in turn is associated with higher levels of economic freedom. We do not find any evidence to suggest that high diversity hampers change towards greater economic freedom and institutions supporting liberal policies. The effect of diversity, moreover, is conditioned positively by higher democracy. Our results raise serious doubt about the centrality of social diversity for explaining economic failure, nor is there evidence to suggest that autocratic measures are required under conditions of social diversity to implement growth-promoting policies. This is good news because history and culture seem to matter less than rational agency for ensuring sound economic management.

More heat, less light! The resource curse & HIV/AIDS: A reply to Olivier Sterck.

We reported fairly robust results suggesting that resource rich countries did less well containing HIV/AIDS than resource poor states (de Soysa and Gizelis, 2013). We argued that public action to prevent the spread of disease was going to be weaker in resource rich states because rulers would have less incentive to fight disease. Olivier Sterck (this issue) criticizes our study on several grounds, arguing that resource rich states can provide anti-retroviral therapy (ART) and thereby fight the AIDS epidemic. He, however, finds no relationship between resource wealth and HIV/AIDS. We argue that his reanalyses do not fully address the theoretical association between resource wealth and the spread of HIV/AIDS and that his argument about ART is more wishful than a realistic expectation. Future research should probe more carefully why resource wealth has not been deployed more effectively for fighting disease-a point we can all agree on.

The natural resource curse and the spread of HIV/AIDS, 1990-2008.

Experts suggest that effective public action can prevent the spread of HIV/AIDS. Countries dependent on natural resource wealth, such as oil, are likely to suffer from governance failures and thereby suffer lower quality public health. Since the cost of fighting disease redistributes income away from rulers, resource wealth is likely to lead to neglect of public action aimed at stemming a deadly disease. We test this proposition in 137 countries from 1990 until 2008 using oil wealth as a proxy for endogenous policy choices on the prevalence of HIV/AIDS, a proxy outcome for ineffective policy and neglect of public action. We find that the 'resource curse' seems to affect the spread of HIV/AIDS, even though oil-rich countries ceteris paribus should have more financial resources for effective public action. The results are robust to a host of controls, alternative indicators, and fixed effects estimation.