I like my politicians to be connected in some way to the real world. They can believe all they want that the sun sets in the east, or that grass is purple, or that the Earth is flat, or that global warming isn’t caused by humans. But making policy based on these beliefs ends up harming all of us, through ridicule, opportunity costs and inept policymaking. What connects us to reality is evidence.
In medicine, just making up facts is frowned upon — obviously. Where it’s possible to find out whether a treatment does more good than harm, it’s a good idea to ask the question.
I have carried over this naive belief into asking whether government policies have effects on health. It’s why dismissing criticism of government policy as “shrill” or “electronic graffiti” might work as a rhetorical flourish in the school debating society on a bad day, but it is no substitute for understanding the effects of policy in the real world.
What if I apply the same principle to my vote? Is there any evidence that health outcomes are better under a particular political tradition?
It’s a dangerous question. It might even lead to accusations of bias. But if we actually want our vote to make a difference, surely finding evidence on outcomes that matter to us is a better way than the usual approaches — which turn out to be height, a mellifluous voice and baby-kissing ability.
The biggest study to look at this question looks at Organisation for Economic Co-operation and Development countries in Europe and North America, and classifies their predominant political ideologies between 1950 and 2000 into one of four categories:
- Social democratic
- Christian democratic (conservative)
- Authoritarian conservative (dictatorship)
This is how the countries were grouped, and their characteristics.
Already I can hear the election strategists firing up their focus groups to test slogans such as “Save the Children. Vote 1 Redistribution Party” or, more likely perhaps, “Vote for us or the children get it”.Their analysis shows that countries with pro-redistributive governments are correlated with having populations with lower infant mortality. In other words, fewer children die.
Of course, it would have to be countered by the qualifier “correlation NOT causation”. There is a similar, but weaker correlation of redistributive policies on adult mortality rates, too.
(Actually, the government’s response, and opposition silence, to the Human Rights Commission report into children in immigration detention doesn’t give me much confidence that the future health of children is a current priority for either party. But I digress.)
It is not the political party elected that matters, but the degree to which they implement redistributive policies. So better health outcomes were obtained by having long periods of policies promoting full employment, regulated labour markets, and public health expenditure.
Another study indicates that it is not just the presence of egalitarian parties or the proportion of votes they get that determines population health. Unsurprisingly, they have to implement policies of universal public health systems (particularly) and welfare systems (in general) to realise the benefits to child health.
Another study looking at health inequalities shows that “Late Democracies” have worse inequalities in health, particularly for women. (This paper looks at mainland European countries, so late democracies are represented by Spain and Greece, which no one is holding up as role models right now!)
A systematic review (with a title worth remembering — it begins “Epi + demos + cracy …”) cautiously concluded four things:
- The transition to capitalism in Eastern European countries probably worsened education-based health inequalities;
- Market-oriented reforms worsen health inequalities;
- The welfare state makes a small improvement in health inequalities; and
- The health of particular groups is improved by particular policy attention.
This last one is especially important in improving Aboriginal and Torres Strait Islander health, where improvements can be made but go backwards if policy attention wanes.
As you’d expect, with something as complex as politics, the answers may not be simple. This research is suggestive, but not conclusive.
There is a suggestion, too, that Australia may be an outlier. Despite Australian governments of all persuasions adopting neoliberal market-based policies, our health outcomes are among the best in the world.
So, what are we left with? It’s possible — perhaps even likely — that we maximise health outcomes by voting for parties with more redistributive policies and higher spending on health and welfare.
If we want to improve Aboriginal and Torres Strait Islander health, we need to vote for parties that commit to focused policies over the long term. It’s becoming harder to find a mainstream party who will openly admit to policies like that.
The principle of evidence-based voting doesn’t need the outcomes to be health outcomes, either. There’s no reason why looking at outcomes like housing, employment, transport and climate protection couldn’t be subject to a hunt through Google Scholar.
Imagine a future where your how-to-vote card comes with the results of a PubMed search. We could all be more confident of outcomes we cared about and be given the ability to vote accordingly.
There would be nothing more likely to strike terror into the heart of a politician than that.