Governance and health in the Arab world

Abstract

Since late 2010, the Arab world has entered a tumultuous period of change, with populations demanding more inclusive and accountable government. The region is characterised by weak political institutions, which exclude large proportions of their populations from political representation and government services. Building on work in political science and economics, we assess the extent to which the quality of governance, or the extent of electoral democracy, relates to adult, infant, and maternal mortality, and to the perceived accessibility and improvement of health services. We compiled a dataset from the World Bank, WHO, Institute for Health Metrics and Evaluation, Arab Barometer Survey, and other sources to measure changes in demographics, health status, and governance in the Arab World from 1980 to 2010. We suggest an association between more effective government and average reductions in mortality in this period; however, there does not seem to be any relation between the extent of democracy and mortality reductions. The movements for changing governance in the region threaten access to services in the short term, forcing migration and increasing the vulnerability of some populations. In view of the patterns observed in the available data, and the published literature, we suggest that efforts to improve government effectiveness and to reduce corruption are more plausibly linked to population health improvements than are efforts to democratise. However, these patterns are based on restricted mortality data, leaving out subjective health metrics, quality of life, and disease-specific data. To better guide efforts to transform political and economic institutions, more data are needed for health-care access, health-care quality, health status, and access to services of marginalised groups.

Figure 1. Map of the Arab world

Figure 2. The Arab world in global context

(A) After improvement in the 1980s, under-5 mortality is now slightly better than the global average. (B) Life expectancy at birth is slightly greater than the global average. (C) The Arab world is the most autocratic region in the world, according to electoral democracy scores from the Polity IV dataset, where a polity2 score of 10 is democracy and a score of −10 is autocracy. (D) Corruption in the Arab world is high according to World Governance Indicator data, where 0 is the global average; the Arab world fares consistently only better than sub-Saharan Africa since 1996. Data from Institute for Health Metrics and Evaluation mortality estimates, World Bank Databank, Polity IV dataset, and the World Bank/Brookings World Governance Indicators (panel 1).

Figure 3. Government effectiveness (mean) versus mortality (mean annual change), 1980–2010

Increases in government effectiveness (standard normal unit) seem to correlate with greater reductions in maternal and adult mortality. Data from World Bank, Polity IV project, and Institute of Health Metrics Evaluation (panel 1).

Figure 4. Democracy score (mean) versus mortality (mean annual change), 1980–2010

On the x-axis, 10 is democracy and −10 is autocracy. Democracy does not seem to have any consistent relation to changes in mortality. Data from World Bank, Polity IV project, and Institute for Health Metrics and Evaluation (panel 1).