Browsing by Author "Kiernan, S."

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Open Access
Democracies linked to greater universal health coverage compared with autocracies, even in an economic recession
(Project HOPE, 2021-08) Templin, T.; Dieleman, J. L.; Wigley, Simon; Mumford, J. E.; Miller-Petrie, M.; Kiernan, S.; Bollyky, T. J.
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.
Open Access
Democracy and implementation of non-communicable disease policies
(Elsevier, 2020) Wigley, Simon; Dieleman, J. L.; Templin, T.; Kiernan, S.; Bollyky, T. J.
In their Article in The Lancet Global Health, Luke Allen and colleagues1 found weak evidence for a positive association between democracy and the implementation of polices recommended by WHO to reduce the burden of premature non-communicable disease mortality.1 As Allen and colleagues note, that finding is in contrast with our research on the positive association between democracy and population health outcomes on non-communicable diseases.2 Accordingly, here we build on the important analysis of Allen and colleagues by closely examining the association between democracy and implementation of non-communicable disease policy.