The Benevolent Dictator: An analysis of the relationship between autocratic regime type and public health

Abstract

How can we explain variation in health outcomes across autocracies? This thesis argues that the development of political institutions creates channels that increase efficiency and stability in a regime to provide public goods, such as health care. I develop this theory further by suggesting that these political institutions are most likely to develop in party-based regimes because these regimes derive their legitimacy on the rule of law. I hypothesize that party-based regimes perform better in life expectancy, infant mortality rate, and health care expenditure compared to monarchical, military, or personalistic autocracies. I carry out statistical analyses and a case study on Chile to test my theory. Looking at a comprehensive data set of all autocracies from 1960 - 2010, the analyses reveal that statistically significant variation in health outcomes exists across autocratic regime type. Moreover, party-based regimes, on average, perform better in life expectancy and infant mortality rate compared to all other regime types. Careful examination of the public health experience under Pinochet’s military-personalistic regime also corroborates the theory. I find that Chile’s favorable health indicators are explained by democratic legacies reproduced over time through the development of political institutions that are conducive to the provision of public goods. Pinochet, on the other hand, implemented neo-liberal health care policies in the late 1970s that negatively impacted public health. The findings of this thesis have significant implications on global health and the study of authoritarian persistence. I hope that this thesis will encourage others to continue my research and incite optimism with respect to the possibility of improving health under autocracy.