برقراری دموکراسی و امید به زندگی در اروپا، 1960-2008

Over the past five decades, two successive waves of political reform have brought democracy to, first, Spain, Portugal and Greece, and, more recently, Central and Eastern European countries. We assessed whether democratization was associated with improvements in population health, as indicated by life expectancy and cause-specific mortality rates. Data on life expectancy at birth, age-standardized total and cause-specific mortality rates, levels of democracy and potential time-variant confounding variables were collected from harmonized international databanks. In two pooled cross-sectional time-series analyses with country-fixed effects, life expectancy and cause-specific mortality were regressed on measures of current and cumulative democracy, controlling for confounders. A first analysis covered the 1960–1990 period, a second covered the 1987–2008 period. In the 1960–1990 period, current democracy was more strongly associated with higher life expectancy than cumulative democracy. The positive effects of current democracy on total mortality were mediated mainly by lower mortality from heart disease, pneumonia, liver cirrhosis, and suicide. In the 1987–2008 period, however, current democracy was associated with lower, and cumulative democracy with higher life expectancy, particularly among men. The positive effects of cumulative democracy on total mortality were mediated mainly by lower mortality from circulatory diseases, cancer of the breast, and external causes. Current democracy was associated with higher mortality from motor vehicle accidents in both periods, and also with higher mortality from cancer and all external causes in the second

Over the last 50 years the governing systems of many European countries have undergone profound changes, with a clear shift from authoritarian regimes to liberal democracies (Black, English, Helmreich, Helmreich, & McAdams, 2000; Huntington, 1991; Judt, 2005). In 1960, at the peak of the Cold War, only about half of all European countries, mainly in the North and West, had liberal democracies, as defined by representative government operating through law, by regular, free and fair elections based on universal suffrage, and by respect for individual rights including freedom of expression and association (Hague & Harrop, 2010). Many other countries still had authoritarian regimes, in which rulers had limited popular accountability, the media were controlled, and political participation was limited (Hague & Harrop, 2010). At that time, several Mediterranean countries were still under right-wing autocratic regimes, and all countries in Central and Eastern Europe were under authoritarian regimes led by communist parties.