SeriesGovernance and health in the Arab world
Section snippets
Background
Uprisings and protests in the Arab world have emphasised social and economic inequity, absence of political accountability, and concerns about government corruption. Although the optimism for more inclusive and effective governance throughout the region has now given way to concerns about the rise of patriarchal conservatism, civil war, and political instability in some countries, the demand for more inclusive and equitable government in the region has been heard. The toppling of regimes in
The role of governance in shaping health
To establish a causal pathway for governance and health, scholars have been divided about whether it is democracy or governance effectiveness that leads to improvements in health and human development. Although definitions of democracy vary and are subject to extensive debate, most studies relating democracy and health consider electoral democracy, as scored by the Polity IV project (panel 1), which is based on the competitiveness, openness, and level of participation in elections. These
Trends in health and governance
Overall, since 1970, health indicators in the Arab world have sharply improved with an average increase in life expectancy of 19 years—the largest gain among world regions, and an average reduction in infant mortality of 60 deaths per 1000 livebirths.15 In fact, five of the ten countries with the largest development gains since 1970 were Arab (Oman, Saudi Arabia, Tunisia, Algeria, Morocco).15, 41 Since 1980, adult mortality has been declining across the region, except in Iraq (appendix p 3).
Measurement of the relation between health and governance
Data for demographic, mortality, and governance trends in the Arab world have rarely crossed out of disciplinary silos in public health, economics, or politics (panel 1). For this paper, we built an extensive dataset for indicators related to health and governance in the Arab world (data available from authors on request). Our primary aim was to synthesise the literature on health and governance in the Arab world, investigate the associations between governance on mortality trends, and explore
Informing the reform agenda
Academic research is divided on whether it is democracy or effective government that leads to improved health. We cannot be any more conclusive about the causal mechanisms between governance and health in the Arab world. Our analysis shows that in the Arab world, democracy and mortality improvements are not associated; however, there does seem to be an association—worthy of further investigation—between government effectiveness and mortality improvements.
In view of the concerns about the
Threats to health during the Arab uprisings
The Arab uprisings, while advocating for increased political accountability, economic opportunity, and equity, have had immediate detrimental effects on health in the region. The conflicts that have accompanied or followed uprisings in Syria, Egypt, Yemen, and Bahrain have led to increased social divisions, migration, political violence, and disruptions in education and health-care provision. These recent challenges come on top of the prolonged conflicts and insecurity in Iraq, Somalia, and the
Improving governance and health
For the first time in the history of the Arab nations, a movement has galvanised to demand freedom and increase political inclusiveness and accountability. However, the initial hope for reform across the region has, in many places, been replaced by violence, fear, or a hardening of the traditional status quo. What the future holds for the Arab world is unclear. The trends shown here, and the published literature, suggest that focusing on building effective and inclusive governments in the
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