Simon Wigley

Background Previous analyses of democracy and population health have focused on broad measures, such as life expectancy at birth and child and infant mortality, and have shown some contradictory results. We used a panel of data spanning 170 countries to assess the association between democracy and cause-specific mortality and explore the pathways connecting democratic rule to health gains. Methods We extracted cause-specific mortality and HIV-free life expectancy estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 and information on regime type from the Varieties of Democracy project. These data cover 170 countries and 46 years. From the Financing Global Health database, we extracted gross domestic product (GDP) per capita, also covering 46 years, and Development Assistance for Health estimates starting from 1990 and domestic health spending estimates starting from 1995. We used a diverse set of empirical methods—synthetic control, within-country variance decomposition, structural equation models, and fixed-effects regression—which together provide a robust analysis of the association between democratisation and population health. Findings HIV-free life expectancy at age 15 years improved significantly during the study period (1970–2015) in countries after they transitioned to democracy, on average by 3% after 10 years. Democratic experience explains 22·27% of the variance in mortality within a country from cardiovascular diseases, 16·53% for tuberculosis, and 17·78% for transport injuries, and a smaller percentage for other diseases included in the study. For cardiovascular diseases, transport injuries, cancers, cirrhosis, and other non-communicable diseases, democratic experience explains more of the variation in mortality than GDP. Over the past 20 years, the average country's increase in democratic experience had direct and indirect effects on reducing mortality from cardiovascular disease (−9·64%, 95% CI −6·38 to −12·90), other non-communicable diseases (−9·14%, −4·26 to −14·02), and tuberculosis (−8·93%, −2·08 to −15·77). Increases in a country's democratic experience were not correlated with GDP per capita between 1995 and 2015 (ρ=–0·1036; p=0·1826), but were correlated with declines in mortality from cardiovascular disease (ρ=–0·3873; p<0·0001) and increases in government health spending (ρ=0·4002; p<0·0001). Removal of free and fair elections from the democratic experience variable resulted in loss of association with age-standardised mortality from non-communicable diseases and injuries. Interpretation When enforced by free and fair elections, democracies are more likely than autocracies to lead to health gains for causes of mortality (eg, cardiovascular diseases and transport injuries) that have not been heavily targeted by foreign aid and require health-care delivery infrastructure. International health agencies and donors might increasingly need to consider the implications of regime type in their efforts to maximise health gains, particularly in the context of ageing populations and the growing burden of non-communicable diseases.

Objective: To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress toward universal health coverage (UHC). Design: Synthetic control analysis. Setting and country selection: Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. Main outcome measures: HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. Results: Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. Conclusions: Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations.

This paper defends a regularly paid basic income as being better equipped to tackle unfair inequalities of outcome. It is argued that the timing of "option-luck" failures – in particular, whether they occur early in a lifetime of calculated gambles, and whether they are clustered together – may lead to a form of "brute bad luck," referred to as "cumulative misfortune." A basic income that is paid on a regular basis provides a way to prevent the emergence of cumulative misfortune, because the basic income at least partially replenishes the individual's ability to take the next calculated gamble. The upshot of this is a nonpaternalistic justification for an unconditional basic income that is paid regularly and is nonmortgageable. This has an important bearing on the debate between those who advocate a one-off endowment at the start of adult life and those who advocate a basic income paid regularly throughout one's life. The paper contends that a regular basic income represents a superior social policy because it prevents the emergence of cumulative misfortune, rather than belatedly attempting to compensate for its effects during our senior years.

A recurring question within contemporary democratic countries relates to whether parliamentary immunity only serves to protect the interests of representatives, rather than the interests of those they were elected to represent. With every act that is suspected of being corrupt (for example, accepting a bribe in return for asking a question or delivering a speech in parliament, failure to declare campaign contributions, insider trading, nepotism etc.), or otherwise illegal (for example, defamation, drunk driving etc.), that is left unexamined by the courts, the justifiability of parliamentary immunity is brought into question. The problem posed by parliamentary immunity is that it affords each representative greater scope to pursue their own personal and political interests, over and above that which is made possible simply by their position of influence. As citizens it is this undemocratic possibility that might incline us to wish for the immunity to be curtailed. The political pressure to circumscribe the immunity is given added impetus by the prevailing public perception that political corruption is widespread.1 Indeed it is increasingly evident that a growing number of countries have either already reduced the scope of parliamentary immunity or are considering doing so.2 The principal rationale behind this trend is that the only telling way to prevent the decision-making..

Many scholars claim that democracy improves population health. The prevailing explanation for this is that democratic regimes distribute health-promoting resources more widely than autocratic regimes. The central contention of this article is that democracies also have a significant pro-health effect independently of public redistributive policies. After establishing the theoretical plausibility of the non-distributive effect a panel of 153 countries for the years 1972 to 2000 is used to examine the relationship between extent of democratic experience and life expectancy. We find that democratic governance continues to have a salutary effect on population health even when controls are introduced for the distribution of health-enhancing resources. Data for 50 autocratic countries for the years 1994 to 2007 is then used to examine whether that press freedom has a positive impact on life expectancy independently of government responsiveness.

One line of argument in defense of an unconditional basic income is that it reduces the dependence of less advantaged citizens on others. However, its claim to help ensure individual self-government is undermined by the fact that it is consistent with social and economic inequality. For those who are more wealthy and talented are better placed to influence the democratic decision-making process according to their interests and contrary to the interests of those who are less advantaged. In sum, a basic income does not provide the sufficient conditions for equal citizenship. One solution to that problem, defended by Rousseau, is that in addition to a social minimum, material inequality should be moderated. In this paper I argue that such a measure is unnecessary provided that we can insulate the political decision-making process from the background inequalities. It is argued, following a recent innovative proposal by Bruce Ackerman and Ian Ayres, that to ensure the effective right to self-government the basic income should be complemented by a voucher of equal value to be used by each and every citizen as a campaign contribution to a candidate of their choice.

This article endeavors to establish the moral force behind the worker’s claim to a compensatory wage in return for the labor burdens she endures. The apparent incompatibility between compensation and voluntary losses suggests that the only reason for providing a compensatory wage is the need to entice a valued service. In response, the article considers and rejects attempts to ground the compensatory wage on duress, mutual trade, and desert. Instead, it argues that the worker is not responsible for her loss of well-being because she would not have incurred it in the absence of the employer’s promise to compensate. Key Words: compensatory wage • contributory wage • detrimental reliance • desert • labor burdens • promises • responsibility.

Cognitive scientists have long noted that automated behavior is the rule, while consciousness acts of self-regulation are the exception to the rule. On the face of it automated actions appear to be immune to moral appraisal because they are not subject to conscious control. Conventional wisdom suggests that sleepwalking exculpates, while the mere fact that a person is performing a well-versed task unthinkingly does not. However, our apparent lack of conscious control while we are undergoing automaticity challenges the idea that there is a relevant moral difference between these two forms of unconscious behavior. In both cases the agent lacks access to information that might help them guide their actions so as to avoid harms. In response it is argued that the crucial distinction between the automatic agent and the agent undergoing an automatism, such as somnambulism or petit mal epilepsy, lies in the fact that the former can preprogram the activation and interruption of automatic behavior. Given that, it is argued that there is elbowroom for attributing responsibility to automated agents based on the quality of their will

Scholars are divided over whether a victim's rights persist when an agent permissibly responds to an emergency. According to the prevailing view the moral force of rights is not extinguished by moral permissibility and the agent, therefore, has a duty to compensate the victim. According to another influential view permissibility does erase the moral force of rights and the agent, therefore, can only have a duty to compensate for reasons other than the fact that they committed a rights transgression. I argue that liability does not follow even if we grant that the victim's rights persevere. A non-pecuniary remedy such as a formal apology provides an adequate way of vindicating the victim's rights and of recognizing the agent's causal role. Thus, the answer to the question of what remedy the permissible transgressor owes the victim does not provide us with an answer to the question of who should bear the burden

The value of education is commonly measured in terms of its ability to improve economic growth or the earnings of individuals. According to that approach, education enables society or individuals to accumulate a stock of human capital, which can then be used to generate macro or micro level income growth.1 In this chapter our aim is to examine education in Turkey based on the human capabilities approach developed by Amartya Sen and, more recently, by Martha Nussbaum (Sen, 1999; Nussbaum, 2000). The capabilities approach rejects a development strategy based on human capital, firstly, because it does not require that all individuals receive a sufficient education and, secondly, because it is based on an impoverished metric of human well-being. In the first place, an approach to development that is based on human capital may postpone extending a basic education to some children if that is the optimal strategy for expanding economic growth or combating income poverty. It may be argued, for example, that the social conditioning of gender roles means it is more costly to expand the educational attainment levels of female children. Thus, prioritizing investment in the length and quality of education available to male children may be seen as a more cost effective way of driving economic growth. The postponement strategy may be further defended on the grounds that income poverty can be best overcome by letting the fruits of growth trickle-down or be redistributed to the poor, rather than by directly improving the earnings potential of the poor. According to the capabilities approach each individual has a fundamental right to at least a basic education because without it they lack the necessary preconditions for doing things and achieving results that they have reason to value. In other words, society has a duty to ensure that each individual can acquire at least a sufficient education, irrespective of their relative ability to contribute towards income growth..

A standard criticism of act-utilitarianism is that it is only indirectly concerned with the distribution of welfare between individuals and, therefore, does not take adequate account of the separateness between individuals. In response a number of philosophers have argued that act-utilitarianism is only vulnerable to that objection because it adheres to a theory of the good which ignores non-welfarist sources of intrinsic value such as justice. Fred Feldman, for example, argues that intrinsic value is independently generated by the receipt of welfare and the degree to which receipt accords with the demands of justice, and that an action is right insofar as it maximizes the sum of both those sources of value. In response it is argued that justicized consequentialism only blocks the objection at the expense of presupposing deontological constraints. In addition, it is argued that the value of justice cannot be explained non-deontically and, therefore, that the proposed theory is not consequentialist all the way down