Are Social-Liberal-Democracies exclusively suited to improve health and longevity of their citizens? The Jonathan Floyd series, part 5

This is the 5th post inspired by Jonathan Floyd’s book, Is political philosophy impossible? that started a new methodology (paradigm, revolution?) called normative behaviourism (NB). The posts so far can be read here.

Today we are going to do a little empirical exercise (DATA!) to show that while social-liberal-democracies (SLDs) are doing good when it comes about being top performers in health/life expectancy but this performance is by now means limited to SLDs. There might be some confounding variables at play here and the conclusion poses a problem for NB.

Particularly, this post is the direct continuation of ‘Blind spot of academic political philosophy: not recognising health as a political incentive and healthy longevity as a political goal’ where it was argued that the extension of NB would include accepting health/longevity as valid/legitimate behaviourist political triggers and variables showing political preferences of people.

The question we ask here is the following: According to the 2 top NB measures, crime and insurgence, it was the SLD-s who came out on top in minimising them. And it seems that they came out exclusively on top meaning no other political format managed to accidentally minimise these 2 measures to beat the top SLD-s. Floyd is not showing this by engaging into empirical research or citing the sources comprehensively (after all he is doing political philosophy, not political science) but he mentions for instance the Polity Project as a main empirical source for data related to less instability in democracies, please see p186 of his book.

Today we take a look at 2 lists, one in terms of general health, another in terms of life expectancy to check whether all countries on top of these lists are SLD-s. Consider these as spot checks.

Health

Here’s a top 10 healthiest countries in the world in 2018 list, according to the rankings of the Legatum Institute. This is only one out of the different ranking options out there for health, but I chose this as it shows other metrics too that provide some immediate insights. One must click to the ‘Health’ column (indicated by a heart and ECG symbol) to obtain the list of top 10 healthiest countries, sorted in descending order. Also drawing the limit at top 10 is arbitrary, we could have done top 20 as well. 

Most notably the column with the running person icon (second column to the right from the heart icon indicating health rankings) show ‘Personal Freedom’ scores. And the point I want to make here is that 3 countries on this list are firmly in the red zone with their prospective ‘Personal Freedom’ scores: Singapore (98), Qatar (104), UAE (119), while 2 other countries have Freedom scores that are not top perfuming: Japan (46) and Hong Kong (31). These ‘Freedom’ scores can be roughly translated to indicate how liberal a particular country is. Well, these countries are not so much. And an even more basic point to make that might be already obvious to the observer: not all these countries have the topmost democracy scores either. Alternatively you can look the Democracy Index for these countries here; you’ll meet some red warnings.

So this makes it quite plausible that SLD-s don’t have a native priority when it comes to providing top health care for their citizens. 

One more observation: the first 2 columns after country column are indicators of prosperity: Economic Quality and Business Environment, you can think of them by now as simply how rich these countries are. And the observation to be made is the amount of overlap between the rankings in these 2 columns and the health rankings: there are 6 countries, so more than 50% of 10 that are top 10 countries in all the 3 columns: the 2 prosperity columns and health. See further on this at ‘Prosperity and Floyd’ section below.

Let’s take a peek at life expectancy then.

Life expectancy

Here am simply using a top google query result out of sheer laziness, one made by geoba.se. It’s not important to know the nitty-gritty details of the statistical model used here to get the 2019 estimates, the results can hardly be way off. Again, top 10 is a somewhat arbitrary threshold.

http://www.geoba.se/population.php?pc=world&type=15

As we can see, not all these countries above can be qualified as hardcore or even ‘anycore’ SLDs.

One extra feature merits here further attention, opening up a whole new kind of political investigation by the way: the serious over-representation of microstates. We’re going to post about this separately. Microstates are those sovereign states with very small population or very small area, or both. Singapore, Luxembourg, Monaco, San Marino, Andorra qualifies here, with Singapore being the largest such microstate with a population of 5.6 million. Also part of the top lists are dependent micro-states, Macau and Hong Kong, that are special administrative regions of China, and Guernsey, an island in the English Channel, a British Crown dependency.  

Prosperity and Floyd

Seeing the apparent connection between wealthiest and healthiest countries above, one cannot help but think that prosperity has something to do as an enabler of an advanced health care service in a particular country. 

However within the default NB framework, Floyd is not particularly keen on using prosperity, a par excellence economic concept, as explanatory.

To put it briefly, prosperity acknowledged as an independent variable seem to be in conflict with NB’s explicit aim of keeping p212

institutions front and centre as the key independent variable being investigated

Floyd’s answer on prosperity, and in general his take concerning economics seems ambiguous to me and one point of his theory that definitely needs further elaboration, even independently of the health/longevity argumentation am doing. I must admit that to me economics and empirical research of prosperity is a very new interest, so my knowledge is seriously embryonic and limited here.

On p184. Floyd mentions that political philosophers have not given ‘due consideration’ to the fact that ‘once prosperity reaches a certain point, democracy is soon demanded’.

One could attempt the bonmot here, thinking the other way round: if democracy is a ‘luxury good’ then you need to be rich first to afford to be a democrat, even richer to be a liberal, and the richest to be egalitarian/social. 

On the other hand, within the Floydian frame, arguments related to the role prosperity is playing when picking out good political results are likened to ‘natural resources’ in the book and dismissed as such when providing an answer to OQ.

‘you cannot choose such prosperity as part of an answer to OQ any more than you can choose the presence or absence of natural resources, and to the extent that you can choose its preconditions, the evidence points squarely in the direction of social-liberal-democratic institutions.’ 

p222

But in case of health/longevity results prosperity seems to be a pretty possible confounding variable, working behind the curtains, causally connected to health/longevity outcomes. Yet, from within the narrow NB paradigm, its position as explanatory factor is severely limited.

Can health and longevity be achieved bottom-up or targeted top-down? Perhaps ‘middle-up/down’?

Within the restricted panorama of current mainstream political philosophy, focusing on institutions or abstract concepts, what hypotheses can be framed concerning health/longevity achievements/metrics, if at all?  

Perhaps SLDs can be assumed to enable better health/longevity than other political systems? If this is an empirical question, then this would require working with more data (~195 countries in the world today), setting up statistical models, running statistical tests, on part of the person who would like to make such a claim.

On the other hand one can try to come up with counter-examples, suggesting a disconnect between SLDs and health/longevity outcomes.

One example that comes into mind is obesity and the high mean body mass index (BMI) scores of USA (17th in 2014, mean BMI: 28.8), New Zealand (28th in 2014, mean BMI: 27.9), Ireland (33 in 2014, mean BMI: 27.5) and UK (40 in 2014, mean BMI:27.3). These are strong democracies, still recognised as social-liberal in many respects, but here the question about their status (especially UK/US) goes back to Jonathan Floyd.

Please also note that Qatar (11th in 2014, mean BMI: 29.2) and UAE (14th in 2014, mean BMI: 29.2) were parts of the top 10 in Health above, have higher BMI scores/rankings than all these 4 democracies above and they are not electoral democracies.

Going back to strong (sometimes even social-liberal) democracies suffering from ‘globesity’, to use a terrible word promoted by the WHO to refer to the global epidemic of overweight and obesity – what is important here is to observe that even in SLD-s there can be a strong incentive to become unhealthy, or a strong disincentive to stay healthy. 

Next comes an intriguing example of what I call top-down forced health effort: the case of the Turkmen president and Turkmenistan. Let me cite from this BBC piece, called Turkmenistan: The regime that throws cigarettes on bonfires that hopefully tells it all:

‘One of the most repressive states in the world is trying to become one of the healthiest. Turkmenistan is promoting fitness and wants to become a smoking-free nation – but when no-one can openly challenge the government’s decisions, how healthy can such a campaign be, asks Abdujalil Abdurasulov.’ 

Turkmenistan: The regime that throws cigarettes on bonfires

I cannot confirm or quantify the statement used by the BBC, ‘One of the most repressive states in the world ‘ but Turkmenistan is firmly in the red in the Democracy Index. Here we have a case of a top-down attempt to change health/longevity outcomes and this is an ongoing experiment and an open question of how much can be achieved this way and at what a price.

The interesting thing is that this campaign seems to be an example of how accidental and  idiosyncratic features of a political leader become part of his personal brand and way of doing politics. One more quote from the BBC piece:

‘A dentist by education, Berdymukhamedov has made health part of his cult of personality. And he is the main focus of the campaign promoting a healthy lifestyle. He cycles in rallies where no-one dares to overtake him. He squats with weights in an empty gym.’

Turkmenistan: The regime that throws cigarettes on bonfires

The last and strongly hypothetical option I’d like to mention is the one that comes in the middle between the bottom-up and top-down scenarios and comes from literally the middle and gets propagated down and up. Yes, am intentionally cryptic here a bit, because this would be the option for Open Lifespan within SLD-s, where the extra incentive is taken to push for health/longevity as prioritised political goals, yet by no way can this be done in a repressive manner. Longer term health/longevity outcomes cannot be achieved in a forced manner. Why? If our arguments in The Open Lifespan answer to Jonathan Floyd’s political philosophy organising question: how should we live? Tens of arguments

are compelling individually and meaningful enough bundled together as a whole then an Open Lifespan political agenda would forcefully end itself by forcing directives onto citizens of a free society. This argument is hidden in the term ‘Open’ of ‘Open Lifespan’: Open Lifespan cannot be achieved with a Closed Society. There I said, much to my contentment. 🙂 But am staying cryptic here concerning implementation cause this middle up/down needs be worked out in great detail first.

Time to wrap up. 

Temporary Conclusion, argumentative style

1A. Improving health/longevity does not rely on exclusively on the establishment of SLDs as there are top health/life expectancy examples that are definitely not SLDs.

1B. High Obesity rankings for existing SLDs can serve as an actual counterexample of disincentivised to stay healthy. SLD do not by themselves make you healthier, not a guaranteed motivation.

2. If health is a valid political goal, an extended NB answer to the OQ providing a compelling and meaningful political system should include that as a metric.

3. If NB includes health as a metric then this seems to not pick out meaningfully default SLDs any better than other political formats.

4. Open Life is a version of society where improving health/longevity is the political top goal.

5. Open Life as a society seems to improve SLDs across all factors, make it more democratic, more liberal and more egalitarian.