Democracies, Autocracies, and Health: Mapping the Political Dimensions of Public Health Outcomes

This paper explores the causal relationship between regime types and public health outcomes, addressing an underexamined yet crucial question in the political science of health. Democracies are often presumed to prioritize public health due to their commitment to safeguarding structural determinants such as human rights and accountability for state-sanctioned violence. However, recent democratic backsliding in countries like the United States, Austria, and Poland highlights how the erosion of democratic norms—manifesting in restrictive abortion laws, oppressive LGBTQ+ measures, and science denialism—can undermine public health. These developments, coupled with the rising frequency of global health crises such as pandemics, underscore the urgent need to systematically assess how regime characteristics shape health outcomes. This study addresses the gap in political science literature by conducting a comprehensive systematic scoping review of existing research on regime types and public health. It maps the causal pathways through which political regimes influence health, comparing democratic and authoritarian strategies during the Covid-19 pandemic. Both regime types showcased their core principles in navigating health crises, revealing distinct approaches to protecting public health amid global challenges. In addition to advancing the understanding of regime-health dynamics, this research contributes to debates on the quality of democracy by highlighting health outcomes as an overlooked yet critical dimension of democratic performance. The study proposes a conceptual framework for future analysis, linking regime type and public health in ways that inform both theoretical advancements and empirical research. By bridging subfields in political science and engaging with the politics of health from a regime-focused perspective, this work rethinks the boundaries and contributions of political science to health and healthcare research.