Healthcare equity and COVID-19 : assessing the relative effectiveness of egalitarian governance and healthcare system capacity on the COVID-19 pandemic

Scholars of public health typically focus on societal equity for explaining public health outcomes. Indeed, the COVID-19 pandemic has led to a spate of studies showing a tight connection between inequitable access to healthcare, welfare services, and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question a bit differently by asking whether more 'egalitarian' forms of democracy matter, given that they should contain more equitable healthcare access and societal infrastructure, such as social capital and trust, for achieving a broader collective good. Our results suggest that more equitable access to healthcare does indeed increase testing rates and lower the death rate. Broader egalitarian processes, measured as egalitarian democracy, however, show the opposite effects, suggesting that factors associated with healthcare capacity to reach and treat matter more than broader societal factors associated with egalitarian governance.