Democracy: the forgotten determinant of mental health

Promoting mental health is a relatively new initiative being taken across the world, stimulated by concerns about the global burden of mental illness, inequalities in mental health and debate about the relationship between quality of life and economic growth. Social factors influence the health of populations but the distribution of these is determined by people who exercise political power through societies' institutions of governance. Inequalities in health (and mental health) arise from the unequal distribution of these social determinants of health. This paper aims to stimulate interest and debate on the role of democracy, a mechanism for allocating political power, as a determinant of health and of mental health in particular.

Drawing principally on the political science literature, we briefly describe the development of democracy in some of its commoner current forms and relate this to the spread of political power and participation in collective decision making and improvements in public health over the past 200 years. We conducted a non-systematic literature search and identified 34 studies examining the link between democracy and health. Despite methodological weaknesses, these papers suggest that there is a weak empirical link between democracy and health, including mental health. We suggest mechanisms that might account for this.

Historical, theoretical and empirical evidence suggests that democracy is a (frequently forgotten) determinant of health.