What Sparks Democratic Action? It’s Not Corruption or Crooked Cops

Government corruption, police abuses and the muzzling of free speech get huge attention from newspapers and democracy advocates, yet none of those are the biggest motivators of political action by individuals in developing democracies, according to a new international survey.

In 13 of the 14 countries where the Pew Research Center’s Global Attitudes surveyors roamed, poor health care was the first or second reason that people said would likely trigger action such as contacting a politician, posting on social media or joining an organized protest. Those countries included the Indian Ocean nations of Indonesia, South Africa and Kenya, where 81 percent of those questioned – the highest in the survey – said lousy health care would rouse them to action.

Poverty was the second biggest motivator overall, and the top reason given for action in Argentina, Greece, Mexico and the Philippines. Poor-quality schools was the top action-inciter for the citizenry in Mexico, Tunisia and South Africa. Only Nigerians picked freedom of speech as the No. 1 driver of political action in Africa’s most populous nation.

Voting is the most common form of action, cited by more than three-quarters of those questioned across the 14 countries. Researchers zeroed in on what people do apart from participating in elections. The survey was conducted from May 20 to August 12, 2018 using 14,875 in-person interviews, in collaboration with the Center for Strategic and International Studies.

The public passion for better health care actually may reflect a big success: the astonishing advances across developing nations in access to medical practitioners, medicines and other primary care. Ethiopia, for instance, has pushed basic health care posts into sight of nearly every village in the country. Access raises expectations for better service, drugs in stock, fast referrals to hospitals for more sophisticated care, and at least a sampling of the modern miracles available in America, Japan and Europe.

There’s also evidence in Africa and Asia that community-led oversight of health clinics and their performance leads to better outcomes. It’s a form of grassroots action that is still budding, yet seems to get communities engaged in goading governments to up their game in the health arena. Once those involved citizens score gains in health, they may look to schools, water, roads and other services for improvements.

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Prime Minister Modicare

In the world’s largest democracy, health care is high on the agenda this year. Indian Prime Minister Narendra Modi has introduced his Ayushman Bharat health-insurance program, instantly dubbed Modicare. Modi described Modicare during its September launch as the world’s “biggest government-sponsored health care scheme” and said the number of beneficiaries would almost equal the combined population of Canada, Mexico and the United States, according to The Hindu Business Line.

Modi said the program, in which more than 8,700 public and private hospitals are participating, would give even the poorest Indians access to services usually enjoyed by better-off Indians. “The program will not differentiate between people based on religion, caste, location,” Modi pledged. “Every eligible person will be able to avail of the benefits.”

Health care indeed seems to be a democracy issue for young people. Three of the six countries with the highest percentages of people surveyed saying poor health care would push them to political action are in sub-Saharan Africa: Kenya, Nigeria and South Africa. That region, which covers most of Africa, is where the world’s youth population is growing fastest.

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Urbanizing, youthful Africa: Addis Ababa, Ethiopia

The surge of people from villages to towns and cities also is probably transforming health care and schools into political catalysts. Indonesia’s urban population rose last year to almost 55 percent from less than 15 percent in 1960, according to United Nations data. In Kenya, a similar story has unfolded: the urban population has almost quadrupled since 1960, to 26 percent. That figure will only keep rising, in Kenya and elsewhere in Africa, meaning the health of democracy may depend on how healthy that youth wave feels.