The Velvet Revolution, peaceful demonstrations led by students and dissidents during the winter of 1989 in what was then Czechoslovakia, brought down the one-party communist government that had ruled the country for 41 years. By 1992, citizens were living in two separate countries - the Czech Republic and Slovakia - in multi-party democratic systems with a free economy.
During his career, Dr Joan Costa-i-Font has linked various apparently disparate concepts from social science to health, such as globalisation and obesity, to highlight how our environment is a crucial influence on our health. Height is often used as a proxy for health and living standards in many countries, with health economists attributing South Koreans' average height advantage of 15cm over North Koreans, despite having the same genetic background, to malnutrition in the communist north.
It is no coincidence that the tallest country in Europe is the Netherlands, which has historically been one of the most democratic.
The collapse of the Soviet bloc provided Dr Costa-i-Font with the conditions for a similar experiment. He studied almost 3,000 households from the Czech Republic and Slovakia, comparing birth dates before and after 1973 with income and stature. The results showed that male residents born before 1973 were 1.5cm shorter than those born between 1973 and 1985, while there was a 2cm height difference between the richest and poorest citizens.
This meant that men who grew up in the democratic states of the Czech Republic and Slovakia were likely to be taller than their fathers who had lived under Soviet communism. Dr Costa-i-Font says the political change meant better living standards for citizens, with the “environmental factors explaining 20 per cent of our height. This happens because of better access to health care, lower inequality, minority inclusiveness, and access to education. It is no coincidence that the tallest country in Europe is the Netherlands, which has historically been one of the most democratic.”
Within the data other trends emerged. Less wealthy and educated Slovaks experienced the biggest increases in height, suggesting that they appear to have benefited more from democracy: “The Slovaks were the minority in Czechoslovakia, and after the transition they had political self-determination. This created a ‘double bang’ of political and economic progress,” Dr Costa-i-Font says.
The problem is that democracy might overlook non-visible health programmes for which people cannot see a direct benefit.
Height increases only affected men, with women’s stature unchanged after the country’s transition to democracy. Similarly, disadvantaged groups such as pensioners, workers or ethnic groups saw fewer benefits. Dr Costa-i-Font says that deeply ingrained social and economic inequalities could explain this: “The cost of transition weighed most heavily on ordinary citizens, who had too little influence on the political decisions that affected them.”
Despite the clear benefits of democratic systems for health, Dr Costa-i-Font cautions against viewing democracy as a panacea for our health. “My research on female franchise extension suggests that when policymakers need wider approval for their choices they have to please more needs, and expand health programmes. The problem sometimes is that democracy might overlook non-visible health programmes for which people cannot see a direct benefit.”
Democracy also requires a system that represents all groups fairly and demands engagement across society, he adds. “The democratic system also assumes the patient-citizen is knowledgeable. Another risk is that some democracies might neglect minorities if they don’t influence the political process.”
Should we be optimistic? Dr Costa-i-Font features in this LSE IQ podcast.
This LSE IQ podcast can also be listened to on LSE Player.
Dr Joan Costa-i-Font was speaking to Peter Carrol, Media Relations Officer at LSE.