Measurement of Freedom

There are many ways to test the hypothesis that democracy and freedom have real benefits for human health and the environment. In order to do so, it is necessary to have some way to measure the amount of freedom for each country. A nonprofit organization called Freedom House has done just that. The staff of Freedom House has compiled a "Freedom in the World'' survey, which measures two things: the degree of political rights and the level of civil liberties enjoyed by the citizenry of each country. For more information on the survey, visit www.freedomhouse.org. All the nations of the world fit into one of several categories of freedom. Some countries, such as most in Western Europe, North America, Australia, and Japan, have obtained the maximum score of seven from 1961 through 2003. At the other end of the spectrum are those countries that have never experienced much freedom during this entire period. There are also quite a few countries whose freedom index has undergone major changes in the past four decades.

With the survey in hand, it is possible to test my hypothesis. We can test the relationship of freedom to health by plotting the freedom survey score of each country on the x axis and some other variable that measures public health on the y axis. One of the most telling variables for epidemiologists and public-health specialists about the state of health care and disease in any country is the rate of infant mortality as discussed in chapter 6. Infant mortality, besides being a measure of the death of infants at birth, also reflects the general level of a population's health. Infant mortality is always low in nations where people have good access to medical care, and it is always quite high in nations where health care is deficient or where there is a large burden of disease. The reason that infant mortality is such a good indicator of the general state of a nation's health is that it takes into account the health of the women giving birth, access to good health care for new-borns, and the availability of postnatal and prenatal care. Figure 7-1 shows the result of plotting infant mortality and freedom survey scores for 172 countries. Each point represents a different country. The straight line shows the statistical regression, which is highly significant (for professionals, the correlation coefficient R2 = 0.34, p = 0.000).

What the figure shows is that there is significant correlation between freedom and infant mortality. In order to explore this relationship between freedom and health more thoroughly, we can compare countries with similar levels of wealth. I chose twenty-one countries that have had very low survey scores since 1961 (call them Group 1), and I compared them to a

Figure 7-1. Infant mortality vs. freedom survey scores for 172 countries.

FREEDOM SURVEY SCORE

group of countries that started out as very unfree and then became much freer during the past forty years (called Group 2). The idea is that if freedom has anything to do with human health and well-being, the rate of infant mortality should have dropped much more in the nations that became free than in those that didn't.

The first group (Group 1—Long-term nonfree) comprised twenty-one countries, including ten African countries, six countries from Asia, two from South and Central America, and three from the Middle East. The other group (Group 2, the group that started out not free and later became freer) consisted of twenty-eight countries: eight from Africa, two from Asia, eight from South and Central America, and ten from Eastern Europe. The average wealth, measured as gross domestic product (GDP), was similar for the two groups of countries.

For the group of countries that remained unfree (Group 1), the annual rate of infant mortality was 81 per 1,000 births, but for those that became much freer (Group 2), the rate was 35. This result goes a long way to supporting the hypothesis that freedom makes a difference in the public health of countries. If we compare the trends in the two groups of nations we find that for Group 1, the average infant mortality rate declined during the period 1990 to 2004 from 93 to 81, a13 percent improvement, while for the Group 2 countries, the rate went from 50 to 35, a 28 percent improvement. Furthermore, the average improvement of all the countries in Group 1 was 16 percent, compared to 35 percent for Group 2 countries. Thus, not only was there a large difference in the single-year infant mortality rate in 2004, but there was also a similar difference in the trends between the two groups. Eight of the Group 1 countries had no improvement at all in the infant mortality rate over the past 14 years, whereas only 1 country in Group 2 showed no improvement during this time interval.

What this analysis shows is that when a dictatorship, a religious autocracy, a monarchy, a Communist regime, or any other type of society with restricted freedom moves toward a freer, more democratic form of government and society, its infant mortality, and by extension, health care and the overall health of its people, improves.

The United Nations compiles an index of the general well-being of humans in each country. The components that go into producing this index, called the human development index (HDI), are life expectancy, wealth and poverty level, and educational level (including literacy).

Figure 7-2 is a plot of the freedom survey scores versus the human development index for all the countries. Just as for infant mortality (but in the opposite direction), there is a very strong correlation between the degree of freedom in a country and the overall quality of life. Again each point represents a different country, and the regression line is highly significant (R2 = 0.40, p = 0.000).

A group from the Paris-based Foundation Nationale des Sciences Politiques ("Sciences Po'') Centre for Peace and Human Security did a similar survey led by Anne-Sophie Novel under the auspices of the United Nations Educational, Scientific and Cultural Organization (UNESCO). This group specifically investigated the connections between freedom of the press and many societal indicators, including human development, and came to very similar conclusions.

Figure 7-2. Correlation between human development index and freedom survey scores. 1

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Figure 7-2. Correlation between human development index and freedom survey scores. 1

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So it appears that freedom is good for us. Freedom is healthy. But freedom is a word that is often abused. It is well known that all sorts of armed groups call themselves freedom fighters, even if what they are actually fighting for is the ascendancy of a brutal, oppressive warlord. In America, all sides of every debate proclaim they are on the side of freedom. A good example of some of these distortions of the meaning of freedom, which is highly germane to the theme of this book, is the claim that government regulations limit freedom. Some might say that if freedom is a good thing for the public health and welfare, then it stands to reason that the government of a free country should not impose limits, such as curbing the rights of individuals or corporations to pollute the environment. Such a view is an error, because the Freedom House survey (which correlates so well with low infant mortality, improved life span, and quality of life) is not about regulations at all. It is about political rights and civil liberties.

The United States has scored a perfect seven on the Freedom House survey throughout the period used, regardless of its regulatory climate. In fact, the nations of Western Europe and others that had a perfect score of seven, which denotes true democracy with maximum political freedom and civil rights, tend to have much stronger regulatory controls protecting the environment and the health of their citizens than do the various dictatorships, tyrannies, and Communist regimes that have consistently scored one or two over the years. And finally, the previously discussed Group 2 nations—those that went from tyranny to freedom in the past forty years—all have increased the degree and especially the enforcement of environmental regulations since becoming free, largely in an effort (most clearly seen in the former Communist nations of Eastern Europe), to reverse decades of disastrous environmental and public-health crises brought about by the complete lack of interest in such issues on the part of totalitarian and autocratic regimes.

One can assume that the majority of my readers live in democratic countries and that they prefer to do so. Most such people would agree that democracy is better than autocracy or totalitarian forms of government. There are many reasons why it feels better to be free than not free, but I

have not considered any of the advantages, benefits, or other assumptions about the value of democratic governments in a general sense. I have only considered how democracy relates to the quality of human health and the environment. If democratic governments are better for public health, then any increase in democracy would lead to improvements in all the quality-of-life parameters we can think of. The data show a strong trend toward increasing democratization in the world during the past century. The logical conclusion therefore is that some portion of the progress that has been made in the quality ofpeople's lives may be directly due to this trend toward freedom.

A central theme of this book is that normal economic forces and natural processes cannot by themselves lead to recovery from pending environmental disaster in the absence of political pressure from advocacy groups, environmental activists, and scientists. The freely expressed desire of the population to live in a clean and healthy environment, combined with scientific data showing the health detriments of pollution, were fundamentally vital to produce the turnaround in environmental trends of the past two decades in the United States and Western Europe.

How do I know that environmental degradation, if allowed to proceed at will, can really cause severe damage to human life? How do I know that such degradation will naturally get worse and worse in the absence of strong and persistent pressure to reverse it? In other words, how do I know that the scientific and political work in the United States and Western Europe on behalf of the environment and all the regulations related to improving environmental conditions have had any positive impact at all, and thus by extension should be encouraged to continue? There are many ways to answer this question, and I present some of the historical evidence in chapter 8.

Another way to answer this question would be to ask if there were somewhere in the world where none of the scientific research had been used to show the negative effects of pollution, where there was no political or social pressure or interest in combating pollution, where the very idea of environmental protection was not considered an important issue, or where people adversely affected by environmental degradation either were not aware of it or had no ability to express their concerns except to themselves. In other words, if we could do an experiment that would allow industrial pollution to mimic the worst days of the Industrial Revolution without any outcry to stop it—where emissions of toxic and noxious pollutants could go unchecked for decades and where the population's exposure both at work and at home could accelerate without any attention at all to the public-health problems, species loss, and depletion of natural resources—we would have our answer.

Of course, we could not even think of doing such an experiment deliberately, but unfortunately such an experiment has already been done. The experiment was the great (as Lenin put it) experiment of Communism. In Eastern Europe, especially from 1960 until the fall of Communism thirty years later, all the conditions I just referred to applied. The centrally planned economy was geared to a massive increase in industrial production, and very little attention was paid to environmental issues. Complainers were seen as subversive anti-Communist dissidents, an interesting irony because in parts of the United States, people who complained about industrial pollution were viewed by some as subversive Communist sympathizers.

Many books and the media have presented the tragic and overwhelming story of environmental degradation in Communist Eastern Europe, although the full extent of the disaster will not be appreciated for many decades. The Soviet Union and most of the Eastern European countries experienced some of the worst environmental degradation ever caused by human beings, whether measured by the amount of toxic materials released, the number of people exposed, the loss of natural resources and destruction of biodiversity, or any other measure. At the same time (as discussed in chapter 2), many of these countries experienced a decrease in life expectancy and an increase in infant mortality—trends that are rarely, if ever, seen in advanced nations in the absence of a disease, epidemic, or war.

A population's increased morbidity (ill health) can come from many factors, including epidemic diseases (such as AIDS in Africa), poor medical care, poverty, famine, or degradation of the diet, as well as from environmental distress. In Eastern Europe, which had problems with food supply and medical services during the final years of Communism, it isn't likely that only pollution and toxic exposures caused the unusual poor health and loss in life expectancy. Poor diet, heavy smoking, alcoholism, suicide, accidents, etc. certainly exacerbated the situation.

The incidence of many infectious diseases such as measles, tetanus, typhoid, and scarlet fever decreased with time in the Soviet Union, as they have everywhere in the developed world. But surprisingly, certain more common infectious diseases such as hepatitis actually increased from 1970 until the demise of the Soviet Union. The United States (and the rest of the developed world) experienced much lower and, more important, decreasing rates during the same period. This raises serious questions about the conditions that led to this unusual trend in health in one of the superpowers of the time.

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