Political Determinants of Public Health Investment in China and India

This article examines long-term political determinants of divergent levels of public health investment in China and India. Addressing the welfare-state literature hypothesis that democracies tend to invest more than non-democracies in social services including public health, we hypothesize that in low-income countries the development ideologies held by political leaders and the degree to which lower classes pressure the state for public services may impact public health investment more strongly than regime type. We offer a test of this hypothesis through comparative historical analysis of democratic India and non-democratic China. Controlling for economic growth rates and including analysis of the outlying Indian state of Kerala, we find support for our hypothesis that development ideology and systematic pressure from the lower classes have a major impact on government investment in public health.