New York: Cambridge University Press, 2015. xiii, 292 pp. (Tables, figures, maps.) US$103.00, cloth. ISBN 978-1-107-10304-7.
This book aims to develop and test a socio-institutional theory of public goods provision that can explain the diversity of health and education outcomes in developing democracies. Arguing that electoral rules function differently in different kinds of societies, three dimensions of social structure are used to determine societal type: the diversity of ethnic groups, their economic equality, and their geographic distribution. The author argues that different arrangements of these three variables in combination with electoral rules will lead to different party-building and policy-making strategies than those asserted under existing electoral theory.
Chapters 3 and 4 develop and test a socio-institutional theory of public goods provision, focusing on low and high ethnic-salience countries. Existing institutional theories are most applicable in low ethnic-salience societies. Two features of electoral rules that affect public goods outcomes are the number of legislative seats per electoral district, and the formula which determines how votes are translated into seats (majoritarianism and proportional representation [PR]). In ethnically diverse societies, PR systems that pre-determine the legislative representation of each ethnic group prevent interethnic coordination. But if ethnic groups are geographically isolated (as in many African countries), first-past-the-post systems would be no better in inducing pre-electoral interethnic coordination. What can be done about this? Selway cites the example of Indonesia, where although ethnic and regional conflicts exist, ethnic-based and regional-based parties have not developed for a very simple reason: the electoral law has successfully avoided such dynamics through the electoral rules established for both legislative and presidential elections. These party-registration rules effectively force parties to be broad-based and multi-ethnic. Such rules will not necessarily work in every ethnically diverse society, but should work in those (like Indonesia and Nigeria) where ethnic groups are geographically concentrated in their own regions.
The core of the book is the chapters examining the provision of health care in several countries that vary along both the electoral-rule and social-structure dimensions of the theory. The key case studies are really those of Thailand and Mauritius, but other case studies are also developed in considerable detail: Botswana, New Zealand, Malaysia, Myanmar, and Indonesia, all of them contributing in different ways to a testing of the theory developed in the first part of the book.
The Thailand case study is fascinating, the core of the analysis directed to understanding the remarkable shift from a highly wasteful expenditure of public health funds in the over-building of hospitals, purchase of over-priced medical supplies, and other forms of pork barrelling and rampant corruption, to the introduction of the universal health-care policy known as the “30-baht scheme” following the constitutional change of 1997. This constitutional change replaced a first-past-the-post system with a proportional representation system, which resulted in the replacement of a fractionalized multiparty system of narrowly oriented parties by an essentially two-party system of nationally oriented parties with independent policy-making capabilities. This led to much more detailed party platforms relating to aspects including health policy, in terms of description of the program, financing, and implementation. The benefits in terms of health outcomes were clearly evident.
The Mauritius case study is similarly detailed and insightful. In contrast to Thailand, Mauritius is an ethnically diverse society, with majoritarian electoral rules, both of which factors would normally be expected to work against effective public goods provision. However, it did not develop a narrow party system similar to pre-1997 Thailand, or an ethnicized party system as developed in Myanmar in its democratic period from 1948 to 1962. Mauritius outperforms Thailand comprehensively on just about every health outcome, a surprising performance, given that Thailand’s health performance is not so bad and that Mauritius is a more complex society. The national health system is so crucial to political success in Mauritius that politicians must pay careful attention to it. (The same was actually true of Thailand in the 1997 to 2006 period). Parties must be seen not only to be not harming the existing free and universal system, but as vigorously improving the system.
Though the book’s introduction promises to examine both health and educational outcomes, health outcomes are developed in much greater detail than educational outcomes. This is implicitly acknowledged in the title, where only health policy is mentioned, and also on p. 248, where it is acknowledged that education and other broad social programs might differ from health policies in ways that make them more difficult to change.
This reviewer is not a political scientist, and therefore not well placed to critique the political science aspects of the book, but can certainly comment favourably on the book’s analysis (using both quantitative and qualitative approaches) of the relationship of health outcomes to different electoral rules and ethnic situations. Just one quibble might be mentioned. In Malaysia, where the book appropriately lauds the remarkably good health outcomes on relatively modest health budgets, a political reason for the pro-poor health policy that is rather underplayed in the analysis is the ruling National Front’s reliance on a gerrymander giving much greater weight to rural electorates than to urban electorates. Since the rural Malay-dominated electorates in Peninsular Malaysia and the bumiputera-dominated electorates in East Malaysia are also the relatively poorest sections of the population, policies designed to satisfy this electorate will inevitably also be pro-poor.
As the author concludes, a one-size-fits-all institutional solution is inadequate for the rich variety of social structures in this world. More sophisticated analysis is needed in order to more accurately design rules for the variety of shortcomings faced by fledgling democracies. The promise of constitutional engineering is that if politicians are given the right incentives, perhaps we can put an end to bad governance. This would certainly have profound outcomes in terms of lowered mortality and improved public health.
Gavin W. Jones
Australian National University, Canberra, Australia
pp. 126-128