An analysis of the various revolutions in the North African nations of Libya, Tunisia, and Egypt pose obvious questions concerning the future of politics, economics and health care: Do such revolutions demarcate a fundamental possibility for economic development, the improvement of health care and the growth of democracy? Johan Galtung (2011) has stressed the commonality of these revolutions as follows: “The recent pan-Arab revolt, described as the Arab Spring, has five characteristics. It is anti-autocratic, anti-kleptocratic (against greedy, corrupt governments), anti-imperialist, for youth and for women.” Nevertheless, it is pertinent to underscore that each of the North African countries active in the Arab spring possess their own unique political, health care, and economic situations: that is they all possess their own unique concerns within the general framework that Galtung advances. In this regard, in order to attempt to glean positives from such revolutions, it first becomes necessary to recapitulate the specific successes and failure of these countries. Moreover, it can be suggested that the three do not necessarily go together, that is, lack of democracy could be accompanied by a universal health care plan, or democracy could mean health care concerns. such as in the case of the United States. Furthermore, insofar as these revolutions are essentially ongoing, it is, of course, difficult to predict what policy decisions will be made by whoever eventually assumes power. Nonetheless, it remains feasible to examine some of the possible turns these revolutions will take through an analysis of the regimes and policies that such movements intend to overthrow. Accordingly, the following essay shall attempt to initially treat these revolutions in their singularity, through an analysis of health care, democracy and economic stability in Libya, Egypt and Tunisia respectively, followed by a commentary on what such revolutionary change may imply for the region and the rest of the world.
In the case of Libya, the question of healthcare becomes a relevant starting point, as it is symptomatic of how politics, economics and international relations are fundamentally imbricated. According to Malcolm and Losleben (2004, p. 78), “Qadhafi’s socialist government has instituted free health services and increased facilities dramatically. Before the UN sanctions, Libya had one of the best healthcare systems in Africa. But when medicines and supplies became difficult to obtain, the quality rapidly declined.” Following the basic socialist inclination of the Qadhafi government, the universalization of healthcare was actuated; however, according to economic sanctions resulting from political decisions, the quality of the healthcare system became difficult to maintain. In this regard, the non-democratic nature of the Qadafhian government led to a certain isolation from the international community, one that reflected itself in economic sanctions, and it thus became difficult to maintain the high quality of previous care. Accordingly, the precipitous decline of healthcare is mainly the result of tension with the international community: the realization of a revolution in Libya, one which would overthrow the Qadhafi government, could mean improved political relations with the outside world, which in turn would lead to an openness in economics that would subsequently improve health care. Nevertheless, the assumption that such political change would necessarily lead to improved health care is difficult to maintain: it is unknown as to who will fill the power vacuum if Qadhafi is dethroned; accordingly, it is unknown as to what the domestic and foreign policy will be of a prospective new government. What the Libyan case nevertheless shows is that democracy is not necessarily equivalent to quality healthcare; however, the Libya case also shows the necessity of maintaining good foreign relations in order to maintain internal policy such as health care, insofar as the increasing globalized world means a greater entanglement of national economies.
The case of Libya bears a similarity to the case of Tunisia. Tunisia, under an authoritarian regime, has nonetheless maintained “workforce skills and educational standards [that] continue to profile Tunisia ahead of its neighbors.” (Oxford Business Group, 2010, p. 27) According to Ziad Duestati, “For years, Tunisia resisted IMF recommendations to cut spending education and healthcare. At the same time, it encouraged trade openness and kept selective controls over certain sectors to avoid boom and bust cycles.” (Oxford Business Group, 2010, p. 27) In this analysis, the very success of Tunisian healthcare and economics was derivative of a strong government intervention within the economic sector. Moreover, these economic decisions contrasted with the recommendations of the Western IMF. Accordingly, Tunisia before the revolution can be considered a success story in healthcare precisely because it did not adhere to Western advice: the dethronement of the government in Tunisia leaves the question open as to whether Tunisia shall continue on this path. A more pro-Western government policy would conceivably adhere to IMF recommendations and thus cut healthcare in favor of economic freedoms.
The case of Egypt once again underscores the link between non-democratic regimes and free healthcare. As Prem Yagasi (2011, p. 246) notes, “Egyptians have free health care within 5 km’s of their residence.” However, Egypt also has a “pluralistic system of healthcare, where the medical services are managed, financed and delivered by three different sectors: government (public), parasitical and private.” (Yagasi, 2011, p. 246) Nonetheless “the majority of Egyptians (56%) have opted for acquiring care at a private facility.” (Yagasi, 2011, p. 246) The most striking feature of the Egyptian healthcare system under the Mubarak regime is its diversity: it combines both private and public healthcare. Nonetheless, that high numbers choose private healthcare as opposed to public healthcare despite the latter being free suggests that the quality of public care is poor: concomitantly, it suggests that the price of private healthcare is not exorbitant. Hence, economic stability in relation to healthcare cost could be ascertained as sufficient. The effects on revolution and of democratization on this pluralistic system once again remain conditioned by who assumes Egyptian hegemony. A more Western system in the style of the United States could see the elimination of this pluralistic system, whereas a Western system in the European style could see more emphasis on public healthcare.