During the 20th century, health statistics dramatically improved in Cuba, China, Singapore and other non-democratic countries.  This has contributed to the widespread assumption that delivering health services is a fundamentally technocratic, apolitical task and that autocrats, unlike democratically elected leaders, govern more efficiently because they can ignore the whims of conflicting constituencies.  I'll discuss three African countries ruled by autocrats: Uganda, Rwanda and Ethiopia, and argue that they deviate sharply from the above pattern. In each case, improvements in public health will continue to be inequitable and unsustainable without commensurate emphasis on political freedom, justice and the rule of law.

Helen C. Epstein is Visiting Professor of Global Public Health and Human Rights at Bard College in Annandale, New York. Her new book "Another Fine Mess: America, Uganda and the War on Terror" has just been published by Columbia Global Reports. Her previous book "The Invisible Cure: Why We Are Losing the Fight against AIDS in Africa" was a New York Times Notable Book and Amazon.com’s best science book of 2007. Her articles have appeared in The New York Review of Books, The New York Times Magazine and other publications and she has worked as a consultant for such organizations as the World Bank, UNICEF, and Human Rights Watch.