Do Communist-Led States Protect Public Health Better Than Capitalism?

By Stephen Gowans

May 5, 2021

Had all capitalist countries managed the Covid-19 pandemic as effectively as the Communist-led countries of China, Cuba, and Vietnam, nearly 147 million people would have been spared illness and over three million lives would have been saved, according to projections based on data from Our World in Data. These projections are based on applying the number of cases and deaths per million for the Communist world to the world as a whole.

Taken together, the Communist countries have limited the spread of the novel coronavirus to 134 cases per million, compared to 24,058 cases per million in the non-Communist world. At the same time, communist countries have held Covid-19 deaths to four per million, while in the capitalist world, the death rate per million has been well over a hundred times greater.

What’s more, according to reports from The New York Times and The Wall Street Journal, North Korea has likely been as successful as its Communist cohorts in protecting public health in the face of the worldwide coronavirus emergency.

Clearly, compared to the capitalist countries, the Communist-led states have not only done a better job of protecting their citizens from the dangers of Covid-19, they have done a supremely better job.


In 1986, sociologist Shirley Ceresto and physician Howard Waitzkin published research in the American Journal of Public Health comparing the performance of Communist-led states and capitalist countries on physical quality of life indicators, including six public health measures: infant mortality, child death rate, life expectancy, population per physician, population per nurse, and daily per capita calorie intake. Using World Bank data, the researchers found that when comparing Communist-led countries with capitalist states at the same level of economic development, the Communist countries came out ahead on all six public health measures.

Waitzkin told The Los Angeles Times that he believed the Communist-led countries fared better because they considered health care to be a basic human right. Ceresto added: “The first thing a country does when it becomes socialist is improve the health care and education and feed the people.” This, she said, “is their goal: To feed their people and get them health care and education.”

In 1992, sociologist and political scientist Vincente Navarro published in The International Journal of Health Services a continent by continent survey of the performance of socialist and capitalist countries in their response to the health needs of their populations. Navarro concluded that socialism and socialist forces [had], for the most part, been better able than capitalism and capitalist forces to improve health conditions.”  

Among other comparisons, Navarro contrasted China with India, showing how life expectancy in the Communist country lagged India’s by seven years when Mao’s forces came to power in 1949. A quarter of a century later, life expectancy had increased by 35 years and was 12 years greater than in India, where life expectancy had increased only 17 years. Today, China continues to lead India in life expectancy at birth.

Navarro concluded that “the socialist experience … has been more frequently than not more efficient in responding to human needs than the capitalist experience.”

Communist Countries Today

As was true in the 1980s, today’s Communist-led states outperform capitalist countries on various measures of public welfare, including life expectancy, hospital beds per thousand, extreme poverty, as well as scoring higher on the human development index, a composite measure of income, life expectancy, and education.

Table 1 shows that average life expectancy is five years greater in Communist countries than capitalist states (77 vs. 72). The lead is even greater in Cuba and Vietnam (seven years), comparing these countries with capitalist states at the same level of economic development.

Table 2 shows that Communist-led states have close to twice as many hospital beds per 1,000 people as capitalist countries, with Cuba having over three times more beds per 1,000 people than capitalist countries at the same level of economic development.

Table 3 shows that the percentage of the population living in extreme poverty is lower in the Communist-led states (for which data are available, namely, China and Vietnam) than in the capitalist world as a whole, or in capitalist countries with a similar GDP per capita.

The idea that extreme poverty is greater in the capitalist than Communist world challenges the myth, industriously cultivated in the rich countries, that capitalism means wealth and development while the Communist countries are uniquely poor. While it is true that some capitalist regions are very wealthy, specifically, those with an imperialist past and present (North America, Western Europe, and Japan), they comprise only a small part of the world’s population, about ten percent. The Communist countries comprise a further one fifth. That leaves the bulk of humanity—seven of every ten people in the world—living within less developed parts of the capitalist sphere. The capitalist norm, then, is not one of wealth and development, but of poverty and underdevelopment.

Capitalism has two faces. One is the face of great wealth. The other is the face of poverty, agony of toil, brutality, and foreign domination. For most human beings, capitalism has showed, and continues to show, only one of its faces: that of poverty, misery, and imperialism. It is from, and against, this sphere that the Communist countries have emerged.

Table 4 shows that the Communist countries have a higher level of human development (the index ranges from 0 to 1, with 1 as the highest level) compared to the capitalist world. The Communist advantage is particularly evident in the cases of Cuba and Vietnam, where human development in these countries exceeds that of capitalist states with roughly the same income per capita.

Managing the Covid-19 Pandemic

Given that the data indicate that Communist-led countries are more responsive to the human and health needs of their populations, we might expect that the Communist-led countries have also been more effective in protecting their populations from the Covid-19 pandemic. The next two tables confirm this expectation.

Table 5 shows the number of infections per million has been considerably lower in the three Communist-led states than in the capitalist world.

Similarly, Table 6 shows that the Communist countries have significantly outperformed capitalist states in limiting the number of Covid-19 deaths per million.

Note that the difference between the Communist and capitalist worlds is not trivial. The infection and fatality rates in the capitalist countries have been, respectively, 180 and 127 times greater than in the Communist states.

Capitalist Exceptions

Some capitalist states have performed better than others. Unique among the capitalist countries in pandemic management are Japan, South Korea, Australia, and New Zealand, which have not only achieved infection and mortality rates well below the capitalist average, but have done better than Cuba, as Table 7 shows.

However, while the performance of these capitalist countries has been very good relative to their capitalist peers, as Table 8 reveals, it has nevertheless been less effective than that of the Communist-led states as a group.

The achievement of the capitalist quartet in limiting infections and deaths challenges the belief that infection control is only possible in Communist-led countries and is not possible in liberal parliamentary states. Moreover, all four countries had a low rate of vaccination as of the end of April, refuting the notion, widely promoted in the Western news media, that vaccines are the sole route to managing the pandemic.

Had all countries performed as well as these four, 121 million people would have been spared illness and 2.6 million lives would have been saved. While these numbers represent a substantial improvement over how the world has performed, they are nevertheless not as substantial as the gains that would have been garnered had all countries performed as effectively as the Communist-led states.

The Confucius Hypothesis

Some analysts have attributed China’s stellar pandemic performance to the country’s Confucian culture rather than its Communist politics, pointing out that other countries with strong Confucian influences, namely Japan and Korea, have also stood out in the degree to which they have effectively managed the virus. These analysts argue that Confucian values of duty, obedience, and social solidarity, have predisposed the populations of the Confucian-influenced countries to more fully comply with government directives on infection control than is true in countries in which individual liberties are valued over the collective needs of the community. 

While there may be some merit to this argument, it is still the case that within the Confucian trio, China has performed the best, and significantly better than its capitalist counterparts, as illustrated in Table 9. This suggests that China’s nature as a Communist-led country has conferred an advantage in pandemic control greater than whatever advantage it has reaped from Confucian values.

China vs. India

It is illuminating to compare China to India, a fellow Asian behemoth which differs from China in having rejected a development path under the red flag of Communism. On all seven human welfare and health indices in Table 10, India lags China, including on the number of physicians per 1,000 people; hospital beds per 1,000 people; ICU beds per capita; and health spending as a percentage of GDP.

Coincident with its poorer performance in meeting the health needs of its population, India has also failed to effectively manage the coronavirus pandemic, severely underperforming its Asian neighbor. To be fair, India’s GDP per capita is less than half that of China’s. However, the gulf between China and India in satisfying their respective population’s health needs is so great that even correcting for the income difference would fail to eliminate the gap between the two countries. On grounds of human development and health, if one had to choose between the two countries as a place of residence, Communist-led China is clearly the better choice.    

Southeast Asia

Southeast Asian countries have also performed better than the average at curbing the spread of the coronavirus and limiting deaths, though not better than the Confucian trio. Within the Southeast Asian group, Vietnam’s performance is unparalleled. Again, inasmuch as Vietnam and China belong to regions with superior pandemic performance, regional factors have likely contributed to their successes in limiting infections and deaths. However, within both groups, the performance of the Communist-led countries has been ne plus ultra, pointing to their politico-economic orientation as an additional factor explaining their superior pandemic control.

Caribbean and Central American Region

The Caribbean and Central American region has performed less effectively than the rest of the world in checking the spread of the coronavirus and limiting fatalities. While Cuba does not lead the region, as its Communist-led cohort countries do theirs, it has performed much better than the regional average and more effectively than the average of all other countries. Moreover, at 0.58 percent, Cuba is second only to Saint Vincent and the Grenadines in case fatality rate, compared to 1.99 percent for the other regions, and 4.64 percent for the Caribbean and Central American region as a whole. Cuba’s low case fatality rate likely reflects the Communist state’s strong emphasis on universal access to a health care system which boasts among the highest number of physicians and hospital beds per capita in the world. Table 2 showed that Cuba not only leads capitalist countries at the same level of development in hospital beds per 1,000 people, but leads capitalist countries in the aggregate.

Table 13 shows health spending as a percentage of GDP among Caribbean and Central American countries. Cuba allocates more resources to health as a percentage of GDP than any other country in the region, demonstrating the Communist-led country’s strong commitment to meeting the health needs of its citizens.

North Korea

Publicly available data for North Korea is scarce if not altogether absent, but there are indications that the DPRK’s performance in checking the spread of the novel coronavirus is consistent with what one would expect of a Communist-led country with strong Confucian influences. Some news reports in Western mainstream news media refer to Pyongyang implementing vigorous measures of pandemic control. For example, The New York Times’ Korea specialist Choe Sang-Hun reported on July 25, 2020 that “North Korea has taken some of the most drastic actions of any country against the virus, and did so sooner than most other nations.” It is clear from the example of China, that countries that have prioritized public health, and have acted quickly and decisively to curb the spread of the coronavirus, have achieved impressive levels of infection control. Additionally, The Wall Street Journal reported on February 26, 2021, that “Alexander Matsegora, Russia’s ambassador to North Korea, said on the embassy’s Facebook page earlier this month that ‘thanks to the most severe bans and restrictions, [North Korea] turned out to be the only country which didn’t get the infection.’”

Given these reports, along with North Korea’s unquestioned ability to manage crises, including the collapse of its foreign markets in the early 1990s, flood- and drought-induced famines in the same decade, and the unremitting threat of US aggression, it seems highly likely that the DPRK has responded to the threat of Covid-19 with a high degree of competence, likely on par with that of its Communist counterparts.

Capitalist Incentives Foster Irrational Public Health Choices

It is instructive to consider that infection control as good as that achieved by the Communist-led countries would have necessitated a departure from capitalist logic in the capitalist countries.  

First, it would have required the temporary closure of a greater percentage of business establishments than most capitalist governments were prepared to tolerate, and for longer periods. Since the shuttering of businesses has deleterious consequences for the profits of business owners, capitalist governments acted to limit business closures in three ways: Shutting down a bare minimum of businesses, allowing many non-essential businesses to continue to operate; re-opening businesses before local infection rates had been brought under control; and failing to require adequate infection control measures for employees in businesses that were allowed to remain open.

Second, to approximate Communist country-performance, capitalist governments would have had to have quickly mobilized substantial public health resources to undertake large-scale screening and robust contact tracing. However, rather than implementing this public solution to a public problem—one which offered no benefit to private investors (except in the UK where contact tracing was handed to a private firm which immediately botched the job)—the leading capitalist governments chose to subsidize major businesses to compensate owners for their pandemic losses and to invest untold billions of dollars in vaccine development or pre-payment of vaccine doses or both, creating a pandemic bonanza for the biopharmaceutical industry and its major shareholders. This is not to say that investing in vaccines was unnecessary or undesirable, but that the timing was driven by capitalist incentives rather than public health rationality.

The leading capitalist countries declined to address the worldwide public health emergency by mobilizing resources for “shoe-leather” epidemiology to bring the pandemic quickly to heel, with the consequence that the emergency worsened. The worsening emergency was then used to justify the roll out of vaccines under emergency use authorization before they had been adequately safety-tested in fully completed Phase III trials.

The winners in this scenario have been the investors whose business interests have been protected from the effects of pandemic disruptions by government subsidies, as well as those wealthy enough to reap the benefits of substantial investments in the biopharmaceutical industry. The losers are the 150 million people who became ill or died unnecessarily and could have been protected from the ravages of the pandemic had their capitalist governments chosen to prioritize the health of the public over the health of their business communities’ bottom lines. Business that were able to remain open to satisfy the demand for goods that shuttered businesses would have provided, Amazon, for example, were also winners.

The leading capitalist governments could have mitigated the emergency to manageable levels, equivalent to those achieved by the Communist-led states, and then worked on the development, testing, and dissemination of vaccines. This would have saved millions of lives, and spared countless millions the potential hazard of being inoculated with vaccines which may or may not be harmful over the long term. This approach, however, would have meant spending public funds on “shoe leather” epidemiology, an investment which offered no profit-making opportunities of consequence to the business class favored by capitalist states. Plus, it would have required the closing of a large proportion of businesses for a month or more, attenuating profits—an anathema in capitalist society.

From the perspective of a capitalist logic, the course chosen was far more desirable, even if it meant more illness and more deaths. Limit business closures to a bare minimum to protect profits. Channel resources into subsidies for major businesses hurt by the pandemic. Make vaccines the main plank of the pandemic management strategy. These were the choices made by capitalist governments guided by capitalist logic. Vaccines offered an alternative to business closures and public expenditures on mass screening and contact tracing—an alternative with the promise of vast profits for those wealthy enough to get in on the action in a consequential way. 

The capitalist governments could have made the public health-friendly choices above to mitigate the emergency, prevent sickness, and save lives. They could have, but had they, they wouldn’t have been capitalist governments.


Capitalist society exists to protect and expand the interests of capitalists, not the interests of those who work for them. Capitalism may or may not exist in Communist society, but where it does exist, it is yoked to the people-centered aims of Communism, not the aims of capitalists. In Communist states, capitalists do not have political mastery.  

The degree to which Communist countries have eclipsed capitalist states in protecting their citizens from Covid-19 is substantial, and is evidenced in this: Had all capitalist countries managed the pandemic as effectively as the three Communist-led states, nearly 147 million people would have been spared illness and over three million lives would have been saved.

This conclusion is arrived at in the following way: At the end of April, 2021, approximately 147.8 million people had tested positive for Covid-19. Assuming a world case rate of 134 cases per million, equal to that of the Communist-led countries, the total number of cases in the world would have been 134 x a world population of 7.7 billion x 1/1 million, or approximately one million cases. Hence, 147.8 million less one million, or 146.8 million people worldwide would have avoided the illness. By significantly reducing infections, the pandemic may have been effectively extinguished, and the circulation of the virus sufficiently retarded that it could have been held in check by wide-reaching screening programs and robust contact tracing. This would have provided breathing room for a more deliberate and careful pace of vaccine development, thereby obviating emergency authorization of vaccine use prior to the collection of sufficient safety data.

Communist-led countries limited Covid-19 deaths to four per million. This fatality rate applied to the world as a whole would have produced a little over 27,000 deaths globally, compared to the 3.1 million who have died to date. In nearly a year and a half, a capitalist logic that discouraged temporary business closures, adopted non-pharmaceutical interventions with great reluctance and abandoned the few that were adopted much too early, and by its very nature favored the profit-making opportunities inherent in the pharmaceuticalization of public health, has cost the world over three million lives to date. Many more needless deaths will follow.