After 1931, the political economy of the island changed irrevocably as the political power base shifted
from urban residents to the majority rural population. The impact of democracy on health was accentuated by the emergence of competitive politics along a left-right dimension with two-party competition
well embedded by the late 1950s, a rural bias in the delimitation of electorates where each national
legislator typically represented fewer than 10,000 voters in the 1930s, and a single-member constituency system that encouraged politicians to engage in parish-pump politics to maximize the government
infrastructure built in their districts. The introduction of democratic politics forced successive governments to continuously expand free public health services into rural areas where voters wanted the same
standards established earlier for the urban population