Democracy & Health

The Impact of Democracy and Media Freedom on Under-5 Mortality, 1961-2011′ Social Science & Medicine, 190: 237-246 · October 2017 (with Arzu Akkoyunlu) [full text]

Abstract: Do democracies produce better health outcomes for children than autocracies? We argue that (1) democratic governments have an incentive to reduce child mortality among low-income families and (2) that media freedom enhances their ability to deliver mortality-reducing resources to the poorest. A panel of 167 countries for the years 1961-2011 is used to test those two theoretical claims. We find that level of democracy is negatively associated with under-5 mortality, and that that negative association is greater in the presence of media freedom. These results are robust to the inclusion of country and year fixed effects, time-varying control variables, and the multiple imputation of missing values.


The Resource Curse and Child Mortality, 1961-2011′ Social Science & Medicine, 176: 142-148 · March 2017 [full text]

Abstract: There is now an extensive literature on the adverse effect of petroleum wealth on the political, economic and social well-being of a country. In this study we examine whether the so-called resource curse extends to the health of children, as measured by under-five mortality. We argue that the type of revenue available to governments in petroleum-rich countries reduces their incentive to improve child health. Whereas the type of revenue available to governments in petroleum-poor countries, encourages policies designed to improve child health. In order to test that line of argument we employ a panel of 167 countries (all countries with populations above 250,000) for the years 1961 to 2011. We find robust evidence that petroleum-poor countries outperform petroleum-rich countries when it comes to reducing under-five mortality. This suggests that governments in oil abundant countries often fail to effectively use the resource windfall at their disposal to improve child health.


‘The Impact of Regime Type on Health: Does Redistribution Explain Everything?’ World Politics  63(4): 647-77 · 2011 (with Arzu Akkoyunlu) [full text] [data]

Abstract: Many scholars claim that democracy improves population health. The prevailing explanation for this is that democratic regimes distribute health-promoting resources more widely than autocratic regimes. The central contention of this article is that democracies also have a significant pro-health effect regardless of public redistributive policies. After establishing the theoretical plausibility of the nondistributive effect, a panel of 153 countries for the years 1972 to 2000 is used to examine the relationship between extent of democratic experience and life expectancy. The authors find that democratic governance continues to have a salutary effect on population health even when controls are introduced for the distribution of health-enhancing resources. Data for fifty autocratic countries for the years 1994 to 2007 are then used to examine whether media freedom—independent of government responsiveness—has a positive impact on life expectancy.


‘Do Electoral Institutions Have an Impact on Population Health? (with Arzu Akkoyunlu) [full text]

Abstract: There is an emerging political economics literature which purports to show that legislatures elected based on proportional electoral rules spend more and redistribute more than legislatures elected based on majoritarian electoral rules. Going a step further the authors of this paper consider whether degree of electoral proportionality has an impact on population health and, in particular, the health of the least advantaged members of society. A panel of 24 parliamentary democracies for the years 1960–2004 is used to examine the relationship between electoral institutions and health. The authors find that greater electoral proportionality is positively associated with overall population health (as indicated by life expectancy) and with the health of the poorest (as indicated by a reduction in infant mortality). A panel of 17 countries for the years 1970–2004 is then used to show to that electoral permissiveness modifies the impact of health spending on infant mortality.