Democracy & Health

‘The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis’ The Lancet · 393(10181): 1628-1640 · 2019 (with T. Bollyky, T. Templin, M. Cohen, D. Schoder, and J.L. Dieleman) [Full text] [Annex]

Abstract: Previous analyses of democracy and population health have focused on broad measures, such as life expectancy at birth and child and infant mortality, and have shown some contradictory results. We used a panel of data spanning 170 countries to assess the association between democracy and cause-specific mortality and explore the pathways connecting democratic rule to health gains.

‘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 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?’ Public Choice 148(3-4): 595-610 · 2011 (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.