Political Democracy as a Determinant of Health

• In Event: 106 - Open Refereed Roundtable Session I
  In Refereed Roundtable: A. Table 08. Inequality and Health

Abstract

A growing literature suggests democratic governance promotes stronger population health. Possible explanations are that democratic nations are more effective than autocracies in growing national revenue, reducing inequality, and keeping leaders accountable to their actions. Few studies test these specific explanations, however. Meanwhile the frequent use of listwise deletion to resolve presence of missing data continues to threaten the conclusions of many studies. This paper uses a minimalistic conception of democracy to maximize the opportunity to test what links democracy to health as well as a careful data imputation strategy over 50 years of annual comparative data. Estimates suggest that on average people living in democratic nations have up to 11.2 years of added life expectancy, 57.3% less infant mortality, and 21.1% less overall mortality. Constraints on executive performance partially mediate the association between democracy and both life expectancy and infant mortality, while competitive political participation partially mediates both executive constraints and the remaining residual effects of democracy. Gross domestic product (GDP) fully mediates the impact of democracy and its mediators on life expectancy and crude mortality, but models still show a residual impact of executive constraints on infant mortality controlling for all else. Findings support the conclusion that democracy promotes stronger health, although it may do so in large part by providing a business-friendly environment that encourages the growth of national income. Nevertheless, democracy contributes a larger unique impact for older regimes. Income inequality does not appear as a mediator.

Authors

• Andrew C. Patterson, University of British Columbia

• Gerry Veenstra, University of British Columbia