Democracy Does Improve Health

Abstract

In this paper, we study the extent to which the spread of democracy affects country-level health outcomes in 115 countries, between 1960 and 2015. To do this, we use both the level and change measures of democracy in our regressions, concentrating on within-country variations. Our finding is that a one standard deviation increase of 0.35 in the level of democracy is associated with a 0.11 standard deviation increase in life expectancy, even after accounting for various country and time features. This corresponds to an increase in life expectancy of around 5 years for a country initially, with a mean life expectancy of 54 years. However, we do not find the change measure of democracy to be consistently influential. These results are robust to employing alternative model specifications, to using different subsamples of the data, and to alternative estimation techniques. We also find that these critical effects are retained when using other measures of health status. In particular, we observe that as the level of democracy rises, each of infant mortality, child mortality, and crude death decreases. We, therefore, conclude that the material role of democratic institutions in fostering population health is of first-order relevance.

Legislative incapacity and underreporting of COVID-19 mortality

“…The implications of our research challenge the notion of an inherent “autocratic advantage.” The results suggest that this perceived advantage is partly attributable to deficiencies in legislative and bureaucratic processes, in addition to data manipulation tactics in authoritarian regimes. These insights corroborate studies asserting the superiority of democratic regimes in managing a spectrum of socio-economic issues ( Acemoglu et al, 2019 , McMann and Tisch, 2021 , Oyèkọ́lá, 2023 ) and their effectiveness in combating the COVID-19 pandemic ( Cassan and Van Steenvoort, 2021 , Neumayer and Plümper, 2022 , Annaka, 2021 , Annaka, 2022 ), thereby questioning the validity of the “autocratic advantage” hypothesis.…”

“…Furthermore, this research contributes to a more layered understanding of the advantages inherent in democratic governance. The prevailing scholarship asserts that democracies are adept at navigating socio-economic dilemmas ( Acemoglu et al, 2019 , McMann and Tisch, 2021 , Oyèkọ́lá, 2023 ) and effectively combating COVID-19 ( Cassan and Van Steenvoort, 2021 , Neumayer and Plümper, 2022 , Annaka, 2021 , Annaka, 2022 ). Our study enriches this discourse, showing that more capable legislatures possess the ability to support the necessary processes for accurately assessing the severity of a pandemic, which constitutes a preliminary step towards effective management of the pandemic ( Jahn et al, 2022 ).…”

“…Furthermore, the overall health status of a population impacts legislative constraints on executives and the underreporting of COVID-19. The nexus between health standards and democratic efficacy has been the subject of scholarly investigation ( Oyèkọ́lá, 2023 , Gingerich and Vogler, 2021 ), with public health also influencing COVID-19 severity and governmental performance during pandemics. Consequently, the percentage of the population fully vaccinated ( Neumayer and Plümper, 2022 ) and median age ( United Nations, 2022 ) are incorporated as control measures.…”