Voting Up? The Effects of Democracy and Franchise Extension on Human Stature

Abstract

We study the health effects of the spread of democratic institutions and the extension of voting rights in 15 European countries since the middle of the nineteenth century. We employ both cross country and cohort variation in heights and employ a new instrument for democracy and the extension of the franchise, the effect of decolonisation on democracy in the colonising country's democratisation to identify the causal effect of democracy on heights. We find robust evidence of a link between democratic quality and human stature. The results indicate that the transition to democracy increased average male heights by 0.7 to 1 cm, equivalent to a onedecade average increase in stature across cohorts. Including the extension of the franchise to women increases the effect on average stature to about 1.7cm. The effect is driven by both political participation and contestation in reducing inequality and expanding health insurance coverage.

The Political Economy of Health: Bringing Political Science In

“…A 2018 update replicated the main results of this review (Barnish et al 2018). The subsequent literature has generally confirmed these findings, while expanding the array of mediating or moderating variables intervening between income and health, the range of health outcomes, or the types of polities considered (e.g., Annaka & Higashijima 2021, Batinti & Costa-Font 2022, Bollyky et al 2019, Ramos et al 2020, Rosenberg et al 2018, Son & Bellinger 2022.…”

“…For example, Kavanagh (2016) and Matsuura (2015Matsuura ( , 2019 both found that constitutional rights to health are associated with better health outcomes, the former worldwide, the latter in US states. Other studies have examined the relationship between health and civil rights laws (McGowan et al 2016), women's suffrage (Batinti et al 2022, Bhalotra & Clots-Figueras 2014, Miller 2008, gender-based representation quotas (Bhalotra et al 2019), proportional representation (Wigley & Akkoyunlu-Wigley 2011), and the strength of political parties (Bellinger 2021), finding positive associations or causal effects on health. Work that concretizes abstract phenomena such as "democracy" and investigates empirically the mechanisms through which they influence health-which political and other social scientists are ideally situated to carry out-is an important contribution to public health research.…”

Does exposure to democracy decrease health inequality?

“…Previous studies have documented that political institutions are important social determinants of health insofar as they hold the decisive “financial, organizational, and policy resources” (Krueger et al 2015). The adoption of a liberal democracy, a political system that protects and recognizes individuals’ rights and freedoms, where the rule of law limits the exercise of government , has been shown to increase population health (Besley and Kudamatsu 2006; Batinti et al 2022), healthy behaviors, and self-assessed health (SAH) (Klomp and de Haan 2009). However, we still know little about whether it can influence the priority of programs that aim at reducing disparities in health compared to other public polic goals.…”

“…Some evidence documents that democracies increase a nation’s likelihood of achieving universal healthcare access (Oswald 2013). The prioritization of public health and universal access to healthcare, can impact the distribution of health outcomes, and health inequality (Besley and Kudamatsu 2006; Batinti et al 2022; Batinti and Costa-Font 2023). Finally, exposure to democracy might in some cases make people more tolerant which in turn can make society more stable and improve people’s mental health.…”