Political regimes and health : competing explanations

Many studies find that democratic governance improves population health. However, few offer a rigorous conceptualization of democracy. Many studies may overestimate the contribution of democracy to population health by removing cases with missing data from their analyses. Some highlight the importance of a legacy of democracy for health, but utilize measures of ‘level’ or degree of democracy that may confound the impact of democracy with other qualities of political regimes. Finally, few studies test specific explanations for the putative health effects of democracy. To address these issues, I use annual time-series data spanning from 1960 through 2010 to investigate variations in population health by political regime type. A combination of data supplementation and multiple imputation facilitates production of a working dataset with virtually complete data for 168 nations. My analysis proceeds utilizing a common measure of the ‘level’ of democracy (the Polity IV scale), followed by the application of a more specific operationalization of democracy that assesses whether countries choose their leaders via free and fair elections. I determine whether democracy is associated with population health outcomes after which I test various competing explanations for how and why democracy ostensibly promotes health while ruling out likely confounders. I find that level of democracy correlates positively with life expectancy and negatively with infant mortality rates and crude mortality rates. However, the accumulation of Polity scores over time (‘democratic capital’) is relevant for infant mortality only, while the strength and legacy of regimes is associated with population health irrespective of regime type. Models using the binary measure of electoral democracy indicate that, on average, people living in democratic nations can expect 10.8 more years of life and have 57% less infant mortality and 21% less overall mortality. I identify several mechanisms that may link political democracy to population health, namely, systems of accountability that constrain the decision-making powers of elected leaders, the promotion of strong institutional frameworks through the distribution of freedoms to compete for political influence and the advancement of economic prosperity. Options for further investigating the influence of democracy on population health are discussed.Arts, Faculty ofSociology, Department ofGraduat