Towards parity democracy

Although no systematic causal review has yet been done, the evidence of a relation between democracy and health is increasingly convincing. In The Lancet Global Health, Hannah Pieters and colleagues report a an innovatively designed study and a novel application of the synthetic control method to investigate the issue of democracy and infant mortality. They investigated whether political transition into democracy that had lasted for at least 10 years affected child mortality, as a proxy for health. Among 24 countries with good counterfactuals, changes in 15 were not significant but nine (38%) showed significant reductions in infant mortality after democratisation. Among these nine countries the average reduction was 13%. Interestingly, the effect increased over time, suggesting that there is an induction period for change while services and organisation are improved. Of note was that the benefits of democratisation increased with increasing child mortality before political change