Despite numerous studies on whether democracy reduces the infant mortality rate (IMR), the empirical results remain mixed at best. In this article, I perform several theoretical and empirical exercises that help explain why and under what conditions we should expect politics to matter most for a decrease in IMR. First, I capitalize on the epidemiological view that IMR – the most commonly used indicator of health in social sciences – is better suited to reflect public health micromanagement than overall social development. Second, I theorize that autocrats have incentives to invest in health up to a certain point, which could lead to a reduction in IMR. Third, I introduce an omitted variable – good governance – that trumps the importance of a political regime for IMR: (1) it directly affects public health micromanagement, and (2) many autocrats made inroads in achieving good governance. Finally, for the first time in such research, I use a disaggregated IMR approach to corroborate my hypotheses.
World Bank. World Development Indicators Online.
Washington, DC:
The World Bank Group. http://www.qog.pol.gu.se/data. Published July 1, 2016. Accessed April 5, 2017.
2.
SunYJohnstonM.Does democracy check corruption? Insights from China and India.Comp Polit. 2009;
42(1):1–19.
3.
BesleyTKudamatsuM.Health and democracy.Am Econ Rev. 2006;
96(2):313–318.
4.
NavarroV.Politics and health: a neglected area of research.Eur J Public Health. 2008;
18(4):354–355.
5.
CharronNLapuenteV.Does democracy produce quality of government?Eur J Polit Res. 2010;
49(4):443–470.
6.
EmmersonD.Minding the gap between democracy and governance.J Democr. 2012;
23(2):62–73.
7.
RothsteinBTeorellJ.What is quality of government? A theory of impartial government institutions.Governance. 2008;
21(2):165–190.
8.
MathewGNayakR.Panchayats at work: what it means for the oppressed?Econ Polit Wkly. 1996; 31(27), 1765–1771.
9.
MathewG.Panchayati Raj institutions and human rights in India. Econ Polit Wkly. 2003; 38(2), 155–162.
10.
TsaiM.Does political democracy enhance human development in developing countries?Am J Econ Sociol. 2006;
65(2):233–268.
11.
BäckHHadeniusA.Democracy and state capacity: exploring a J‐shaped relationship.Governance. 2008;
21(1):1–24.
12.
Dixit A. Democracy, autocracy and bureaucracy. Journal of Globalization and Development 2010; 1(1). https://doi.org/10.2202/1948-1837.1010. Accessed April 20, 2018.
13.
CharronNLapuenteV.Which dictators produce quality of government?Stud Comp Int Dev. 2011;
46(4):397–423.
14.
MontinolaGJackmanR.Sources of corruption: a cross-country study.Br J Polit Sci. 2002;
32(1):147–170.
15.
Nur-TeginKCzapH.Corruption: democracy, autocracy, and political stability.Econ Anal Policy. 2012;
42(1):51–66.
16.
SungH.Democracy and political corruption: a cross-national comparison.Crime Law Soc Change. 2004;
41(2):179–193.
17.
SenA.Development as Freedom.
New York, NY:
Alfred A. Knopf; 1999.
18.
KriegerN.Epidemiology and the People’s Health: Theory and Context.
New York, NY:
Oxford University Press; 2011.
19.
MorrowJSmithABueno de MesquitaBSiversonR.Political competition and economic growth.J Democr. 2001;
12(1):58–72.
20.
BaumMLakeD.The invisible hand of democracy: political control and the provision of public services.Comp Polit Stud. 2001;
34(6):587–621.
21.
GradsteinM.Rent seeking and the provision of public goods.Econ J. 1993;
103(420):1236–1243.
22.
WeingastBShepsleAJohnsenC.The political economy of benefits and costs: a neoclassical approach to distributive politics. J Polit Econ. 1981;
89(4):642–664.
23.
WittmanD.Why democracies produce effective results.J Polit Econ. 1989;
97(6):1395–1424.
24.
AcemogluDJohnsonSRobinsonJ.The colonial origins of comparative development: an empirical investigation.Am Econ Rev. 2001;
91:1369–1401.
25.
BatesR.Markets and States in Tropical Africa.
Berkeley, CA:
University of California Press; 1984.
26.
BesleyTBurgessR.The political economy of government responsiveness: theory and evidence from India.Q J Econ. 2002;
117(4):1415–1451.
27.
ChowdhuryS.The effect of democracy and press freedom on corruption: an empirical test.Econ Lett. 2004;
85(1):93–101.
28.
KiesslingJ. Democratization and child mortality. Stockholm University Working Paper. http://www2.ne.su.se/paper/wp07_08.pdf. Published December 12, 2006. Accessed April 5, 2017.
29.
BaumMLakeD.The political economy of growth: democracy and human capital.Am J Polit Sci. 2003;
47(2):333–347.
30.
VollmerSZieglerM. Political institutions and human development—does democracy fulfil its ‘constructive’ and ‘instrumental’ role? World Bank Policy Research Working Paper. http://elibrary.worldbank.org/doi/pdf/10.1596/1813-9450-4818. Published January 2009. Accessed September 13, 2013.
31.
GerringJThackerSAlfaroR.Democracy and human development.J Polit. 2012;
74(1):1–17.
32.
McGuireJ.Political regime and social performance.Contemp Polit. 2013;
19(1):55–75.
33.
WigleySAkkoyunlu-WigleyA.Do electoral institutions have an impact on population health?Public Choice. 2011;
148:595–610.
34.
NikolovaM.Minding the happiness gap: political institutions and perceived quality of life in transition.Eur J Polit Econ. 2015;
45:129–148.
35.
FrancoÁÁlvarez-DardetCRuizM.Effect of democracy on health: ecological study.BMJ. 2004;
329(7480):1421–1423.
36.
GhobarahHHuthPRussettB.Comparative public health: the political economy of human misery and well‐being.Int Stud Q. 2004;
48(1):73–94.
37.
LinRChenYChienLChanC.Political and social determinants of life expectancy in less developed countries: a longitudinal study.BMC Public Health. 2012;
12(1):85.
38.
MackenbachJHuYLoomanC.Democratization and life expectancy in Europe, 1960–2008.Soc Sci Med. 2013;
93:166–175.
39.
MuntanerCBorrellCNgEet al.
Politics, welfare regimes, and population health: controversies and evidence.Sociol Health Illn. 2011;
33(6):946–964.
40.
NaviaPZweifelT.Democracy, dictatorship, and infant mortality.J Democr. 2000;
11(2):99–114.
41.
NaviaPZweifelT.Democracy, dictatorship, and infant mortality revisited.J Democr. 2003;
14(3):90–103.
42.
GauriVKhaleghianP.Immunization in developing countries: its political and organizational determinants.World Dev. 2002;
30(12):2109–2132.
43.
McGuireJ.Minimising harm in violence risk assessment: practical solutions to ethical problems?Health Risk Soc. 2004;
6(4):327–345.
44.
PandeA. Taking time and space into consideration: correcting Zweifel and Navia’s (2000) model on the effect of regime on infant mortality rates. Unpublished manuscript; 2003.
45.
ShandraJNoblesJLondonBWilliamsonJ.Dependency, democracy, and infant mortality: a quantitative, cross-national analysis of less developed countries.Soc Sci Med. 2004;
59(2):321–333.
46.
RossM.Is democracy good for the poor?Am J Polit Sci. 2006;
50(4):860–874.
47.
TruexR.The myth of the democratic advantage. St Comp Int Dev. 2015; 52(3): 261-277.
48.
GerringJKnutsenCSkaaningSet al. Electoral democracy and human development. V-Dem Working Paper; 2015.
49.
BurrowayR.Democracy and child health in developing countries.Int J Comp Sociol. 2016;
57(5):338–364.
50.
De la CroixDDelavalladeC.Growth, public investment and corruption with failing institutions.Econ Gov. 2009;
10(3):187–219.
51.
GuptaSDavoodiHTiongsonE.Corruption and the provision of health care and education services. In JainAK, ed. The Political Economy of Corruption.
London, England:
Routledge; 2001:111–141.
52.
HallerödBRothsteinBDaoudANandyS.Bad governance and poor children: a comparative analysis of government efficiency and severe child deprivation in 68 low-and middle-income countries.World Dev. 2013;
48:19–31.
53.
HolmbergSRothsteinB.Dying of corruption.Health Econ Policy Law. 2011;
6(4):529–547.
KaufmannDKraayAMastruzziM.Governance matters III: governance indicators for 1996, 1998, 2000, and 2002.World Bank Econ Rev. 2004:
18(2):253–287.
56.
NorthD.Institutions, Institutional Change and Economic Performance.
Cambridge, England:
Cambridge University Press; 1990.
57.
UslanerE.Corruption, Inequality, and the Rule of Law: The Bulging Pocket Makes the Easy Life.
Cambridge, England:
Cambridge University Press; 2008.
58.
HolmbergSRothsteinB. Correlates of corruption. Q Gov Inst. University of Gothenburg, Working Paper; 2011:12.
59.
RothsteinB.Quality of government and epistemic democracy. Paper presented at the Workshop Epistemic Democracy in Practice at Yale University; October 20–22, 2011; New Haven, CT.
60.
TavitsM.Policy positions, issue importance and party competition in new democracies.Comp Polit Stud. 2008;
41(1):48–72.
61.
BaldacciEClementsBGuptaSCuiQ.Social spending, human capital, and growth in developing countries.World Dev. 2008;
36(8):1317–1341.
62.
LewisCLloyd-SherlockP.Social policy and economic development in South America: an historical approach to social insurance.Econ Soc. 2009;
38(1):109–131.
63.
McGuireJ.Basic health care provision and under-5 mortality: a cross-national study of developing countries.World Dev. 2006;
34(3):405–425.
64.
RajkumarASwaroopV.Public spending and outcomes: does governance matter?J Dev Econ. 2008;
86(1):96–111.
65.
WagstaffAClaesonM.Rising to the Challenges: the Millennium Development Goals for Health.
Washington, DC:
World Bank; 2004.
66.
RosenbergDShvetsovaO.Autocratic health versus democratic health: different outcomes variables for health as a factor versus health as a right. In: GallegoMSchofieldN, eds. The Political Economy of Social Choice; 2016:1–20.
67.
CutlerDDeatonALleras-MuneyA.The determinants of mortality.J Econ Persp. 2006;
20(3):97–120.
68.
BlackRMorrisSBryceJ.Where and why are 10 million children dying every year?The Lancet. 2003;
361(9376):2226–2234.
69.
JonesGSteketeeRBlackRBhuttaZMorrisS, Bellagio Child Survival Study Group.
How many child deaths can we prevent this year?The Lancet. 2003;
362(9377):65–71.
70.
LassiZHaiderBBhuttaZ.Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2010; (11):CD007754.
71.
MartensPSu-MiaAHuynenMRazaM.Is globalization healthy: a statistical indicator analysis of the impacts of globalization on health.Glob Health. 2010;
6:16.
72.
MathersJParryJLewisSGreenfieldS.What impact will an increased number of teaching general practices have on patients, doctors and medical students?Med Educ. 2004;
38:1219–1228.
73.
HansenCLønstrupL.The rise in life expectancy and economic growth in the 20th century.Econ J. 2015;
125(584):838–852.
74.
ChenAOsterEWilliamsH.Why is infant mortality higher in the United States than in Europe?Am Econ J Econ Policy. 2016;
8(2):89–124.
75.
MathewsTMenackerFMacDormanM.Infant Mortality Statistics From the 2002 Period: Linked Birth/Infant Death Data Set.
Hyattsville, MD:
National Center for Health Statistics; 2004.
76.
MathewsTMacDormanM. Infant Mortality Statistics From the 2008 Period: Linked Birth/Infant Death Data Set.
Hyattsville, MD:
National Center for Health Statistics; 2012.
77.
BravemanPHeckKEgerterSet al.
The role of socioeconomic factors in black-white disparities in preterm birth.”Am J Public Health. 2015;
105(4):694–702.
KvashaE.Mortality of children under one year of age in Russia: what has changed after the transition to the new definition of live birth and stillbirth. Demograficheskoe Obozrenie (English selection). 2014;
5:69–84.
80.
Bueno de MesquitaBSmithA.The dictator's handbook: why bad behavior is almost always good politics. New York: PublicAffairs. 2011.
81.
McGuireJ.Social policy and mortality decline in East Asia and Latin America.World Dev. 2001;
29(10):1673–1697.
82.
FalletiTG.Infiltrating the state: the evolution of health care reforms in Brazil, 1964–1988. In: MahoneyJThelenK, eds. Explaining Institutional Change: Ambiguity, Agency, and Power.
Cambridge, England:
Cambridge University Press; 2009.
83.
GolinowskaSSowaA.Investing in health institutions in transition countries. CASE Netw Stud Anal. 2007; 348:1-57.
84.
AcemogluDJohnsonSRobinsonJ.The rise of Europe: Atlantic trade, institutional change and economic growth.Am Econ Rev. 2005;
95(3):546–579.
85.
GandhiJLust-OkarE.Elections under authoritarianism.Annu Rev Polit Sci. 2009;
12:403–422.
86.
OlsonM.Dictatorship, democracy, and development.Am Polit Sci Rev. 1993;
87(3):567–576.
87.
ClarkWPoastPFloresTKaufmanR.Why some autocracies perform so well?. 2011, Unpublished paper.
88.
BloomD,
Canning C. The health and wealth of nations.Science. 2000;
287(5456):1207–1209.
89.
MayerSSarinA.An assessment of some mechanisms linking economic inequality and infant mortality.Soc Sci Med. 2005;
60(3):439–660.
90.
PickettKWilkinsonR.Income inequality and health: a causal review.Soc Sci Med. 2015;
128:316–326.
91.
MeltzerARichardsS.A rationale theory of the size of government.J Polit Econ. 1981;
89(5):914–927.
92.
AcemogluDRobinsonJ.Economic Origins of Dictatorship and Democracy.
New York, NY:
Cambridge University Press; 2006.
93.
BoixC.Democracy and Redistribution.
New York, NY:
Cambridge University Press; 2003.
94.
LiHXuLZouH-F.Corruption, income distribution, and growth.Econ Polit. 2000;
12(2):954–1985.
95.
ZhuangJde DiosEMartinA.Governance and institutional quality and the links with economic growth and income inequality: with special reference to developing Asia. Asian Development Bank Economics Working Paper Series No. 193; 2010.
96.
HuberEMustilloTStephensJ.Politics and social spending in Latin America.J Polit. 2008;
70(2):420–436.
97.
ClaessensSDjankovSLangL.The separation of ownership and control in East Asian corporations.J Financ Econ. 2000;
58(1–2):81–112.
98.
TeorellJDahlbergSHolmbergSRothsteinBKhomenkoASvenssonR.The Quality of Government Standard Dataset, version Jan16. University of Gothenburg: The Quality of Government Institute. http://www.qog.pol.gu.se. Published January 2016. Accessed July 15, 2016.
99.
World Bank. World Development Report 2004: Making Services Work for Poor People.
Washington, DC:
World Bank; 2003.
100.
GortmakerSWiseP.The first injustice: socioeconomic disparities, health services technology, and infant mortality.Annu Rev Sociol. 1997;
23:147–170.
101.
RosenbergD.Political competition, agenda power, and incentives to innovate: an empirical examination of vested-interest theory.Rev Policy Res. 2015;
32(4):413–442.
102.
CharronN.Do corruption measures have a perception problem? Assessing the relationship between experiences and perceptions of corruption among citizens and experts.Eur Polit Sci Rev. 2016;
8(1):147–171.
103.
CurrieJMorettiE.Mother’s education and the intergenerational transmission of human capital: evidence from college openings.Q J Econ. 2003;118:1495–1532.
104.
KornaiJEgglestonK.Welfare, Choice, and Solidarity in Transition: Reforming the health sector in Eastern Europe.
Cambridge, England:
Cambridge University Press; 2001.
105.
WigleySAkkoyunlu-WigleyA.The impact of regime type on health: does redistribution explain everything?World Polit. 2011;
63(4):647–677.
106.
JustesenM.Democracy, dictatorship, and disease: political regimes and HIV/AIDS.Eur J Polit Econ. 2012;
28:373–389.
