12/10/11
Health and Democracy
Are democratic countries healthier than autocracies? This question has been debated and
researched intensely as democracy has spread throughout the post World War II era. Health is
important in the measurement of how a regime takes care of its people, and therefore the
measurement of health in a country can help to answer the widely asked question of whether
democracies truly are better than autocracies, especially since a state is supposed to defend its
people from any potential risks. The question of health is more important now than ever, as
democracy is rapidly spreading through the world. Oppressed citizens of non-democratic
countries are fighting for their freedoms and changing the governing structures of their countries.
These citizens believe that democracy will bring a better world, with better health, because they
will be able to choose who makes the policies. Since the people can choose who will be
representing them they can hold people accountable for failures or successes, and vote in the next
election accordingly. In autocracies the reigning power will always remain in power even if the
people of the country disapprove of the leadership. But does the option of letting the people
decide who represents them in office automatically equal better health?
In the article “Health and Democracy,” Timothy Besley and Masayuki Kudamatsu
present and interpret data on the correlation between the effects of democracy on health, in hopes
of answering the previous question. Before they get into the data and underlying factors of the
data they provide background information on the progression of health over the years. Life
expectancy and prosperity have both increased throughout history with an association, but the
causation is hard to determine. They attribute three reasons for the increase of life expectancy
over the course of history: improvement of infrastructure and decrease in malnutrition, increase
in medical care, and improvements in lifestyle and knowledge. The improvements in
infrastructure have resulted in clean water and better sanitation facilities. The development of
antibiotics and the ability to control infectious diseases are key factors in the improvement of
health care. The globalization of knowledge through education and economics is the underlying
factor for all of these improvements.
Next they explain differences between democracies and autocracies that could have led to
better health in democratic countries. They once again provide three reasons for this. The first is
public health will be more of a priority for groups who are in power under a democracy than the
people of political influence in autocracies. The second point explains that because leaders of
autocracies are not elected officials; they are not obligated to pursue the satisfaction of their
people to remain in power, while democratic officials are elected to represent their people, and if
they do not they will not be reelected. The third reason ties into the second because democratic
officials are elected, so the people will choose the smarter, wiser leaders while in autocracies
there is no change in leadership.
They explained why democracies should have better health, but do they. First they state
that empirical research has shown that there is some correlation between economic growth and
democracies, however, it is not a substantial amount. Next they cite research of a strong
correlation between life expectancy and democracy. The first outcome is that democracies have a
greater average life expectancy of roughly 3.5 years. For the second outcome, income per capita
was taken into account, and democracies still have a greater life expectancy by around 2 years.
Countries that have been democratic since 1956 have a greater life expectancy than countries that
have been autocratic since 1956 by more that 5 years, and continuous democracies have a lower
child mortality rate by 17%. Besley and Kudamatsu do, however, acknowledge the chance that
democracies could be correlated with other existing factors that could undermine the research by
concluding that there is no institutional effect. With the country fixed effects democracies since
1956 no longer have an advantage over autocracies since 1956. In contrast countries that have
made a switch to democracy over this time period have a larger life expectancy by 2 years.
Democracies remain democratic with good education as proven from previous research by
Edward L. Glaeser (2005), and in this research it is also proven true, as more people above the
age of 15 has led to a higher life expectancy for those countries. After this they examine access
of clean water and good sanitation facilities, and compare between the two regime types. It is 15
points higher in democracies, and 11 points higher in democracies that have been democratic
since 1956. The relationship between democracy and immunization is also positive. The numver
of children from the ages of 12 to 23 months who receive the DPT (diphteria, pertussis, tetanus)
is higher by 9 points in democracies. In addition to all of this, democratic governments also
spend $160 more per person on health related issues than autocracies. Besley and Kudamatsu
conclude that the type of political institution matters in the health of a population, with
democracies being healthier.
Another article, “Democracy, Dictatorship, and Infant Mortality Rate,” written by
Thomas D. Zweifel and Patricio Navia, comes to the same conclusion as the previous article: that
democracies are healthier. They discuss three reasons why political scientists have come up with
different outcomes on this subject over the years. The first is that democracies facilitate social
and economic development more than autocracies because they are able to address the needs of
their population better through the idea of accountability. Democracies do this by bringing power
to leaders who voice the concerns of their people. Democracies are also able to accomplish this
by allowing for political rights, civil liberties, and a free market. Political rights allow people the
option to run for government to voice their concern, civil liberties gives people freedoms which
autocracies do not allow, and a free market allows for citizens to be both consumers and
suppliers. The second reason for this ongoing debate is in contrast to the first, saying that
democracies stop the development of other countries. Proponents of this idea claim that
democracies slow development because they buffer the state intervention that is necessary for a
country to develop. The final reason they give is that there is no relationship between democracy
and development.
In their article they use infant mortality rates to express hunger problems in countries.
They do this because there is no way of measuring hunger related deaths. They simply relate the
two because 24,000 people die of hunger each year and three fourths of that is children under the
age of 5. They ran into a problem of their data because 91% of the Infant mortality rates in
democracies were in rich countries, while 87% of the infant mortality rates in autocracies was in
poor countries. This is important because economic development affects the infant mortality rate
and the likelihood of democracy. To correct this they used the Heckman two-step method, which
corrects the bias. They found that the infant mortality rate drops as GDP increases, and infant
mortality rate is higher in autocracies at every level of income. Both of these articles end up
coming to the same conclusion through empirical research.
Research Design
Research Question and Hypothesis: Instead of asking if health is better in democracies than in
autocracies, I am going to investigate if health is better in full democracies than in full
autocracies. A full democracy is a country with a polity score of six or higher, while a full
autocracy is a country with a polity score of negative six or lower. I predict that health will be
better in full democracies than in full autocracies.
Data: The data I will be using for measuring the regime type of countries is the Polity score. The
Polity IV project is ongoing research that quantifies how democratic or autocratic for governing
institutions. It is a twenty-one -point scale ranging from -10 to 10. The higher the number the
more democratic, and the lower the number the more autocratic. It has six components that
measure the key qualities of how the executive is selected, the constraints on the authority of the
executive, and political competition. For the child mortality rate and life expectancy I will be
using data from the World Bank Indicators.
Method: With the data I will separate the countries between full democracy (+6) and the full
democracies (-6) on the polity score through 2000 to 2010. I am not going to use countries that
have experienced regime change in the past 10 years because conflict will alter the numbers for
life expectancy and child mortality. Once I have those countries I will do a random sample
drawing from each category to get 10 countries from each for a total of 20. Then I will compare
the two regime types on average life expectancy and child mortality.