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Unformatted text preview: POLITICAL ECONOMY † Health and Democracy By T IMOTHY B ESLEY AND M ASAYUKI K UDAMATSU * In spite of the inexorable march of democ- racy around the globe, just how democratic in- stitutions affect human well-being is open to debate. The evidence that democracy promotes prosperity is neither strong nor robust. More- over, which aspects of policy making and hu- man well-being are promoted by democracies is still a subject of debate. 1 Even if correlations between democracy and outcome measures can be found, there is an overriding difficulty of interpreting them as causal effects. Whether democracy matters, per se, or simply serves as a proxy for societal and political development presents a difficult prob- lem for research in this area. Thinkers such as Seymour Martin Lipset (1959) have argued that democracy can thrive only when conditions are right. If this is correct, then becoming demo- cratic may serve only as a proxy for these hard- to-measure cultural and societal preconditions. This paper explores these issues further by reconsidering the link between democracy and health using panel data from a cross section of countries. The data show a strong (conditional) correlation between life expectancy and democ- racy. This relationship is robust to controlling for the initial level of human capital as well as political histories. The data also suggest that health policy interventions are superior in democracies. I. Background Human history has witnessed remarkable in- creases in life expectancy alongside increases in prosperity. Samuel H. Preston (1975) showed that this relationship is nonlinear, with the larg- est gains in life expectancy being associated with increases in income per capita at low in- comes. These increases in life expectancy can be traced to three factors, all of which are as- sociated with increases in prosperity, although the direction of causation is hard to establish. 2 First, there are reductions in malnutrition and improvements in infrastructure such as clean water supply and improved sanitation facilities. Second, and very important in recent history, there is medical intervention through control (due to immunization and insecticides) and treatment of infectious diseases using antibiot- ics (see, for example, Davidson Gwatkin, 1980). Third, there are improvements in knowl- edge and lifestyle. Angus S. Deaton (2004, p.109) notes that “health improvement ulti- mately came from the globalization of knowl- edge, facilitated by local political, economic, and educational conditions.” The literature to date has focused more on the latter influences (education and economics) rather than the po- litical foundations of increased life expectancy....
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- Spring '08
- Democracy, Life expectancy, per capita, Torsten Persson, Daron Acemoglu, Health and Democracy