Does Democracy or Good Governance Enhance Health? New Empirical Evidence 1900-2012

Abstract

It has been long debated whether regime types have impacts on human development. More specifically, compared to authoritarianism, are democracies more likely to provide public goods, including infrastructure that improve food provision and health care, and thus enhance health? Some studies support an optimistic view, and argue that with the accountability mechanisms of democratic elections, democracy is helpful in improving health. Some recent studies challenge the optimistic argument, and point out good governance, rather than regime types, as a more crucial determinant of human development. Using a newly collected dataset that covers 173 countries over the years 1900-2012 and contains more nuanced measures than commonly used, we intend to disentangle the debate. The results suggest that across models with various specifications, regime types have more consistent effects than quality of government on health outcomes throughout the entire period. Furthermore, we find that the mixed results of extant studies are due to that 1) the commonly used governance indicators are measured only for the recent decades, and the sample does not reflect the entire range of variation; 2) the positive effects of democracy are especially salient once the level of democracy has achieved certain threshold; 3) the positive effects of democracy are especially stable when both vertical and horizontal accountability mechanisms are improved.