Democracy and child health in developing countries

The rise of democracy across the world brought with it expectations that governments would be more attentive and responsive to the welfare of the people, creating better services and better health. Indeed, a considerable body of scholarship finds that democracy has significant, direct effects on multiple measures of well-being, particularly life expectancy and infant mortality. Despite several recent critiques, the paramount theme is that democracy is good for health. This study contributes to this literature by assessing the relationship between democracy and child diarrhea and malnutrition across 52 developing countries. Using a multilevel modeling strategy, the analysis examines the country-level effects of democracy and development on child health, while simultaneously taking into account wealth, education, and other household characteristics at the individual level. Contrary to much previous scholarship, democracy does not exhibit a significant association with diarrhea or malnutrition. Instead, gross domestic product (GDP) per capita and improved sanitation and water have substantial effects on child health at the country level. At the individual level, household wealth and maternal education have the largest health-enhancing impact on child diarrhea and malnutrition. Furthermore, the size and strength of the relationship between wealth and health does not vary by political regime. These results demonstrate the enduring importance of socioeconomic status regardless of political context, and they support a small but growing literature that calls the democracy–health link into question.