Democracy Matters for Child Health.

Abstract

Background and objectives: The influence of democracy and democratization on health is difficult to disentangle from a complex web of factors such as population characteristics and social determinants of health. The goal of this study was to begin to characterize the roles of the individual attributes of democracy on a key measure of health, mortality rates among female children under five years of age.

Methods: We conducted a retrospective observational cohort study utilizing data over a study period from 1975-2021 with data from 173 countries. We utilized publicly available data from the Global State of Democracy Indices (GSoD) and the United Nations Inter Agency Group for Child Mortality Estimation (UN-IGME) databases.

Results: Our data support prior work showing that strength of democracy is associated with improved population health measures. Stronger democracies are associated with improvements in female child mortality, even controlling for within-country variation over time and for income level. This relationship is most pronounced when examining the relationship between protections of civil rights and child mortality.

Conclusions: Child mortality increases when democracy declines. With declines in democracy worldwide, it is critical that advocates are concerned with the global democratic experience, especially with policies that compromise fundamental rights.