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First published online November 30, 2016

Democracy and child health in developing countries

Abstract

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.

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Appendices

Appendix 1. Analytic sample
ArmeniaKazakhstan
AzerbaijanKenya
BangladeshKyrgyz Republic
BeninLesotho
BoliviaLiberia
BrazilMadagascar
Burkina FasoMalawi
CambodiaMali
CameroonMoldova
Central African RepublicMorocco
ChadMozambique
ColombiaNamibia
ComorosNepal
Cote d’IvoireNicaragua
Democratic Republic of the CongoNiger
Dominican RepublicNigeria
EgyptPeru
EthiopiaRepublic of the Congo
GabonRwanda
GhanaSenegal
GuatemalaSwaziland
GuineaTanzania
HaitiTogo
HondurasUganda
IndiaUzbekistan
JordanZambia
Appendix 2. Descriptive statistics.
 MeanStandard deviationMinimumMaximum
Country level
 Democracy score2.335.24−9.009.00
 Democratic (vs autocratic)0.620.490.001.00
 History of democracy0.290.300.001.00
 History0.170.280.001.00
 Improved sanitation and water57.7919.8624.5096.50
 GDP per capita2.880.861.064.89
Individual level
 Diarrhea0.150.360.001.00
 Underweight0.170.380.001.00
 Household wealth31.0024.240.00100.00
 Mother’s education
  Primary0.330.470.001.00
  Secondary0.260.440.001.00
  Higher0.050.220.001.00
 Mother employed0.490.500.001.00
 Urban residence0.370.480.001.00
 Mother’s age28.416.7215.001.00
 Female household head0.160.360.0049.00
 Child’s age28.3417.150.001.00
 Male0.510.500.0059.00
 Household size6.863.562.0036.00
GDP: gross domestic product.
Appendix 3. Country-level correlation matrix.
 12345678
1. Diarrhea (country mean)1.00       
2. Underweight (country mean)0.121.00      
3. GDP per capita−0.29−0.621.00     
4. Improved sanitation/water−0.41−0.670.691.00    
5. Democracy score0.080.11−0.17−0.141.00   
6. Democratic (vs autocratic)0.020.13−0.17−0.100.921.00  
7. History of democracy−0.24−0.020.290.280.610.641.00 
8. History−0.28−0.100.380.360.450.430.941.00
GDP: gross domestic product.
Appendix 4. Individual-level correlation matrix.
 12345678910111213
1. Diarrhea1.00            
2. Underweight0.031.00           
3. Primary education0.04−0.061.00          
4. Secondary education−0.03−0.11−0.411.00         
5. Higher education−0.03−0.07−0.16−0.131.00        
6. Mother employed0.020.030.03−0.160.0041.00       
7. Household wealth−0.06−0.19−0.160.390.34−0.181.00      
8. Urban residence−0.02−0.12−0.070.260.20−0.090.511.00     
9. Mother’s Age−0.040.01−0.04−0.120.050.15−0.01−0.021.00    
10. Fem House Head0.01−0.030.030.050.010.04−0.040.05−0.011.00   
11. Child’s age−0.140.090.004−0.010.0020.050.030.010.20−0.0011.00  
12. Male0.020.02−0.010.010.004−0.0050.010.002−0.001−0.0010.0031.00 
13. Household size0.010.04−0.04−0.09−0.080.04−0.002−0.070.16−0.07−0.01−0.0011.00

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Article first published online: November 30, 2016
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Keywords

  1. Child health
  2. cross-national
  3. democracy
  4. health inequality
  5. multilevel

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Rebekah Burroway

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Rebekah Burroway, Department of Sociology, Stony Brook University, Stony Brook, NY 11794, USA. Email: [email protected]

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