The Link between Democratic Institutions and Population Health in the American States.

CONTEXT This project investigates the role of state-level institutions in explaining variation in population health in the American states. Although cross-national research has established the positive effects of democracy on population health, little attention has been given to subnational units. We leverage a new dataset to understand how political accountability and a system of checks and balances are associated with state population health. METHOD We estimate error correction models and two-way fixed effects models to estimate how the strength of state-level democratic institutions are associated with infant mortality rates, life expectancy, and midlife mortality. FINDINGS We find that institutions that promote political accountability are related to lower infant mortality across the states, while those that promote checks and balances are associated with longer life expectancy. We also find that policy liberalism is associated with better health outcomes. CONCLUSIONS Subnational institutions play an important role in population health outcomes and more research is needed to understand the linkage between democracy and health. We are the first to explore the link between democratic institutions and population health within the United States contributing to both the social science literature on the positive effects of democracy and the epidemiological literature on subnational health outcomes.