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Electoral Democracy and Working-Age Mortality.
Jennifer Karas Montez1, Kent Jason Cheng1, Jacob M Grumbach2
1Syracuse University.
The Milbank Quarterly
|May 26, 2023
Summary
Strengthening electoral democracy in US states could save thousands of working-age lives annually. Declining democracy is linked to higher mortality from drug poisoning, infectious diseases, homicide, and suicide.
Area of Science:
- Public Health
- Political Science
- Sociology
Background:
- Working-age mortality rates in the US are high and increasing, predating the COVID-19 pandemic.
- Potential links between democratic erosion and population health have been under-examined.
- This study investigates the association between electoral democracy and mortality in working-age adults.
Purpose of the Study:
- To examine the relationship between state-level electoral democracy and working-age mortality.
- To assess the mediating roles of economic, behavioral, and social factors.
- To estimate the potential impact of strengthening democracy on mortality rates.
Main Methods:
- Utilized the State Democracy Index (SDI) from 2000-2018.
- Merged SDI data with state-specific, age-adjusted mortality rates for adults aged 25-64.
- Employed statistical models adjusting for covariates and examined mediating factors.
Main Results:
- Increased electoral democracy was associated with significantly lower working-age mortality.
- A shift from moderate to high democracy levels could have prevented over 20,000 deaths in 2019.
- The association was strongest for drug poisoning and infectious disease mortality, followed by homicide and suicide.
Conclusions:
- Electoral democracy is a critical determinant of population health.
- Erosion of democratic processes poses a significant threat to public health.
- Policy interventions aimed at strengthening electoral democracy may yield substantial public health benefits.
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