Department of Social Policy and Intervention, University of Oxford, United Kingdom.
Soc Sci Med. 2022 Dec;314:115459. doi: 10.1016/j.socscimed.2022.115459. Epub 2022 Oct 17.
What explains variation across countries in the effect of democratization on child mortality rates? Democratic transitions, on average, improve health outcomes but there is substantial variation across countries in whether democratization leads to lower-than-expected child mortality post-transition. As yet, there is no convincing quantitative explanation for this variation. In this paper, we argue that whether you have a protest-led or violence-led democratic transition alters the trajectory of child mortality post-transition. Our paper makes two contributions. First, we offer a more detailed account of how the type of resistance movement promoting regime change affects health post-transition. We also draw on novel data to categorise the movements producing democratic transitions as violent or peaceful, moving beyond earlier work which operationalised peaceful democratizations in terms of battle-related deaths. Second, we extend earlier research by examining whether the nature of the democratization movement constitutes a necessary cause of higher or lower-than-expected child mortality following democratization. Across 51 transitions, countries that have a protest-led transition have lower-than-expected child mortality rates after the transition to democracy than countries with other kinds of movements (β = -0.17, p = 0.003). Countries with violence-led transitions, meanwhile, have, on average, higher-than-expected child mortality rates after their transition (β = 0.20, p = 0.001). These associations hold when we adjust for covariates (including all possible combinations of various confounding variables). We also find evidence that protest-led transitions may be a necessary condition for avoiding increased child mortality post-transition. Finally, we conduct a deviant case analysis of transitions that appear to be contrary to our theory, finding that these cases are likely instances of measurement error. Democratization may not always improve health, but such health improvements are more likely when regime change is protest-led. This is because such movements are more likely to build broad coalitions committed to consensual politics post-transition, a critical feature of successful democracies.
是什么解释了民主化对儿童死亡率的影响在各国之间的差异？民主转型平均来说改善了健康结果，但在民主转型后是否会导致低于预期的儿童死亡率方面，各国之间存在着很大的差异。到目前为止，还没有令人信服的定量解释来解释这种差异。在本文中，我们认为，民主转型是由抗议还是暴力推动的，会改变转型后儿童死亡率的轨迹。我们的论文有两个贡献。首先，我们提供了一个更详细的说明，即推动政权更迭的抵抗运动的类型如何影响转型后的健康。我们还利用新的数据来将推动民主转型的运动分为暴力或和平，超越了早期以与战斗相关的死亡来界定和平民主转型的工作。其次，我们通过检验民主化运动的性质是否构成民主化后高于或低于预期的儿童死亡率的必要原因，扩展了早期的研究。在 51 次转型中，与其他类型的运动相比，以抗议为导向的转型国家在向民主过渡后的儿童死亡率低于预期（β=-0.17，p=0.003）。而以暴力为导向的转型国家，在向民主过渡后的儿童死亡率平均高于预期（β=0.20，p=0.001）。当我们调整协变量（包括各种混杂变量的所有可能组合）时，这些关联仍然成立。我们还发现有证据表明，以抗议为导向的转型可能是避免转型后儿童死亡率增加的必要条件。最后，我们对与我们的理论相悖的转型进行了异常案例分析，发现这些案例很可能是测量误差的实例。民主转型不一定总能改善健康，但当政权更迭是由抗议推动时，这种健康改善更有可能发生。这是因为这种运动更有可能在转型后建立致力于共识政治的广泛联盟，这是成功民主的一个关键特征。
