Democracy and health: Evidence from within-country heterogeneity in the Congo

- Previous studies have highlighted the positive effect of democracy on health.
- We study this relationship using heterogeneity in how chiefs in Congo gain power.
- We find little or no evidence of an impact of a chief being elected on health.
- Findings show that aid may better focus on education and gender discrimination.

The literature documents a positive association between democracy and health, and studies supporting this claim have largely relied on cross-country panel analyses. In many developing countries, however, local traditional leaders at the micro-level play a key role in individuals' daily lives while the influence of the national government is largely negligible. In response, this study revisits the relationship between democracy and health using micro-level household data from 816 randomly selected villages in Eastern Congo. We find little or no evidence that health outcomes are better in villages that are governed by elected leaders compared to villages where leaders are not elected. Our data suggest that efforts to improve health outcomes in this setting may need to focus on issues such as gender discrimination and education.