Skip to main content Accessibility help

Democracy at Work: Moving Beyond Elections to Improve Well-Being



How does democracy work to improve well-being? In this article, we disentangle the component parts of democratic practice—elections, civic participation, expansion of social provisioning, local administrative capacity—to identify their relationship with well-being. We draw from the citizenship debates to argue that democratic practices allow citizens to gain access to a wide range of rights, which then serve as the foundation for improving social well-being. Our analysis of an original dataset covering over 5,550 Brazilian municipalities from 2006 to 2013 demonstrates that competitive elections alone do not explain variation in infant mortality rates, one outcome associated with well-being. We move beyond elections to show how participatory institutions, social programs, and local state capacity can interact to buttress one another and reduce infant mortality rates. It is important to note that these relationships are independent of local economic growth, which also influences infant mortality. The result of our thorough analysis offers a new understanding of how different aspects of democracy work together to improve a key feature of human development.


Corresponding author

Michael Touchton is Assistant Professor of Political Science, University of Miami. Department of Political Science, 1300 Campo Sano, Coral Gables, FL 33146 (
Natasha Borges Sugiyama is Associate Professor of Political Science, University of Wisconsin-Milwaukee. Department of Political Science, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI 53201 (
Brian Wampler is Professor of Political Science, Boise State University. Department of Political Science, 1910 University Dr, Boise, ID, 83725 (


Hide All
The authors would like to thank John Ishiyama, the APSR Editorial Board, and four anonymous reviewers for their suggestions. Special thanks go to Merike Blofield, Laura Gómez-Mera, Evelyne Huber, Wendy Hunter, James W. McGuire, Jennifer Pribble, and Kurt Weyland for their valuable comments. Thanks also go to seminar participants at the University of Miami, Clemson University, Utah State University, and Arizona State University. Previous versions of this article were presented at annual meetings of The American Political Science Association, the Mid-West Political Science Association, the Southern Political Science Association, and the Latin American Studies Association; we thank our discussants and audience for their insightful questions. Claire Adida deserves special recognition in this regard. Thank you to Boise State University's School of Public Service, which provided funding to support this research.



Hide All
Abers, Rebecca, and Keck, Margaret. 2013. Practical Authority. Oxford: Oxford University Press.
Abrucio, Fernando, L. 2005. “A Coordenação Federativa no Brasil.” Revista de Sociologia e Política 24 (June): 4167.
Almeida, Carla, Cayres, Domitila Costa, and Tatagiba, Luciana. 2015. “Balanço dos Estudos Sobre os Conselhos de Políticas Públicas na Última Década.” Lua Nova 94 (April): 255–94.
Ames, Barry. 2001. The Deadlock of Democracy in Brazil. Ann Arbor: University of Michigan Press.
Aquino, Rosana, de Oliviera, Nelson F., and Bareto, Mauricio. 2009. “Impact of the Family Health Program on Infant Mortality in Brazilian Municipalities.” American Journal of Public Health 99 (1) (January): 8793.
Arellano, Manuel, and Bond, Stephen. 1988. Dynamic Panel Data Estimation Using PPD: A Guide for Users. London: Institute for Fiscal Studies.
Avelino, George, Brown, David, and Hunter, Wendy. 2005. “The Effects of Capital Mobility, Trade Openness, and Democracy on Social Spending in Latin America, 1980–1999.” American Journal of Political Science 49 (3) (July): 625–41.
Avritzer, Leonardo. 2002. Democracy and the Public Space in Latin America. Princeton, NJ: Princeton University Press.
Avritzer, Leonardo, and de Souza, Clóvis Leite. 2013. Conferências Nacionais: Atores, Dinâmicas Participativas e Efetividade. Brasília: IPEA.
Baiocchi, Gianpaolo, Heller, Patrick, and Silva, Marcelo Kunrath. 2011. Bootstrapping Democracy. Stanford, CA: Stanford University Press.
Besley, Timothy, and Kudamatsu, Masayuki. 2006. “Health and Democracy.” The American Economic Review 96 (2) (May): 313–8.
Boix, Carles. 2001. “Democracy, Development, and the Public Sector.” American Journal of Political Science 45 (1) (January): 117.
Brazilian Institute for Geography and Statistics. 2016. Survey of Basic Municipal Profiles. Retrieved January 1, 2016 (
Brazilian Ministry of Health. 2016. “Portal da Saude: Datasus.” Retrieved January 1, 2016 (
Brazilian Ministry of Social Development. 2016. “MDS: Bolsa Família.” Retrieved January 1, 2016 (
Brown, David, and Hunter, Wendy. 2004. “Democracy and Human Capital Formation Education Spending in Latin America, 1980 to 1997.” Comparative Political Studies 37 (7) (September): 842–64.
Cameron, Colin, and Trivedi, Pravin. 2009. Microeconometrics Using Stata. College Station, TX: Stata Press.
Cleary, Matthew. 2007. “Electoral Competition, Participation, and Government Responsiveness in Mexico.” American Journal of Political Science 51 (2) (April): 283–99.
Cornwall, Andrea, and Coelho, Vera Schatten. 2007. Spaces for Change? Vol. 4. London: Zed Books.
Dahl, Robert. 1971. Polyarchy: Participation and Opposition. New Haven: Yale University Press.
Diamond, Larry. 1999. Developing Democracy: Toward Consolidation. Baltimore: JHU Press.
Diaz-Cayeros, A., Estevez, F., and Magaloni, B. 2016. The Political Logic of Poverty Relief: Electoral Strategies and Social Policy in Mexico. New York: Cambridge University Press.
Diener, Ed, Lucas, Richard, Schimmack, Ulrich, and Helliwell, John. 2009. Well-Being for Public Policy. New York: Oxford University Press.
Dollar, David, and Kraay, Aart. 2001. Trade, Growth, and Poverty. Washington, D.C.: World Bank, Development Research Group, Macroeconomics and Growth.
Drèze, Jean, and Sen, Amartya. 2013. An Uncertain Glory. Princeton, NJ: Princeton University Press.
Dryzek, John. 2000. Deliberative Democracy and Beyond. Oxford University Press on Demand.
Eakin, Marshall. 1997. Brazil: The Once and Future Country. New York: St. Martin's Press.
Evans, Peter, and Heller, Patrick. 2015. “Human Development, State Transformation, and the Politics of the Developmental State.” In Oxford Handbook on Transformation of the State. New York: Oxford University Press, 691714.
Faguet, Jean-Paul. 2004. “Does Decentralization Increase Government Responsiveness to Local Needs?: Evidence from Bolivia.” Journal of Public Economics 88 (3) (March): 867–93.
Ferraz, Claudio, and Finan, Federico. 2011. “Electoral Accountability and Corruption: Evidence from the Audits of Local Governments.” American Economic Review 101 (4) (April): 1274–311.
Ferreira, Francisco. 2010. “Distributions in Motion: Economic Growth, Inequality, and Poverty Dynamics.” World Bank Policy Research Working Paper No. 5424.
Fiszbein, Ariel, and Schady, Norbert. 2009. Conditional Cash Transfers. Washington: World Bank.
Fox, Jonathan. 2015. “Social Accountability: What does the Evidence Really Say?World Development 72 (August): 346–61.
French, Jan. 2013. “Rethinking Police Violence in Brazil: Unmasking the Public Secret of Race.” Latin American Politics and Society 55 (4): 161–81.
Frey, Bruno, and Stutzer, Alois. 2002. Happiness and Economics. Princeton, NJ: Princeton University Press.
Fung, Archon, and Wright, Erik Olin. 2003. Deepening Democracy. New York: Verso.
Gerring, John, Knutsen, Carl Henrik, Skaaning, Svend-Erik, Teorell, Jan, Coppedge, Michael, Staffin, I. Lindberg, and Matthew Maguire. 2015. “Electoral Democracy and Human Development.” V-Dem Institute Working Paper 9.
Gibson, Edward. 2013. Boundary Control. New York: Cambridge University Press.
Giraudy, Agustina. 2013. “Varieties of Subnational Undemocratic Regimes: Evidence from Argentina and Mexico.” Studies in Comparative International Development 48 (1) (March): 5180.
Grindle, Merilee. 2007. Going Local. Princeton, NJ: Princeton University Press.
Gurza, Lavalle, Jessica Voigt, Adrian, and Serafim, Lizandra. Forthcoming. “Afinal o que Fazem os Conselhos: Padrões Decisórios e o Debate dos Efeitos das Instituições Participativas.” Dados.
Hagopian, Frances. 1996. Traditional Politics and Regime Change in Brazil. Cambridge, UK: Cambridge University Press.
Hilbe, Joseph. 2007. Negative Binomial Regression, 2nd ed. Cambridge, UK: Cambridge University Press.
Huber, Evelyne. 1996. “Options for Social Policy in Latin America: Neoliberal versus Social Democratic Models.” In Welfare States in Transition, ed. Esping-Andersen, Gosta. London: SAGE, 141–91.
Huber, Evelyne, and Stephens, John. 2012. Democracy and the Left. Chicago, IL: University of Chicago Press.
Hunter, Wendy, and Sugiyama, Natasha Borges. 2014. “Transforming Subjects into Citizens: Insights from Brazil's Bolsa Família.” Perspectives on Politics 12: 4 (December): 829–45.
Ipeadata. “Pobreza – Pessoas Pobres, Pessoas Indigentes.” 2016. IPEA. Retrieved April 1, 2016 (
Khandker, Shahidur, Koolwal, Gayatri, and Samad, Hussain A.. 2010. Handbooks on Impact Evaluation. Washington, D.C.: World Bank Publications.
King, Gary, Keohane, Richard, and Verba, Sidney. 1994. Designing Social Inquiry. Princeton, NJ: Princeton University Press.
Kohli, Atul. 2004. State-directed Development. Cambridge, UK: Cambridge University Press.
Kosack, Stephen. 2012. The Education of Nations: How the Political Organization of the Poor, not Democracy, led Governments to Invest in Mass Education. Oxford: Oxford University Press.
Lake, David, and Baum, Matthew. 2001. “The Invisible Hand of Democracy: Political Control and the Provision of Public Services.” Comparative Political Studies 34 (6) (August): 587621.
Lamounier, Bolivar, and Meneguello, Rachel. 1986. Partidos Políticos e Consolidação Democrática. São Paulo: Editora Brasiliense.
Lindert, Kathy, Linder, Anja, Hobbs, Jason, and de la Brière, Bénédicte. 2007. “The Nuts and Bolts of Brazil's Bolsa Família Program: Implementing Conditional Cash Transfers in a Decentralized Context,” SP Discussion Paper No. 0709. World Bank.
Lustig, Nora, Lopez-Calva, Luis, and Ortiz-Juarez, Eduardo. 2013. “Declining Inequality in Latin America in the 2000s: The Cases of Argentina, Brazil, and Mexico.” World Development 44 (April): 129–41.
Macinko, James, Guanais, Frederico, and de Souza, Maria de Fatima. 2006. “Evaluation of the Impact of the Family Health Program on Infant Mortality in Brazil, 1990–2002.” Journal of Epidemiology and Community Health 60 (1) (January): 13–9.
Mainwaring, Scott. 1999. Rethinking Party Systems in the Third Wave of Democratization. Stanford: Stanford University Press.
Marshall, Thomas. 1950. Citizenship and Social Class. Garden City, NY: Doubleday.
McGuire, James. 2010. Wealth, Health, and Democracy in East Asia and Latin America. New York: Cambridge University Press.
McNulty, Stephanie. 2011. Voice and Vote: Decentralization and Participation in Post-Fujimori Peru. Palo Alto: Stanford University Press.
Mettler, Suzanne. 2007. Soldiers to Citizens. Oxford University Press.
Nussbaum, Martha. 2011. Creating capabilities. Cambridge: Harvard University Press.
O'Donnell, Guillermo. 1998. “Horizontal Accountability in New Democracies.” Journal of Democracy 9 (3) (July): 112–26.
Ostrom, Elinor. 1996. “Crossing the Great Divide: Coproduction, Synergy, and Development.” World Development 24 (6) (June): 1073–87.
Pateman, Carole. 2012. “Participatory Democracy Revisited.” Perspectives on Politics 10 (1) (March) 719.
Peruzzotti, Enrique, and Smulovitz, Catalina. 2000. “Societal Accountability in Latin American.” Journal of Democracy 11 (4) (October): 147–58.
Pierson, Paul. 1993. “When Effect becomes Cause: Policy Feedback and Political Change.” World Politics 45 (04) (July): 595628.
Pires, Roberto. 2011. Efetividade das Instituições Participativas no Brasil. Brasilia: IPEA.
Pires, Roberto, and Vaz, Alexander. 2012. Participação Social como Método de Governo? Um Mapeamento das" Interfaces Socioestatais" nos Programas Federais. Instituto de Pesquisa Econômica Aplicada (IPEA) Working Paper No. 1707.
Pitkin, Hanna. 1967. The Concept of Representation. Berkeley: University of California Press.
Pogrebinschi, Thamy, and Samuels, David. 2014. “The Impact of Participatory Democracy: Evidence from Brazil's National Public Policy Conferences.” Comparative Politics 46 (3) (April): 313–32.
Power, Timothy. 2010. “Optimism, Pessimism, and Coalitional Presidentialism: Debating the Institutional Design of Brazilian Democracy.” Bulletin of Latin American Research 29 (1) (January): 1833.
Przeworski, Adam, Alvarez, Michael, Cheibub, Jose, and Limongi, Fernando. 2000. Democracy and Development: Political Institutions and Material Well Being in the World. New York: Cambridge University Press.
Przeworski, Adam, Stokes, Susan, and Manin, Bernard, eds. 1999. Democracy, Accountability, and Representation Vol. 2. Cambridge, UK: Cambridge University Press.
Putnam, Robert, Leonardi, Robert, and Nanetti, Raffaela. 1994. Making Democracy Work. Princeton, NJ: Princeton University Press.
Rasella, Davide, Aquino, Rosana, Santos, Carlos, Paes-Sousa, Rômulo, and Barreto, Mauricio. 2013. “Effect of a Conditional Cash Transfer Programme on Childhood Mortality: A Nationwide Analysis of Brazilian Municipalities.” The Lancet 382 (9886) (July): 5764.
Ravallion, Martin, and Chen, Shaohua. 2007. “China's (Uneven) Progress against Poverty.” Journal of Development Economics 82 (1) (January): 142.
Rodrik, Dani. 2000. “Growth versus Poverty Reduction: A Hollow Debate.” Finance and Development 37 (4) (December): 89.
Roodman, David. 2014. “xtabond2: Stata Module to Extend xtabond Dynamic Panel Data Estimator.” Statistical Software Components.
Ross, Michael. 2006. “Is Democracy Good for the Poor?American Journal of Political Science 50 (4) (October): 860–74.
Rueschemeyer, Dietrich, Stephens, Evelyne Huber, and Stephens, John D.. 1992. Capitalist Development and Democracy. Cambridge, UK: Cambridge University Press.
Samuels, David J. 2003. Ambition, Federalism, and Legislative Politics in Brazil. New York: Cambridge University Press.
Sandbrook, Richard, Edelman, Marc, Heller, Patrick, and Teichman, Judith 2007. Social Democracy in the Global Periphery. New York: Cambridge University Press.
Schramm, Joyce Mendes, and Szwarcwald, Celia Landmann. 2000. “Diferenciais nas Taxas de Mortalidade Neonatal e Natimortalidade Hospitalares no Brasil: Um Estudo com Base do Sistema Único de Saúde (SIH/SUS).” Caderno Saúde Pública 16 (October): 1031–40.
Sen, Amartya. 1999. Development as Freedom. New York: Alfred A. Knopf.
Skocpol, Theda. 1995. Protecting Soldiers and Mothers. Cambridge, MA: Harvard University Press.
Smulovitz, C., and Peruzzotti, E. 2000. Societal Accountability in Latin America. Journal of Democracy, 11 (4), 147158.
Snyder, Richard. 2001. “Scaling Down: The Subnational Comparative Method.” Studies in Comparative International Development 36 (1) (March): 93110.
Soares, Fábio Veras, Ribas, Rafael Perez, and Osório, Rafael Guerreiro. 2010. “Evaluating the Impact of Brazil's Bolsa Família: Cash Transfer Programs in Comparative Perspective.” Latin American Research Review 45 (2): 174–90.
Somers, Margaret. 2008. Genealogies of Citizenship. Cambridge, UK: Cambridge University Press.
Speck, Bruno. 2011. “Auditing Institutions” in Corruption and Democracy in Brazil. Power, Timothy and Taylor, Matthew, Eds. South Bend: University of Notre Dame Press.
Sugiyama, Natasha Borges. 2013. Diffusion of Good Government. Notre Dame, IN: University of Notre Dame Press.
Sugiyama, Natasha Borges, and Hunter, Wendy. 2013. “Whither Clientelism?Comparative Politics 46 (1) (October): 4362.
Tarrow, Sidney. 1998. Power in Movement. New York: Cambridge University Press.
Teichman, Judith. 2004. “The World Bank and Policy Reform in Mexico and Argentina.” Latin American Politics and Society 46 (1) (April): 3974.
Tendler, Judith. 1997. Good Government in the Tropics. Baltimore, MD: Johns Hopkins University Press.
Touchton, Michael, and Wampler, Brian. 2014. “Improving Social Well-Being Through New Democratic Institutions.” Comparative Political Studies 47 (10) (September): 1442–69.
United Nations Development Programme (UNDP). 2015. “Agenda for Sustainable Development.” Retrieved January 1, 2016 (
Viana, Ana Luiza, and dal Poz, Mario Roberto. 1998. “A Reforma do Sistema de Saúde no Brasil e o Programa de Saúde da Família.” PHYSIS: Revista Saúde Coletiva, 8 (2): 1142.
Wampler, Brian. 2015. Activating Democracy. Notre Dame: University of Notre Dame Press.
Weyland, Kurt. 1996. Democracy without Equity. Pittsburgh, PA: University of Pittsburgh Press.
Wood, Charles. 1977. “Infant Mortality Trends and Capitalist Development in Brazil: The Case of São Paulo and Belo Horizonte.” Latin American Perspectives 47 (4): 5665.
Wooldridge, Jeffrey M. 2013. Introductory Econometrics, A Modern Approach, 5th ed. Nelson Education.
World Bank. 2016. “Gini Index.” Washington, D.C.: World Bank Indicators. Retrieved January 1, 2016 (
World Health Organization. 2016. “Global Health Observatory.” WHO. Retrieved January 1, 2016 (
Yashar, Deborah. 2005. Contesting Citizenship in Latin America. New York: Cambridge University Press.
Xue, Jinjun. 2012. Growth with Inequality. Singapore: World Scientific Press.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

American Political Science Review
  • ISSN: 0003-0554
  • EISSN: 1537-5943
  • URL: /core/journals/american-political-science-review
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
Type Description Title
Supplementary materials

Touchton supplementary material

 Word (41 KB)
41 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed