Skip to main content

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: 53
Total number of PDF views: 616 *
Loading metrics...

Abstract views

Total abstract views: 1579 *
Loading metrics...

* Views captured on Cambridge Core between 24th February 2017 - 16th December 2017. This data will be updated every 24 hours.