Strong democratic functioning is good for population health. However, democratic functioning eroded in many U.S. states in recent decades. The erosion was especially pronounced for one aspect of democratic functioning—electoral democracy, which refers to free and fair elections. This brief summarizes findings from a study examining how changes in electoral democracy in the 50 states predicted changes in the risk of death among adults ages 25-64 during 2000-2019. Findings demonstrate that democratic erosion strongly predicts rising deaths from drug poisoning, infectious disease, suicide, and homicide.

Document Type

Research Brief


Population Health, Public Policy, Health and Democracy


Inequality and Stratification | Politics and Social Change | Public Affairs, Public Policy and Public Administration | Sociology






This project was supported by research grant R01AG055481 from the National Institute on Aging (NIA). The authors also acknowledge the services and support of the Center for Aging and Policy Studies at Syracuse University, funded by Center Grant P30AG066583 from the NIA. The content of the published study is solely the responsibility of the authors and does not necessarily represent the views of the NIA


National Institute on Aging (NIA), Center for Aging and Policy Studies at Syracuse University

Funding ID

R01AG055481, P30AG066583

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.