Are Competitive Elections Good for Your Health? Evidence from the 1918 Flu and Covid-19

Abstract

The spread and lethality of infectious diseases partly depend on government efforts to mitigate them. Yet local governments vary substantially in their responses to public health emergencies, with some taking aggressive measures early and often, and others doing relatively little. What explains this variation? Using novel data on local government responses to the 1918 influenza A (H1N1) ``Spanish Flu'' and 2020 Covid-19 pandemics in the United States, we show that the policy choices of electorally vulnerable incumbents have changed considerably in the last 100 years. In 1918, electorally vulnerable incumbents enacted more nonpharmaceutical interventions for longer periods of time, promoting and enforcing them more aggressively than in less-competitive jurisdictions. More electorally competitive localities subsequently experienced fewer influenza-related deaths, fewer pneumonia cases, and lower overall excess mortality. By 2020, however, these patterns had shifted: more competitive localities still experienced lower rates of Covid-19 infection and death, but authorities in these places became more reluctant to implement nonpharmaceutical interventions. These differences are in part due to greater reliance on pharmaceutical measures and an epidemiologically-significant change in political geography: more competitive localities became more suburban. On net, political competition still appears beneficial for public health, but for different reasons than in 1918.