Cross-national time series analysis of the association between population density and population health outcomes

Abstract This study examines the global association between population density and public health using data from 151 countries spanning 2000–2020. Drawing on two competing theoretical perspectives—the Malthusian view, which links population pressure to resource depletion and deteriorating health, and the Boserupian framework, which emphasizes innovation and adaptation—the analysis investigates how demographic concentration is associated with national health outcomes. Using a two-way fixed-effects panel model, the study estimates the association between population density and three key indicators—life expectancy, infant mortality, and under-five mortality—while controlling for socioeconomic and institutional factors. The results reveal a positive and statistically significant association between higher population density and improved health outcomes, particularly in developing countries, suggesting that demographic pressure can be associated with technological and institutional adaptation that enhances healthcare accessibility and efficiency. However, the study also notes that these global‑level findings differ from subnational research reporting adverse health impacts in densely populated areas, largely due to differences in analytical scale and data aggregation. The findings underscore the importance of effective institutions and infrastructure planning in sustaining density‑related health benefits. Future research should explore subnational and spatial mechanisms to unpack this macro-level “black box,” examining how governance, the environment, and infrastructure mediate the density–health relationship.