Death and disease exacts a heavy toll on citizens in many democracies. I argue that the funding and distribution of health policy in democracies are subject to political economic distributive pressures. Patterns of partisanship, strategic importance, and quality of legislative representation condition the provision of public health funding within countries. In turn, public health spending alters district mortality outcomes. I assemble administrative district level data for late Third Republic France and model its health funding and mortality rates. Political importance, not need, plays a prominent role in determining who lives and dies in democracies. In an environment analogous to modern developing countries but absent international political pressures, my results demonstrate that poor health is not just a consequence of lack of funding but also domestic political economy incentives.