Association of Rule of Law and Health Outcomes: An Ecological Study

BMJ Open. Volume 5, Issue 10. October, 2015

Posted: 17 May 2018

See all articles by Angela Maria Pinzon-Rondon

Angela Maria Pinzon-Rondon

Universidad del Rosario

Amir Attaran

University of Ottawa - Department of Epidemiology and Community Medicine; University of Ottawa - Common Law Section

Juan Carlos Botero

Pontifica Universidad Javeriana Law School

Angela Maria Ruiz-Sternberg

Universidad del Rosario

Date Written: 2015

Abstract

Objectives: To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes.

Setting: Global project.

Participants: Data set of 96 countries, comprising 91% of the global population.

Primary and secondary outcome measures: The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice.

Results: The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries’ level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (p<0.05). Rule of law remained significant in all the multivariate models, and the following adjustment for potential confounders remained robust for at least one or more of the health outcomes across all eight subindices of the rule of law. Findings show that the higher the country's level of adherence to the rule of law, the better the health of the population.

Conclusions: It is necessary to start considering the country's adherence to the rule of law as a foundational determinant of health. Health advocates should consider the improvement of rule of law as a tool to improve population health. Conversely, lack of progress in rule of law may constitute a structural barrier to health improvement.

Suggested Citation

Pinzon-Rondon, Angela Maria and Attaran, Amir and Botero, Juan Carlos and Ruiz-Sternberg, Angela Maria, Association of Rule of Law and Health Outcomes: An Ecological Study (2015). BMJ Open. Volume 5, Issue 10. October, 2015. Available at SSRN: https://ssrn.com/abstract=3169346

Angela Maria Pinzon-Rondon (Contact Author)

Universidad del Rosario ( email )

Calle 12 No. 6-25
Bogota, DC
Colombia

Amir Attaran

University of Ottawa - Department of Epidemiology and Community Medicine ( email )

451 Smyth Road
Ottawa, Ontario K1H 8M5
Canada

University of Ottawa - Common Law Section ( email )

57 Louis Pasteur Street
Ottawa, K1N 6N5
Canada
613-562-5800 ext: 2015 (Phone)
613-562-5659 (Fax)

Juan Carlos Botero

Pontifica Universidad Javeriana Law School ( email )

Cale 40 # 6-23 piso 7
Bogotá, DC 110231
Colombia

Angela Maria Ruiz-Sternberg

Universidad del Rosario

Calle 12 No. 6-25
Bogota, DC
Colombia

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