Sick regimes and sick people: a multilevel investigation of the population health consequences of perceived national corruption

Abstract

Abstractobjective There is a paucity of empirical work on the potential population health impact of living under a regime marred by corruption. African countries differ in the extent of national corruption, and we explore whether perceived national corruption is associated with population health across all rungs of society.methods World Health Survey data were analysed on 72 524 adults from 20 African countries.The main outcome was self-reported poor general health. Multilevel logistic regression was used to assess the association between poor health and perceived corruption, while jointly accounting for individual-and country-level human development factors. In this research, we use Transparency International's corruption perception index (CPI), which measures 'both administrative and political corruption' on a 0-10 scale. A higher score pertains to a higher rate of perceived corruption within society. We also examined effect modification by gender, age and socio-economic status.results Higher national corruption perception was consistently associated with an increase in poor health prevalence, also after multivariable adjustments, with odds ratio (OR) of 1.62 (95% CI: 1.01-2.60). Stratified analyses by age and gender suggested this same pattern in all subgroups. Positive associations between poor health and perceived corruption were evident in all socio-economic groups, with the association being somewhat more positive among less educated people (OR = 1.61, 95% CI: 1.01-2.58) than among more educated people (OR = 1.40, 95% CI: 0.83-2.37).conclusions This study is a cautious first step in empirically testing the general health consequences of corruption. Our results suggest that higher perceived national corruption is associated with general health of both men and women within all socio-economic groups across the lifespan. Further research is needed using more countries to assess the magnitude of the health consequences of corruption.

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa

“…75 Emerging evidence suggests that African countries with higher corruption levels also experience lower health outcomes. 171,172 One area of interest concerns the purchasing of health services, which ensures the link between revenue generation and service delivery. The term "strategic purchasing" was coined as early as 2007 173 with reference to maximising health system performance by continuously optimising how interventions are purchased and has been highlighted as a means to support UHC advances.…”

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“…Corruption poses a direct threat to patients' health when those who are recruited are ill-qualified and not competent to do their jobs properly. Most of the identified literature on the link between corruption and health outcomes is based on a general comparison of data sets, for example, comparing child mortality rates with the corruption perceptions index (CPI) [75], or world health survey data with the CPI [76], or antibiotic consumption with the CPI [77]. From these studies and based on Mungiu-Pippidi [33] and Khan's [34] ideas about the prevalence of particularism and patronage in developing countries, we can infer a significant likelihood that some health workers are hired in non-transparent ways that disregard merit.…”

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“…Dessa forma, a área social é a que sofre de maneira mais incisiva os efeitos da corrupção. Estes resultados são reforçados por Witvliet et al (2013), que apontam que o maior nível de corrupção percebida em países africanos pode ser associado a condições de saúde precárias, principalmente quando a população tem menor nível de escolaridade e de renda.…”