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

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.

Global project.

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

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.

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.

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.

Below:  Scatter plots of rule of law with health outcomes. (A) Infant mortality, (B) maternal 562 mortality, (C) life expectancy and (D) cardiovascular disease and diabetes mortality

Full article at: http://goo.gl/EY6ocm

By: Pinzon-Rondon AM1, Attaran A2, Botero JC3, Ruiz-Sternberg AM1.

• 1Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
• 2Faculties of Law and Medicine, Canada Research Chair in Law, Population Health and Global Development Policy, University of Ottawa, Ottawa, Ontario, Canada.
• 3The World Justice Project, Washington, DC, USA.  

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