State Variation in HIV/AIDS Health Outcomes: The Effect of Spending on Social Services and Public Health

OBJECTIVE:

Despite considerable advances in the prevention and treatment of HIV/AIDS, the burden of new infections of HIV and AIDS varies substantially across the country. Previous studies have demonstrated associations between increased healthcare spending and better HIV/AIDS outcomes; however, less is known about the association between spending on social services and public health spending and HIV/AIDS outcomes. We sought to examine the association between state-level spending on social services and public health and HIV/AIDS case rates and AIDS deaths across the United States.

DESIGN:

We conducted a retrospective, longitudinal study of the 50 U.S. states over 2000-2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000 people matched with a unique dataset of state-level spending on social services and public health per person in poverty.

METHODS:

We estimated multivariable regression models for each HIV/AIDS outcome as a function of the social service and public health spending 1 and 5 years earlier in the state, adjusted for the log of state GDP per capita, regional and time fixed effects, Medicaid spending as % of GDP, and socio-demographic, economic, and health resource factors.

RESULTS:

States with higher spending on social services and public health per person in poverty had significantly lower HIV and AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure (P ≤ 0.05).

CONCLUSION:

Our findings suggest that spending on social services and public health may provide a leverage point for state policymakers to reduce HIV/AIDS case rates and AIDS deaths in their state.

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By:  Talbert-Slagle KM1, Canavan ME, Rogan EM, Curry LA, Bradley EH.

• 1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA. 
• AIDS. 2016 Feb 20;30(4):657-63. doi: 10.1097/QAD.0000000000000978.

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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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