Quality of Governance and Health Outcomes in Developing Countries

• In Event: Trust and Regime Influences on Health and Healthcare

Abstract

National health outcomes vary widely across developing countries. What explains this massive variation in health outcomes? We introduce a new theoretical argument that takes seriously the governing styles of national political executives. An original typology of executive decision-making and behavior produces three distinct types: programmatic, clientelistic, and corrupt. From this typology, we hypothesize that the proportion of clientelistic decisions by an executive will be negatively associated with health outcomes, because the nature of one-to-one clienteslitic exchanges will discourage the provision of public goods that boost public health. Also, the proportion of corrupt decisions by an executive will have a negative association with health outcomes, as funds that could be used to improve public health are instead used for private gain.

To test the theoretical argument and resulting hypotheses, we compile a national-level dataset of developing countries and employ cross-sectional time-series models of several health outcomes. Our findings suggest that corruption and patronage—a form of clientelism—negatively affect health outcomes. Moreover, the estimated effect of patronage depends on the level of economic development. The results call attention to the importance of political executive agency in public health outcomes, thus moving the literature beyond structural determinants of health.

Our paper addresses the annual meeting’s theme of “Populism and Privilege” in two main ways. First, it produces a theoretical lens through which the actions of political elites, and populist leaders in particular, may be understood. Second, the paper contributes to our overall understanding of the connection between executive actions and public health, with a focus on the health of disadvantaged individuals. In this way, the paper explores the process by which those with limited privilege may gain access to health services and experience improved health outcomes.

Authors

• Taeko Hiroi, The University of Texas at El Paso

• Gregory Schober, University of Texas at El Paso