Corruption costs lives: evidence from a cross-country study

Determinants of COVID-19 vaccination coverage in European and Organisation for Economic Co-operation and Development (OECD) countries

Introduction

In relatively wealthy countries, substantial between-country variability in COVID-19 vaccination coverage occurred. We aimed to identify influential national-level determinants of COVID-19 vaccine uptake at different COVID-19 pandemic stages in such countries.

Methods

We considered over 50 macro-level demographic, healthcare resource, disease burden, political, socio-economic, labor, cultural, life-style indicators as explanatory factors and coverage with at least one dose by June 2021, completed initial vaccination protocols by December 2021, and booster doses by June 2022 as outcomes. Overall, we included 61 European or Organisation for Economic Co-operation and Development (OECD) countries. We performed 100 multiple imputations correcting for missing data and partial least squares regression for each imputed dataset. Regression estimates for the original covariates were pooled over the 100 results obtained for each outcome. Specific analyses focusing only on European Union (EU) or OECD countries were also conducted.

Results

Higher stringency of countermeasures, and proportionately more older adults, female and urban area residents, were each strongly and consistently associated with higher vaccination rates. Surprisingly, socio-economic indicators such as gross domestic product (GDP), democracy, and education had limited explanatory power. Overall and in the OECD, greater perceived corruption related strongly to lower vaccine uptake. In the OECD, social media played a noticeable positive role. In the EU, right-wing government ideology exhibited a consistently negative association, while cultural differences had strong overall influence.

Conclusion

Relationships between country-level factors and COVID-19 vaccination uptake depended on immunization stage and country reference group. Important determinants include stringency, population age, gender and urbanization, corruption, government ideology and cultural context.

Alternative Systems: The Interplay Between Criminal Groups' Influence and Political Trust on Civic Honesty in the Global Context

Individuals' endorsement of standards of civic honesty is necessary for democracies to flourish. A critical driver of civic honesty is the relationship of trust between individuals and institutions. Research has yet to systematically assess the contextual factors that may moderate this relationship. In this study, we examined the societal influence of organized criminal groups. Criminal groups operate as alternative systems of authority that erode the reliability of institutions' moral standards. We employed a new indicator that quantifies their societal influence to test the hypothesis that the association between individuals' political trust and civic honesty would weaken in countries more strongly affected by criminal groups. Multilevel evidence across 83 representative national samples (N = 128,839) supported this hypothesis. Moreover, the association between political trust and civic honesty was negative in contexts where criminal groups' influence was more extreme. We discuss the implications of the findings and future research directions.

Shushing the press shortens lives: cross-national evidence of the impact of press freedom on life expectancy

AIMS

Press freedom around the globe has deteriorated over the past decade, especially during the COVID-19 pandemic. This paper explores the effect of press freedom, as a cornerstone of democracy, on life expectancy.

METHODS

Exploring cross-country data, we use the ordinary least square method to estimate the association between press freedom and life expectancy. In addition, we adopt three novel instrumental variables to explore the causal relationship.

RESULTS

Our estimations indicate that a freer press leads to higher life expectancy, and the effect exists independently of the level of democracy. In addition, the effect of continuous exposure to press freedom is stronger than sporadic free press status. The results are robust to measurement errors, influential outliers, and country-specific heterogeneity.

CONCLUSIONS

This study reveals the fundamental role of press freedom in promoting public health that was previously underexplored. Therefore, enhancing freedom of expression can be an effective tool to address three of the United Nations Millennium Development Goals, that is, reduce under-five mortality, improve maternal health, and combat HIV/AIDS.JEL:I1 H7 D02.

Determinants of life-expectancy and disability-adjusted life years (DALYs) in European and Organisation for Economic Co-operation and Development (OECD) countries: A longitudinal analysis (1990-2019)

•We relate 68 factors to population health observed in 61 countries over 30 years.•Using random forests, multiple imputation and generalized estimating equations.•GDP per capita and demographics are key; income inequality is not.•Health and social expenditure are more influential than freedom and corruption.•On the macro-level, life-style effects appear to be mediated by cultural context.

Does voluntary health insurance improve health and longevity? Evidence from European OECD countries

The financing structure of the healthcare system and, particularly, the voluntary health insurance (VHI) constituent, has been a vital pillar in improving the overall quality of life. Consequently, this study aims to shed light on the effect of VHI on the population's health and longevity in a sample of 26 European OECD countries. The methodology employed covers both hierarchical clustering and the novel dynamic panel threshold technique. First, the descriptive cluster analysis unveils a delimitation of the countries into four main groups with respect to a broad set of health status indicators. Second, the estimates show that VHI is a significant determinant of health and longevity. More specifically, we find that the relationship between variables is characterized by a threshold effect, whose estimated value is roughly 6.3% of the total healthcare financing. Also, the heterogeneity analysis unveils consistent differences regarding the impact of VHI on health and longevity for the supplementary and complementary types of VHI. Overall, results are strongly robust, the signs and the significance of the coefficients being preserved in the presence of several additional control factors. From a policy perspective, the study's findings can be used nationwide to stimulate regulatory policies to encourage the achievement of a satisfactory level of private health insurance.

Corruption In Health Care Systems: Trends In Informal Payments Across Twenty-Eight EU Countries, 2013-19

Corruption is a major challenge in health care systems across the European Union (EU), where it manifests most visibly as informal payments from patients to providers. A higher prevalence of informal payments has been associated with lower public health care expenditure. EU member states have experienced significant changes in public health care expenditure throughout the 2000s. Given the lack of research on the topic, we explored trends in informal payments using representative data from twenty-eight EU member states during the period 2013-19 and in relation to changes in public health care expenditure. Overall, we found that informal payments increased in 2019 compared with 2013, whereas the perception of corruption decreased. Although higher public health care expenditure was associated with less corruption, we found a smaller effect size between informal payments and this expenditure throughout the study period. Our results suggest that informal payments may be driven by other factors, although the directionality of this relationship requires further investigation. Moreover, additional public health care investments may be insufficient to confront corruption unless coupled with measures to limit wasteful spending and increase transparency. Policy makers should understand that factors external to health systems, including media coverage and cultural and political factors, should be explored to explain country-level differences in corruption.

Vaccination, life expectancy, and trust: patterns of COVID-19 and measles vaccination rates around the world

OBJECTIVES

We estimate patterns of covariation between COVID-19 and measles vaccination rates and a set of widely used indicators of human, social, and economic capital across 146 countries.

STUDY DESIGN

We conduct exploratory analyses of social patterns that uphold vaccination success for COVID-19 and measles.

METHODS

We use publicly available data on COVID vaccination rates and other country-level indicators from Our World in Data, Human Development Report, Corruption Perception Index, and the World Bank to devise bivariate correlations and multiple regression models.

RESULTS

About 70% of the variability in COVID-19 vaccination rates in February 2022 can be explained by differences in the Human Development Index (HDI) and, specifically, in life expectancy at birth. Trust in doctors and nurses adds predictive value beyond HDI, clarifying controversial discrepancies between vaccination rates in countries with similar levels of HDI and vaccine availability. Cardiovascular disease deaths, an indicator of general health system effectiveness, and infant measles immunization coverage, an indicator of country-level immunization effectiveness, are also significant, though weaker, predictors of COVID-19 vaccination success. Measles vaccination in 2019 is similarly predicted by HDI and trust in doctors and nurses.

CONCLUSIONS

The remaining variability in COVID-19 vaccination success that cannot be pinned down through these sets of metrics points to a considerable scope for collective and individual agency in a time of crisis. The mobilization and coordination in the vaccination campaigns of citizens, medical professionals, scientists, journalists, and politicians, among others, account for at least some of this variability in overcoming vaccine hesitancy and inequity.

Corruption in the health sector: A problem in need of a systems-thinking approach

Health systems are comprised of complex interactions between multiple different actors with differential knowledge and understanding of the subject and system. It is exactly this complexity that makes it particularly vulnerable to corruption, which has a deleterious impact on the functioning of health systems and the health of populations. Consequently, reducing corruption in the health sector is imperative to strengthening health systems and advancing health equity, particularly in low- and middle-income countries (LMICs). Although health sector corruption is a global problem, there are key differences in the forms of and motivations underlying corruption in health systems in LMICs and high-income countries (HICs). Recognizing these differences and understanding the underlying system structures that enable corruption are essential to developing anti-corruption interventions. Consequently, health sector corruption is a problem in need of a systems-thinking approach. Anti-corruption strategies that are devised without this understanding of the system may have unintended consequences that waste limited resources, exacerbate corruption, and/or further weaken health systems. A systems-thinking approach is important to developing and successfully implementing corruption mitigation strategies that result in sustainable improvements in health systems and consequently, the health of populations.

Analyzing the impact of energy consumption, the democratic process, and government service delivery on life expectancy: evidence from a global sample

Life expectancy is one of the crucial criteria for determining the quality of life in today's societies. As such, the study of factors affecting life expectancy is a key issue for policymakers. This study aims to investigate the impact of energy consumption, the democratic process, and government service delivery on life expectancy in 100 countries during 2000-2018, using panel quantile regression. The impact of these factors on life expectancy has been estimated in quantiles of 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, and 0.95. Also, the impact of GDP, CO₂ emission, and Gini coefficient variables has been explored as controlling variables on life expectancy. The results show that the impact of CO₂ emissions and the democratic process on life expectancy is negative in all quantiles, and the impact of GDP is negative in all quantiles except 0.95. Moreover, the relationship between hydroelectricity consumption and life expectancy in the 0.05, 0.1, 0.2, 0.8, and 0.9 quantiles is negative and significant. Accordingly, based on the results, the impact of petroleum and other liquids consumption, government service delivery, and Gini coefficient on life expectancy in all quantiles is positive and only the impact of the Gini coefficient on life expectancy in all quantiles is significant.

Corruption and Population Health in the European Union Countries-An Institutionalist Perspective

Even though the European Union (EU) is considered one of the best performers in the world in fighting corruption, the situation changes when the analysis is shifted to the national dimension of its member states, with significant differences concerning the effects of corruption on population health. Using the theory of New Institutional Economics as a complementary tool that provides additional representativeness to this phenomenon, the aim of this paper is to empirically investigate the impact of corruption on population health, considering also other demographic and socio-economic determinants. Using data collected at the EU level registered between 2000-2019, we employ panel date models to validate the ongoing effect of perceived corruption on population health. Our empirical findings fully validate the institutionalist perspective, according to which countries with inclusive institutions better control the anomaly of corruption while benefitting from higher life expectancy and reducing child mortality rates. Conversely, the EU countries with rather extractive institutions suffer in terms of both longevity of population and infant mortality. Our study emphasizes that in tackling corruption pressure on population health, the most effective way is to improve the quality of governance in countries with fragile institutions.

Influences of Digital Transformation on Life Expectancy and the Gender Gap in European Countries

Our paper empirically examines the influence of the digital transformation process on life expectancy employing a sample of 20 European countries over the period from 2015 to 2020. In the models, digitalization is captured by six measures. Our results illustrate that using the internet and online activities reduce life expectancy, whereas business digitization, e-commerce, digital public services, and higher digital skills in the population can improve the life expectancy of men and women, leading to a reduction in the gender gap. Furthermore, we detect that men are significantly more affected by the implementation of digital transformation, while online administrative procedures also lead to a rise in life expectancy but only in women. These effects only exist in the long term. We also find that digital connectivity, business digitization, e-commerce, and digital skills help people survive longer during the Covid-19 pandemic.

Effect of public corruption on the COVID-19 immunization progress

The coronavirus disease (COVID-19) outbreak has resulted in the death of over four million people since late 2019. To reduce the human and economic costs of COVID-19, different vaccines have been developed and distributed across countries. There has been significant cross-country variation in the vaccination of people against COVID-19. In this study, we focus on public corruption to explain the significant cause of cross-country variation in immunization progress. We suggest that countries with a higher degree of public corruption have been less successful in the vaccination of their population, controlling for other important determinants of immunization progress.

Corruption: An Impediment to Delivering Pathology and Laboratory Services in Resource-Limited Settings

OBJECTIVES

Corruption is a widely acknowledged problem in the health sector of low- and middle-income countries (LMICs). Yet, little is known about the types of corruption that affect the delivery of pathology and laboratory medicine (PALM) services. This review is a first step at examining corruption risks in PALM.

METHODS

We performed a critical review of medical literature focused on health sector corruption in LMICs. To provide context, we categorized cases of laboratory-related fraud and abuse in the United States.

RESULTS

Forms of corruption in LMICs that may affect the provision of PALM services include informal payments, absenteeism, theft and diversion, kickbacks, self-referral, and fraudulent billing.

CONCLUSIONS

Corruption represents a functional reality in many LMICs and hinders the delivery of services and distribution of resources to which individuals and entities are legally entitled. Further study is needed to estimate the extent of corruption in PALM and develop appropriate anticorruption strategies.

Informal out-of-pocket payments experience and individuals' willingness-to-pay for healthcare services in Greece

BACKGROUND

Informal out-of-pocket payments to healthcare providers are not uncommon in the Greek health system. We explore individuals' willingness-to-pay (WTP) to secure zero out-of-pocket full coverage for healthcare services and medications and we estimate the impact of past informal payments and individuals' opinion about the legalization of informal payments on WTP.

METHODS

We conducted a survey of 2841 participants from November 2016 to February 2017. We obtained information on WTP using the contingent valuation method. A two-part regression model was used to estimate the association between WTP, informal payments, and respondents' opinion about legalizing such payments.

RESULTS

About 80% of the respondents were willing to pay an average of €95 per month to obtain free access to full healthcare coverage and medications. About 65% of the respondents were involved in an informal payment at least once during the past four months with an average payment of €247. Higher informal payments and supportive opinions towards the legalization of informal payments increased the likelihood of WTP and were also positively associated with increased WTP amounts overall (p < 0.001).

CONCLUSIONS

This survey reveals that individuals' WTP is critically affected by previous experiences and attitudes towards informal payments. Our results imply that the potential introduction of official fees might not suffice to limit informal payments and suggest the need for stricter regulatory policies.

Prospective associations between US state-level corruption and individual-level cardiovascular risk factors among middle-aged Americans: The National Longitudinal Survey of Youths 1979

OBJECTIVES

To estimate the associations between US state-level corruption and risk factors for cardiovascular disease, one of the leading causes of mortality and morbidity in the nation.

METHODS

We used a US nationally-representative sample of middle-aged adults from the National Longitudinal Survey of Youths 1979 and data from the Corruption in America Survey to estimate the associations between state-level illegal (private gains) corruption and legal (political gains) corruption in 2013 and individual-level risks of incident diabetes, hypertension, obesity, and depression between 2014 and 2016.

RESULTS

Medium and higher levels of illegal corruption were associated with odds ratios (ORs) of 1.75 (95% CI 1.06-2.88) for incident diabetes and 1.70 (95% CI 1.15-2.51) for incident hypertension, respectively. Furthermore, a higher level of legal corruption was associated with ORs of 1.84 (95% CI 1.08-3.13) for diabetes and 1.58 (95% CI 1.05-2.38) for hypertension. No consistent associations were observed for obesity or depression.

CONCLUSIONS

Our findings suggest that higher levels of corruption contribute to increased risks of developing diabetes and hypertension. Investing resources into fighting corruption may be means to reduce the national burden of cardiovascular disease.

Corruption and health outcomes within an economic and cultural framework

The purpose of this paper is to investigate the relationship between corruption and population health. Our cross-sectional sample covers 185 countries (54 high-income and 131 low-income countries) and the period of the analysis is 2005-2017. This research provides clear evidence that the level of corruption significantly affects physical health (expressed as life expectancy and Mortality rate) and mental health (expressed by happiness), under the moderating role of economic development and cultural framework. Moreover, we validate a powerful and positive correlation between the income level and both physical and mental health. Culture also has an important role in the corruption-health nexus, because we find evidence supporting four out of the six dimensions of culture (individualism versus collectivism, indulgence versus restraint, uncertainty avoidance and masculinity vs femininity) as having influence upon the physical and mental health of individuals. When we estimate the results on subsamples of countries (high-income and low-income countries), we validate a crisscross effect of corruption. Thus, a high level of corruption more deeply affects the physical health of population in low-income countries than in high-income countries. On the other hand, mental health is more pronouncedly affected by corruption in high-income countries than in low-income countries. This study may have important implications for national or international policy makers who need to acknowledge that anti-corruption policies play an important role in increasing population health, but they also need to adopt them according to the economic and cultural context of each nation.