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The Right to Health: Institutional Effects of Constitutional Provisions on Health Outcomes

Abstract

The “right to health” is increasingly enshrined in national constitutions around the world—present today in a slight majority of written constitutions. Whether this trend is good, bad, or meaningless is considerably debated. Contrary to skeptics’ worries, this study finds empirical evidence of a positive role of the right to health in the production of population health. Estimating the most widely promulgated theories of the economic and social determinants of health, and the role of electoral democracy, provides a foundation from which to evaluate the effect of the right to health. This study assembles and analyzes data for 144 countries between 1970 and 2010 and finds that, controlling for these factors, a constitutional right to health contributes significantly to wellbeing. Assembled quantitative and case-study evidence both support the idea that institutional environments shaped by a right to health encourage more and better delivery of health services, which in part account for positive impact on health outcomes. These results suggest that focusing research on political institutions primarily on democratic participation rights ignores important impacts of “entitlement” rights on norms and actors in health policy-making. Overall, the right to health is both an important contextual factor for health research and meaningful institutional innovation.

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Notes

  1. 1.

    The Commission on Social Determinants of Health perhaps best embodies these conflicting notions as it nods to the use of a rights-based framework for health equity, yet does not consider the effect of constitutions or formalizing those rights on health equity and does not include instantiating rights among its 60 formal recommendations.

  2. 2.

    Legal system classification coded Muslim, civil law, common law, or civil/common law mixed based on University of Ottawa JuriGlobe (University of Ottawa).

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Acknowledgments

I am grateful for a National Science Foundation Law & Social Sciences grant and a Leonard Davis Institute Innovative/High Risk Research Grant that supports this project. I extend my sincere thanks to Devesh Kapur, Jennifer Prah Ruger, Guy Grossman, Julia Lynch, Rogers Smith, Matt Levendusky, and Neelanjan Sircar as well as two anonymous reviewers for helpful comments and advice and to Tom Ginsburg for both data and inspiration for this project; all errors are, of course, my own.

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Correspondence to Matthew M. Kavanagh.

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Appendices

Appendix 1

(Table 6).

Table 6 Alternative estimators (DV: log under-5 mortality (per 1000 live births), 1970–2010)

Appendix 2

Table

Table 7 Health rights and under-5 mortality + spending and services variables (DV: log under-5 mortality (per 1000 live births), 1970–2010)

Appendix 3

Table

Table 8 Variables

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Kavanagh, M.M. The Right to Health: Institutional Effects of Constitutional Provisions on Health Outcomes. St Comp Int Dev 51, 328–364 (2016). https://doi.org/10.1007/s12116-015-9189-z

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Keywords

  • Health
  • Development
  • Constitution
  • Law
  • Rights