TY - JOUR
T1 - Neo-liberal economic practices and population health
T2 - A cross-national analysis, 1980-2004
AU - Tracy, Melissa
AU - Kruk, Margaret E.
AU - Harper, Christine
AU - Galea, Sandro
PY - 2010/4
Y1 - 2010/4
N2 - Although there has been substantial debate and research concerning the economic impact of neo-liberal practices, there is a paucity of research about the potential relation between neo-liberal economic practices and population health. We assessed the extent to which neo-liberal policies and practices are associated with population health at the national level. We collected data on 119 countries between 1980 and 2004. We measured neo-liberalism using the Fraser Institutes Economic Freedom of the World (EFW) Index, which gives an overall score as well as a score for each of five different aspects of neo-liberal economic practices: (1) size of government, (2) legal structure and security of property rights, (3) access to sound money, (4) freedom to exchange with foreigners and (5) regulation of credit, labor and business. Our measure of population health was under-five mortality. We controlled for potential mediators (income distribution, social capital and openness of political institutions) and confounders (female literacy, total population, rural population, fertility, gross domestic product per capita and time period). In longitudinal multivariable analyses, we found that the EFW index did not have an effect on child mortality but that two of its components: improved security of property rights and access to sound money were associated with lower under-five mortality (p = 0.017 and p = 0.024, respectively). When stratifying the countries by level of income, less regulation of credit, labor and business was associated with lower under-five mortality in high-income countries (p = 0.001). None of the EFW components were significantly associated with under-five mortality in low-income countries. This analysis suggests that the concept of neo-liberalism is not a monolithic entity in its relation to health and that some neo-liberal policies are consistent with improved population health. Further work is needed to corroborate or refute these findings.
AB - Although there has been substantial debate and research concerning the economic impact of neo-liberal practices, there is a paucity of research about the potential relation between neo-liberal economic practices and population health. We assessed the extent to which neo-liberal policies and practices are associated with population health at the national level. We collected data on 119 countries between 1980 and 2004. We measured neo-liberalism using the Fraser Institutes Economic Freedom of the World (EFW) Index, which gives an overall score as well as a score for each of five different aspects of neo-liberal economic practices: (1) size of government, (2) legal structure and security of property rights, (3) access to sound money, (4) freedom to exchange with foreigners and (5) regulation of credit, labor and business. Our measure of population health was under-five mortality. We controlled for potential mediators (income distribution, social capital and openness of political institutions) and confounders (female literacy, total population, rural population, fertility, gross domestic product per capita and time period). In longitudinal multivariable analyses, we found that the EFW index did not have an effect on child mortality but that two of its components: improved security of property rights and access to sound money were associated with lower under-five mortality (p = 0.017 and p = 0.024, respectively). When stratifying the countries by level of income, less regulation of credit, labor and business was associated with lower under-five mortality in high-income countries (p = 0.001). None of the EFW components were significantly associated with under-five mortality in low-income countries. This analysis suggests that the concept of neo-liberalism is not a monolithic entity in its relation to health and that some neo-liberal policies are consistent with improved population health. Further work is needed to corroborate or refute these findings.
UR - http://www.scopus.com/inward/record.url?scp=77955920872&partnerID=8YFLogxK
U2 - 10.1017/S1744133109990181
DO - 10.1017/S1744133109990181
M3 - Article
C2 - 19723354
AN - SCOPUS:77955920872
SN - 1744-1331
VL - 5
SP - 171
EP - 199
JO - Health Economics, Policy and Law
JF - Health Economics, Policy and Law
IS - 2
ER -