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Given change in the universal developmental agenda and the quality of governance in the last two decades, this paper re-examines the relationship between governance, health expenditure and maternal mortality using panel data for 184 countries from 1996 to 2019. By employing the ‘dynamic panel data regression model’, the study reveals that a one-point improvement in the governance index decreases maternal mortality by 10–21%. We also find that good governance can better translate health expenditure into improved maternal health outcomes through effective allocation and equitable distribution of available resources. These results are robust to alternative instruments, alternative dependent variables (such as infant mortality rate and life expectancy), estimation by different governance dimensions and at the sub-national level. Additional findings using ‘Quantile regression’ estimates show that the quality of governance matters more than the health expenditure in countries with a higher level of maternal mortality. While the ‘Path regression’ analysis exhibits the specific direct and indirect mechanisms through which the causal inference operates between governance and maternal mortality.
Previous chapters examined how medical providers and the health care financing system have contributed to health inequities that Black people and disabled people in the United States encounter. But having health insurance and getting to see an unbiased, high quality doctor are not necessarily the most important contributors to promoting health and health equity, either for individuals or at the population level. More important are other determinants of health. These include individual behaviors like smoking, diet, and exercise and –critically – the social and physical environments that shape individual conduct.1 To give one example: neighborhood safety and availability of parks or playgrounds nearby influence a person’s ability to exercise conveniently and safely. Healthy behavior takes some individual initiative, but that initiative is far more likely when social and physical environments make healthy options available and easy to choose.2
The 2019 Global Health Security Index (GHS Index) assessed the US and the UK as the two countries best prepared to address a catastrophic pandemic. The preparedness rankings of this index have had little correlation with the actual experiences of COVID-19 in various countries. In explaining this disrepancy, the paper argues that better indicators and more data would not have fixed the problem. Rather, the prevailing paradigm of global health security that informs instruments such as the GHS Index needs to be interrogated. This dominant paradigm narrowly conceptualises global health security in terms of the availability of a technical infrastructure to detect emerging infectious diseases and prevent their contagion, but profoundly undertheorises the broader social and political determinants of public health. The neglect of social and political features is amplified in instruments such as the GHS Index that privilege universalised templates presumed to apply across countries but that prove to be inadequate in assessing how individual societies draw on their unique histories to craft public health responses.
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