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Neo-liberal economic practices and population health: a cross-national analysis, 1980–2004

Published online by Cambridge University Press:  01 April 2010

Melissa Tracy ,
Margaret E. Kruk ,
Christine Harper  and
Sandro Galea
Melissa Tracy
Affiliation:
Doctoral student, Department of Epidemiology, School of Public Health, University of Michigan, USA
Margaret E. Kruk
Affiliation:
Assistant Professor of Health Management and Policy, School of Public Health, University of Michigan, USA
Christine Harper
Affiliation:
Research Assistant, Department of Epidemiology, School of Public Health, University of Michigan, USA
Sandro Galea*
Affiliation:
Professor of Epidemiology, School of Public Health, Director, Center for Global Health, University of Michigan, USA
*
Correspondence to: Sandro Galea, Director of the Center for Global Health, Professor of Epidemiology, School of Public Health, 109 Observatory Street, Room 3663, Ann Arbor, MI 48109-2029, USA. Email: [email protected]
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Abstract

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 Institute’s 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.

Type
Articles
Information
Health Economics, Policy and Law , Volume 5 , Issue 2 , April 2010 , pp. 171 - 199
Copyright
Copyright © Cambridge University Press 2009

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