The Effect of a Constitutional Right to Health on Population Health in 157 Countries, 1970–2007: the Role of Democratic Governance

A number of studies have evaluated the effect of a right to health as a mechanism for achieving desirable health outcomes, yet no study has sought institutional conditions that make this mechanism more effective at population level.I hypothesise whether a right to health is only an effective instrument for improving health in countries that demonstrate good governance in which effective mechanisms for enforcing the right to health, as well as controlling government behaviour, exist. Annual data from 1970 to 2007 was obtained for a panel of 157 countries, to study the effects of introducing into national constitutions an explicit, enforceable, right to health and democratic governance on infant and under-five mortality rates. The introduction of a right to health in a national constitution was significantly associated with reductions in both mean infant and under-five mortality rates. The effect was large in countries with high scores for democratic governance, whereas in countries with low scores for democratic governance, approximately half of the effect of introducing a constitutional right to health was present. The results suggest that introducing a constitutional right to health is likely to be an effective mechanism for improving health in countries that have a high level of democratic governance. However, whereas a right to health is likely to be less effective in countries with low scores for democratic governance in the short run, there can be a longer term health benefits if governance subsequently improves, the right to health remains in the constitution.