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Comparative Public Health: The Political Economy of Human Misery and Well-Being


  • Author's note: We thank the Weatherhead Initiative on Military Conflict as a Public Health Problem, the Ford Foundation, and the World Health Organization for financial support and Gary King, Lisa Martin, and Ben Valentino for helpful comments.


Nearly 10 percent of the world's economic resources are devoted to health care. But why do certain countries devote more resources to public health? Why are some countries better than others at achieving tangible health outcomes using the same level of economic resources? Surprisingly, political scientists and public health scholars have done only limited systematic research on these important questions. We address them by developing and testing an analytical framework of domestic and international political influences on public health. We use new data from the World Health Organization to examine cross-national variation first in the level of public expenditures on health, and then in the level of achievement of health outcomes. We measure these influences and their relative impact in terms of dollars and years of health, respectively. Dictatorship, severe income inequality, ethnic heterogeneity, and persistent international hostilities substantially depress the amount of public resources allocated to health care. Moreover, we analyze the extent to which, given the same level of resources allocated to public health, overall national health performance suffers further from unequal provision of services, rapid urbanization, and civil conflict.