Public health · 2026
Assessing the relationship between the rule of law and health-related indicators: Evidence from an ecological analysis of 120 countries.
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Durmuş Veli
Аннотация
OBJECTIVES: Health outcomes differ widely across countries, influenced by socioeconomic and institutional conditions. While social determinants are well studied, the role of legal and governance structures is less understood. Examining the rule of law may clarify how foundational institutions shape population health and health system performance. The aim of this study is to examine the association between the rule of law and key health outcomes, while accounting for other socioeconomic determinants.
STUDY DESIGN: Cross-sectional ecological study.
METHODS: This study analyzed data from 120 countries, incorporating socioeconomic and health outcome indicators, with the Rule of Law Index as the dependent variable. Data were sourced from global institutions, and countries were categorized by World Bank income levels. Descriptive statistics and multiple linear regression analyses were employed.
RESULTS: The Rule of Law (ROL) Index declined from high-income to low-income countries, indicating weaker legal and institutional frameworks in lower-income settings. Correlation analyses revealed the ROL index was correlated with health-related outcomes (p < 0.05). After adjusting for the countries' total population, gross domestic product, current health expenditure per capita, expected years of schooling, and GNI per capita, the ROL showed an independent association with life expectancy, neonatal mortality, maternal mortality, health care access, and health coverage (p < 0.05).
CONCLUSIONS: This study offers a novel contribution to the expanding body of literature on the political and institutional determinants of health by empirically examining, on a global scale, the significant role of the rule of law in shaping health system structures and population health outcomes.
STUDY DESIGN: Cross-sectional ecological study.
METHODS: This study analyzed data from 120 countries, incorporating socioeconomic and health outcome indicators, with the Rule of Law Index as the dependent variable. Data were sourced from global institutions, and countries were categorized by World Bank income levels. Descriptive statistics and multiple linear regression analyses were employed.
RESULTS: The Rule of Law (ROL) Index declined from high-income to low-income countries, indicating weaker legal and institutional frameworks in lower-income settings. Correlation analyses revealed the ROL index was correlated with health-related outcomes (p < 0.05). After adjusting for the countries' total population, gross domestic product, current health expenditure per capita, expected years of schooling, and GNI per capita, the ROL showed an independent association with life expectancy, neonatal mortality, maternal mortality, health care access, and health coverage (p < 0.05).
CONCLUSIONS: This study offers a novel contribution to the expanding body of literature on the political and institutional determinants of health by empirically examining, on a global scale, the significant role of the rule of law in shaping health system structures and population health outcomes.