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Globalization and Health

, 6:11

First Online: 29 May 2010Received: 08 September 2009Accepted: 29 May 2010DOI: 10.1186-1744-8603-6-11

Cite this article as: Biggs, S.L., Dell, E.M., Dixon, V.L. et al. Global Health 2010 6: 11. doi:10.1186-1744-8603-6-11


BackgroundThe link between political freedom and health is unclear. We aimed to determine the association by exploring the relationship of historical and cumulative freedom levels with important health outcomes.

MethodsWe obtained countrywide health indicators for life expectancy, infant mortality, maternal mortality ratio, % low birth weight babies, Gini coefficient a measure of wealth inequality and various markers of freedom based on political rights and civil liberties. We applied multivariable logistic regression to examine the association between health indicators and within-country years of freedom as determined by Freedom House rankings.

ResultsThe total proportion of free years from 1972-2005, the duration of current freedom level, and the Gini coefficient show independent positive associations with health indicators, which remain after the adjustment for national wealth, total government expenditure, and spending on health. Countries identified as having high total proportion of free years demonstrated significantly better health outcomes than countries with low levels of freedom life expectancy, Odds Ratio OR 7.2, 95% Confidence Interval CI, 2.3-22.6, infant mortality OR 19.6, 95% CI, 5.6-67.7, maternal mortality ratio, OR 24.3, 95% CI, 6.2-94.9, and % low birth weight babies OR 3.8, 95% CI, 1.4-10.8. This was also the case for infant mortality OR 3.4, 95% CI, 1.0-8.4, maternal mortality ratio OR 4.0, 95% CI, 1.2-12.8, and % low birth weight babies OR 2.6, 95% CI, 1.0-6.6 among countries considered as having medium levels of freedom.

InterpretationWe found strong associations between country-level freedom and important health outcomes. The cumulative level of freedom over time shows stronger associations with all health indicators than the duration of current freedom level.

Electronic supplementary materialThe online version of this article doi:10.1186-1744-8603-6-11 contains supplementary material, which is available to authorized users.

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Author: Samantha L Biggs - Evelyn M Dell - Vanessa L Dixon - Michel R Joffres - Chris Beyrer - Kumanan Wilson - James J Orbins


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