Is Corruption and Poor Public Health Related?

Originally posted on MedCityNews

StateHealthRankings1

 

StateCorruption1-588x394

Look at these two maps. See those green circles? Guess what they have in common? Poor health and corrupt public officials.

The first map is from the 2013 America’s Health Rankings report.
The second one is from a report on “The Impact of Public Officials’ Corruption on the Size and Allocation of U.S. State Spending.”

In study from Indiana University and City University of Hong Kong, researchers identified the 10 most corrupt states and the 10 least corrupt states. The list was based on the number of public officials who were convicted for violations of federal corruption laws. The study included more than 25,000 convictions.

The report concluded that:

…at the expense of social sectors, corruption is likely to distort states’ public resource allocations in favor of higher-potential ‘bribe-generating’ spending and items directly beneficial to public officials, such as capital, construction, highways, borrowing, and total salaries and wages.

…state government expenditures on public welfare, health, and hospitals tend to be lower in states with higher degrees of corruption. public officials’ corruption is negatively and significantly associated with per capita state expenditures on public welfare, health, and hospitals.

Corruption may tempt public officials to choose public expenditures less on the basis of public welfare than on the opportunity they offer for extorting bribes.

“States with higher levels of corruption are likely to favor construction, salaries, borrowing, correction, and police protection at the expense of social sectors such as education, health and hospitals,” the report said. This made me wonder about health rankings in the states in the top 10 list, so I used the Health Rankings report from 2013 to compare the two lists. Five of the most corrupt states are also the least healthy. I added a the health ranking to this list of the most corrupt states in the country, based on this report:

1. Mississippi – ranked 50th in overall health
2. Louisiana – ranked 48th in overall health
3. Tennessee – ranked 42nd in overall health

4. Illinois
5. Pennsylvania
6. Alabama – ranked 47th in overall health
7. Alaska
8. South Dakota
9. Kentucky – ranked 45th in overall health
10. Florida

The criteria used to assess health do reflect public spending on that sector. Here are a few of the 27 criteria that the Health Rankings report uses to rank the health of American citizens:

  • Behaviors: Smoking, drug deaths, physical inactivity (all negative)
  • Community and environment: violent crime, children in poverty, air pollution (all negative)
  • Public & health policies: Lack of health insurance (negative), public health funding (positive)
  • Clinical care: Primary care physicians (positive), preventable hospitalizations (negative)
  • Outcomes: Disparity in health status, cardiovascular deaths, cancer deaths (all negative)

The Health Rankings analyzes a set of behaviors, public and health policies, community and environmental conditions, and clinical care data to assess the health of the nation.

Are the most honest states the healthiest as well? Looks like it. Five of the healthiest states are also in the corruption report’s most honest list. Here are the least corrupt states with my notes on where the states rank in the health index.
1. Oregon
2. Washington
3. Minnesota – ranked 3rd in overall health
4. Nebraska
5. Iowa
6. Vermont – ranked 2nd in overall health
7. Utah – ranked 6th in overall health
8. New Hampshire – ranked 6th in overall health
9. Colorado – ranked 8th in overall health
10. Kansas

The report concludes that most corrupt states could have spent $1,308 less annually per capita if they had “only an average corruption level.” Instead of going to bribes, those taxpayer dollars could have gone to fund the Medicaid expansion or a state health insurance exchange.

One guess how many of the gang of 5 (most corrupt and least healthy states) have expanded Medicaid? Only 1 – Kentucky. Mississippi, Tennessee, Louisiana and Alabama have not.