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The enduring influence of institutions on universal health coverage: an empirical investigation of 62 former colonies

Miller, Michael, Toffolutti, Veronica and Reeves, Aaron (2018) The enduring influence of institutions on universal health coverage: an empirical investigation of 62 former colonies. World Development, 111. pp. 270-287. ISSN 0305-750X

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Identification Number: 10.1016/j.worlddev.2018.07.010


In this paper, we argue that particular institutional arrangements partly explain the large and persistent differences in health systems and health outcomes observed in former colonies. Drawing on data from the World Health Organization for 62 countries, covering the period 2000–2014, we explore whether economic (risk of expropriation) and health (complete cause of death registries) institutions explain mortality rates and access to healthcare. To identify this relationship, we use settler mortality and the distance of the capital from the nearest major port – factors associated with institutional arrangements – to explain cross-national variation in health outcomes and the universality of health systems. We find that inclusive institutions arrangements – that protect and acknowledge the rights of citizens – are associated with better health outcomes (e.g. lower infant mortality and lower maternal mortality) as well as with better health systems (e.g. more skilled birth attendance and greater immunization). Inclusive institutions not only foster economic growth but improve health and well-being too.

Item Type: Article
Official URL:
Additional Information: © 2018 Elsevier Ltd.
Divisions: International Inequalities Institute
Subjects: J Political Science > JV Colonies and colonization. Emigration and immigration. International migration
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
JEL classification: I - Health, Education, and Welfare > I1 - Health > I10 - General
P - Economic Systems > P1 - Capitalist Systems > P16 - Political Economy
P - Economic Systems > P5 - Comparative Economic Systems > P51 - Comparative Analysis of Economic Systems
Date Deposited: 13 Aug 2018 10:49
Last Modified: 20 Oct 2021 00:40
Projects: 313590-HRES, Joseph Rowntree Foundation
Funders: European Research Council

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