Governance matters: an ecological association between governance and child mortality.
BACKGROUND
Governance of a country may have widespread effects on the health of its population, yet little is known about the effect of governance on child mortality in a country that is undergoing urbanization, economic development, and disease control.


METHODS
We obtained indicators of six dimensions of governance (perceptions of voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) and national under-5 mortality rates for 149 countries between 1996 and 2010. We applied a semi-parametric generalized additive mixed model to examine associations after controlling for the effects of development factors (urbanization level and economy), disease control factors (hygienic conditions and vaccination rates), health expenditures, air quality, and time.


RESULTS
Governance, development, and disease control showed clear inverse relations with the under-5 mortality rate (p<0.001). Per unit increases in governance, development, and disease control factors, the child mortality rate had a 0.901-, 0.823-, and 0.922-fold decrease, respectively, at fixed levels of the other two factors.


CONCLUSIONS
In the effort to reduce the global under-5 mortality rate, addressing a country's need for better governance is as important as improvements in development and disease control.
Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Room 722, No. 17, Xuzhou Road, Taipei City 100, Taiwan.
Ro-Ting
RT
Lin
Division of Biostatistics, University of Texas School of Public Health at San Antonio Regional Campus, 7411 John Smith Road, Suite 1100, San Antonio, TX 78229, USA Research to Advance Community Health Center, University of Texas Health Science Center at San Antonio Regional Campus, 7411 John Smith Road, Suite 1050, Room 505, San Antonio, TX 78229, USA.
Lung-Chang
LC
Chien
Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 633, No. 17, Xuzhou Road, Taipei City 100, Taiwan.
Ya-Mei
YM
Chen
Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Room 722, No. 17, Xuzhou Road, Taipei City 100, Taiwan Global Health Center, College of Public Health, National Taiwan University, Room 108, No. 17, Xuzhou Road, Taipei City 100, Taiwan ccchan@ntu.edu.tw.
Chang-Chuan
CC
Chan
D002648:Child; D046688:Child Mortality; D003140:Communicable Disease Control / Q000706:statistics & numerical data; D057217:Economic Development / Q000706:statistics & numerical data; D005163:Factor Analysis, Statistical; D005260:Female; D006076:Government; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011057:Politics; D014507:Urbanization
Child mortality; Governance; Social determinants; Urbanization; World health