title: Association of rule of law and health outcomes: an ecological study.
abstract: OBJECTIVE
  To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes.
  
  
  METHODS
  Global project.
  
  
  METHODS
  Data set of 96 countries, comprising 91% of the global population.
  
  
  METHODS
  The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice.
  
  
  RESULTS
  The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries' level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (p<0.05). Rule of law remained significant in all the multivariate models, and the following adjustment for potential confounders remained robust for at least one or more of the health outcomes across all eight subindices of the rule of law. Findings show that the higher the country's level of adherence to the rule of law, the better the health of the population.
  
  
  CONCLUSIONS
  It is necessary to start considering the country's adherence to the rule of law as a foundational determinant of health. Health advocates should consider the improvement of rule of law as a tool to improve population health. Conversely, lack of progress in rule of law may constitute a structural barrier to health improvement.
authors.affiliation: Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Pinzon-Rondon
authors.affiliation: Faculties of Law and Medicine, Canada Research Chair in Law, Population Health and Global Development Policy, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Attaran
authors.affiliation: The World Justice Project, Washington, DC, USA.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Botero
authors.affiliation: Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Ruiz-Sternberg
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D003416:Criminal Law; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006076:Government; D006305:Health Status Indicators; D006806:Human Rights; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007603:Jurisprudence; D035846:Law Enforcement; D008017:Life Expectancy; D008428:Maternal Mortality; D009026:Mortality; D011247:Pregnancy; D064890:Social Determinants of Health / Q000331:legislation & jurisprudence*; D012959:Socioeconomic Factors
keywords: HEALTH ECONOMICS; LAW (see Medical Law); PUBLIC HEALTH