Abstract :
Although there has been substantial debate and research concerning
the economic impact of neo-liberal practices, there is a paucity of research
about the potential relation between neo-liberal economic practices and
population health. We assessed the extent to which neo-liberal policies
and practices are associated with population health at the national level.
We collected data on 119 countries between 1980 and 2004. We measured
neo-liberalism using the Fraser Institute’s Economic Freedom of the World
(EFW) Index, which gives an overall score as well as a score for each of five
different aspects of neo-liberal economic practices: (1) size of government,
(2) legal structure and security of property rights, (3) access to sound money,
(4) freedom to exchange with foreigners and (5) regulation of credit, labor
and business. Our measure of population health was under-five mortality.
We controlled for potential mediators (income distribution, social capital
and openness of political institutions) and confounders (female literacy, total
population, rural population, fertility, gross domestic product per capita
and time period). In longitudinal multivariable analyses, we found that the
EFW index did not have an effect on child mortality but that two of its
components: improved security of property rights and access to sound money
were associated with lower under-five mortality (p50.017 and p50.024,
respectively). When stratifying the countries by level of income, less regulation
of credit, labor and business was associated with lower under-five mortality in
high-income countries (p50.001). None of the EFW components were
significantly associated with under-five mortality in low-income countries.
This analysis suggests that the concept of ‘neo-liberalism’ is not a monolithicentity in its relation to health and that some ‘neo-liberal’ policies are
consistent with improved population health. Further work is needed to
corroborate or refute these findings.
