Constitutionalizing Health: Rights, Democracy and the Political Economy of Health Policy
Empirical mixed methods study of the effects of including health as a right in written constitutions. Nested analysis includes: large-N statistical analysis of 40 years of global health data showing that countries with a right to health have better health outcomes and provide more health services, controlling for dominant social and economic determinants + qualitative study based on over 150 in-depth process tracing interviews from South Africa, India, Thailand, and Malawi showing the causal mechanism for this effect lies in the institutional impact of a right to health on health policy change, including policy venue shifts and changes in the relative power of policy actors.
Appendix of interviews
HIV Policy Diffusion Project
Scientists and physicians spend significant effort identifying the optimal standards of medical care across a wide variety of health and disease areas to improve wellbeing. Translating up-to-date science into policy can be critical for patients and public health—yet the guideline policies that govern public health and medical practice often lag behind evidence; sometimes far behind. HIV provides a case in point: scientific consensus has emerged that shifting clinical practice to start people living with HIV on antiretroviral treatment (ART) quickly rather than waiting for their immune system to significantly deteriorate, as was the recommended practice in the past, has overwhelming benefits. Yet our analysis shows that policy choice among countries is inconsistent: Across the income spectrum and in both high and low HIV-prevalence countries one finds some countries that have quickly adopted their national policies to advances in HIV treatment while others lag behind medical consensus. Today fewer than half of national HIV guidelines recommend immediate HIV treatment for all and over fifty countries retain HIV treatment policies considered substantially out of date by global medical organization standards. Why?
The dominant explanations for this lag is insufficient diffusion of knowledge, different interpretations of data, or insufficient resources for implementation. Yet for HIV treatment there exists perhaps the most extensive global knowledge diffusion and funding infrastructure ever created. Why do we still see such differences between countries? We are testing a theory about the systematic effects of politico-economic factors by constructing a database of multiple HIV treatment guidelines from over 100 countries, across 3 episodes of WHO normative guidance change, to statistically explore this question. We are supplementing this data with qualitative interviews with policymakers and scientists to triangulate causal processes in the translation of medical evidence into policy.