Authors: Robert Gillanders, Idrissa Ouedraogo, Eugenie Maïga, Doris Aja-Eke
Corruption, the abuse of public power for private gain, is economic and social poison. Corruption undermines economic development for countries, regions, and firms, drives away foreign direct investment, and leads to poor infrastructure.
Moving away from the economic consequences, corruption kills trust and support for democratic institutions and is, as the Biden administration recently acknowledged, a threat to national and global security.
So, it is not an over-exaggeration to claim that corruption threatens the functioning and survival of states. For many people around the world, it is also a threat to their own lives.
Corrupt health systems come in many forms. Some are plagued by grand corruption whereby those at the top embezzle funds or award contracts based on personal advantage resulting in distorted decision making and inefficiency. For example, construction of hospitals and the purchase of expensive, high-tech equipment can be lucrative for corrupt officials and politicians because of the opportunities for personal gain. These are often prioritised at the expense of primary health care programmes such as immunization and family planning.
In addition to misuse of the health budget, countries that are both poor and corrupt tend to allocate fewer resources to their health budgets than other budget lines, such as investment in roads and housing which can provide greater opportunities for corrupt officials to benefit themselves.
In other countries, petty corruption in the form of bribery means that accessing health care is prohibitively costly and scarce resources are stolen to feed an illicit market. Less well-off citizens may not be able to obtain basic health services because of their inability to pay, thereby exacerbating health inequalities – inequalities that are compounded by the crucial importance of early childhood health for a person’s lifetime earnings and wellbeing.
Sadly, many people are unfortunate enough to live in countries where both petty and grand corruption are common and mutually reinforcing through corroded norms whereby corruption is rationalised as something everyone does.
A very stark example of the health effects of corruption is the role it plays in infant mortality. Studies have shown that corruption drives higher rates of infant mortality. This happens through depressed economic growth, policy distortions and increased inequality.
We also know that corruption, by causing inefficiency, killing trust, and restricting the availability of service, can drive down the vaccination rates of new-borns. Corruption kills, and it is particularly deadly to children.
However, adults are also at risk from the miasma of corruption. Around the world in the context of fundamental public health threats like Polio and Ebola, a strong link from corruption and trust in government to vaccine hesitancy has been found.
In the context of COVID-19, low trust has also been found to predict vaccine hesitancy. Work carried out by DCU’s Anti-Corruption Research Centre and the Institute for Corruption Studies at Illinois State University, found that early in the pandemic more corrupt US states had lower levels of compliance with so-called “shelter in place” orders.
To put it mildly, corruption makes the public health response to COVID-19 significantly more challenging. Given that more corrupt countries are also likely to have much weaker health systems, we can understand why evidence is beginning to emerge that such countries have had higher COVID-19 fatality rates. More work is needed on this important topic but once again the evidence points to corruption as a killer.
Corruption also plays a role in shaping mental health outcomes. Not surprisingly given what we have seen about the nasty effects of corruption, corrupt countries are less happy places.
Those who have experienced bribery demands in relation to accessing basic government services in sub-Saharan Africa are more likely to report feeling anxious. The largest effect is for those who report paying bribes to access medical care. Health sector corruption hurts both physical and mental health.
In Vietnam, evidence points to corruption causing an increased risk of psychological distress through its effects on income and trust. This effect is strongest for women, reflecting a common finding that women bear a disproportionate share of the burden of corruption.
We can also observe this in a recent DCU Business School research paper that finds that those who have experienced corruption are more likely to express the view that domestic violence is sometimes justifiable - a chilling example of how corruption ruins lives, especially for women.
This tendency for corruption to impose particular costs on women is at the core of our Irish Research Council-funded project, Corruption, Gender and Sustainable Development (COGS). COGS is a three-year collaboration between DCU and Université Norbert Zongo that will explore how corruption obstructs female entrepreneurship and is a particular barrier to women trying to access health and education services.
Corruption is a disease. To treat it, we need to understand how it spreads, who is most likely to suffer, and what we can do to support the victims.