Doctoral Dissertation Research: Constitutions and the Political Economy of Health

该项目旨在了解在一个国家的宪法中保护健康作为一项权利是否以及如何改善其公民的健康。目前，世界上仅有一半以上的成文宪法以看似可强制执行的语言列入了“健康权”。然而，这是否有利于健康结果和健康政策尚不清楚。著名的伦理学家认为，它应该有利于公共卫生政策，而许多法律的专家表示怀疑-但目前几乎没有经验证据。该项目采用定量分析和定性实地研究相结合的方法，审查将健康作为一项宪法权利制度化的影响。如果健康权确实能够改善健康-扩大民间社会、法律的系统和卫生相关官员的权力，以改善卫生政策和卫生成果-那么它就可以成为改善社会中个人福祉的有力工具。否则，它可能会扭曲卫生政策。该项目旨在通过跨学科研究建立科学知识，解决法律，公共卫生和政治学领域的这些悬而未决的问题。虽然美国缺乏明确的宪法权利，但卫生政策日益合法化，随着《平价医疗法案》的出台，国家在卫生领域的作用和法院作为仲裁者的作用正在扩大。因此，本研究的经验教训可能会提供适用于美国的见解。此外，这项研究可能有助于国家安全和援助机构实施更有效的全球卫生计划，确定何时，如果，以及如何法律的机构可以改善卫生决策。在全球范围内，平均每20年就对国家宪法进行一次重大修改，因此健康权是否有意义，以及是什么因素使其有意义，是宪法起草者和卫生政策制定者的重要信息。本研究从比较的角度出发，评估宪法规定的健康权作为政治经济健康制度的运作和效果。将政治经济学的见解和工具引入公法研究有助于扩大比较宪政主义的新兴领域-在这种情况下，弥合了现有的社会经济权利的规范和理论研究与卫生和社会政策的实证研究之间的差距。增加关于人口健康生产函数的科学知识也是一个目标。 该项目通过南非、印度和泰国的混合方法“嵌套分析”来实现这一目标，该分析将大N统计回归与基于小N实地调查的案例研究相结合。首先，这项研究将建立一个涵盖40年的国家健康、人口、经济和宪法特征的全球小组数据集，并使用多层次回归分析，全面审查健康权与健康结果之间的经验关系。如果这项研究的假设是正确的，那么在拥有健康权的国家，控制对国家福祉的主要经济，人口和政治解释，应该有明显更好的健康结果。 第二，这项研究将通过在南非、印度和泰国的实地工作，寻求将健康权与有利于健康的决策直接联系起来的证据，从而获得因果影响力。对访谈和档案数据的个案内分析将允许对最近的卫生和与卫生有关的决策进行“过程跟踪”，以帮助确定在大N分析中观察到的统计关系是否是因果关系。最终，来自该项目的数据应提供强有力的证据，说明宪法规定的健康权是否以及如何影响公共卫生结果-并对卫生政策、宪法编写和法律的改革产生影响。

This project seeks to understand whether and how protecting health as a right in a nation's constitution improves the health of its citizens. Currently, just over half of written constitutions in the world include a "right to health" in seemingly enforceable language. Whether this is beneficial to health outcomes and health policy, however, is not clear. Prominent ethicists suggest it should benefit public health policy while many legal experts have voiced skepticism -- yet little empirical evidence is currently available. This project uses a mix of quantitative analysis and qualitative field research to examine the effects of institutionalizing health as a constitutional right. If a right to health does operate to improve health -- expanding the power of civil society, the legal system, and health-related officials to improve health policy and health outcomes -- then it could be a powerful tool to improve the wellbeing of individuals in society. If not, it may problematically distort health policy. This project seeks to build scientific knowledge through interdisciplinary research, addressing these unanswered questions for the fields of law, public health, and political science. While the United States lacks an explicit constitutional right, health policy is increasingly legalized and, with the Affordable Care Act, the role of the state in health and of courts as arbiters is expanding. As such, lessons from this study may provide insights applicable to a U.S. context. In addition, this research may help national security and aid agencies implement more effective global health programs by identifying when, if, and how legal institutions can improve health policymaking. Globally, the average national constitution is significantly rewritten every 20 years, so whether a right to health is meaningful, and what factors make it so, are important pieces of information for constitution drafters and the health policymakers. This study sets out to assess, in comparative perspective, the operation and effect of a constitutional right to health as an institution within the political economy health. Bringing insights and tools from political economy to the study of public law can help expand the emerging field of comparative constitutionalism -- in this case bridging the gap between existing normative and doctrinal studies of socioeconomic rights and the large field of empirical research on health and social policy. Adding to scientific knowledge on the production function of population health is also a goal. This project does so through mixed-methods "nested analysis" in South Africa, India, and Thailand that combines a large-N statistical regression with small-N fieldwork-based case studies. First, the study will construct a global panel dataset with national health, demographic, economic, and constitutional characteristics spanning 40 years and use multilevel regression analysis to examine the empirical relationship globally between a right to health and health outcomes. If the study's hypotheses are correct, there should be observably better health outcomes in countries with a right to health, controlling for the dominant economic, demographic, and political explanations for national wellbeing. Second, the study will gain causal leverage by seeking evidence directly linking the right to health with pro-health policymaking through field work in South Africa, India, and Thailand. Within-case analysis of interview and archival data will allow "process tracing" of recent health and health-related policymaking to help determine whether the statistical relationship observed in the large-N analysis is causal. Ultimately, data from this project should provide strong evidence about whether and how a constitutional right to health affects public health outcomes -- with implications for health policy, constitution-writing, and legal reform.