Corruption undermines health care systems: a human rights issue

Human Rights and Corruption
The Universal Declaration of Human Rights (UDHR) was established in 1948. It is one of the most impressive historical documents to date because it was agreed upon by nearly all countries around the world and it does not pertain to the norms of one nation. The UDHR states that all people have the right to security. Corruption is a destabilizing factor that violates a person’s human right to security. In both high-income and low-income parts of the world rampant corruption in society is a problem and it is a violation of human rights. It compromises not only a country’s economic system, but also its health care system.
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Corruption is a complex problem that is difficult to conceptualize. The World Bank has two general definitions of corruption. The first is defined as covert corruption and pertains to corruption carried out by people who provide a service to the population (e.g. doctors and police officers). The second is defined as overt corruption and is regarding the high-profile corruption carried out by large powerful organizations (e.g. governments). Transparency International defines corruption as being ‘the abuse of public office for private gain’ and created a corruption perception index (CPI). The outcome of the 2013 CPI showed large variations between nations. As compared to all other countries around the world, Spain experienced the greatest plummet on the scale from 2012 to 2013. This decline in placement shows that corruption is not merely an isolated problem within Africa, Asia or Latin America, but is also a concern within Western Europe.

Health consequences of corruption
Corruption negatively affects population health. A study on the Philippines concluded that corruption is disproportionately harmful to the health of children. Using the CPI to study adult health in 20 African nations, Witvliet and colleagues identified that higher levels of perceived corruption in society were associated to poorer population health within all socioeconomic groups for both men and women. Other research has concluded that lower-socioeconomic groups and women in particular are often victims of corruption within the health care system and this can severely impact their health.
Corruption can destabilize a health care system
Research has shown that corruption can hamper economic development and destabilize governmental systems, thereby negatively impacting health care systems. Unfortunately, health care systems around the world all share the commonality of being imperfect and corruption within the health care system is a problem worldwide. This is due to the massive amounts of public funds being pumped into the health care system and the many actors involved. At both the organizational and individual level there is the susceptibility of exposure to corruption, and how an entity responds when given the opportunity to act corruptly can weaken the health care system. For example, in highly corrupt countries, to enhance their personal economic situation, health professionals may sell medication or demand payments for health services that should have been free, which leads to poorer population health outcomes and a dysfunctional health care system. Around the world, corruption within the private sector and fraud has been linked to corroding the health care system. Private providers have access to a substantial amount of public funds and it is often difficult to indentify if payments are being handled correctly. Doctors may order an expensive medical treatment for financial gains or prescribe a certain medication not because it is the most appropriate, but rather due to receiving benefits or special rewards. Health professionals may bill the insurance company for treatments that never occurred. These are just a few examples of how corruption can destabilize the health care system by generating huge financial loss and contribute to health care costs becoming uncontainable. In Europe, high levels of corruption within the health care system are particularly evident in Southern, Central and Eastern Europe. However, research is limited concerning the extent to which this has destabilized the health system within these countries. Nevertheless, prior empirical evidence has shown that these countries, especially in Eastern Europe, experience poorer health outcomes and have weaker health care systems as compared to Western Europe.
Health care professionals and their relationship with their patients thrive on trust. Living in a corrupt society or working in a corrupt health care environment may cause health care professionals to act unethically and this is a potential destabilizing factor to the health care system. In many countries task forces have been created to combat this issue, however to date corruption undermining the health care system is still a problem in most countries around the world.
Message to policy makers
Patients navigating within a health care system fraught with corruption will bear the brunt of the ill- health consequences of corruption, and it is the helpless, in particular the children, elderly and the poor who will suffer most. It is well-established that governments around the world must take measures to contain corruption, and that citizens should hold governmental systems accountable, especially if we expect to strengthen population health and the health care system. Yet governments worldwide are violating human rights by not ensuring that corruption is curtailed. This might be a driving force behind the failure to reach Millennium Development Goals (MDGs) and is perhaps one of the many contributing factors to the widening of health inequalities both within and between countries. If we aim to reduce the destabilization of health care systems, greater transparency should not merely be a goal to strive for, but a fundamental component within government and to health care systems around the world.

Dr. Witvliet, Norwegian University of Science and Technology (NTNU), Department of Sociology and Public Health
American social epidemiologist working at the Norwegian University of Science and Technology (NTNU) in the Department of Sociology and Political Science. Her most recent book is Can Your Country Make You Sick? Multi-level Explorations of Population Health and Human Rights in a Global Perspective. ‘s-Hertogenbosch: Boxpress (2013).