State Capacity and Public Health: Epidemic Dynamics of Malaria and HIV in Africa

• In Event: Poster Session: Studies in Comparative Political Development

Abstract

Scholars are increasingly interested in the quality of governance and public goods provision by states, and in particular, whether and why outcomes vary within states. In this paper, I focus on one important type of public good—public health—and assess whether living in state-controlled territory has any discernible effect on the incidence of common endemic diseases, such as malaria and HIV. Consistent with previous research, I find that malaria rates are significantly lower in state-incorporated regions of Africa. Paradoxically, I find that the opposite is true of HIV. This finding contradicts the few studies that evaluate the relationship between state-capacity and HIV. To explain this finding, I propose and test the theory that anti-HIV stigma attenuates the efficacy of public health messaging and other interventions in state-incorporated areas. Because people fear that association with HIV, or with groups at high risk of HIV, will reveal information about their private behaviors to the state, they will avoid contact with the public health system, resulting in lower levels of HIV-related knowledge. Less knowledgable individuals in these incorporated areas are more likely to engage in high-risk behavior, resulting in higher transmission and incidence rates of HIV. My results suggest that this explanation is plausible, though further research based on non-observational data is warranted.

Author

• Michael F. Seese