4.1 Corruption and Growth: Grease for the Wheels or Sand in the Gears?
Corruption and its effects on development and economic growth rank among the most popular topics in development economics. We commonly see two very different arguments on how corruption affects economic growth. According to Leff (Reference Leff1964), Huntington (Reference Huntington1968), and Lui (Reference Lui1985), corruption greases the wheels of growth via two channels. First, it speeds up the governmental process if regulations are cumbersome. Second, it increases competition for scarce government resources since, the argument runs, a system built on bribery enables the most efficient firms to pay the highest bribes (Jain, Reference Jain2001; Aidt, Reference Aidt2003; Svensson, Reference Svensson2005). Both Klitgaard (Reference Klitgaard1991) and Acemoglu and Verdier (Reference Acemoglu and Verdier1998) show that where fighting corruption is costly, the growth-maximizing level of corruption is positive.
Myrdal (Reference Myrdal1968), on the other hand, argues that corruption throws sand in the gears of growth. First, corruption is nothing but a tax on investment, differing in that the payment does not end up as public revenues. To the extent that this deprives the government of revenue required to provide productive public goods such as infrastructure projects, corruption is detrimental to growth. Second, it further reduces government spending on productive public goods in sectors where it is more difficult for corrupt public employees to extract bribes, such as health and education (Wei, Reference Wei1999). Third, it shifts government spending away from needed operation and maintenance toward spending on new equipment and projects. Allowing roads and bridges to deteriorate to the point where they need to be rebuilt, for example, creates new opportunities for bribery. Moreover, corruption reduces innovation, a key engine of growth, via several channels. First, it affects allocation of talent. According to Murphy et al. (Reference Murphy, Shleifer and Vishny1993), if corruption is widespread, returns to ability are not captured by an entrepreneur, and hence entrepreneurship becomes less attractive. Most of the talented people choose to become corrupt public employees instead of entrepreneurs who organize production and improve technology by innovation. Second, innovation requires permits supplied by public employees. Since demand for permits is highly inelastic, it turns innovators, who are often strapped for cash, into prime targets for bribery (Mo, Reference Mo2001). Finally, many arguments that corruption enhances efficiency rest upon hypothetical cases in which bribe payers obtain a license or contract more quickly, and perhaps at lower cost, than by playing by the rules. But as Rose-Ackerman (Reference Rose-Ackerman1999) points out, many corrupt transactions are not closed-ended. Instead, word of bribe payments can spread rapidly, particularly among under- or unpaid officials, encouraging them to contrive their own ways of squeezing payments out of private parties and intensifying bosses’ pressures upon functionaries (who may have to pay off their superiors to get their jobs) to pass more revenues up the ladder. A firm’s corrupt payments can also signal that “we pay bribes” and may create legal vulnerabilities useful in demanding further payments.Footnote 1
Partly due to the differences in empirical method and specification, and partly to differences in cross-country corruption indices used, the empirical evidence regarding the relationship between corruption and economic growth is conflicting as well. While studies such as Mauro (Reference Mauro1995), Keefer and Knack (Reference Knack and Keefer1997), Mo (Reference Mo2001), Swaleheen (Reference Swaleheen2011), Cieslik and Goczek (Reference Cieślik and Goczek2018), and Grundler and Potrafke (Reference Gründler and Potrafke2019) all find a negative relationship between corruption and growth, Brunetti (Reference Brunetti1997) and Svensson (Reference Svensson2005) do not find a statistically significant relationship between the two.
Studies such as Mendez and Sepulveda (Reference Méndez and Sepúlveda2006), Aidt et al. (Reference Aidt, Dutta and Sena2008), and Saha and Sen (Reference Saha and Sen2020) find that the effects of corruption on growth are conditional on both the quality of political institutions and the political regimes. Mendez and Sepulveda (Reference Méndez and Sepúlveda2006) find an inverse U-shaped relationship between corruption and growth in countries with strong political institutions where people have access to political and civil liberties. Among autocratic countries in which political and civil liberties do not exist, they find no statistically significant relationship. Aidt et al. (Reference Aidt, Dutta and Sena2008) find similar results regarding the countries with weak political institutions but a strong negative relationship between corruption and growth in democratic countries. Saha and Sen (Reference Saha and Sen2020), on the other hand, show contrasting results for countries with strong political institutions, finding that higher corruption leads to lower growth in democratic countries.
The fifty American states offer intriguing perspectives on these issues. They are, as already noted, civil societies in their own right and in many cases are comparable in economic scale to whole countries elsewhere. They share a common legal and economic framework within the federal system, yet vary considerably in their economic, political, and demographic makeup. Their levels of prosperity, the extent and nature of their engagement with global and regional economies, and, as noted, their political cultures and economic value systems reflect a variety of historical and contemporary influences. Many states can embrace considerable economic diversity within their own borders. That combination of common and divergent influences, together with the sheer economic influence the states can exert both individually and collectively, makes the question of corruption and growth an important focus for comparative analysis.
Using the Corruption Conviction Index (CCI) as their measure of corruption, both Glaeser and Saks (Reference Glaeser and Saks2006) and Johnson et al. (Reference Johnson, LaFountain and Yamarik2011) find that corrupt states’ per capita GDPs grow significantly more slowly. Dincer (Reference Dincer2020), on the other hand, uses CRI to measure corruption and analyzes its effects on levels of per capita income, not the growth rate of per capita GDP. According to Hall and Jones (Reference Hall and Jones1999), analyzing the variation in the levels of per capita income, in fact, is more informative than analyzing the variation in growth rates because the income levels are more relevant to welfare as measured by the consumption of goods and services. Besides, a number of growth models predict converging growth rates in the long run, due to technology transfers. This is especially true for US states. In these models, as Hall and Jones (Reference Hall and Jones1999) argue, differences in income levels are the interesting differences to explain: Jones (Reference Jones1995), for example, presents a model implying that different government policies are associated with differences in income levels, not in growth rates. Dincer (Reference Dincer2020) too finds evidence showing detrimental effects of corruption on economic development; per capita incomes are significantly lower in more corrupt states.
4.1.1 Empirical Analysis
In this chapter, we estimate the relationship between corruption and median incomes in US states using annual data between 1984 and 2021. Because median income is a lot more sensitive to the underlying distribution of wealth in a state, we use median household incomes as our dependent variable instead of per capita personal incomes.
The results of an Arellano–Bover/Blundell–Bond type system GMM (Generalized Method of Moments) estimation that assumes corruption is endogenously determined are presented in Table 4.1. In our regressions, following the growth literature, we also control for education measured as the share of population with a college degree or above, urbanization measured as the share of farm employment in total employment and the government size/scope measured by the Fraser Institute’s Economic Freedom Index (EFI). We use both CCI and CRI as our measures of corruption and find evidence of a negative effect of corruption on median incomes across states over time. On average, a 1 standard deviation increase in CCI causes median incomes in a state to decrease by approximately 1.75 percent. To put that in perspective, consider states such as Alabama and Mississippi, on the one hand, and Vermont and Wisconsin, on the other. If corruption in Alabama were as low as in Vermont, median incomes would have been $1,000 more annually. Since more than 15 percent of Alabama’s population live below the poverty line ($30,000 for a household of 4), a $1,000 difference is not trivial. In Mississippi, where the poverty rate is close to 20 percent, the situation is even worse. Reducing corruption in Mississippi to its level in Wisconsin would mean approximately $1,250 more for each household. Although the estimated standardized coefficient of CRI is smaller than that of CCI, it is still statistically and economically significant.
Table 4.1 Corruption and median incomes: Arellano–Bover/Blundell–Bond system GMM estimation (dependent variable: Log median income)
| (1) | (2) | |
|---|---|---|
| Log Median Income−1 | 0.829 | 0.763 |
| (0.070)Footnote *** | (0.071)Footnote *** | |
| CCI−1 | −0.006 | |
| (0.004)Footnote * | ||
| CRI−1 | −0.043 | |
| (0.021)Footnote ** | ||
| Log Education | −0.112 | −0.067 |
| (0.024)Footnote *** | (0.026)Footnote *** | |
| Log Urbanization | −0.034 | −0.037 |
| (0.009)Footnote *** | (0.009)Footnote *** | |
| Log EFI | 0.203 | 0.185 |
| (0.066)Footnote *** | (0.073)Footnote *** | |
| N | 1800 | 1800 |
| Autocorrelation Tests | ||
|---|---|---|
| Arellano-Bond AR(1) z p value Arellano-Bond AR(2) z p value | −5.82Footnote *** 0.00 0.66 0.51 | −5.80Footnote *** 0.00 0.71 0.48 |
| Overidentification Tests | ||
|---|---|---|
| Hansen χ2 p value | 11.74 0.47 | 19.62Footnote * 0.075 |
Standard errors (clustered at the state level) in parentheses. All models control for state and time fixed effects.
*** , **, and * represent statistical significance at 1 percent, 5 percent, and 10 percent levels, respectively. Log Median Income_1, CCI, and CRI are assumed to be determined endogenously.
4.2 Corruption and Income Inequality
Corruption affects economic inequality as well as growth. The effects of wealth and income inequalities range from life expectancy and access to basic services such as healthcare and education to the ability to exercise human rights and gain access to justice. According to Johnston (Reference Johnston and Ward1989), corruption favors the “haves” rather than the “have nots,” particularly if the stakes are large; thus, many of the burdens of corruption fall disproportionately on low-income individuals, while its benefits are likely to accrue to better-connected individuals and higher-income groups (Gupta et al., Reference Gupta, Davoodi and Alonso-Terme2002, 23).
Corruption affects income inequality through several channels. First, as Gupta et al. (Reference Gupta, Davoodi and Alonso-Terme2002) argue, it generates a tax system that disproportionately favors the high-income individuals. It facilitates tax evasion (Beekman et al., Reference Beekman, Bulte and Nillesen2014; Banerjee et al., Reference Banerjee2022) while reducing the progressivity of the tax system, leading to reduced tax revenues. Lower revenues in turn reduce both the quantity and the quality of the public goods such as health care and education (Gupta et al., Reference Gupta, Davoodi and Alonso-Terme2002). Second, corruption affects the composition of government spending: corrupt governments spend less on public goods such as health care and education and more on goods that allow the collection of large bribes and whose value is difficult to monitor (Gupta et al., Reference Gupta, Reza Davoodi and Tiongson2000). As Dincer and Teoman (Reference Dincer and Teoman2019) argue, reduced budget shares are not the only problem: corrupt public officials steal millions of dollars from health care and education budgets too. In other words, corruption raises the costs and/or quality of public goods while reducing their quantity. Meanwhile, higher costs of public goods lead to higher taxes. This again disproportionately favors high-income individuals: lower-income individuals are the ones who mostly benefit from public goods provided by the government, while high-income individuals have the resources to evade taxes by bribing the government officials. Third, corruption affects redistribution policies. Corrupt public officials divert funds within social programs targeting the low-income individuals to the wealthier and better-connected individuals. Fourth, it raises inequalities in asset ownership. Only the better-connected individuals get the most profitable government contracts and projects. This leads to the creation of a small group of asset owners who have the resources to bribe public officials and increase their assets. Since assets are used as collateral to borrow and invest, high inequities in asset ownership reduce the ability of the poor to borrow and invest, adding further to economic inequalities (Gupta et al., Reference Gupta, Davoodi and Alonso-Terme2002). Finally, corruption lowers social trust (Rothstein and Eek, Reference Rothstein and Eek2009). Several studies find positive effects of trust – both institutional and social – on health and education outcomes and hence economic inequalities (Mohseni and Lindstrom, Reference Mohseni and Lindstrom2007).
Although theoretically there is a clear positive relationship between corruption and economic inequality, cross-country empirical evidence regarding the relationship between the two is conflicting, mostly due to the differences in the sample of countries used. While Li, Xu, and Zou (Reference Li, Xu and Zou2000) find an inverse U-shaped relationship between corruption and income inequality, Chong and Calderon (Reference Chong and Calderon2000) find that the effects of corruption on inequality are conditional on the level of incomes in a country. They find a negative relationship between corruption and income inequality in high-income countries and a positive one in low-income countries. While Gupta et al. (Reference Gupta, Davoodi and Alonso-Terme2002) and Gyimah-Brempong and de Camacho (Reference Gyimah-Brempong and de Gyimah-Brempong2006) find empirical evidence showing that inequality increases as corruption increases, Dobson and Ramlogan-Dobson (Reference Dobson and Ramlogan-Dobson2010) find the opposite.
4.2.1 Empirical Analysis
To our knowledge, there are only two studies analyzing the relationship between corruption and economic inequality in US states. While Apergis, Dincer, and Payne (Reference Apergis, Dincer and Payne2010) use the Gini index of income inequality to measure economic inequality, based on data from the Current Population Survey of the Census Bureau, Dincer and Gunalp (Reference Dincer and Gunalp2011) use various Atkinson indices as well as the Gini index. Both studies find a positive relationship between CCI and income inequality across fifty states over the last two decades of the twentieth century. In this chapter, following Dincer and Gunalp (Reference Dincer and Gunalp2011), we use the Gini index as our income inequality measure, constructed from the American Community Survey covering annual data between 2010 and 2021, and both CCI and CRI as our corruption indices. Because income inequality changes very slowly, current inequality is likely to be affected by inequality in the previous period. Owing to this dynamic nature of inequality, we estimate the effects of corruption on economic inequality with an Arellano–Bover/Blundell–Bond type system GMM estimation, assuming that corruption is endogenously determined as we have done in our growth regressions earlier. In our regressions, we control for states’ median incomes too. The results are presented in Table 4.2. According to our estimations, corruption causes income inequality to increase. On average, a 1 standard deviation increase in CCI causes a state’s Gini index to increase by approximately 0.3 standard deviations, indicating that approximately 8.5 percent of the difference in Gini index between Alabama and Vermont and 12.5 percent of the difference between Mississippi and Wisconsin is explained by the differences in CCI. Although the estimated standardized coefficient of CRI is smaller than that of CCI, it is still statistically and economically significant. Taken all together, our evidence strongly suggests that more extensive corruption in a state leaves its citizens poorer and increases income inequalities among them. As we shall see in Chapters 4–8, those factors contribute to further disparities in public health and other public policy areas.
Table 4.2 Corruption and income inequality: Arellano–Bover/Blundell–Bond system GMM estimation (dependent variable: Gini)
| (1) | (2) | |
|---|---|---|
| Gini−1 | 1.128 | 1.131 |
| (0.109)Footnote *** | (0.047)Footnote *** | |
| CCI−1 | 0.002 | |
| (0.001)Footnote * | ||
| CRI−1 | 0.017 | |
| (0.006)Footnote *** | ||
| Log Median Income | 0.484 | 0.195 |
| (0.286)Footnote * | (0.142) | |
| Log Median Income2 | −0.021 | −0.009 |
| (0.013)Footnote * | (0.006) | |
| N | 550 | 550 |
| Autocorrelation Tests | ||
|---|---|---|
| Arellano–Bond AR(1) z p value Arellano–Bond AR(2) z p value | −1.75 0.08 0.65 0.51 | −3.39 0.00 1.78 0.08 |
| Overidentification Tests | ||
|---|---|---|
| Hansen χ2 p value | 0.36 0.83 | 1.57 0.46 |
Standard errors (clustered at the state level) in parentheses. All models control for state and time fixed effects.
* , **, and *** represent statistical significance at 1 percent, 5 percent, and 10 percent levels, respectively. Gini−1, CCI, and CRI are assumed to be determined endogenously.
4.3 Can Citizens Limit Power? Corruption and Trust in Government
Corruption comes in many shapes and sizes, but an element common to most cases is an imbalance of power: those who have it exploit it for their own benefit, while those who do not endure the consequences. Thucydides (Reference Ratcliffe2018 ed.) said as much in his Melian Dialogue of 416 BCE: “Right, as the world goes, is only in question between equals in power, while the strong do what they can and the weak suffer what they must.”
To the extent that corruption is rooted in political power, it is hardly surprising that it can have important political outcomes of several sorts. It can create, perpetuate, and exploit inequalities, conferring advantages upon a few at the expense of the many while helping its beneficiaries entrench themselves and defend their gains. It can place immense stress upon legal frameworks, becoming so embedded in institutions and routine processes that it acquires a spurious sort of legitimacy. It can give rise to political resentments and contention; indeed, opposition to abuses of power and wealth is arguably what gives rise to the basic idea of corruption in the first place (Johnston, Reference Johnston2014: Ch. 1). Such reactions can be a democratizing and innovative force, spurring reform, toppling old regimes, and bringing new interests and viewpoints to power, but they equally may give rise to faux populism, scapegoating, demagoguery, and even repression. Patronage and clientelism can distribute short-term benefits – usually small or symbolic – to the have-nots, while extracting far larger costs in the long term by perpetuating dependency and elite domination. Cynical leaders may engage in covert corruption while publicly championing reform. Meanwhile, continuous allegations, and even solid evidence, of corruption may lead to “scandal fatigue,” distracting from deeper issues and draining energy away from more ambitious reform efforts.
There are likely to be almost as many political consequences of corruption as there are cases, but among the most important are those involving trust in government, in those who lead it, and in other citizens. Closely related is popular willingness to participate in politics. Both issues are critical to the viability, and vitality, of democratic life.
4.3.1 The Social Foundations of Politics
Democratic politics and institutions function best in a setting of limited, conditional trust and judicious skepticism with respect to both government and other people (for a classic account, see Lane, Reference Lane1962). Citizens who see their leaders break laws and enrich themselves at public expense – or who just believe such activities are commonplace – are likely to trust them less. Such trust can spill over into apathy or cynicism if people conclude that voting the scoundrels out, and political participation generally, is futile (de Sousa and Moriconi, Reference De Sousa and Moriconi2013) or that reform appeals serve mostly to distract attention from the crooks. Indeed, where corruption is perceived to be pervasive or where past reform efforts have failed, venal officials may enjoy an atmosphere of impunity.
Evidence from several countries, however, points to a variety of connections among corruption (both as perceived and as experienced), trust (in government and among citizens), and political participation – linkages that vary with contrasting contexts and can also reflect variations in research methods (Školnik, Reference Školnik2020a). Giommoni (Reference Giommoni2021) finds that exposure to news about corruption scandals tends to depress citizen participation in Italian municipal elections and discourages candidates from challenging incumbents, making it easier for the latter to retain their hold on office. Morris and Klesner (Reference Morris and Klesner2010: 1278), analyzing Americas Barometer data from Mexico, found “widespread perceptions of corruption, low levels of interpersonal and political trust, and some pessimism regarding the efforts of the government to address the problem.” While interpersonal trust was largely unrelated to more public aspects of the distrust-and-corruption connection in their findings, the data suggest that corruption contributes to a climate of opinion inhibiting reform mobilization. Školnik’s (Reference Školnik2020b) data from Colombia suggest that while perceptions of extensive corruption reduce citizen participation in many political activities, personally experiencing it produces an increase. In Senegal, by contrast, field experiments by Inman and Andrews (Reference Inman and Andrews2009) found that perceptions of corruption increased citizens’ likelihood of both voting and protesting. Olsson (Reference Olsson2014), using survey data from thirty-three countries, shows that corruption lessens citizens’ sense of political efficacy and thus reduces participation. Reciprocity – a sustaining factor in many accounts for strong civil societies and democratic accountability, and central to sustaining collective action (Ostrom, Reference Ostrom1998) – can in practice cut in two different directions depending upon institutional quality and levels of mutual trust:
… reciprocity tells us that if through the design of institutions we can make people trust that most other agents in their society will behave in a trustworthy and cooperative manner, they themselves will do likewise. If not, they will defect, even if the outcome will be a social trap type of situation and thereby detrimental to their interests.
Many of these connections make intuitive sense. But liberal democracy American-style may be particularly vulnerable on grounds of trust and participation – not just because of the scope of legal or “influence market” corruption the country seems to experience (see Chapters 1–3 of this book) but also with respect to citizens’ expectations regarding their place, and rights, in the system.
As Zakaria (Reference Zakaria1997: 25–26) observes, for a century and more liberal democracy (as against illiberal varieties offering elections but little else) has promised what he calls the tradition of “constitutional liberalism,” derived from the Greeks and Romans. It
… developed in Western Europe and the United States as a defense of the individual’s right to life and property, and freedom of religion and speech. To secure these rights, it emphasized checks on the power of each branch of government, equality under the law, impartial courts and tribunals, and separation of church and state.
Underlying that scenario is a grand social bargain that is both fundamental and surprisingly fragile. Liberal democracy, and in particular Americans’ idealized variant of it, does not promise results but is presumed to offer individual liberty and a voice in decisions affecting one’s life. Two aspects of that bargain that often receive relatively little discussion are important here. First, unlike social democracies, socialist, or nationalist systems – much less authoritarian regimes – outside of major national crises, American democracy asks relatively little of citizens. Loyalty to the constitution or political order is defined, on a day-to-day basis, in terms of compliance with laws and norms justified – ideally – as maintaining openness and fairness, not in terms of all-consuming loyalty to particular leaders, parties, or overarching national identity. Those loyalties are limited and conditional; citizens remain free to choose identities, religions, political parties, and lifestyles – in effect, free to be themselves within a broad and diverse social arena. Moreover, Americans are comparatively lightly taxed (OECD, 2022; Tax Policy Center, 2020) and – while not all might agree – lightly regulated, at least in their personal lives. In a system where individual liberty is so central, the importance of trust in that political order is clear. Second, and equally important, American democracy promises relatively little. The economy remains largely in private hands and is widely regarded as offering opportunities based on individual initiatives, but few if any ensured outcomes. Compared to many other affluent democracies, American governments provide only modest direct social benefits, and the public role in providing those that do exist – tax subsidies for home ownership, for example (Desmond, Reference Desmond2023), or Social Security as social insurance rather than as a personal savings program (Markowitz, Reference Markowitz2023) – is often de-emphasized or misunderstood. Inequalities in the economy are immense and continue to grow yet are tolerated in a normative climate where wealth is seen by many as an outcome of hard work and diligence in taking advantage of opportunities (but for a perspective on the growing tensions within that climate, see Hacker and Pierson, Reference Hacker and Pierson2020).
That American democracy rests in part upon longstanding myths yet falls short of its ideals in many ways is both true and, for our immediate purposes, beside the point. The ideas outlined earlier are widely accepted justifications for the system overall, not claims about day-to-day realities. They are also a shorthand version of values many Americans view as defining their role in the larger system – at the risk of overstating the point, as their democratic birthright.
4.3.2 Corruption and the Social Bargain
Corruption threatens to disrupt and discredit precisely those values. Recall Warren’s (Reference Warren2004) argument that in a democracy, the essence of corruption is the “duplicitous exclusion” of people from decisions that affect their lives and from the institutions and processes that are supposed to protect their liberties and individual dignity. The social bargain outlined earlier can be undermined in significant ways if people perceive that laws and institutions have been captured by others seeking, or already holding, unfair advantages, and that their opportunities to defend their interests have been taken away. If interpersonal trust is in a shaky condition, suspicions that others are seizing such advantages may become all the stronger, while expectations that others will cooperate in reform will likely suffer (“Why should I be the honest loser?”). Rothstein and Uslaner (Reference Rothstein and Uslaner2005: 53, and passim.) argue that inequalities – both material and of opportunity – undermine trust and weaken social capital and that “dishonest government undermines trust at least indirectly.”
These connections have found a definite place in the contemporary anti-corruption debate. Indeed, Transparency International (2022) builds its entire analysis on a definition of corruption as “the abuse of entrusted power for private gain.” That is a strong definition in terms of breadth, and because it highlights certain expectations between those with power and those without. It encounters serious problems, however, where power that has been inherited, bought, seized by violence, or otherwise not “entrusted” by anyone, as is often the case in seriously corrupt systems. Still, in the vast majority of instances we would call corrupt, someone has acted in untrustworthy ways, at least with respect to the broader public and its interests.
But corruption can also thrive when there is too much trust and vigilance is relaxed, when trust is uncritical, or where there is little or none. If I do not trust an official to follow the rules, I may try to buy some predictability, either from the official or via a seemingly helpful middleman (Khanna and Johnston, Reference Khanna and Johnston2007). Trust and the standards that flow from it can have strong situational aspects, as a Polish sociologist friend explained to one of us (Johnston) in connection with his youthful days working on a construction crew under the old communist regime. Theft of tools and materials was routine – almost expected – for if they belonged to the state, then they belonged to everyone, and if they belonged to everyone, then they belonged to no one. But when it emerged that one crew member had stolen from another’s personal stash, that was a very different thing, and direct measures were called for – probably after work, in a back alley.
Corruption can also underwrite a kind of in-group trust (You, Reference You and Uslaner2017: 476). Seeing another as predictably corrupt might be useful knowledge in some situations; alternatively, we might conclude that “He’s crooked but I can adjust our financial data and take that into account.” Corrupt group schemes (Gong, Reference Gong2002), or even just knowledge of them, can place people in shared jeopardy, creating interdependence or even a highly pragmatic kind of solidarity: consider the notion of “honor among thieves,” or the strong senses of obligation that can accumulate over time in a patronage network (Springborg, Reference Springborg1979). Political patronage or similar favors, when common enough to become a routine expectation, exemplify Axelrod’s (Reference Axelrod1990) well-known findings about repeated successful transactions as a source of trust. We might even imagine corrupt in-group trust eventually becoming a source of Putnam’s (Reference Putnam2000) “bonding” social capital.
There are broader systemic connections between corruption and trust, too. Democracy envisions citizens as formal equals but, as noted, often exists amid significant material and social inequalities, and vests control over resources in a few with the expectation that such authority will be accepted by the many. But if we believe adverse outcomes and events are the doing of corrupt officials or rigged procedures, democratic institutions and processes can become all but unworkable. As we may be seeing in contemporary American politics, such effects can be long-lasting, for trust is difficult to build and easy to destroy.
4.3.3 “Who Ya Gonna Believe? Me or Your Own Eyes?”Footnote 2
Globally, higher-quality governments tend to enjoy somewhat broader, if still limited and conditional, political trust (Uslaner, Reference Uslaner2017: 302; Rothstein, Reference Rothstein2011). Causality is complex because those governments are also more likely to have resources, institutions, and political support that help sustain good policy and implementation. The United States, thanks to a history of generally sound public institutions (but on their recent effectiveness, see Fukuyama, Reference Fukuyama2014), long enjoyed solid if not overwhelming public trust. But that is no longer the case: according to Pew Research, while 77 percent of poll respondents in October 1964 said they “trust the government in Washington to do what is right ‘just about always’ or ‘most of the time,’” by May 2022, after nearly six decades of mostly-declining trust, that figure had dropped to 20 percent (Pew Research, 2022). By comparison, when in 2020, Ipsos (2022) asked a comparable question about government trust in the thirty-seven countries that were Organisation for Economic Co-operation and Development (OECD) member states at that time, just short of 46 percent overall expressed trust in their national governments.
It would be a mistake to exaggerate levels of trust in the past, or to attribute the recent decades’ decline solely to corruption (for a partial dissent see Uslaner, Reference Uslaner2017: 303) or to any other single cause. Inequality, domestic tensions, and a generalized sense of unfairness in society can also weaken trust (Uslaner, Reference Uslaner2017: 302–303, 305), as can policy issues as diverse as border protection and government aid for various segments of the population. Specific events have interrupted the decline at times: trust in government enjoyed a marked, if brief, increase to 60 percent in the wake of the terrorist attacks of September 11, 2001 (Pew Research, 2022). Finally, trends in trust may well be influenced by the sharply contrasting worldviews on display in various news media. As You (475) notes, few of us have a clear idea of how much corruption actually occurs; We depend for that upon the news media, yet their reporting is also shaped by financial and, increasingly, partisan considerations.
4.3.4 Do We Trust Each Other?
Interpersonal trust is part of this picture too. Trust among neighbors and people we encounter in everyday life is an essential part of social capital, which in turn figures prominently in most discussions of collective action (Putnam, Reference Putnam2000; You, 479). As noted, if I do not trust my fellow citizens, I am more likely to look askance at any advantages they gain and at any anti-corruption commitments they proclaim, particularly if their schemes require me to forgo benefits of my own. Adding to the complexity, our earlier discussions of state political cultures suggest that we might well find substantial contrasts in mutual trust between, say, Moralistic and Individualistic states.
Measuring interpersonal trust, however, can be complicated. Since the late 1950s, many pollsters have at least occasionally asked respondents some variation on the following question: “Generally speaking, would you say that most people can be trusted or that you need to be very careful in dealing with people?”Footnote 3 (Ortiz-Ospina and Roser, Reference Ortiz-Ospina and Roser2016). That question has often been criticized – some might say the two statements are simultaneously true – but it has been used in surveys for a long time in part because it has been used in surveys for a long time, creating an extended time series. If we take that sort of item as a benchmark, the United States emerges with middling or slightly better scores: An early 2022 survey of thirty countries found 33 percent of American respondents said most people can be trusted, compared to 11 percent in Brazil, 47 percent in Norway, and 56 percent in both India and China (IPSOS, 2022). A broader cross-section based on World Values Survey data showed that in 2014, 38.2 percent of US respondents said most people can be trusted, much the same as the result for 1998 (39.6 percent). At the top of the table in 2014 were The Netherlands at 66.2 percent, Sweden (63.8), and China (62.7),Footnote 4 and on the lower end were the Philippines (2.8 percent), Trinidad and Tobago (3.2), and Colombia (4.1) (Our World in Data, Reference Ortiz-Ospina and Roser2023). Many of the most apparently trusting countries – for example, the Netherlands and Sweden – score well on corruption and procedural fairness indices too (Uslaner, Reference Uslaner2017: 304; Grimes, Reference Grimes, Zmerli and van der Meer2017) but, as the example of China shows, that pattern has some striking exceptions.
Overall, the United States may not be experiencing a comprehensive crisis of trust: while political trust is in sad shape, interpersonal trust is at least moderately intact. But what do we find at the state level?
4.3.5 Empirical Analysis
Connections between trust and corruption are not limited to law-breaking by public officials. Particularly when we consider Warren’s argument regarding “duplicitous exclusion,” they are shaped by citizen expectations regarding their place and rights in society and by their perceptions of the political and social clout of money and elite privilege. A 2015 Rutgers-Eagleton Poll of 843 adult respondents in New Jersey,Footnote 5 for example, found 54.8 percent strongly agreed, and 24.3 percent somewhat agreed, with the statement: “When it comes to politics, people like me get overruled by the big campaign contributors.” Among those strongly agreeing, 42.1 percent strongly disagreed with the statement that “today’s economy offers most people a fair chance,” and another 23.2 percent somewhat disagreed. In that same survey, 56.7 percent strongly agreed, and 19.6 percent said “somewhat agree,” with the statement: “More and more there is one set of rules for the rich, and another for the rest of us.” A May 2015 The New York Times surveyFootnote 6 found that just 31 percent of adults agreed that “all Americans have an equal chance to influence the elections process,” while 66 percent (and 55 percent of Republicans) said “wealthy Americans have more of a chance.” In the same survey, 55 percent said “candidates who win public office promote policies that directly help the people and groups who donated money to their campaigns” “most of the time,” and 30 percent responded “sometimes”; only 13 percent said “rarely” or “never.” A 2019 poll found 82 percent saying “large corporations,” and the same percent saying “people who are wealthy,” have “too much power and influence in today’s economy” (Pew Research, 2020). Those are an important qualification upon the country’s favorable whole-country corruption index scores (see Chapter 1 of this book) and suggest that assessments of American corruption must include more than outright bribery. They also underline the importance of cases such as that of Clarence Thomas, the most senior Justice on the United States Supreme Court in terms of time served, whose rewarding relationships with a Texas billionaire have raised concern among many citizens (Robin, Reference Robin2023; Pilkington, Reference Pilkington2023).
To investigate relationships between corruption and trust in government in greater detail and to emphasize the diverse influences identified in Chapters 1–3, we focus now on the fifty states using data from the 2016 Cooperative Congressional Election Study (Milyo, Reference Milyo2019). Respondents were asked, “How often can you trust your state government to do what is right?” We assign a score of 1 for “hardly ever,” 2 for “some of the time,” 3 for “most of the time,” and 4 for “just about always.” According to that survey, trust in state governments is unimpressive at best, as 73 percent of the respondents chose “hardly ever” or “some of the time.” Only 3 percent responded “just about always.”
What factors help account for such low levels of trust? We estimate a multilevel regression (Table 4.3) with ordered probit controlling for respondents’ demographic characteristics and their ideological beliefs. The CCI is our corruption measure, and because there is an unknown time lag between corrupt actions and convictions, we use five-year moving averages. We start by estimating a parsimonious model of trust with CCI as the only independent variable and end with a comprehensive model including, inter alia, income inequality by state, an important variable affecting trust in government in previous studies (see, e.g., Uslaner, Reference Uslaner2017).
Table 4.3 Corruption and trust in state government: ordered probit estimation (dependent variable: Trust in state government)
| 1 | 2 | 3 | |
|---|---|---|---|
| Log CCI | −0.209 (0.094)Footnote ** | −0.208 (0.098)Footnote ** | −0.212 (0.097)Footnote ** |
| Liberal Respondent | −0.186 (0.09)Footnote ** | −0.197 (0.088)Footnote ** | |
| Liberal Governor | −0.304 (−0.098)Footnote *** | −0.343 (0.102)Footnote *** | |
| Liberal Respondent * Liberal Governor | 0.940 (0.162)Footnote *** | 0.959 (0.169)Footnote *** | |
| Age | −0.007 (0.002)Footnote *** | −0.007 (0.002)Footnote *** | |
| Female | −0.155 (0.069)Footnote ** | −0.161 (0.069)Footnote * | |
| White | −0.140 (0.083)Footnote * | −0.122 (0.080) | |
| Postgraduate | 0.185 (0.112)Footnote * | 0.184 (0.106)Footnote * | |
| Log Top5 | −0.268 (0.118)Footnote ** | ||
| Log Top52 | 0.038 (0.017)Footnote ** | ||
| N | 1,011 | 1,011 | 1,011 |
| Pseudo R2 | 0.03 | 0.03 | 0.03 |
Standard errors are given parentheses.
* , **, and *** represent significance at 0.10, 0.05, 0.01 levels, respectively.
The estimated coefficient of CCI is negative and statistically significant in all estimations, indicating that people are less likely to trust their state governments where corruption is more common. The signs of the estimated coefficients of the control variables are mostly consistent with previous studies such as Wolak (Reference Wolak2020). As income inequality, measured as the income share of the top 5 percent in a state, increases, trust in government decreases, albeit at a decreasing rate. Older people and women are less likely to trust their state governments, taking the other independent variables into account. People who define themselves as liberal are more likely to trust their state governments if they also regard the governor of their state as liberal. Finally, trust in state government is likely to be higher among people who have a postgraduate degree.
The overall picture emerging from Table 4.3, as in our earlier discussions, is that trust in state governments reflects a range of influences, much as we would expect, but can be significantly disrupted by corruption. Given the fact that on any given day citizens are more likely to interact with state agencies and authorities (and with the local governments the states charter and regulate) than with their federal counterparts, these are important findings. We will say more about the implications of that finding later, and in Chapters 8 and 9.
4.4 Corruption and Voter Participation
Given the importance of state government and the disruptive potential of corruption, will citizens respond to it by political means? The earlier data point to a pessimistic initial assessment. But to investigate the effects of corruption on voter participation in more detail, we use data from general elections between 1984 and 2016 to estimate an Arellano–Bover/Blundell–Bond type System GMM regression controlling for lagged voter participation, as well as for state and time fixed effects. Because variables such as voter participation represent individual preferences, voter participation in general elections in any year (e.g., 2016) is expected to be a function of voter participation in previous elections (e.g., 2012). Without the lagged dependent variable, the independent variables we use, such as ideology, population, and population density, would be assumed to represent the full set of information that explains the dependent variable. With the lagged dependent variable, on the other hand, we control for the entire history of the independent variables so that any effect is conditioned on this history. In other words, any effect of a right-hand side variable represents the effect of new information.
The results of the estimation are given in Table 4.4. We measure participation as the share of people in a state’s voting-age population who voted in a general election. Our corruption measure is again the five-year moving average of CCI. According to our results, there is indeed a negative relationship between corruption and voter participation in a state. Regarding the control variables, we find that participation is higher in densely and highly populated states. Some commonly used control variables such as per capita GDP, income inequality, poverty, and education were not statistically significant, possibly due to the presence of the lagged dependent variable, and hence were excluded from the regressions.
Table 4.4 Corruption and voter participation: Arellano–Bover/Blundell–Bond system GMM estimation (dependent variable: Voter participation)
| 1 | 2 | |
|---|---|---|
| Voter Participation−1 | 0.932 (0.082)Footnote *** | 0.957 (0.057)Footnote *** |
| Log CCI | −0.016 (0.008)Footnote ** | −0.013 (0.007)Footnote * |
| Log Ideology | 0.107 (0.034)Footnote *** | |
| Log Ideology2 | −0.015 (0.005)Footnote *** | |
| Log Population | −0.013 (0.006)Footnote ** | |
| Log Population Density | −0.034 (0.017)Footnote * | |
| Log Population * Log Population Density | 0.003 (0.001)Footnote ** | |
| N | 400 | 400 |
| Autocorrelation Tests | ||
|---|---|---|
| Arellano-Bond AR(1) z p value Arellano-Bond AR(2) z p value | −4.33Footnote *** 0.000 1.49 0.135 | −4.46Footnote *** 0.000 1.73Footnote * 0.084 |
| Overidentification Tests | ||
|---|---|---|
| Hansen χ2 p value | 0.022 30.81 | 0.047 37.46 |
Standard errors (clustered at the state level) in parentheses. All models control for state and time fixed effects.
*** , **, and * represent statistical significance at 1 percent, 5 percent, and 10 percent levels, respectively. Voter Participation−1 and log CCI are assumed to be determined endogenously.
Finally, we find a somewhat surprising result regarding ideology and voter participation, supporting Plane and Gershtenson (Reference Plane and Gershtenson2004). Using the State Ideology Index constructed by Berry et al. (Reference Berry, Ringquist and Fording1998, Reference Berry, Fording and Ringquist2010, Reference Berry, Fording and Ringquist2013), we find that voter participation, after taking corruption into account, is maximized in states in which voters are “centrist.” Perhaps centrist states have more balanced and competitive party systems making it more likely that corrupt events will be raised as campaign issues, and offering voters ready alternatives to their current elected officials. Also, while we cannot use group data to make claims about individuals (Robinson, Reference Robinson1950), it is tempting to speculate (pending more appropriate data) that more centrist voters are less bound to their current state political regimes and officials and, therefore, more open to respond to corruption by turning out to vote, and by reconsidering their previous allegiances. Consistent with that sort of interpretation is the finding (Keith, Reference Keith1992) that while “leaners” (voters who lean toward one party or another without fully identifying with it) are strongly critical of the parties they lean against, they also tend to be at least somewhat critical of the party they lean toward (Pew Research, 2017) – creating, perhaps, a pool of voters who will respond to corrupt dealings by turning out to vote. As noted, any such interpretations remain hypotheses at best; moreover, we do not know whether reports of corruption are widely believed and by whom, how state political cultures influence the sorts of corruption that are regarded as serious, whether voters turn out in an effort to “throw the scoundrels out,” or whether they might even back accused incumbents on grounds of distrusting opposition politicians or the press. Still, setting all those interpretations to one side, we can make a case that corruption, as measured by convictions, can disrupt politics as usual at the state level, both in terms of citizen participation and – perhaps more important for the long run – in terms of its effects upon essential levels of citizen trust.
4.5 Corruption and Democratic Distemper
The importance of these findings, and of the further questions they raise, should not be underestimated. The sheer size of some states and their governments and the collective national impacts of all fifty states in terms of spending and employment make citizen trust and participation at the state level key variables in any assessment of American corruption and democracy.
In 1932, Justice Louis Brandeis famously argued that the states can be “laboratories” of democracyFootnote 7 where new ideas and policies can emerge, be implemented and tested, and have a chance to earn public confidence and support. Elazar (Reference Elazar1984) has made a similar argument regarding the states as civil societies. To those notions, we might add the Supreme Court’s recent attempts to delegate major and controversial social questions such as abortion to the states, and its trust – not shared by all – that state political systems will handle such issues in democratic and accountable ways. We could be forgiven, in a time when several states are working hard to restrict voting, intervene in the substance of education, and defend heavily gerrymandered representation (Chandler, Reference Chandler2023), for thinking Brandeis’s assessment is overoptimistic. There is no guarantee that states will maximize democracy or actively contribute to a flexible, innovative national system of federalism even in the best of times, but if corruption significantly impairs trust and participation in their politics, local interests and political divisions could make such positive contributions even less likely. At the very least, the distinctive influences shown in our data as shaping the incidence and significance of corruption at the state level, and state-by-state variations in the extent and institutional locations of both legal and illegal corruption, suggest that the states will vary considerably in the ways they participate in the federal system.
Worse yet, public awareness and civil-society monitoring of corruption issues are weakened considerably by the decline of local journalism – particularly, of newspapers, which traditionally have played a critical role in covering state and local politics. Not only might that trend make it less likely that state and local corruption and misrule will come to light and be analyzed in depth (Gao, Lee, and Murphy, Reference Gao, Lee and Murphy2018), it also contributes to an unfortunate “nationalization” of politics in which state and local events and decisions are increasingly seen merely as extensions of controversies, personalities, and outcomes at the national level (Bump, Reference Bump2023). Not only are critically important governments, their policies and implementation processes, and their capacity for earning popular trust vulnerable to disruption because of corruption; corrupt processes and their contribution to general democratic decay may increasingly be taking place beyond the public’s view.
5.1 Introduction
Corruption and racism are conceptually distinct pathologies, but in practice they can entwine in ways that are deeply unjust, difficult to alleviate, and – as we shall see – can be fatal. This chapter examines some of the connections between structural corruption, as outlined in Chapter 1, and the concepts of structural or institutional racism (sometimes subsumed under the term “critical race theory”) that have become more relevant, compelling, and controversial in recent years (Iati, Reference Iati2021; Sawchuck, Reference Sawchuck2021; Mandavilli, Reference Mandavilli2021). Not only are corruption and racism fundamental moral and ethical concerns in the United States, but also they are embedded in powerful institutions; in enduring characteristics of states, localities, and their political and social makeup; and in past and current public policy. Influences such as political culture; affluence, poverty, and their distributions across society; and patterns of distrust, racial segregation, and party competition, to name some prime examples, reflect and perpetuate the imbalances of power at the heart of corruption and racism both.
Now we consider one tragic manifestation of the corruption-and-racism nexus: police killings of Black Americans. (In a later chapter, we consider the disproportionate effects of the COVID pandemic upon Black communities in the context of corruption issues in public health.) We will show that while it is hardly the sole cause of those killings, structural corruption – like structural racism, a matter not only of everyday interactions but also embedded in longer-term characteristics of states, localities, institutions, and public policies – contributes to police killings in distinct and demonstrable ways.
5.2 Enforcement, Violence, and Control: Police Killings of Black AmericansFootnote 1
The tragic killing of George Floyd, a Black American, by Minneapolis police during a May 2020 arrest caused major protests that spread from that city across America and into over fifty other countries. The fatal police beating of Tyre Nichols in Memphis in January 2023 kept the issue of police brutality against Black Americans at the forefront of the national agenda. In the wake of those events, and the earlier deaths of Breonna Taylor inside her Louisville home, Michael Brown in Ferguson, Missouri, and Eric Garner in New York City – among others – we must ask why so many Black Americans are killed by the police.
Our evidence suggests that police can kill Black Americans, often with impunity, because of a lack of accountability and impartiality, of which corruption is both a cause and a symptom. We do not focus here upon individual cases. Rather, we are concerned with the ways a problem that is national in scope is embedded in the politics, economics, and demographics of the communities and states within which it occurs. Examining police killings of Black Americans in that wider context is emphatically not to normalize, much less excuse or justify, police violence. It is, instead, a way to challenge the argument that such killings, like corruption, are the work of a few “bad apples” in otherwise well-functioning institutions. Our findings point to ways in which the responsibility for police killings is deeply rooted in the values of the wider society.
5.2.1 Police and Society
Sarat et al. (Reference Sarat, Douglas and Umphrey2011) characterize the law as a means of punishment and of regulation. Therein lies a chronic hazard: laws would seem to have little value in either sense unless backed up by coercion or its credible threat, and yet that coercion itself must be regulated by law. Punishments are difficult to regulate, for reasons ranging from the ways police encounters often take place (outside of public view, in situations marked by confusion, vulnerability, and ambiguity) to the human failings and outright biases of those responsible for enforcement. All too often the measured and proportional application of coercion gives way to violence – or death. Similarly, maintaining necessary social order can easily give way to social control of more sinister sorts, including, but hardly limited to, the perpetuation of class, racial, and other inequalities, and the imposition of political, policy, and cultural preferences, again facilitated by coercion. What constitutes excessive force by police is a controversial issue. Killings, by tragic contrast, are unambiguous outcomes, and we have data on their occurrence. Those data, in turn, are indicators of a larger dilemma – one our analysis seeks to draw out by emphasizing a range of possible causes.
Using annual data from fifty states covering the period between 2013 and 2019, we find a positive relationship between corruption and police killings that remains robust when alternative influences are taken into account. We discuss, first, the channels through which corruption and other political variables – political culture, party competition, ideology, and the power of special interest groups – could affect police killings of Black Americans. We then describe our data, methodology, and results and examine important issues raised by the research.
5.2.2 The Thin Blue Line?
Civilians’ risk of being killed by police in America is considerably higher than in similar countries, but for Blacks, the risk is approximately three times higher than for Whites (Buehler, Reference Buehler2017; DeGue et al., Reference DeGue, Fowler and Calkins2016). The American Public Health Association (APHA) argues that even when no one has been killed, the extended consequences of police violence include mental and physiological harm disproportionately affecting Black individuals and communities and their ability to achieve positive health outcomes (APHA, 2018; see also Alang et al., Reference Alang, McAlpine, McCreedy and Hardeman2017; Sewell, Reference Sewell2017; Bor et al., Reference Bor, Venkataramani, Williams and Tsai2018; Das et al., Reference Das, Singh and Kulkarni2021).
Social scientists in several disciplines have investigated these issues from the standpoint of conflict theory, racial threat hypotheses, and a range of demographic and economic variables (see, e.g., Tolliver et al., Reference Tolliver, Hadden and Snowden2016; Edwards et al., Reference Edwards, Esposito and Lee2018; and Moore et al., Reference Moore, Robinson and Clayton2018). Racial diversity and segregation are consistently found to be important factors explaining variations across counties, cities, and states in police killings of Blacks (Nicholson-Crotty, Nicholson-Crotty, and Fernandez, Reference Nicholson-Crotty, Nicholson-Crotty and Fernandez2017; Johnson et al., Reference Johnson, Vil and Gilbert2019). Size of the Black population and the degree of segregation in a community are positively related to police killings of Blacks, pointing to racial bias, be it explicit or implicit (Siegel et al., Reference Siegel, Sherman and Li2019; Mesic et al., Reference Mesic, Franklin and Cansever et al.2018). Experimental evidence shows that being Black is strongly associated with others’ perceptions of threat (Eberhardt et al., Reference Eberhardt, Goff, Purdie and Davies2004) and affects police decisions to shoot (Correll et al., Reference Correll, Park and Judd2002, Reference Correll, Park and Judd2007). Class conflict is important as well (Jacobs and O’Brien, Reference Jacobs and O’Brien1998); according to Blalock (Reference Blalock1967), Turk (Reference Turk1966), and Quinney (Reference Quinney1970), poor people are more likely to be perceived as threatening. The more economically unequal the society, the greater the likelihood that dominant interests enforce their control through coercion (Chambliss and Seidman, Reference Chambliss and Seidman1982). Coercion is a key factor sustaining de facto systems of order in unequal societies (Jacobs and Britt, Reference Jacobs and Britt1979).
The role of police in maintaining such hierarchies is exemplified in many ways. During his 2015 presidential campaign, Donald Trump referred to the police as “the force between civilization and total chaos” (Chammah and Aspinwall, Reference Chammah and Aspinwall2020). Such “thin blue line” imagery is particularly powerful for some: black-and-white American flags with a blue line dividing an upper segment from the lower were displayed by white supremacists during the 2017 “Unite the Right” march in Charlottesville, Virginia, and are a common sight elsewhere. Defenders of the symbol describe it as only expressing respect for law enforcement, but others see it as symbolizing the police as a force suppressing a segment of society, or as openly racist (Chammah and Aspinwall, Reference Chammah and Aspinwall2020). Whatever one’s interpretation, there is no doubt that deeper questions of race, justice, accountability, and the proper role of coercion are embedded in controversies regarding law enforcement in America.
5.3 Political Determinants of Police Killings
Policing in America is generally regarded as a local government function: police departments’ jurisdictions usually follow municipal or county lines, and local governments play a major role in funding police budgets, selecting leadership, and (subject to Civil Service laws) recruiting the rank-and-file. Crime and law enforcement issues figure prominently in local politics, and former police officers often run for, and win, elective offices. But less widely recognized is the fact that under the Tenth Amendment to the US Constitution, in all but a few instancesFootnote 2 local police departments exercise the police powers of the states. Those powers are subject to both legal and constitutional limits, but typically, like the existence and functions of local governments themselves, are matters in which the states may intervene at their pleasure. Even “home rule” localities are merely exercising such expanded discretion as their states may allow.
Thus, state laws, politics, and social values play major political as well as legal roles in empowering and defining the limits of local police. For much of the nation’s history, the politics and legislatures of many states have been dominated by rural and/or suburban interests hostile to cities (Graham, Reference Graham2017; Gamm and Kousser, Reference Gamm and Kousser2013). In recent years, those groups have if anything become more assertive and more willing to preempt local decisions (Boso, Reference Boso2019; Fowler and Witt, Reference Fowler and Witt2019). Both recent police killings and mass responses to them have exacerbated those political frictions. In Texas, for example, several legislators have proposed laws that would withhold significant funding from any municipality that “defunds the police,” as defined by various standards or declared by the Governor (Knight, Reference Knight2021). The Governor himself has gone even further: his proposal would require, inter alia, a de-funding city to allow any area annexed in the previous thirty years to hold a de-annexation referendum (Engel, Reference Engel2021). In Texas’s rapidly expanding urban areas such a process might amount to a dismemberment of the city.
Daniel Elazar (Reference Elazar1984), whose analysis of states’ political cultures we will consider later, has argued persuasively that the American states are civil societies in their own right. Local governments are immersed in those civil societies through their histories, politics, economies, mass media ecosystems, and popular images. The claim here is not that states and their local governments are sui generis, but rather that which state one lives in can affect local processes and outcomes in many ways. Similarly, we do not suggest that state-level influences upon localities are devoid of internal contrasts, tensions, and contradictions. Far from it: quite a few American states are more populous, larger in area, and more socially diverse than many other countries. Their political arenas, while usually not as fragmented or competitive as the federal system as a whole, encompass many contentious interests and values. Moreover, as civil societies, the states are exposed to differing economic, political, demographic, and technological trends and stresses. How the states reconcile diverse pressures and demands, how people and groups interact with each other, what values and traditions are seen as justifying a state’s social order (a potentially crucial consideration in racial terms), and how such political controversies and settlements can affect local policing will be central concerns in our discussion of political culture. That in turn is just one of several possible political factors influencing the pattern of police killings of Black Americans.
5.3.1 Corruption
Corruption, particularly of the structural sort, is not merely a matter of misconduct by individuals. Rather, it is a manifestation of broader “bad governance” in public institutions (Rose-Ackerman and Palifka, Reference Rose-Ackerman and Palifka2016). According to Rothstein and Teorell (Reference Rothstein and Teorell2008), “good governance” requires political equality on the input side to be complemented by impartiality on the output side of the political system – that is, in the exercise of authority. Rose-Ackerman and Palifka (Reference Rose-Ackerman and Palifka2016) argue that “good governance” requires accountability as well. Corruption impedes both accountability and impartiality in public institutions including police departments, and thus could contribute to police killings of Blacks.
When corruption takes hold, the uses of police powers – including coercion – can become more arbitrary, negotiable, and discriminatory in ways that reflect officers’ own interests and preferences, not the law and justice. According to the Mollen Commission, formed to investigate New York Police Department (NYPD) corruption in the early 1990s, police corruption and police violence often go hand in hand. Comparing a sample of 234 problem officers that NYPD selected based on corruption allegations and comments from field commanders to a random sample of 234 officers from similar commands, the Commission found that the officers alleged to be corrupt were over five times as likely to have five or more unnecessary force allegations against them than the officers from the random sample group (Mollen Commission, 1994, 46).
Lack of impartiality in the form of racial bias, explicit or implicit, is a major problem in many police departments. Over the last two decades, law enforcement officials with alleged connections to white supremacists have been exposed in many states (German, Reference German2020). Implicit bias is harder to show, but experimental studies (e.g., Correll et al., Reference Correll, Park and Judd2007; Sadler et al., Reference Sadler, Correll and Park2012) find evidence of bias against Blacks among police stemming from implicit attitudes and stereotypes. Compounding those problems is that police are rarely held accountable for their actions. Although approximately 1,000 police killings are reported each year in America, as of 2021, only 139 police officers had been arrested since 2005 for murder and manslaughter – a 1 percent arrest rate. Of those 139 officers, only forty-four (with forty-two cases still pending in 2021) were convicted, with most convictions coming on lesser charges, and some serving no prison time (Lopez, Reference Lopez2021). With little or no accountability and impartiality, the police can become a powerful force not only in themselves but for themselves, fostering an us-versus-them mentality. Based on data from two million 911 calls in two cities, Hoekstra and Sloan (Reference Hoekstra and Sloan2022) find that while White and Black officers dispatched to White and racially mixed neighborhoods fire their guns at similar rates, White officers are five times more likely to fire their guns when they are dispatched to predominantly Black neighborhoods.
Bad policies led by bad governance only exacerbate the problem. Since the 1990s, police departments in many cities have implemented variants of the policy known as “broken windows” policing, encouraging aggressive enforcement against minor offenses. That strategy has eventually morphed into “quota-based” policing. Arrest and ticket quotas are informal, and even illegal in several states, but they exist. A 2015 lawsuit filed by a group of police officers claimed that members of the NYPD were coerced into targeting Black men to fulfill their arrest quotas (Goldstein and Southall, Reference Goldstein and Southall2020). In 2019, three officers, including a police chief, in Florida were sentenced to prison for falsely arresting Black men in order to keep their department’s burglary clearance rate at 100 percent. Such policies have caused the number of contacts – often physical – between police and Black Americans to increase, increasing the likelihood of more deaths of Blacks. George Floyd, for example, was accused of passing a bad $20 bill, while Eric Garner was suspected of selling cigarettes illegally on a street corner.
5.3.2 Political Culture
We would expect social values to influence the laws, the social order police are expected to uphold, and the powers and limits – both intended and actual – shaping their conduct. To incorporate those values into our analysis, we draw upon Elazar’s (Reference Elazar1984) typology of American political subcultures. Elazar, as noted in Chapter 3, classified the states by three political subcultures or combinations among them: Moralistic (M), Individualistic (I), and Traditionalistic (T).
Elazar’s view of states as civil societies is important here. Political culture as an attribute of a civil society is not merely an overall balance of public opinion, much less a harmonious consensus. Rather, it is a dynamic but lasting pattern of relationships among segments of the population and the wider society. Internal diversity is a fact of life in most states but its significance, and how a state deals with it, is part of what Elazar’s theory compares and contrasts. A state’s political culture is not a matter of formal agreement; indeed, it is unlikely to be fully spelled out anywhere nor be consciously articulated by anyone. It is more a set of longstanding, overarching beliefs about what the civil society is; what defines and justifies relationships among government, public interest, and self-interest; acceptable tactics and limits of political contention and social competition; and expectations regarding the ways people will deal with each other. Larger and more diverse states can reflect a mix of political cultures, and social change may gradually reshape the political culture over the long term. Moreover, segments of the population may well dissent from the dominant settlement – sometimes, sharply. Thus, a state’s law enforcement and policing, involving as they do the implementation and defense of laws, policies, underlying values, and visions of the social order, will be the focus of strongly held – at times, clashing – values, aspirations, and fears. States embodying contrasting political cultures deal with those internal issues in distinctive ways, as we shall see.
A focus on state political cultures in a discussion of killings by police may strike many as misguided, particularly when the scheme dates back to the 1960s and characterizes states based on migration and settlement patterns in the late 1800s and early 1900s. Elazar makes it clear, however, that American states as civil societies have longstanding and distinctive histories, value systems, and responses to change. Moreover, as local police forces exercise powers delegated by their respective states, they are at least theoretically accountable to state laws, and routinely deal with people and expectations originating well beyond the city limits. Those expectations can vary significantly: according to a recent report by Amnesty International (2015), only eight states require that a warning be given (where feasible) before lethal force is used, and no state meets the requirement for a warning under international standards. Moreover, none of the states’ “use of lethal force” laws include accountability such as obligatory reporting for the use of force and firearms by law enforcement officers.
In the absence of mandated standards governing the use of force, we might well expect local values, traditions, and political dynamics to play a critical role in shaping police behavior. As for the time dimension, a strength of Elazar’s scheme is that it spells out influences that are deeply rooted, slow to change, and reflect long-term influences upon matters of current concern – a key issue when considering systemic racism and corruption. Political cultures are integral to the systems of social order police are expected to maintain, and it seems more likely they would be widely expected to moderate major social change (hence, the “thin blue line”) than to facilitate it.
5.3.3 Political Ideology
Political culture is not the same as political ideology. As Fisher (Reference Fisher2016) argues, states exhibiting any of the three political cultures can be either liberal or conservative or some mixture of both. Utah, for example, is a moralistic state, as is Minnesota, but while Utah is one of the most conservative and Republican states, Minnesota is liberal and Democratic.
According to social dominance theory (Sidanius and Pratto, Reference Sidanius, Pratto, Sniderman, Tetlock and Carmines1993), conservatism and racism are correlated because both seek to uphold the superiority of one group over others. Social dominance theory views all societies as group-based hierarchies in which at least one dominant group enjoys a disproportionate share of positive social value (e.g., wealth, health), and at least one subordinate group endures a disproportionate share of negative social value (e.g., incarceration). Politics becomes an exercise in intergroup competition over scarce resources, with political ideology supporting claims upon these resources (Sidanius et al., Reference Sidanius, Pratto and Bobo1996). Liberals, by contrast, tend to be more sensitive to, and upset by, inequality than conservatives (Napier and Jost, Reference Napier and Jost2008; Jost et al., Reference Jost, Federico and Napier2009), which helps explain why liberals are more likely than conservatives to perceive racism as a problem (Cooley et al., Reference Cooley, Brown-Iannuzzi and Cottrell2019). Not surprisingly, there is also a big divide between liberals and conservatives in how the police are perceived. According to a Cato Institute survey, Democrats (40 percent) are about half as likely as Republicans (78 percent) to believe the police are impartial. Some 80 percent of Republicans believe that police only use lethal force when necessary, while 63 percent of Democrats believe police are too quick to use it (Ekins, Reference Ekins2017). Quite apart from the attitudes of police officers themselves, ideology seems likely to influence the ways the police and their conduct are perceived, as well as community expectations and responses integral to encounters with the public.
5.3.4 Special Interest Groups: The Influence of Police Unions
Police cannot police themselves, and ordinarily will not be policed by civilian elected officials, for familiar reasons including their effective monopoly on legitimate coercion in most situations and the us-versus-them outlooks noted already. But another major factor contributing to weak police accountability has only come in for public debate relatively recently. That is the way police unions push back in almost every state against laws intended to hold police accountable and the influence they exercise in prosecutorial and other local and state elections via contributions and endorsements. Officers who see themselves as beyond the control of civilian officials, and who view prosecutors as reliable allies, may be less constrained by restrictions on the use of force. While police are theoretically accountable to elected officials in their jurisdictions, if they are not just a political force in themselves but a force for themselves such accountability may be weak. When district attorneys run for office, they often get donations and public backing from powerful police unions representing the officers they are supposed to prosecute in the event of misconduct. District Attorneys are not the only ones receiving donations from police unions. According to a report published by Campaign Zero, a police reform group launched in 2015, over a ten-year period Governor Jerry Brown and 118 of California’s 120 state legislators received contributions from police unions (Campaign Zero, 2018). In 2016, a bill that would have allowed public access to police misconduct records was killed in that state’s Senate Appropriations Committee (Thompson, Reference Thompson2016). In New York, it took almost a decade and the killing of George Floyd to repeal Section 50A of New York’s Civil Rights Law, which exempted police misconduct records from disclosure under the state’s open records law. In recent years, police unions spent more than $1 million supporting vulnerable incumbent legislators who opposed the repeal. In more than two-thirds of the states, a police officer’s disciplinary history is mostly unavailable through public records requests (Barkan, Reference Barkan2020). Indeed, fourteen states have “police bill of rights” laws giving special protections to police officers under investigation for misconduct (Campaign Zero, 2018).
5.3.5 Political Party Competition
Political parties offer special interest groups access to policymaking in exchange for their support, typically in the form of campaign contributions and endorsements. While competing with each other in some respects, parties have issues they “own” in the sense that voters consistently consider one better than others at dealing with those issues (Otjes and Green-Pedersen, Reference Otjes and Green-Pedersen2019). While the Republican Party is known as the “party of law enforcement,” Democratic Party is known as the “party of labor.” Republicans oppose unions in the public or private sector unless they represent the police – because police tend to vote Republican and the union is an effective way to mobilize them. Thus, police unions differ from the rest of the labor movement; they rely on the conflict symbolized by the “thin blue line” rhetoric and view themselves as police first, with other issues being secondary. Even their terminology differs: they are generally called “associations,” not “unions,” and their chapters are usually called “lodges,” not “locals” (Williams, Reference Williams2015). Most are not affiliated with the nation’s major labor federations: the International Union of Police Associations (IUPA), for example, is the only police union affiliated with the AFL-CIO. Nevertheless, IUPA is very influential. For example, while one AFL-CIO union passed a resolution urging that IUPA be disaffiliated after the killing of George Floyd, the move was rejected by the larger Federation: because of the continuing decline of unionization in America, the AFL-CIO could not afford to lose any members (Kelly, Reference Kelly2020). Similarly, the Democratic Party could not afford to lose police union support; while Democrats want police reform, as the “party of labor,” they also support public sector unions, including police unions. Moreover, neither party can afford to be viewed as “soft on crime.” In these ways, police unions have accumulated significant influence in both political parties.
Via public endorsements, campaign contributions, and personal connections, police unions can build lasting political relationships in either party, weakening pressures for accountability. From the unions’ point of view, such relationships reflect important long-term political investments – relationships expected to withstand short-term controversies. In more competitive states, both parties will compete for police unions’ support. In Illinois, for example, Rahm Emanuel, then the Democratic Mayor of Chicago, did not mind picking a fight with the Chicago Teachers Union but took care to maintain a friendly relationship with the Chicago Fraternal Order of Police (Emmanuel, Reference Emmanuel2020).
5.4 Empirical Analysis
5.4.1 Data
Our dependent variable is the percentage of Blacks among people killed by the police (% Black Civilians Killed) in each state from 2013 to 2019. The data are from mappingpoliceviolence.org, an advocacy group collecting data using sources such as fatalencounters.org as well as social media, obituaries, and police reports. The data from both mappingpoliceviolence.org and fatalencounters.org have been used by Nicholson-Crotty et al. (Reference Nicholson-Crotty, Nicholson-Crotty and Fernandez2017) and Johnson et al. (Reference Johnson, Vil and Gilbert2019). Police killings are defined as a person killed as a result of being shot, beaten, restrained, intentionally hit by a police vehicle, pepper sprayed, tasered, or otherwise harmed by police, be they on-duty or off-duty. Over the years covered in our study, more than 7,500 people were killed by the police in America; 23 percent of them were Black. A 2019 Census Bureau estimate put the Black share of the United States population at 13.5 percent.
Our main variable of interest explaining variations in police killings is corruption. We measure corruption using CCI. Because it likely takes time for corruption to affect police behavior, we use moving averages of CCI over five years. The relationship between % Black Civilians Killed and CCI is shown in Figure 5.1.

Figure 5.1 CCI and % Black Civilians Killed
The other political variables we are interested in are political culture and ideology of the states, the influence of special interest groups – particularly police unions – in state politics, and political party competition. To investigate how political culture affects corruption, an operational measure of Elazar’s (Reference Elazar1984) classification is needed. Following Dincer and Johnston (Reference Dincer and Johnston2017), we create a dummy variable equal to 1 if the dominant political culture in a state is Moralistic and 0 otherwise. To measure how liberal/conservative the voters are in each state, we use the Ideology Index constructed by Berry et al. (Reference Berry, Ringquist and Fording1998, Reference Berry, Fording and Ringquist2013). The index runs from 0 to 100, with 0 representing extremely conservative and 100 representing extremely liberal states. To measure police union influence, we use data from the National Institute on Money in Politics showing the number of special interest groups registered to lobby in each state (Lobby). The influence of police unions in state capitols is positively related to the influence of special interest groups in general. Business associations and labor unions are the two most influential special interest groups in each state, frequently opposing each other. It is interesting to note, however, that no matter who the winner is, police unions never lose. Union-busting bills backed by business associations in Wisconsin in 2011 and Iowa in 2017, for example, both exempted police and firefighters. Finally, political party competition is measured by the Folded Ranney Index, which runs from 0.5 to 1, with 0.5 representing no competition and 1 representing perfect competition in each state (Holbrook and La Raja, Reference Holbrook, La Raja, Gray, Hanson and Kousser2017).
Our demographic and economic control variables follow the literature and reflect our arguments earlier about the importance of policing in maintaining an established social order and, by implication, in dealing with inter-group tensions. We first control for population density (Density) and share of Black population (% Black Population) in each state. We expect more killings in densely populated states with large Black populations. Next, we control for how segregated Blacks and Whites are in the largest city in each state, as segregation might be expected to be associated with more killings. As Enos and Celaya (Reference Enos and Celaya2018) argue, segregation facilitates categorization, making social categories, such as race, more cognitively salient and, thus, leading to stereotyping and discrimination. The most commonly used measure of segregation between two groups is the Dissimilarity Index, measuring the relative distributions of each group across neighborhoods within the same city. The index runs from 0 to 100, with 0 representing total integration – that is, that both groups are distributed in the same proportions across all neighborhoods. An index of 100 represents total segregation, indicating that the members of one group reside in completely different neighborhoods from those of the second group (data from CensusScope). Economic controls are Median Income and Racial Income Gap, measured as the White/Black median income ratio (data from the Bureau of the Census). We expect the Racial Income Gap to be positively related to police killings, but we have no explicit hypothesis regarding Median Income.
Our final three controls relate to police in each state: share of full-time sworn police officers who are Black (% Black Police), share of full-time officers represented by a union (% Collective Bargaining), and share of feloniously killed police officers (% Police Killed). The data for % Black Police and % Collective Bargaining are from the Bureau of Justice Statistics’ Law Enforcement Management and Administrative Statistics (LEMAS), while the data for % Police Killed are from the FBI’s Law Enforcement Officers Killed and Assaulted (LEOKA) Program. Previous studies did not find statistically significant effects of % Black Police on police killings (Hickman and Piquero, Reference Hickman and Piquero2009; Johnson et al., Reference Johnson, Vil and Gilbert2019), but none of them investigated how share of Black police officers interacts with share of Black population. We expect fewer police killings in states with large Black populations if the police departments in these states employ more Black police officers. With respect to collective bargaining by police, several studies have found that collective bargaining agreements protect police from accountability for misconduct including killings (Dharmapala et al., Reference Dharmapala, McAdams and Rappaport2019; Johnson et al., Reference Johnson, Vil and Gilbert2019). Jason Van Dyke, for example, convicted for shooting Laquan McDonald in Chicago in 2014, had had twenty citizen complaints, at least ten of them for excessive force; none resulted in disciplinary action. Finally, we expect violence against police officers to increase police shootings in a state. There is anecdotal evidence showing a positive relationship between violence against police and police shootings (BondGraham, Reference BondGraham2019).
5.4.2 Results
We estimate a random effects (RE) model with feasible generalized least squares (FGLS) because some of our variables of interest and some of our control variables are time invariant:
FGLS estimation, which uses both between- and within-groups variation in the data, is efficient, and the Hausman test does not reject the null hypothesis that the RE model is consistent. The results of FGLS estimation are presented in Table 5.1. In all estimations, we control for region and year dummies.
Table 5.1 Corruption and police killings of Black Americans: FGLS estimation (dependent variable: % black civilians killed)
| 1 | 2 | 3 | 4 | |
|---|---|---|---|---|
| CCI | .008 | .009 | .022 | 0.008 |
| (.004)Footnote * | (.004)Footnote ** | (.005)Footnote *** | (0.004)Footnote *** | |
| Segregation | .159 | .141 | .135 | 0.131 |
| (0.092)Footnote * | (.071)Footnote ** | (.063)Footnote ** | (0.089) | |
| % Black Population | 1.779 | 1.573 | 1.783 | 1.336 |
| (.396)Footnote *** | (.290)Footnote *** | (.288)Footnote *** | (0.297)Footnote *** | |
| % Black Police | .659 | .608 | .384 | 0.531 |
| (.409) | (.269)Footnote ** | (.247) | (0.341) | |
| % Black Population × % Black Police | –3.766 (.965)Footnote *** | –3.325 (.672)Footnote *** | –3.347 (.614)Footnote *** | –2.547 (0.825)Footnote *** |
| % Police Killed | .046 | .042 | .039 | 0.048 |
| (.024)Footnote * | (.025)Footnote * | (.026) | (0.026)Footnote * | |
| Density | .196 | .196 | .191 | 0.241 |
| (.072)Footnote *** | (.061)Footnote *** | (.055)Footnote *** | (0.068)Footnote *** | |
| Log Median Income | .729 | .584 | 0.613 | |
| (.196)Footnote *** | (.218)Footnote *** | (0.192)Footnote *** | ||
| Racial Income Gap | 3.717 | 2.734 | 3.045 | |
| (1.231)Footnote *** | (1.405)Footnote * | (1.159)Footnote *** | ||
| Log Median Income × Racial Income Gap | −.332 (.111)Footnote *** | −.243 (.126)Footnote * | –0.272 (0.105)Footnote *** | |
| Political Culture | −.086 | −.064 | –0.073 | |
| (.016)Footnote *** | (.015)Footnote *** | (0.019)Footnote *** | ||
| Ideology | −.181 | −.194 | –0.160 | |
| (.071)Footnote ** | (.061)Footnote *** | (0.067)Footnote *** | ||
| Lobbying | 48.333 | 53.563 | 38.968 | |
| (20.544)Footnote ** | (20.273)Footnote *** | (25.326) | ||
| Political Party Competition | .195 | .131 | 0.200 | |
| (.097)Footnote ** | (.090) | (0.095)Footnote ** | ||
| % Collective Bargaining | .143 | 0.172 | 0.119 | |
| (.069)Footnote ** | (.063)Footnote *** | (0.064)Footnote * | ||
| N | 350 | 350 | 336 | 287 |
| R2 within | .011 | .028 | .028 | 0.029 |
| Between | .876 | .925 | .939 | 0.917 |
| Overall | .564 | .602 | .592 | 0.561 |
Robust standard errors are given in parentheses.
*** , **, and * represent statistical significance at 0.01, 0.05, and 0.10 levels, respectively.
We start with estimating a parsimonious model with only a few demographic control variables and end with a comprehensive model with all political variables. The estimated coefficient of CCI is positive and statistically significant in all estimations, indicating that in more corrupt states Blacks are killed by the police disproportionately. The magnitude of the effect is significant as well. A one standard deviation increase in CCI causes % Black Civilians Killed to increase by 0.10 standard deviations, or 5 percentage points. The median value of % Black Civilians Killed is approximately equal to 0.20. The standardized coefficients of % Collective Bargaining and % Black Police (in states with large Black minority populations such as Alabama and South Carolina) are the same.
The signs of the political variables follow our expectations. In Moralistic states, the share of Black civilians killed is significantly lower (more than 5 percentage points). The influence of police unions in state politics and the share of police covered by a collective bargaining agreement negotiated by unions are both positively related to % Black Civilians Killed. Political party competition too increases the share of Black civilians killed by the police.
The signs of the estimated coefficients of our control variables are mostly in line with the previous literature. In densely populated states in which Blacks and Whites are segregated, Blacks are killed disproportionately. The effect of the size of the Black minority in a state’s population on police killings varies with the Black percentage of officers employed in police departments: a larger Black percentage in the population is related to more police killings of Blacks, but as police departments employ more Black officers that effect decreases. The effects of Racial Income Gap on % Black Civilians Killed are also conditional on how wealthy a state is: in states with higher median incomes, the effect of Racial Income Gap upon police killings of Blacks remains positive but is smaller. Figures 5.2 and 5.3 show the marginal effects of % Black Population (conditional on % Black Police) and Racial Income Gap (conditional on Log Median Income) on % Black Civilians Killed are within the observed range of data. The downward sloping solid line represents the marginal effects, while the dotted lines represent the 95 percent confidence intervals for those estimates. Finally, as expected, there is a positive relationship between violence against the police and the police violence against Black civilians. In several respects, our data are consistent with the view that policing tends to uphold the dominant social order and values rather than impartially applying the law, and that corruption – signaling as it does problems with accountability to legal and professional standards – adds to those problems and their consequences.Footnote 3

Figure 5.2 Marginal effects of % Black Population (conditional on % Black Police)

Figure 5.3 Marginal effects of Racial Income Gap (conditional on Log Median Income)
5.4.3 Robustness of Results
To investigate whether our results are robust with respect to different measures of corruption, we also estimate our regressions using CRI. As with CCI, we use the five-year moving averages. The results of the RE estimation are presented in the first column of Table 5.2. The estimated coefficient of CRI is positive and statistically significant.
Table 5.2 Corruption and police killings of Black Americans: FGLS estimation (dependent variable: % black civilians killed)
| 1 | 2 | |
|---|---|---|
| CRI | .008 | .008 |
| (.005)Footnote * | (.004)Footnote * | |
| Segregation | .183 | .154 |
| (.104)Footnote * | (.086)Footnote * | |
| % Black Population | 1.667 | 1.413 |
| (.438)Footnote *** | (.326)Footnote *** | |
| % Black Police | .835 | .765 |
| (.429)Footnote * | (.277)Footnote *** | |
| % Black Population × % Black Police | –3.879 (1.121)Footnote *** | –3.233 (.826)Footnote *** |
| % Police Killed | .042 | .036 |
| (.023)Footnote * | (.024)Footnote * | |
| Density | .213 | .222 |
| (.074)Footnote *** | (.064)Footnote *** | |
| Log Median Income | .725 | |
| (.222)Footnote *** | ||
| Racial Income Gap | 3.828 | |
| (1.396)Footnote *** | ||
| Log Median Income × Racial Income Gap | −.342 (.126)Footnote *** | |
| Political Culture | −.089 | |
| (.018)Footnote *** | ||
| Ideology | −.183 | |
| (.070)Footnote *** | ||
| Lobbying | 42.337 | |
| (21.533)Footnote ** | ||
| Political Party Competition | .236 | |
| (.095)Footnote ** | ||
| % Collective Bargaining | .136 | |
| (.077)Footnote * | ||
| N | 350 | 350 |
| R2 within | .011 | .026 |
| between | .871 | .922 |
| overall | .561 | .598 |
Robust standard errors are given in parentheses.
*** , **, and * represent statistical significance at 0.01, 0.05, and 0.10 levels, respectively.
The second robustness issue is the estimation method. We also estimate our comprehensive model controlling for state fixed effects, excluding the time invariant control variables. The estimated coefficient of CCI is equal to 0.008 – only slightly lower than the FGLS estimate of 0.009, but only marginally significant statistically, since within-state variation in CCI is not high enough in the period covered in our sample.Footnote 4
5.5 A Systemic Dilemma
Our findings support, for the most part, our hypotheses and the ideas discussed at the outset regarding a link between corruption and more numerous police killings of Black Americans. Moreover, they underline the “embeddedness” of the police killings dilemma and the ways in which corruption both reflects and illuminates deeper social divisions and problems of accountability. We simply cannot write off the results we have seen to a few “bad apples” among law enforcement officers. Rather, the police killings that occur with tragic frequency are rooted in the social structure and racial dynamics of states and local communities and in political processes that too often enable the police to become a powerful interest in and for themselves, able to engage in violence with impunity. Thus, the links among corruption, the social and political characteristics of our states and communities, and police killings of Black Americans are fundamental and troubling. “Thin blue line” styles of thinking and emphasis on coercion must give way to better strategies for maintaining peace and upholding values of justice on behalf of all in society. If events of recent years have shown us anything, we get the kind of policing that unaccountable departments and officers have decided serves their interests, that a share of the population supports, and that the rest of us, knowingly or otherwise, have shown we will tolerate. In Chapter 7, we will revisit similar connections in the context of public health outcomes, particularly as regards racial disparities that have become evident during the COVID-19 pandemic, and there too we will witness significant interconnections between systemic corruption and systemic racism.
6.1 Introduction
At first glance, environmental policy and implementation might seem less connected to corruption than, say, military procurement, public works, or campaign financing, but in fact this policy sector highlights several of the core concerns of this book. For one thing, environmental issues are often portrayed (with varying degrees of accuracy and honesty) as pitting private self-interest against the public good – a tension built into by many corruption issues. To the extent that that view is accurate, we might expect corruption originating with interests with a stake in blocking such rules, and/or with officials willing to put their influence and delaying tactics out for rent, to impede the passage and implementation of stringent, innovative environmental standards. Moreover, while sound environmental policy can offer citizens significant benefits both tangible (better health and reduced medical expenses) and intangible (lively and attractive natural surroundings), public (cleaner air and water), and divisible (reduced risk of damage from storms), sustaining political support for environmental safeguards raises an issue we have encountered in Chapter 4: questions of trust (see, on several sorts of connections between corruption and trust, Uslaner, Reference Uslaner2017). That is particularly true for environmental policies that entail (or can be portrayed by opponents as imposing) short-term costs and inconvenience in exchange for promises of longer-term, widely shared benefits. Will the eventual benefits actually materialize? Will my neighbors and my economic competitors play by the new rules? Will the interests of ordinary citizens help shape new policies, or will business-oriented interest groups and big-money political contributors take over?
Similarly, as we have seen with other issues, environmental hazards, health risks, and associated policy questions can differ greatly from one state to the next (Pope et al., Reference Pope, Burnett and Thun2002). So can the political clout, connections, and economic significance of various “clean” and “dirty” industries. Urban and rural states’ environmental challenges and options are similarly diverse, and those issues are fought out in political arenas that differ in ways we have explored in other chapters. Therefore, in this chapter we investigate not only corruption but also questions of trust and the ways they interact to shape environmental policies and implementation across states.
Interest in the relationship between corruption and environmental policy has grown over the last few decades. Multiple studies suggest that corruption and poor institutional quality have negative effects on social welfare by weakening trust, collective action, and support for environmental policies either selectively or across the board and, similar to our findings about social distancing and compliance with stay-at-home orders issued in response to COVID-19, by reducing public willingness to engage in activities like household recycling – thereby reducing the stringency of environmental policies and access to public goods such as sanitation and clean drinking water (Davidovic, Reference Davidovic2023; Davidovic and Harring, Reference Davidovic and Harring2020; Harring, Jagers, and Löfgren, Reference Harring, Jagers and Löfgren2021; Harring, Jagers, and Nilsson, Reference Harring, Jagers and Nilsson2019: Rothstein, Reference Rothstein2021; Tacconi and Williams, Reference Tacconi and Aled Williams2020). In the United States, many polluting industries are located in states that score high on measures of corruption such as Illinois, Louisiana, New Jersey, and Alabama (Kerth and Vinyard, 2012). Meanwhile, states with high social capital and trust, such as Maine and Vermont, are among the greenest. According to a survey conducted by Kennedy (Reference Kennedy2016), 70 percent of Vermont’s population and more than 60 percent in Maine agree with the statement that environmental regulations are worth the cost.
Analysts have only recently begun to consider the joint roles of corruption and trust in the determination of public policy, and to our knowledge there has been little published research on whether the effect of corruption on public policy depends on the level of trust (an exception is Dincer and Fredriksson, Reference Dincer and Fredriksson2018). Such relationships can be complex and varying, depending upon the kinds of policy and trust in question. Social capital and trust (in particular, generalized trust, defined as trust among strangers) facilitate collective action in society, particularly among members of large organizations such as environmental lobby groups, enabling citizens and civil society groups to oppose polluting industries effectively (Knack and Keefer, Reference Knack and Keefer1997; Putnam, Reference Putnam2000; Im et al., Reference Im, Hashem Pesaran and Shin2003; Poulsen and Svendsen, Reference Poulsen and Svendsen2005; Sønderskov, Reference Sønderskov2008; Sønderskov, Reference Sønderskov2009; Chong et al., Reference Chong, Gullien and Rios2010; Chamlee-Wright and Storr, Reference Chamlee-Wright and Storr2011). Such collective action in turn reduces transaction costs because trusting people are more likely to believe others will play by the rules in person-to-person contacts.
Levels of trust, in turn, affect the relative strength of industry and environmental lobby groups. When trust is low, environmental groups with large numbers of potential members face severe free-riding collective action problems (Olson, Reference Olson1971). On the other hand, business and industry groups face significantly less challenging collective action problems when it comes to efforts such as pushing for easier monitoring and enforcement, due to high industry concentration, their more limited, focused, and mutually reinforcing agendas, and the perceived financial threats of environmental laws and enforcement. In addition, they can appeal to generalized public support for business and its claims to be pursuing economic growth, effectively engaging in what Schattschneider (Reference Schattschneider1960) called the “mobilization of bias.” Business interests are therefore relatively strong in the political process. We would expect corruption to facilitate the industry lobby’s established influence activities and to serve its economic interests by reducing the stringency of environmental policy. Environmental groups, by contrast, remain decentralized, relatively unorganized, must continually appeal for public support across a wide range of issues, and are likely to have fewer financial resources. They will thus normally have much less influence over environmental issues than industry groups, particularly when generalized trust is low.
By contrast, when the level of trust is high, environmental groups can more readily convince others of the likely benefits of their proposed policies and can engage more effectively in the policymaking process (Knack, Reference Knack, Grootaert and Van Bastelaer2002; Sønderskov, Reference Sønderskov2009). They consequently become more evenly matched with the industry. While we would expect greater corruption to increase both environmental and industry groups’ influence activities, the net policy effect of corruption would be smaller (or negligible) as the two sides would be more equal in strength and influence.
Pennsylvania, another low-trust state that scores high in corruption indices, is a good example of how corruption and trust can interact to affect environmental policy. The Center for Public Integrity’s (2015) rankings show Pennsylvania has some of the weakest campaign finance, lobbying, and ethics laws in the nation – not a surprise, to the extent that low levels of trust might lead parties, candidates, and contributors to assume that their competitors would only break or circumvent any limits that might be put in place. A different 2020 assessment gave the Commonwealth only middling marks on campaign finance regulation with a rank of 19th among the fifty states and District of Columbia (Coalition for Integrity, 2020). Those laws allow elected officials to accept unlimited campaign donations and gifts from individuals, lobbyists, and political action committees (Campaign Finance Institute, 2023). Between 2000 and 2015, most likely as a consequence of the growth of fracking in the state (Crable, Reference Crable2023), the natural gas industry quintupled its donations to political parties and elected officials; between 2007 and 2018, that spending totaled $69.6 million (Conservation Voters of Pennsylvania, 2018). Not surprisingly, in 2015, Pennsylvania had a lower effective tax rate on natural gas extraction than ten other natural gas producing states, according to the state’s Independent Fiscal Office. Moreover, Pennsylvania has some of the weakest state regulations governing the natural gas industry (Richardson et al., 2013). In all, according to a 2019 tabulation by Global Witness, Pennsylvania legislators voting in favor of HB 1100, a tax-credit bill strongly backed by oil and gas interests, received an average of $2,455 in contributions from the industry in 2018, compared to a mean of $370 for those who voted against. It is scarcely surprising that an interest group channeled more funds to lawmakers supporting legislation it favored than to those voting against. Still, the disparity and the focus on that one bill are striking, given the fact that the state’s legislators routinely consider a wide range of other issues and bills in addition to the tax credits (Global Witness, 2019).
6.2 Corruption, Trust, and Collective Action: Findings in the Literature
The theoretical literature has long suggested that corruption has a negative impact on social welfare by, among other things, reducing environmental quality (Lopez and Mitra, Reference Lopez and Mitra2000; Fredriksson and Svensson, Reference Fredriksson and Svensson2003; Barbier et al., Reference Barbier, Damania and Leonard2005; Wilson and Damania, Reference Wilson and Damania2005). Corruption enables firms to influence policy- and rule-making, to break or bend the rules, and to weaken enforcement or render it more inconsistent. Thus, the empirical literature shows that corruption results in increased deforestation and air pollution and reduces natural capital and access to public goods, as noted earlier (Fredriksson and Svensson, Reference Fredriksson and Svensson2003; Damania et al., Reference Damania, Fredriksson and List2003; Barbier et al., Reference Barbier, Damania and Leonard2005; Pellegrini and Gerlagh, Reference Pellegrini and Gerlagh2006; Cole, Reference Cole2007; Anbarci et al., Reference Anbarci, Escalares and Register2009; Barbier, Reference Barbier2010; Leitão, Reference Leitão2010; Ivanova, Reference Ivanova2011; Biswas et al., Reference Biswas, Farzanegan and Thum2012; Grooms, Reference Grooms2015).
Knack (Reference Knack, Grootaert and Van Bastelaer2002) and Sønderskov (Reference Sønderskov2009) support the notion, advanced earlier, that trust facilitates collective action in large groups. One theoretical explanation is that individuals cooperate on collective action dilemmas conditional on expecting others to also do so (Sugden, Reference Sugden1984). This has occurred through human evolution, as it was advantageous when dealing with collective action problems (Axelrod, Reference Axelrod1990; Tooby et al., Reference Tooby, Cosmides and Price2006). Another explanation is that in large-N collective action dilemmas when personal knowledge and reputation effects are limited, trust serves as an alternative source of information (Hayashi et al., Reference Hayashi, Ostrom and Walker et al1999). According to Knack and Keefer (Reference Knack and Keefer1997), trust and associated civic norms may improve the quality of government and, hence, the quality of public policies by affecting levels and types of political participation. The participation of informed voters can be an important check on politicians and improve politicians’ understanding of how different policies affect various groups. Trust and similar civic norms reduce the collective action problems faced by voters seeking to have that sort of input and to monitor politicians’ actions (see also Putnam, Reference Putnam2000). Greenpeace, Sierra Club, and National Wildlife Federation membership data for 1987 from List and Sturm (Reference List and Sturm2006) indicate that the correlation coefficient between trust and membership in these organizations, measured in terms of percentages of state populations, equals 0.6, consistent with Sønderskov (Reference Sønderskov2008). The possibility of reverse causality between greater associational activity has been tested and rejected by Uslaner (Reference Uslaner2002).
Putnam (Reference Putnam1993) provides supporting evidence from Italy: in regions with higher levels of trust, public goods are provided more efficiently. He also reports that where trust is low, citizens contact government officials primarily about narrow personal issues. In contrast, in regions where the level of trust is high, citizens are more concerned with issues affecting welfare across society. LaPorta et al. (Reference LaPorta, Florencio and Andrei1997) find that trust raises cooperation (particularly in large organizations), improves the performance of government and participation in civic and professional societies, and hence raises countries’ overall performance. Overall, in the environmental sector, corruption, trust, and related distributions of social capital are important determinants of public policy and group behavior and can significantly influence outcomes for individual citizens, and in the fifty state political arenas.
The empirical literature on the effects of trust on the environment and collective action in individual US states supports our hypothesis. Savage et al. (Reference Savage, Isham and McGrory Klyza2005) describe a rapid increase in the number of environmental groups in Vermont since 1985, which they attribute to the formation of social capital. Several case studies suggest that the levels of trust and social capital affect participation in natural resource management in the US (Breetz et al., Reference Breetz, Fisher-Vanden, Jacobs and Schary2005; Leahy and Anderson, Reference Leahy and Anderson2010), watershed management in Japan (Ohno et al., Reference Ohno, Tanaka and Sakagami2010), and maintenance of soil and water conservation projects in India (Bouma et al., Reference Bouma, Bulte and van Soest2008).
We therefore expect levels of trust to affect the relative ability of polluting industry and environmental interest groups, respectively, to influence policy outcomes – but in contrasting ways. Environmentalists, who are numerous, dispersed, and concerned with a wide range of specific issues, need higher levels of trust to form and sustain lobby groups, while industry interests can organize without such high levels of trust: they are fewer in number, which facilitates coordination, monitoring, and enforcement, and share common or similar policy goals. When the level of trust is low, polluting industry groups should therefore have the upper hand, while environmentalists will consistently find it more difficult to organize. On the other hand, when trust increases, the environmentalists are likely to gain organizational strength and influence and may eventually match their industry counterparts.
It follows that an increase in the level of corruption should reduce the stringency of environmental policy when the level of trust is low. When industry lobby groups are better able to form and act, an increase in corruption should facilitate their activities. On the other hand, when general levels of trust are sufficiently high and environmental lobby groups are better able to organize and influence policy, an overall increase in corruption – which, after all, shapes the expectations of officials as well as the tactics of lobby groups – should facilitate the activities of the environmental and industry lobby groups in a similar fashion, resulting in a small or negligible overall effect on environmental policies. In other words, the effect of corruption should decline or disappear at high levels of trust.
6.3 Empirical Analysis
To test these hypotheses, we use annual data for a panel of 48 contiguous US states for the years 1977 to 1994. While it would be preferable to have a longer time dimension extending to a more recent date, we are constrained in this case by the limits of available data on what we consider to be some of the most appropriate indicators. The time dimension of the data we do have may offer some advantages for our purposes, however, in that it reflects the realities of a phase during which emergent environmental policy questions were often handled in the political arena, rather than in the courts. (For example, see the chronology of US Supreme Court rulings relevant to climate change and the environment that appears at Justia.com (2023); that listing includes four cases prior to 1994 (including two from the first decade of the twentieth century) and twenty since that time.) Data on environmental policy stringency come from Levinson (Reference Levinson, Carraro and Metcalf2001), who constructs an industry-adjusted index of state environmental compliance costs based on the Census Bureau’s Pollution Abatement Costs and Expenditures (PACE) survey. That index accounts for states’ industrial compositions and can be used to compare regulations both across states in a given year and within states over time.Footnote 1 As our measure of corruption, we use CRI. Finally, we follow Putnam (Reference Putnam2000), who uses the DDB Needham Life Style Surveys (DDB) to measure trust. DDB asks respondents if they agree with the statement “most people are honest.” The responses are reported on an agree/disagree scale of 1 to 6, where 6 represents the highest level of agreement. Following Nagler (Reference Nagler2011), we construct the trust index by averaging responses in each state for each year using the survey sample weights. In order to investigate the interconnections hypothesized in the discussions earlier, we interact CRI with Trust.
We also include a set of economic and demographic control variables in our estimation. First, we control for the presence of state-level strategic interaction in environmental policy. Fredriksson and Millimet (Reference Fredriksson and Millimet2002) and Konisky (Reference Konisky2007) suggest that states take their neighbors (which may at times be competitors for investment) into account when implementing environmental policies. We include the income-weighted average of neighboring states’ environmental policy stringency (Neighbor Stringency). Second, we control for per capita GDP (GDP). We expect per capita GDP to have a positive effect on Stringency if environmental quality is a normal good (Kahn and Matsusaka, Reference Kahn and Matsusaka1997). Third, we include energy and land prices. Energy Price is the state-level average of industrial sector energy prices that reflects supply and demand conditions in the local market for energy, and Land Price is the state-level average of agricultural land prices per acre (Fredriksson et al., Reference Fredriksson, List and Millimet2004). The price variables reflect interest group and voter pressures on the stringency of environmental regulations. The variable % Legal Services is the share of legal services in GDP in a state, and helps account for differences in enforcement of environmental regulations across states. It reflects the resources allocated to monitoring and enforcing regulation, or to protecting firms from enforcement (see, e.g., Fredriksson et al., Reference Fredriksson and Svensson2003; Gray and Shimshack, Reference Gray and Shimshack2011). Finally, Education reflects the level of environmental awareness and hence the demand for stricter environmental policies. Education is measured by the percentage of individuals with a college degree or above.
We estimate the relationship between environmental policy, corruption, and trust using an Arellano–Bover/Blundell–Bond type system GMM estimator. The results, which are presented in Table 6.1 and Figure 6.1, suggest that the effect of an increase in the level of corruption on environmental policy is conditional on a state’s level of trust. In states with low levels of trust, corruption weakens environmental policy. However, as the level of trust increases, the effect of corruption declines. Eventually, at high levels of trust, corruption has no effect (or even a positive effect) on environmental policies because the industry and environmental groups have more equal strength and influence.
Table 6.1 Corruption, trust, and environmental stringency: Arellano–Bover/Blundell–Bond system GMM estimation (dependent variable: Stringency)
| (1) | (2) | (3) | (4) | |
|---|---|---|---|---|
| Stringency −1 | 0.684 | 0.442 | 0.513 | 0.511 |
| (0.063)Footnote *** | (0.101)Footnote *** | (0.061)Footnote *** | (0.062)Footnote *** | |
| CRI | −0.296 | −1.515 | −0.078 | −1.714 |
| (0.122)Footnote ** | (0.861)Footnote * | (0.077) | (0.842)Footnote ** | |
| Trust | 0.150 | 0.153 | 0.254 | 0.096 |
| (0.052)Footnote *** | (0.091)Footnote * | (0.062)Footnote *** | (0.071) | |
| CRI × Trust | 0.407 | 0.438 | ||
| (0.232)Footnote * | (0.214)Footnote ** | |||
| Neighbor Stringency−1 | 0.270 | 0.342 | 0.234 | 0.211 |
| (0.079)Footnote *** | (0.093)Footnote * | (0.064)Footnote *** | (0.065)Footnote *** | |
| ln GDP | −11.163 | −9.565 | ||
| (5.593)Footnote ** | (5.526)Footnote * | |||
| ln GDP2 | 0.572 | 0.486 | ||
| (0.298)Footnote * | (0.294)Footnote * | |||
| Energy Prices | −0.031 | −0.027 | ||
| (0.008)Footnote *** | (0.008)Footnote *** | |||
| Land Prices | 0.025 | 0.028 | ||
| (0.014)Footnote * | (0.015)Footnote * | |||
| GDP Share of Legal Services | 13.995 | 13.421 | ||
| (4.707)Footnote *** | (4.479)Footnote * | |||
| Education | −2.417 | −5.998 | ||
| (1.654) | (2.606)Footnote ** | |||
| Education2 | 3.618 | 10.657 | ||
| (3.071) | (4.882)Footnote ** | |||
| N | 816 | 816 | 816 | 816 |
| Autocorrelation Tests | ||||
|---|---|---|---|---|
| Arellano-Bond AR(1) z p value Arellano-Bond AR(2) z p value | −3.95Footnote *** 0.00−0.54 0.46 | −3.18Footnote *** 0.00−0.95 0.50 | −3.81Footnote *** 0.00−0.76 0.47 | −3.73Footnote *** 0.00−0.68 0.49 |
| Overidentification Tests | ||||
|---|---|---|---|---|
| Hansen χ2 p value | 44.12 1.00 | 35.51 1.00 | 31.23 1.00 | 38.76 1.00 |
Standard errors (clustered at the state level) in parentheses. Stringency−1, and CRI are assumed to be determined endogenously. All models control for state and time fixed effects.
*** , ***, and * represent statistical significance at 1 percent, 5 percent, and 10 percent levels, respectively.

Figure 6.1 Marginal effects of CRI on Stringency (conditional on Trust)
Our results are both statistically and economically significant. A one standard deviation increase in corruption in Mississippi, a low trust state, decreased environmental stringency by approximately 0.2 standard deviations in the late 1980s and the early 1990s. On the other hand, in a high trust state such as Vermont, the standardized effect of corruption was not statistically significantly different from zero within the observed values of Trust. In Delaware, another high-trust state, the effect was positive.
As mentioned earlier, our measure of environmental stringency is constructed based on self-reported abatement costs. Hence, misreporting is a concern. As a robustness test, we also estimate a parsimonious model using per capita carbon emissions as the dependent variable. The data come from the Carbon Dioxide Information Analysis Center (CDIAC).Footnote 2 The results of the Arellano–Bover/Blundell–Bond system GMM estimation are presented in Table 6.2. The results are consistent with our earlier results. The estimated coefficients of CRI and the interaction term are significant at least at the 5 percent level and have the expected signs. Corruption has a positive effect on aggregated emission levels, but the effect declines as the level of trust rises. Figure 6.2 shows the marginal effect of CRI on emissions, conditional on the level of Trust. For low levels of trust, the marginal effect of corruption is clearly positive – that is, higher levels of corruption, greater emissions. However, as Trust rises, the marginal effect declines and eventually becomes negative.
Table 6.2 Corruption, trust, and emissions: Arellano–Bover/Blundell–Bond system GMM estimation (dependent variable: Emissions)
| (1) | |
|---|---|
| Emissions−1 | 1.023 (0.004)Footnote *** |
| CRI | 7.611 (3.686)Footnote ** |
| Trust | 0.950 (0.451)Footnote ** |
| CRI × Trust | −2.029 (0.966)Footnote ** |
| ln GDP | −0.460 (0.187)Footnote *** |
| Stringency−1 | −0.104 (0.059)Footnote * |
| N | 816 |
| Autocorrelation Tests | |
|---|---|
| Arellano-Bond AR(1) z p value | −1.55 0.12 |
| Arellano-Bond AR(2) z p value | 0.05 0.96 |
| Overidentification Tests | |
|---|---|
| Hansen χ2 p value | 44.30 1.00 |
Standard errors (clustered at the state level) in parentheses. Emissions−1 and CRI are assumed to be determined endogenously. The model controls for state and time fixed effects.
*** , **, and * represent statistical significance at 1 percent, 5 percent, and 10 percent levels, respectively

Figure 6.2 Marginal effects of CRI on Emissions (conditional on Trust)
This analysis dovetails with discussions in Chapter 7 of this book, such as the analysis of compliance with COVID social distancing rules to be presented in Chapter 7. Environmental policy is a useful area to study interactions among corruption, trust, and public policy because the states, as civil societies in their own right, have considerable flexibility in making and implementing policy, and because corruption, trust, and the range and relative strength of industrial and environmental interest groups can vary considerably from one state to the next. Given that range of state-level influences, it is not surprising that environmental trends and effects are often observed only with a considerable time lag, facilitating corrupt influences that themselves are usually kept secret. Our findings may also have policy implications regarding anti-corruption reforms aimed at strengthening environmental and other policies, endeavors that will inevitably require resources and time. If greater trust does mitigate the effects of corruption, additional reform efforts should be allocated to states with low levels of trust, and environmental advocates in those states (like their counterparts in others) should be as concerned about deepening social capital and trust as they are about alleviating specific environmental problems.
6.4 Conclusion
The connections among corruption, trust, and the economics and politics of making and implementing environmental policies reinforce important findings in Chapters 3–5 of this book regarding the deep roots and pervasive consequences of corruption. Corruption does indeed seem to weaken environmental safeguards, particularly where trust is weak, and does so in ways that are also apparent when we look in more detail at specific states. Furthermore, the strength of that finding varies depending upon levels of trust in a state – a finding that should not be surprising when we think about the ways environmental issues can pit private against public interests and can raise compelling questions as to whether one’s neighbors and competitors will follow any rules that are made and abide by any restrictions on the use of money to influence policy decisions. The similarities between the findings in this chapter that (of necessity) refer specifically to realities of some years ago and our findings regarding compliance with COVID-19 rules and restrictions (see Chapter 7 of this book) suggest that the apparent behaviors and attitudes in question are neither new nor transitory. Instead, they are likely deeply rooted within American and state politics.
One important implication of those findings, one to which we will return in Chapters 8 and 9, is that any conception of American corruption that is confined to specific acts of official misconduct or venality, or to private interests that pay overt bribes, is seriously incomplete. The same is true of any program for reform limited to enacting new anti-corruption laws. What is emerging from our chapters is a political system that seems increasingly unable to engage the trust and active support of citizens and economic interest groups, and an economy in which citizens – for good reason, in most cases – lack a sense of a common stake or destiny. As even a brief look at recent headlines will suggest, it is a system increasingly unable to foster trust in officials, institutions, and policies, and whose processes and effectiveness suffer from a lack of trust among citizens themselves. Important as environmental issues are in themselves, they also reflect disquieting trends and truths regarding the ability of a democratic republic to govern itself in ways that are both effective and widely accepted as fair.
Looked at that way, America and its states face a challenge not only of regulating political and administrative processes, and relationships between wealth and power (see, for a pessimistic account, Hacker and Pierson, Reference Hacker and Pierson2020), but also of restoring – or creating anew – politics at the state and national level that deserves, and can engage, social trust in its processes and outcomes. As difficult as controlling corruption itself has always been, rebuilding trust is equally challenging. As we shall see in Chapter 9, addressing that challenge will mean understanding, and making intelligent changes in, several aspects of our political processes. It will also require us to understand the outlooks of a citizenry among whom trust has become seriously depleted. Failing those tests will mean not only continued corruption but also that our responses to serious state and national challenges will be seriously ineffective. For evidence on that point, we turn to the effects of corruption on public health provision, and on our responses to the ravages of COVID-19 in Chapter 7.
7.1 Introduction: Enough to Make You Sick
However controversial its details may be in some quarters, public health is a core function of modern governments. That is true in the sense both of direct public provision of care and facilities and of public responsibility for the overall state of public health and safety. According to a compilation of US Census data by the Urban Institute,Footnote 1 in 2020 states and localities spent $345 billion overall on health and hospitals.Footnote 2 That amounted to the third-largest share of direct general expenditures at the state and local levels. Health and hospitals accounted for 10 percent of all direct expenditures, trailing only public welfare and elementary and secondary education. The states made 46 percent of health and hospital expenditures, while local governments were responsible for 54 percent. In most years, such spending accounts for the largest shares of county and special-district budgets. There are large variations among the states, however: in Vermont, the state accounted for 98 percent of direct health and hospital spending, while Indiana’s corresponding figure was 13 percent. Nationwide, state and local governments spent $1,041 per capita on health and hospitals in 2020, with Wyoming spending the most at $2,961, followed by South Carolina ($1,818) and North Carolina ($1,688). New Hampshire spent the least ($163), edging out Arizona ($281) and North Dakota ($388) at the bottom of the table.
Our concern in this chapter is not primarily with the overall scope of corruption in the public health sector; that would be difficult to estimate with any precision. Rather, we will examine the possible effects of illegal corruption in the states’ government and political systems, as measured by our three indices, upon public health outcomes for whole states and segments of the population. In a field formally dedicated, as much as any other, to maintaining citizens’ wellbeing and quality of life, our data suggest that the extent of corruption in the broader political arena is linked to major variations in public health outcomes including both contrasts in access to, and quality of, health care services, and public cooperation with public policies during the COVID-19 pandemic. Both sets of issues raise profound questions of justice, equity, and the quality of government.
First, we examine the effects of corruption upon compliance with social distancing and stay-at-home orders during the pandemic. Then, we turn to vaccination. Finally, we examine specific issues posed by the COVID-19 pandemic for Black Americans. In that latter connection, we find not only reasons for general concern but also disturbing similarities to our findings regarding police killings of Black Americans as reported in Chapter 5.
7.2 Corruption, Social Distancing, and Vaccination
Social distancing and vaccination were central aspects of the public policy response to COVID-19. Compliance with social distancing and vaccination became a critical concern as the virus spread to ever more vulnerable communities less able to handle large numbers of critically ill patients. Many of these communities lack not only the physical and social infrastructure needed to fight the COVID-19 pandemic but are also often viewed as having endemic corruption.
We find that states with higher corruption had lower levels of social distance compliance and lower levels of vaccination (data available at CDC, 2021). Our findings suggest that communities where corruption is endemic found it difficult to contain and mitigate COVID-19 by relying on public cooperation with social policy-based controls. There is some evidence that public health aid can be effective even in corrupt communities (Dietrich, Reference Dietrich2011). Still, as such communities typically already suffer from poor healthcare infrastructure and outcomes (Azfar and Gurgur, Reference Azfar and Gurgur2008; Ciccone et al., Reference Ciccone, Vian and Maurer2014; Friedman, Reference Friedman2018; Dincer and Teoman, Reference Dincer and Teoman2019), they will face future crises with few effective weapons in their arsenals. Moreover, additional funding directed towards fighting such crises could be diverted from intended beneficiaries by corruption (Suryadarma and Yamauchi, Reference Suryadarma and Yamauchi2013; Briggs, Reference Briggs2014).
7.2.1 Corruption and Compliance with Social Distancing and Vaccination
Starting with California in mid-March of 2020, the majority of American states instituted shelter-in-place/stay-at-home orders as part of their social distancing policies. Schools, restaurants, and bars were closed; nonessential businesses were ordered to keep workers home and let them work remotely. People were asked not to leave their homes unless necessary.
Enforcement and penalties, however, varied significantly across the states. While in some there were no penalties, in most violations were considered a misdemeanor punishable with a small fine, usually not enforced. In Arizona, for example, violators could be charged with a class 1 misdemeanor, which has a fine up to $2,500. In Tennessee, on the other hand, no penalties were specified (see Mazziotta, Reference Mazziotta2020, for state-by-state fines and penalties). In states such as Kentucky, Maryland, Michigan, and Pennsylvania protesters, sometimes armed with assault rifles, packed state capitols and streets in defiance of state orders. In London, by contrast, police arrested people in Hyde Park protesting social distancing orders (Estes, Reference Estes2020; Parveen, Reference Parveen2020). Thus, although social distancing was mandated in theory, in practice states often depended heavily on voluntary compliance. This resulted in significant variations in social distancing across the states.
While policies such as shelter in place/stay at home were somewhat effective, as a response to widespread resistance to complying with social distancing, the federal government introduced Operation Warp Speed (OWS), supporting the development of vaccines. Once vaccines were granted emergency use authorizations by the Food and Drug Administration (Fisk, Reference Fisk2021) in late 2020, OWS worked with pharmacies across the US to make them available at no cost to individuals. To achieve herd immunity, a large majority of the population needed to be vaccinated. Although the herd immunity threshold is not known for COVID-19, according to the World Health Organization, the figure for measles is 95 percent and for polio, 80 percent. As of early 2023, only 65 percent of the US population had been vaccinated against COVID-19, and there was significant variation across states ranging from 50 percent in Alabama and Mississippi to 80 percent in Rhode Island and Vermont.
Corruption might not seem a likely influence upon compliance with social distancing and vaccination, but in many ways, it embodies the ways people sort out their own preferences versus civic responsibility. Our data suggest that it did influence compliance through its effects on trust in government, social capital, and government legitimacy, which in turn are important determinants of compliance with shelter-in-place/stay-at-home orders and vaccination.
7.2.2 Trust in Government and Social Capital
Trust in government is an important determinant of social capital, which is defined as networks and norms shared among people and facilitating cooperation to help solve collective action problems (Fukuyama, Reference Fukuyama1995; Putnam, Reference Putnam2000). Social capital manifests itself in communities as reciprocal relationships between civic participation and interpersonal trust. The more people participate in their communities, the more they trust others, all else being equal; the greater trust people hold for others, the more likely they are to participate (Fukuyama, Reference Fukuyama1995; Brehm and Rahn, Reference Brehm and Rahn1997). Interpersonal trust depends heavily on trust in government (Levi, Reference Levi, Braithwaite and Levi1998; Levi and Stoker, Reference Levi and Stoker2000; Rothstein, Reference Rothstein2000, Reference Rothstein2005). According to Rothstein and Eek (Reference Rothstein and Eek2009), when forming their beliefs about others in a community, people draw inferences from the behavior of government officials: “[I]f it proves that I cannot trust the local policemen and judges, then whom in the society can I trust?” (Rothstein and Eek, Reference Rothstein and Eek2009, 90). Several political science studies find negative effects of corruption on trust in government (Anderson and Tverdova, Reference Anderson and Tverdova2003; Chang and Chu, Reference Chang and Chu2006; Rothstein and Eek, Reference Rothstein and Eek2009; see also Ch. 5 of this book). Because trust in government and interpersonal trust are positively related, corruption affects interpersonal trust negatively. Lower interpersonal trust in turn means lower civic participation, and lower civic participation means lower social capital. Since both social distancing and vaccination are collective action problems, we expect less compliance with shelter-in-place/stay-at-home orders and less vaccination in more corrupt states with low social capital.
Collective action problems arise when short-term interests of individuals conflict with long-term collective interests. According to Olson (Reference Olson1971: 2), if the members of a large group rationally seek to maximize their personal welfare, they will not act to advance their group objectives unless there is coercion to force them to do so, or unless some separate incentive, distinct from the achievement of the group interest, is offered to the members of the group individually on the condition that they help bear the costs or burdens involved in the achievement of the group objectives.
Sønderskov (Reference Sønderskov2009) argues that social capital facilitates collective action in large groups. Individuals are more likely to cooperate in collective action when they expect others to do likewise. Given a large number of individuals, it is costly and difficult, even impossible, to get specific information on other individuals’ trustworthiness. In such situations, social capital serves as a short-cut to information on trustworthiness (Sønderskov, Reference Sønderskov2009: 53–54; see also Ostrom, Reference Ostrom1998).
Gilson (Reference Gilson2003) argues that the production of health and health care requires cooperation within health systems, which in turn requires trust. Trust facilitates the use of the health system and leads to better self-rated outcomes (Radin, Reference Radin2013). Several empirical studies present persuasive evidence regarding the effects of trust in government in particular, and social capital in general, on compliance with public health policies (Buckman et al., Reference Buckman, Liu, Cortright, Tumin and Syed2020). Blair et al. (Reference Blair, Morse and Tsai2017), for example, investigate the behavior of Liberians during the 2014–2015 Ebola outbreak, finding that people with lower trust in government took fewer steps to protect themselves and were less likely to comply with social distancing orders. Vinck et al. (Reference Vinck, Pham and Bindu2019), in the context of a later outbreak in the Democratic Republic of Congo, find similar results: low trust in government explains lower willingness to adopt preventative behavior and accept a vaccine. The relationship among trust, social capital, and compliance with public health policies is not specific to COVID-19, or to Sub-Saharan Africa: Nawa and Fujiwara (Reference Nawa and Fujiwara2019) using data from Japan, Ronnerstrand (Reference Berry, Fording and Ringquist2013) from Sweden, Chuang et al. (Reference Chuang and Ya-Li Huang2015) from Taiwan, and Jung et al. (Reference Berry, Fording and Ringquist2013) and Ronnerstrand (Reference Rönnerstrand2014) from America all find a positive relationship between trust/social capital and vaccination. Yaqub et al. (Reference Yaqub, Castle-Clarke and Sevdalis2014) identify low trust/social capital as a main cause of vaccine hesitancy in Europe. Trust and social capital are also found, in some contexts, to be determinants of mental and physical health (Lochner et al., Reference Lochner, Kawachi and Brennan2003; Yip et al., Reference Yip, Subramanian and Mitchell2007; Kim et al., Reference Kim, Subramanian, Kawachi, Kawachi, Subramanian and Kim2008; Almedom and Glandon, Reference Almedom, Glandon, Kawachi, Subramanian and Kim2008; Ahnquist et al., Reference Ahnquist, Wamala and Lindstrom2012; Rodgers et al., Reference Rodgers, Valuev and Hswen2019). According to Kawachi and Berkman (Reference Kawachi, Berkman, Berkman and Kawachi2000), trust and social capital affect health-related behaviors via diffusion of health information and adoption of healthy norms of behavior (see also Lindstrom, Reference Lindstrom, Kawachi, Subramanian and Kim2008).
7.2.3 Trust in Government and Legitimacy of Government
The second channel through which corruption affects social distancing is the legitimacy of government. Legitimacy is linked to trust in government and is defined as the belief that government does what is appropriate and fair most of the time. As such, we expect legitimacy to affect how people behave toward government in crises (Easton, Reference Easton1965; Tyler, Reference Tyler2006; Christensen and Lægreid, Reference Christensen and Lægreid2020). Legitimacy increases compliance with government policies (Tyler, Reference Tyler2006). Christensen and Lægreid (Reference Christensen and Lægreid2020) argue that the comparative success of the Norwegian government in fighting COVID-19 (Cohen, Reference Cohen2022) was partially due to its legitimacy. It is crucial that policies implemented to fight the pandemic be seen by the people as appropriate and fair (Christensen and Lægreid, Reference Christensen and Lægreid2020). Government legitimacy is important for compliance with laws and regulations. Paternoster et al. (Reference Paternoster, Brame and Bachman1997) find that domestic assault suspects arrested in a procedurally fair manner are less likely to commit further acts than those arrested in procedurally unfair ways. Kuperan and Sutinen (Reference Kuperan and Sutinen1998) find that legitimacy affects compliance by Malaysian fishermen with a regulation banning them from fishing in a zone along the coast. Levi and Sacks (Reference Levi and Sacks2009), using survey data from Sub-Saharan Africa, find that compliance with tax laws is positively related to government legitimacy. Seligson (Reference Seligson2002) and Boly et al. (Reference Boly, Gillanders and Miettinen2019) find negative relationships between corruption and government legitimacy, and Ali et al. (Reference Ali, Fjeldstad and Sjursen2014) find that corruption weakens tax compliance in South Africa and Uganda. In the COVID-19 context, therefore, to the extent that corruption weakens the legitimacy of government, we expect it will also reduce compliance with shelter-in-place/stay-at-home orders.
7.2.4 Empirical Analysis: Data
Investigating the relationship between corruption and social distancing presents several challenges, perhaps the most important being the measurement of compliance with social distancing. We use the Shelter-in-Place Index constructed by SafeGraph,Footnote 3 measuring stay-at-home – the percentage of people in a state staying home on a particular day – compared to population movement data representing 45 million smartphone devices (CDC, 2021). The index ranges from −100 to 100, where 0 indicates no change from a baseline defined as the average percentage of people staying home all day and every day across the seven days ending February 12, 2020. Home is defined as the most common night-time location of the smartphone device in the previous months, identified to a precision of about 100 square meters. The Shelter-in-Place Index for any particular day is constructed as follows:

On May 2, 2020 (the last day of our sample), for example, the actual percentage of people staying home in Illinois was 40.5 while the baseline was 25. Hence, the index for Illinois on May 2 is equal to 15.5 (see data and documentation at CDC, 2021 for details). Our sample covers four consecutive Saturdays starting from April 11. Over the last three weeks of April and the first week of May, shelter-in-place/stay-at-home orders were in place in all but five states. While these data are drawn from the early days of what became a multi-year pandemic, we believe they are appropriate: the pandemic was a new and threatening public concern, people’s attention regarding government countermeasures ran high, and lines of partisan contention over COVID-19 responses had yet to harden into place. We measure corruption using CCI. We also control for several economic and demographic variables to minimize omitted variable bias.
We expect corruption to affect social distancing through two channels: social capital/interpersonal trust and trust in government/legitimacy of government. To control for the mediating effects of social capital, we first control for how generous people are, and how engaged they are civically, in each state in terms of charitable giving and volunteering. These are the most relevant components of social capital in the context of this study. We use the State Generosity Index (SGI) constructed by WalletHub, which ranges from 0 to 100 (see WalletHub, 2022 for details). We construct a dummy variable, SGI, which is equal to 1 if a state falls into the highest quartile of the SGI.
In addition, we control for the percentage of people tested positive for COVID-19 in each state on four consecutive Thursdays starting from April 9, 2020 (COVID-19 Positive). Since higher positivity rates indicate a higher infection risk, they should affect compliance with social distancing orders. The third control variable is Trump – the percentage of votes Donald Trump received in each state in the 2016 presidential election (US Elections Project, 2023). Trump showed his support loudly and repeatedly for people protesting (and violating) shelter-in-place/stay-at-home orders issued by the governors of several states. In addition, he called into question the legitimacy of public institutions and leaders in numerous ways. The variable Trump also controls for political ideology, which affects risk perception: according to a poll conducted by Axios/Ipsos, while 60 percent of Republicans believed that the real number of COVID-19-related deaths was lower than the official count, more than 60 percent of Democrats believed the real number was higher (Axios, 2020). Using state-level data, Hsiehchen, Espinoza, and Slovik (Reference Hsiehchen, Espinoza and Slovic2020) find that Republicans were less likely to comply with social distancing orders.
The next two control variables are per capita personal income (Income) and unionization (Union). Social distancing is costlier for some than others: people living paycheck to paycheck, and those who cannot work from home, may be less likely to comply with stay-at-home orders. Regarding unionization, the pandemic resulted in job losses across the country, but many union workers had various protections due to their collective bargaining agreements. NBC News reported that approximately 150,000 United Auto Workers members at Ford, General Motors, and Fiat Chrysler lost their jobs but continued to receive supplemental unemployment benefits. Their contracts gave members at least six months of extra pay on top of unemployment insurance, adding up to 85 percent of their hourly wages. Unionization also affects social capital via political and civic engagement (Nissen, Reference Nissen2010; Kerrisey and Schofer, Reference Kerrisey and Schofer2013). Our Income data are from the Bureau of Economic Analysis (2023) and Union data are from the Union Membership and Coverage Database (Unionstats, 2023). Finally, we control for population density, as the risk of infection is higher in densely populated urban communities. The data are from the Census Bureau (United States, Department of Commerce, 2023).
In our vaccination regressions, we use the share of population who are fully vaccinated as of January 2023 as our dependent variable (Kaiser Family Foundation, State Health Facts – KFF, 2023). Our control variables are chosen based on several nationally representative surveys conducted during the pandemic (Daly and Robinson, Reference Daly and Robinson2021; Sziglayi et al., Reference Sziglayi, Kyla and Shah2021; Ruiz and Bell, Reference Ruiz and Bell2021) and systematic reviews such as Wang and Liu (Reference Wang and Liu2022). Demographic and economic factors such as education, race, and income play a significant role in people’s decision to get vaccinated. While politically conservative people are also less likely to be vaccinated, vaccination rates are higher in more densely populated states. We measure education as the share of population age 25 and above who have less than a high school degree, race as the population share of Blacks and income as per capita personal income. The data are from the Census Bureau and the Bureau of Economic Analysis as before. Finally, to measure political ideology, we construct a dummy variable, which is equal to 1 if the governor of a state is Republican.
7.2.5 Empirical Analysis: Results
To investigate the effects of corruption on social distancing, we estimate a system of four equations with seemingly unrelated regressions (SUR) in which the dependent variables are the Shelter-in-Place Indices for April 11, April 18, April 25, and May 2, 2020. Each Saturday forms one fourth of the system. Estimating a system with SUR has several advantages: first, SUR is more efficient because it allows errors to be correlated across the equations. Second, because each equation has the same set of independent variables, it allows us to conduct joint tests to investigate whether quarantine fatigue worsens the collective action problem. Quarantine fatigue manifests itself as boredom, anxiety, and stress (Marcus, Reference Marcus2020) and can make it more difficult to comply with stay-at-home/shelter-in-place orders when people are feeling the psychological effects of social distancing. Where trust/social capital is low, this becomes an even greater problem.
The maximum likelihood estimates with robust standard errors clustered at the state level are presented in Table 7.1. To show the mediating effects of social capital, we first estimate our regression without SGI, the generosity index. The estimated coefficient of CCI is negative and statistically significant in all four equations, indicating that in corrupt states people are less likely to comply with shelter-in-place/stay-at-home orders. The absolute value of the estimated coefficient decreases when we estimate the regression with SGI, indicating that one of the channels through which corruption affects social distancing is indeed via deterioration in social capital. The magnitude of the effect is significant as well. Based on the estimated coefficients in Equation 4, a one-standard deviation increase in CCI causes the Shelter-in-place Index to decrease by approximately 10 percent. The standardized effect of COVID-19 Positive is only slightly greater than 10 percent, suggesting that corruption was roughly as strong a determinant of compliance as were trends in COVID-19 itself. Perhaps more interesting, the magnitude of the corruption effect increases each week. The estimated coefficient of CCI in Equation 4 (Shelter-in-Place Index on May 2) is 2.5 times greater than the one in Equation 1 (Shelter-in-Place Index on April 11).Footnote 4 As “quarantine fatigue” developed, people stayed home less and less during the time period that our sample covers. Across all states, on average, the Shelter-in-Place Index decreased by 30 percent from April 11 to May 2. On the other hand, in states such as Mississippi, Montana, Oklahoma, and South Dakota that fall into the highest quartile of CCI, compliance decreased more than 50 percent, even though the risk of infection remained high and the percentage of people testing positive for COVID-19 stayed the same or increased. Our results show that “quarantine fatigue” makes the collective action problem even more difficult where corruption is high.
Table 7.1 Corruption and compliance with stay-at-home orders: maximum likelihood SUR estimation (dependent variable: Log shelter-in-place index)
| Equation 1 April 11, 2020 | Equation 2 April 18, 2020 | Equation 3 April 25, 2020 | Equation 4 May 2, 2020 | |||||
|---|---|---|---|---|---|---|---|---|
| COVID-19 Positive | 0.760 | 0.804 | 0.801 | 0.847 | 1.209 | 1.248 | 1.188 | 1.260 |
| (0.146)Footnote *** | (0.147)Footnote *** | (0.185)Footnote *** | (0.194)Footnote *** | (0.182)Footnote *** | (0.184)Footnote *** | (0.270)Footnote *** | (0.274)Footnote *** | |
| CCI | −0.017 | −0.016 | −0.018 | −0.017 | −0.031 | −0.030 | −0.044 | −0.043 |
| (0.008)Footnote ** | (0.007)Footnote ** | (0.008)Footnote ** | (0.006)Footnote *** | (0.008)Footnote *** | (0.006)Footnote *** | (0.015)Footnote *** | (0.012)Footnote *** | |
| SGI | 0.101 | 0.095 | 0.090 | 0.140 | ||||
| (0.039)Footnote ** | (0.038)Footnote ** | (0.048)Footnote * | (0.053)Footnote *** | |||||
| Trump | −0.010 | −0.009 | −0.008 | −0.007 | −0.013 | −0.012 | −0.019 | −0.018 |
| (0.003)Footnote *** | (0.002)Footnote *** | (0.002)Footnote *** | (0.002)Footnote *** | (0.003)Footnote *** | (0.002)Footnote *** | (0.003)Footnote *** | (0.003)Footnote *** | |
| Log Income | 0.101 | 0.122 | 0.115 | 0.134 | 0.087 | 0.106 | 0.187 | 0.218 |
| (0.079) | (0.065)Footnote * | (0.082) | (0.068)Footnote ** | (0.085) | (0.073) | (0.124)Footnote ** | (0.105)Footnote ** | |
| Union | 0.009 | 0.009 | 0.008 | 0.007 | 0.011 | 0.010 | 0.012 | 0.012 |
| (0.004)Footnote ** | (0.004)Footnote ** | (0.004)Footnote ** | (0.003)Footnote ** | (0.004)Footnote ** | (0.004)Footnote ** | (0.006)Footnote ** | (0.006)Footnote ** | |
| Density | 0.032 | 0.035 | 0.038 | 0.041 | 0.040 | 0.043 | 0.041 | 0.046 |
| (0.009)Footnote *** | (0.008)Footnote *** | (0.009)Footnote *** | (0.008)Footnote *** | (0.012)Footnote *** | (0.011)Footnote *** | (0.013)Footnote *** | (0.012)Footnote *** | |
| Constant | 1.733 | 1.406 | 1.513 | 1.206 | 1.699 | 1.403 | 0.797 | 0.328 |
| (0.712)Footnote ** | (0.712)Footnote ** | (0.940) | (0.779) | (0.969)Footnote * | (0.853)Footnote * | (1.411) | (1.221) | |
| Correlation Matrix of Residuals | ||||||||
|---|---|---|---|---|---|---|---|---|
| April 11 | April 18 | April 25 | May 2 | |||||
| April 11 | 1, 1 | |||||||
| April 18 | 0.829, 0.806 | 1, 1 | ||||||
| April 25 | 0.882, 0.871 | 0.814, 0.794 | 1 | |||||
| May 2 | 0.866, 0.847 | 0.794, 0.763 | 0.859, 0.846 | 1, 1 | ||||
Robust standard errors (clustered at the state level) in parentheses. All models control for region fixed effects.
*** , **, and * represent statistical significance at 1 percent, 5 percent, and 10 percent levels, respectively.
The estimated coefficients of the control variables are also statistically significant and their signs are consistent with our expectations.Footnote 5 People responded to shelter-in-place/stay-at-home orders if more people tested positive for COVID-19. In densely populated and more charitable states, they stayed at home more as well. The estimated coefficient of Trump is not only negative, as expected, but its magnitude is also greater than that of CCI, consistent with the increasing political polarization regarding COVID-19 issues. Based on the estimated coefficients in Equation 4, a one-standard deviation increase in Trump reduces the Shelter-in-Place Index by 20 percent. Finally, in richer states and states where more workers are unionized, more people complied with social distancing policies.Footnote 6
We use the share of population who were fully vaccinated as of January 2023 as our dependent variable in our vaccination regressions and estimate the effect of corruption using ordinary least squares (OLS). The results are given in Table 7.2. The estimated coefficient of CCI is again negative and statistically significant in all estimations, indicating that in more corrupt states people are less likely to be vaccinated. The absolute value of the coefficient decreases when we estimate the regression with SGI, again indicating that one of the channels through which corruption affects vaccination is via deterioration in social capital. The magnitude of the effect is significant as well. Based on the estimated coefficients in Equation 1, a one-standard deviation increase in CCI causes the percentage of people fully vaccinated to decrease by approximately 3.5 percent. Again, the estimated coefficients of the control variables are statistically significant and their signs are consistent with our expectations.Footnote 7
Table 7.2 Corruption and vaccination: OLS estimation (dependent variable: Vaccination)
| Equation 1 | Equation 2 | Equation 3 | ||||
|---|---|---|---|---|---|---|
| CCI | −0.017 | −0.015 | −0.012 | −0.010 | −0.015 | −0.014 |
| (0.005)Footnote ** | (0.006)Footnote ** | (0.005)Footnote ** | (0.005)Footnote ** | (0.006)Footnote ** | (0.005)Footnote ** | |
| SGI | 0.066 | 0.064 | 0.046 | |||
| (0.033)Footnote ** | (0.032)Footnote ** | (0.038) | ||||
| Density | 0.220 | 0.231 | 0.284 | 0.297 | 0.244 | 0.250 |
| (0.055)Footnote *** | (0.051)Footnote *** | (0.058)Footnote *** | (0.056)Footnote *** | (0.054)Footnote *** | (0.052)Footnote *** | |
| Republican | −0.091 | −0.089 | −0.086 | −0.085 | −0.090 | −0.091 |
| (0.030)Footnote *** | (0.029)Footnote *** | (0.027)Footnote *** | (0.025)Footnote *** | (0.029)Footnote *** | (0.029)Footnote *** | |
| Log Income | 0.079 | 0.088 | ||||
| (0.054) | (0.047)Footnote * | |||||
| Black | −0.467 | −0.469 | ||||
| (0.134)Footnote ** | (0.126)Footnote *** | |||||
| Education | −1.109 | −0.834 | ||||
| (0.583)Footnote * | (0.690) | |||||
| Constant | −1.301 | −1.431 | −0.388 | −0.413 | −0.305 | −0.349 |
| (0.609)Footnote ** | (0.530)Footnote *** | (0.033)Footnote *** | (0.035)Footnote *** | (0.062)Footnote *** | (0.082)Footnote *** | |
Robust standard errors (clustered at the state level) in parentheses.
*** , **, and * represent statistical significance at 1%, 5%, and 10% levels, respectively.
Unfortunately, we cannot control for some important variables in our regressions because state-level data are not available. The first two are interpersonal trust and trust in government, both of which are likely to mediate the effects of corruption on social distancing. Low interpersonal trust may make people more likely to self-quarantine because they question others’ social distancing behavior. It may also weaken social networks. Without networks, staying home is less of a sacrifice for an individual and less costly. Trust in government is a crucial determinant of government legitimacy. Unfortunately, two frequently used surveys that ask questions regarding trust, the American National Election Study (ANES) and the General Social Survey (GSS), are both nationally representative surveys, and sampling is not done at the state level.
The second variable is social and traditional media misinformation, which may affect people’s behavior towards social distancing and vaccination by, among other things, undermining government legitimacy. Bursztyn et al. (Reference Bursztyn, Rao, Roth and Yanagizawa-Drott2020) investigate the effects of misinformation by comparing two major cable news shows, Hannity and Tucker Carlson Tonight. These shows aired back-to-back on Fox News and had relatively similar content but differed significantly in their coverage of the COVID-19 pandemic. While Carlson warned his viewers about the dangers of COVID-19, Hannity dismissed the risks as less threatening than the common flu and contended that Democrats were using it against Donald Trump. Using survey data on more than 1,000 Fox News viewers aged 55 or older, Bursztyn et al. (Reference Bursztyn, Rao, Roth and Yanagizawa-Drott2020) found that viewership of Hannity was associated with changing behavior (washing hands, social distancing, etc.) four days later than other Fox News viewers, while viewership of Tucker Carlson Tonight was associated with changing behavior three days earlier. Bridgman et al. (Reference Bridgman, Merkley and Loewen2020) conducted a nationally representative survey of more than 2,000 Canadians 18 or older that included questions about common misperceptions regarding COVID-19, social distancing compliance, and exposure to traditional news and social media. They found that exposure to traditional news media was associated with fewer misperceptions and more social distancing compliance, while conversely, social media exposure was associated with more misperceptions and less compliance. Pierri et al. (Reference Pierri, Perry and DeVerna2022) find similar results regarding vaccination using county and state-level Twitter data from the first quarter of 2021 in the US.
7.2.6 A Matter of Trust?
Studies from across the social sciences have pointed to corruption as corrosive to trust/social capital, which are vital to compliance with public health orders. Using data from American states, we have shown that more corrupt states are likely to have lower compliance with shelter-in-place/stay-at-home orders and lower rates of vaccination.
While it would be facile to expect our results to hold in all other countries, the fact that many of the channels motivating our study are salient in a variety of different contexts does suggest that the links between corruption and compliance with public health orders could be fruitfully investigated in other societies. Even with the external validity caveats that would require, we believe that our results have practical implications. Fang et al. (Reference Fang, Wang and Yang2020) found that lockdown was an effective policy in China, while Dave et al. (Reference Dave, Friedson and Matsuzawa2021) found that stay-at-home/shelter-in-place orders at the outset of the pandemic reduced the number of COVID-19 infections by more than 50 percent over a span of three weeks in America. In that light, our findings suggest corruption has significant implications for the spread of COVID-19. Corruption also reduces the quality of healthcare (Mostert et al., Reference Mostert, Njuguna and Olbara2015; Friedman, Reference Friedman2018), making the problem even worse. Hence, more corrupt states might need additional resources to fight future pandemics, even though such states’ institutions might struggle to deal effectively with both a pandemic and a rapid influx of funds.
Finally, evidence shows that corruption reduces the willingness to contribute to pure public goods (Beekman et al., Reference Beekman, Bulte and Nillesen2014), and to the provision of quasi-public goods such as infrastructure (Gillanders, Reference Gillanders2014) – though perhaps only once it passes a threshold level (Bose et al., Reference Bose, Capasso and Murshid2008). Compliance with public health policies generates a benefit to society that is both non-rival and non-excludable – the two characteristics of a pure public good. Therefore, one interpretation of our results is that corruption reduces individuals’ willingness to contribute to pure public goods in the health domain, a finding with implications reaching well beyond the COVID-19 crisis. Organizations such as the World Bank view public health in general, and pandemic preparedness in particular, as global public goods (Stein and Sridhar, Reference Stein and Sridhar2017). Our results, subject to the external validity caveats noted earlier, identify corruption as a significant barrier to the provision of such global public goods.
7.3 COVID-19, Corruption, and Race: The Pandemic Is Not Colorblind
The COVID-19 pandemic killed over 1.1 million people in America (CDC, 2023). The mortality rate for White Americans, while unprecedented since the 1918 H1N1 pandemic, was nevertheless lower than that for Blacks (Rossen, Reference Rossen2020). In Chicago, for example, seventy of the city’s first 100 recorded deaths were Black (Eldeib et al., Reference Eldeib, Gallardo and Johnson2020). As Egede and Walker (Reference Egede and Walker2020) and Tai et al. (Reference Tai, Shah, Doubeni, Sia and Wieland2020) argue, structural racism is one of the root causes of racial health inequities in America. Bailey et al. (Reference Bailey, Krieger, Agénor, Graves, Linos and Bassett2017) define structural racism as ways in which societies foster racial discrimination through mutually reinforcing inequitable systems (in housing, education, employment, health care, criminal justice, and so on) that in turn reinforce discriminatory beliefs, values, and distribution of resources. A meta-analysis covering more than 300 studies shows that racism leads to poorer physical and mental health outcomes (Paradies et al., Reference Paradies, Ben and Denson2015). The COVID-19 pandemic only reinforced inequities between Blacks and Whites in America. In part because Black Americans are disproportionately employed in businesses featuring frequent face-to-face encounters with the public, and because they often live in inner cities or inner-ring suburbs with high population densities (Egede and Walker, Reference Egede and Walker2020), in 2020 excess mortality for Blacks was approximately three times higher than for Whites (Rossen, Reference Rossen2020).
Corruption affects all races, but Black Americans suffer more severely because of poverty and political vulnerability. Black poverty rates are significantly higher than those for Whites – over twice as high nationally, and five or more times higher in some counties. As poverty increases, reliance on publicly provided services such as health care increases. Corruption lowers both the quantity and the quality of publicly provided health care; furthermore, the poor are less able to afford small bribes for the health care that is supposed to be free, or to pay for private alternatives. Urban Black neighborhoods rely heavily on “safety net hospitals” that provide health care regardless of insurance status or ability to pay. The disproportionate share of unpaid or underpaid care that these hospitals provide often leads them to operate with thin financial margins while assuming responsibility for providing critical services (Chatterjee, Sommers, and Joynt Maddox, Reference Chatterjee, Sommers and Joynt Maddox2020). In Chicago, according to 2022 estimates by the Health Care Council of Chicago, by 2024, a dozen safety net hospitals will have lost $1.8 billion combined (Brown, Reference Brown2022). In urban areas across the country, some safety-net hospitals close their doors entirely while others cut services. In a few cases, such as Houston’s Ben Taub Hospital, aggressive public investment and patient support enable safety-net hospitals to provide essential care to large numbers of poor, or poorly insured, patients (Nuila, Reference Nuila2022). But they are very much the exception and illustrate the essential role of sound, well-resourced, and well-administered institutions and policy in providing quality health care to the less affluent segments of the American people. Corruption, by obstructing the formation and implementation of such policies, and by diverting the resources needed to make them work, is likely to weaken the healthcare safety net for those who need it most.
COVID-19 only compounded the structural racism experienced by Black neighborhoods served by already-struggling safety net hospitals. Anecdotal evidence shows how: when a small safety net hospital in Chicago tried to transfer some patients because its ICU was full, others said they were full despite reporting otherwise to the state of Illinois, and others said they were taking no transfers or only transfer patients needing higher-level care. Some hospitals refused patients covered by publicly funded insurance (Schorsch, Reference Schorsch2020). In Los Angeles, some hospitals declined or delayed transfers of COVID-19 patients due in part to their health insurance or lack thereof (Evans et al., Reference Evans, Berzon and Hernandez2020). In New Orleans, patients, mostly Black, were sent back home to die; in some cases, treatment was discontinued even as relatives begged hospitals to keep trying (Waldman and Kaplan, Reference Waldman and Kaplan2020).
Black Americans have higher rates of heart disease, hypertension, diabetes, lung disease, asthma, and obesity, among other illnesses making them more susceptible to dying from COVID-19, but that has little to do with genetic or cultural factors (Non et al., Reference Non, Gravlee and Mulligan2012; Kaufman et al., Reference Kaufman, Dolman and Rushani2015). Rather, the neighborhoods in which they live, work, play, and age do not allow them to be healthy. If they do not exercise enough, it is likely because they live in neighborhoods in which exercising outdoors is dangerous and there are not any gyms. If they eat foods high in sugar, fat, and sodium, it is likely because those foods are the only affordable options in their “food desert” neighborhoods (Bridges, Reference Bridges2020). If they do not go to the doctor as often as White Americans, it is likely not only because they lack health insurance but also because trustworthy, high-quality health care providers are not available. According to a recent survey by “The Undefeated,” an ESPN television series, and the Kaiser Family Foundation, Black Americans trust hospitals in their neighborhoods less than do Whites, and the majority of Blacks believe people are treated differently based on their race by health care providers (Hamel et al., Reference Hamel, Lopes and Muñana2020).
In several respects, structural corruption parallels structural racism as a phenomenon and affects health outcomes for Black Americans more adversely than for Whites. These effects occur both directly via corruption in health care and indirectly via several economic and social channels. First, corruption affects the composition of government spending. Corrupt governments spend less on health care and more on goods affording large bribes and whose value is difficult to monitor, such as military goods (Gupta et al., Reference Gupta, Reza Davoodi and Tiongson2000). It is much easier to collect large bribes on fighter jets than on doctors’ and nurses’ salaries (Mauro, Reference Mauro1998). As Dincer and Teoman (Reference Dincer and Teoman2019) argue, reduced spending on health care goods is not the only problem. Corruption drains millions of dollars from health care services too; Medicare, Medicaid, and Workers’ Compensation fraud are not uncommon in America. It also increases tax evasion and reduces the progressivity of the tax system, leading to reduced tax revenues. Lower revenues in turn reduce both the quantity and the quality of public services including health care (Gupta and Alonso-Terme, Reference Gupta, Davoodi and Alonso-Terme2002).
Corruption also affects redistributive policies and widens socioeconomic inequities. Corrupt officials divert funds within social programs away from the poor toward wealthier and better-connected individuals. In Washington, DC, in 1996, two city officials were convicted of accepting bribes to enroll unqualified individuals for subsidized housing and move them up the waiting list (Rose-Ackerman, Reference Rose-Ackerman1999). Corruption raises inequities in asset ownership. Better-connected individuals get the most profitable government projects, creating a privileged group who have the resources to bribe officials and increase their own assets. Since they in turn are used as collateral to borrow and invest, high inequities in asset ownership reduce the ability of the poor to borrow and invest, further widening politico-economic inequities (Gupta and Alonso-Terme, Reference Gupta, Davoodi and Alonso-Terme2002). Finally, several studies find positive effects of trust – both institutional and social – on health outcomes (Mohseni and Lindstrom, Reference Mohseni and Lindstrom2007). But corruption lowers institutional trust, such as trust in health care (Radin, Reference Radin2013), and also social trust (Rothstein and Eek, Reference Rothstein and Eek2009). Similarly, Passas (Reference Passas2022) argues that both illegal and legal corruption undermine preparedness for policy crises and implementation of countermeasures, with legal or institutional corruption posing particularly serious challenges in those respects.
7.3.1 Empirical Analysis: Data
Evidence from the 171 large metropolitan counties in thirty-five American statesFootnote 8 for which race-related data are available, as classified by the National Center for Health Statistics (NCHS), shows that corruption increases the gap between Black and White COVID-19-related deaths. We first estimate a linear model using both state and county-level variables with OLS regression, in which the dependent variable is the gap in COVID-19-related deaths between Blacks and Whites. Death Gap is measured as the population share of Blacks died from COVID-19 divided by the population share of Whites died from COVID-19.
The data for COVID-19-related deaths by race are from the Centers for Disease Control and Prevention (CDC) and cover the 15-month period from January 1, 2020 to March 31, 2021. Next, the same model is estimated with quantile regression to analyze whether the effects of corruption on Death Gap differ in counties with high health inequities. Corruption is measured using CCI data as described in Chapter 2.
Several county- and state-level politico-economic and demographic control variables are used in the regressions to minimize omitted-variable bias. If corruption is correlated with any of these control variables, omitting them causes the coefficient of CCI to be estimated with a bias. The first control variable is the Poverty Gap between Blacks and Whites, measured as the population share of Blacks who are poor divided by the population share of Whites who are poor. The data are from the Census Bureau’s American Community Survey (ACS). The second is political support for Donald Trump during the 2020 presidential election (Trump). Several opinion polls show that COVID-19 has strong partisan dimensions: Gollwitzer et al. (Reference Gollwitzer, Martel and Brady2020), for example, find that conservative counties are less likely to follow the CDC’s social distancing/facemask guidelines, leading to higher infections and deaths (see also the results earlier in this chapter). Indeed, two decades’ worth of mortality data from a variety of causes (Denworth, Reference Denworth2022) show that both Blacks and Whites in Democratic-voting counties have lower mortality figures than their counterparts in Republican-voting counties, although it must be noted that mortality rates are higher for Blacks than Whites in both cases. Perhaps a surprise is that differences in vaccine uptake accounted for only 10 percent of the county-level contrasts in COVID-19 deaths; the differences likely had more to do with behavioral contrasts such as the frequency of un-masked social activities. In any event,
…[b]y February 2022 the COVID death rate in all counties Donald Trump won in the 2020 presidential election was substantially higher than in counties that Joe Biden won – 326 deaths per 100,000 people versus 258.
The third control variable is per capita spending (in $1,000s) on public welfare in each state (Public Welfare Spending). It includes cash assistance through Temporary Assistance for Needy Families, Supplemental Security Income, and other payments made directly to individuals as well as payments to health care providers under programs like Medicaid. The data are from the Urban Institute. Demographic control variables are population density (Density) and Age Gap – measured as the population share of Blacks who are older than 64 divided by the population share of Whites who are older than 64.
Several studies, such as Wong and Li (Reference Wong and Li2020), find that densely populated counties with older populations have higher COVID-19-related death rates. The data are from ACS. All control variables are from 2020.
7.3.2 Empirical Analysis: Results
The results of the OLS estimation are presented in Table 7.3. The estimated coefficient of CCI is positive and statistically significant, indicating that corruption widens the gap in COVID-19-related deaths between Blacks and Whites. A one-standard deviation increase in CCI causes Death Gap to increase by approximately 10 percentage points. That result is not trivial: Poverty Gap has the same standardized positive effect on Death Gap. Then, the full model is estimated by adding Public Welfare Spending. The estimated coefficient of CCI stays positive and statistically significant, but its magnitude decreases, indicating that corruption not only affects health inequities directly but also indirectly through spending on public welfare.
Table 7.3 Corruption and the gap in COVID-19-related deaths between Blacks and Whites: OLS estimation
| CCI | 0.07 (0.02)Footnote *** | 0.06 (0.02)Footnote *** |
| Poverty Gap | 0.09 (0.03)Footnote *** | 0.07 (0.03)Footnote ** |
| Trump | 1.09 (0.32)Footnote *** | 0.96 (0.35)Footnote *** |
| Age Gap | 1.37 (0.27)Footnote *** | 1.30 (0.28)Footnote *** |
| Density | 0.04 (0.01)Footnote *** | 0.04 (0.01)Footnote *** |
| Distrust in Health Care | 0.10 (0.05)Footnote * | |
| Public Welfare Spending | −0.03 (0.01)Footnote ** | |
| Constant | −0.69 (0.27)Footnote ** | −0.62 (0.30)Footnote * |
| N | 171 | 171 |
| R2 | 0.25 | 0.27 |
Robust standard errors clustered at the state level given in parentheses.
* , **, and *** represent statistical significance levels at 0.10, 0.05, and 0.01, respectively.
Estimated coefficients of all control variables are statistically significant and have the expected signs: for example, in densely populated counties in which Age Gap is wider, Death Gap is wider as well. While increase in Distrust in Health Care causes Death Gap to widen, increased Public Welfare Spending narrows it. Moreover, in conservative counties supporting Donald Trump, the gap in COVID-19-related deaths between Blacks and Whites is wider.
Finally, the effects of corruption on Death Gap are estimated with quantile regression. OLS regression models the relationship between CCI and the conditional mean of Death Gap across all counties in the data set, thus providing only a partial view of the relationship. Quantile regression, by contrast, allows us to analyze this relationship at different points in the conditional distribution of Death Gap. This is important because the effects of corruption are likely to differ significantly, with a stronger effect on Death Gap at higher quantiles. In other words, corruption widens the Black/White gap in COVID-19-related deaths even more in counties with high health inequities. Figure 7.1 shows how the effects of CCI on Death Gap differ over quantiles and how the magnitude of the effects at various quantiles differs significantly from the overall OLS coefficient estimates, even in terms of the confidence intervals around each estimated coefficient.

Figure 7.1 Differential effects of corruption on the gap in COVID-19-related deaths between Blacks and Whites across quantiles
Black solid line represents the coefficients of CCI estimated by quantile regression while the gray solid line represents the one estimated by ordinary least squares. Dashed black and gray lines represent the respective 95 percent confidence intervals.
These results have important implications regarding vaccine equity; for example, data show that as of mid-2022, Black Americans were still getting vaccinated at a lower rate than Whites (Ndugga et al., Reference Ndugga, Hill and Artiga2022). Some might argue that vaccine hesitancy plays a significant role in that gap, but several nationwide surveys show that Black Americans are not hesitant to get vaccinated (Summers, Reference Summers2021). Political factors are important as well: while federal guidelines regulate the distribution of vaccines both across and within states, state governors decide who receives the first doses of the vaccine and who administers them. The responsibility to distribute and administer vaccines fairly and effectively falls first on governors and only then on health care providers.
Structural corruption affects vaccine equity as well. Corruption in that sense is not merely a matter of misconduct by individuals, but rather a manifestation of bad governance and a lack of impartiality on the part of institutions. There is ample anecdotal evidence of lack of impartiality in vaccination in the form of racial discrimination. In Louisiana and Georgia, two states that score high on the CCI, an NPR study (McMinn et al., Reference McMinn2021) found few vaccine sites in predominantly Black neighborhoods in urban counties. In Florida, another high-scoring state, priority was given to predominantly White gated communities whose developers were major contributors to political action committees supporting the governor (Shaw, Reference Shaw2021). Not surprisingly, the 2021 White-to-Black vaccination ratio was greater than 2 in Florida (Pham and Alam, Reference Pham and Alam2021).
7.4 Conclusion
The COVID-19 pandemic highlighted important health inequities between Blacks and Whites caused by structural racism. The OLS and quantile estimations presented just earlier support the argument that structural corruption exacerbates those health inequities. By impeding or preempting impartiality, corruption causes politico-economic and socio-economic inequities to increase, in turn causing health inequities to increase even more. Berkowitz et al. (Reference Berkowitz, Cené and Chatterjee2020) argue that it is time to take racial health equity seriously, starting with solving the collective action problems evident in our findings regarding social distancing, mask-wearing, and vaccination. Corruption is yet another collective action problem (Persson, Rothstein, and Teorell, Reference Berry, Fording and Ringquist2013) that must be solved if we are to take racial equity seriously.
That said, efforts to isolate statistically separate effects of structural corruption from those of more ordinary varieties did not bear fruit. That, in a way, is not surprising if we understand “structural” to refer to the ways in which corruption, like racism, can be embedded in, perpetuated, and protected by the workings of institutions and inequalities in politics and the economy. The manifest difficulties we have had in reducing corruption in the United States, and around the world, strongly suggest that there is more to the problem than just “deviance,” and that we should also think of corruption as the abuse of imbalances of power (Johnston and Fritzen, Reference Johnston and Fritzen2021).
That leaves us with an aspect of corruption that is difficult to deny, even if it is hard to tease out quantitatively – the ways in which it is made more tenacious – indeed, is protected in important ways – by institutions and political processes, rather than occurring and persisting in defiance of those influences. We believe we have addressed that phenomenon by incorporating long-term, deeply embedded factors in the analysis such as political culture, institutional influences (centralization/decentralization), longer-term aspects of social structure (urbanism and population density), and by our focus on legal as well as illegal corruption.
Still, neither this analysis, nor others in the literature, arrive at “solutions” for racial contrasts in health care and COVID outcomes, any more than for police killings of Black Americans. Indeed, they cannot, for we are neither examining discrete problems nor mere deviance within otherwise fair and just institutions. Further, the evident importance of state-level political cultures and ideologies makes it clear that neither policy reforms, budgetary reallocations, nor health policy changes confined to single jurisdictions can mitigate the tragic trends we have seen. Instead, a fundamental reassessment of institutions and power relationships, of our expectations about the roles of citizens and government, and of social values so familiar that they rarely come up for debate, is required. Health care – like policing – is fundamental not only to individual wellbeing but also to the overall vitality and fairness of our states and communities. Whether we can and will do better is an urgent question that we must all answer.





