The effect of universal health coverage on pollution induced mortality across 91 countries

Abstract

This study investigates the mitigating role of universal healthcare coverage (UHC) in reducing mortality from air pollution, focusing on deaths caused by particulate matter pollution (PMP) and ambient ozone pollution (AOP) across 91 countries from 2000 to 2023. The empirical analysis employs unbalanced panel data and multiple estimation techniques, including fixed-effects models with clustered standard errors, Robust Weighted Least Squares, and the Wooldridge control-function approach. By accounting for heteroskedasticity, non-normality, and potential endogeneity, the analysis provides a comprehensive assessment of the relationship between UHC and pollution-induced mortality. Results reveal that higher UHC scores significantly reduce pollution-induced mortality. The protective effect is highly robust for particulate matter pollution across all model specifications, whereas the evidence for ambient ozone pollution is generally supportive but becomes sensitive to the inclusion of common time effects, suggesting a less robust association. Specifically, a one-point increase in UHC score (on a 0–100 scale) is associated with a decline of approximately 2.9 deaths per 100,000 people from PMP and 0.08 deaths per 100,000 people from AOP in the baseline specification. These results highlight that strengthening UHC is not only a social equity imperative but also a key instrument for environmental health adaptation, reinforcing the synergy between public health policy and climate resilience objectives.