Health care comprises a major segment of the US economy and is a critical influence upon citizens’ quality of life. The quality of health care and access to it are negatively affected by corruption. So too is citizen compliance with public health policies, a fact that became apparent during the COVID-19 pandemic. Stay-at-home orders, for example, were significantly less effective in states with more extensive corruption. Low levels of trust in government contributed to those disparities. Such effects are more pronounced in poorer areas and Black communities. Racial contrasts in vaccine equity – access to vaccinations and related services – were pronounced and, again, reflected levels of corruption. Particularly intractable problems of collective action posed by structural corruption and structural racism must be addressed if disparities in the quality of health care are to be reduced.

Police killings of Black Americans are influenced not only by specific law enforcement situations but also by corruption – where corruption in a state is more extensive, police killings are more frequent. State-level factors may seem remote from local policing, but in fact the constitutional and political connections are strong and deep-rooted. Police killings of Black Americans also reflect contrasts in the states’ political cultures and aspects of communities’ racial composition. Median income levels and the economic gaps between Black and White populations also influence the patterns of police killings. Lobbying activities, political party competition, and police unionism contribute to overall levels of accountability. These diverse and often deep-rooted influences, many of them linked to the expectations communities have of their police and the attitudes of police toward their work and the surrounding communities, show that dealing with the problem of police killings of Black Americans will require fundamental changes of many sorts.