Corruption runs rampant in most countries, and that has big impacts on things like health care.

By , a former intern at Foreign Policy, and , a national security and intelligence reporter at Foreign Policy.

Corruption in the United States is apparently at its worst in almost a decade, according to a new global report released Thursday by Transparency International. Advocates attribute the drop to declining trust in democratic institutions and poor oversight of pandemic-related financial aid.

In the annual Corruption Perceptions Index (CPI), the United States fell to a low of 67 out of a maximum possible score of 100, down from a high of 76 in 2015. By its nature, corruption is difficult to document, so the index relies on a variety of different sources to measure the level of perceived public sector corruption. The lower the score, the worse the corruption. Two-thirds of the 180 countries and territories included in the 2020 index scored below 50, with an average of 43.

Scott Greytak, the advocacy director for the U.S. office of Transparency International, cited a broader “decay” in U.S. political institutions as a major contributor to the country’s declining rating. Gretyak noted that public confidence in U.S. elections has been undercut by disinformation and record-setting amounts of untraceable money in elections—especially in 2020, when twice as much was spent compared with 2016.

“Second, and increasingly important, are these series of really bombshell exposés by media outlets that are demonstrating how much dirty money is flowing into the United States’ financial system,” he said, referencing a joint investigation published by BuzzFeed News and the International Consortium of Investigative Journalists last year that revealed how major banks had knowingly allowed trillions of dollars of suspect financial transactions to go ahead, enabling drug kingpins, kleptocrats, and terrorists to move corrupt cash around the world.

The 2020 index also revealed how global corruption has hamstrung countries’ abilities to protect public health and their economies during the pandemic. In the United States, there have been repeated reports of loans issued under the Payment Protection Program, intended to support small businesses, flowing to not-so-small businesses: Among the beneficiaries are defense contractors, the international fast food chain Shake Shack, and the Los Angeles Lakers.

“COVID-19 is not just a health and economic crisis. It’s a corruption crisis. And one that we’re currently failing to manage,” said Delia Ferreira Rubio, the chair of Transparency International. “The past year has tested governments like no other in memory, and those with higher levels of corruption have been less able to meet the challenge. But even those at the top of the CPI must urgently address their role in perpetuating corruption at home and abroad.”

Health care systems and drug procurement have long been vulnerable to corruption. The report found that the more corrupt a country or territory was, the less money was spent on health care, regardless of levels of economic development. “While corruption differs in scale and scope across regions, it proved to be a universal obstacle to effectively combatting COVID-19,” the report notes.

Since 2012, the earliest point of comparison under the index’s current methodology, half of the countries and territories on the index have remained stagnant, registering little to no improvement in efforts to combat corruption.

Another side effect of the pandemic is that authoritarian governments have seized on it as an excuse to silence critics, curtail civil liberties, and increase surveillance. The report found that high levels of corruption closely correlated with a reliance on undemocratic methods to control the pandemic. The Philippines, which scored 34 out of 100, saw one of the longest and strictest lockdowns early on in the pandemic, as President Rodrigo Duterte warned the police would “shoot … dead” people who violated the restrictions.

Cailey Griffin is a former intern at Foreign Policy. Twitter: @keenstoryteller

Amy Mackinnon is a national security and intelligence reporter at Foreign Policy. Twitter: @ak_mack