Health politics

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Elizabeth Warren and Bernie Sanders campaigning for extended US Medicare coverage in 2017. Warren Medicare for All (36492682584).jpg
Elizabeth Warren and Bernie Sanders campaigning for extended US Medicare coverage in 2017.

Health politics or politics of health is an interdisciplinary field of study concerned with the analysis of social and political power over the health status of individuals. [1] [2]

Contents

Health politics, incorporating broad perspectives from medical sociology to international relations, is interested not only in the understanding of politics as government/ governance, but also politics as civil society and as a process of power contestation. It views this wider understanding of politics to take place throughout levels of society - from the individual to the global. As such the politics of health is not constrained to a particular area of society, such as state government, but rather is a dynamic, ongoing social process that takes place ubiquitously throughout our levels of society. [3]

Overview

A memorial to the Great Famine (Ireland), a famine event in Ireland that faced elongated suffering from the UK's domestic policy failures at the time under the Prime Ministers Sir Robert Peel and Lord John Russell. Irish Famine Sculpture - Flickr - boulanger.IE.jpg
A memorial to the Great Famine (Ireland), a famine event in Ireland that faced elongated suffering from the UK's domestic policy failures at the time under the Prime Ministers Sir Robert Peel and Lord John Russell.

Health politics is a joint discipline between public health and politics. Like many other interdisciplinary fields such as sociology, phenomenology or public policy, health politics incorporates approaches and methodologies of other related fields of study such as intersectionality. [4] It examines the political nature of health and healthcare within the wider public health and medical contexts. [5] [6]

An early publication in the discipline of health politics was a 1977 article by P.J. Schmidt titled "National Blood Policy, 1977: a study in the politics of health" [7] which focused on policy in the United States. Through his work in biopolitics, French philosopher Michel Foucault also offered insight into health politics through his 1979 essay "The politics of health in the eighteenth century" (English translation by Lynch, 2014). [8]

Central contestations

Apolitical study of health and healthcare

A key issue that health politics engages with is the apolitical nature of health within academia, health professions, and wider society. [9] [10] As an interdisciplinary area of study, it is seen as underresearched with literature focusing on the social and cultural determinants of health at the lack of political ones. [11] [12]

By integrating analysis on social power and politics within health and healthcare systems, a better understanding of barriers in health inequality and inequity can be gained. [13]

It critiques public health for professionalizing health and healthcare systems to an extent that it removes it from public engagement, depoliticizing it in the process. [14] This then transfers power away from the public body and into the medical profession and industry such that they can 'determine what health is and therefore, how political it is (or, more usually, is not)'. [1] Combining political science with the study of public health, health politics aims to understand the unique interplay of politics within this policy domain to locate the politics of health. [15]

"Among professionals in public health, the political system is commonly viewed as a subway's third rail: avoid touching it, lest you get burned. Yet it is this third rail that provides power to the train, and achieving public health goals depends on a sustained, constructive engagement between public health and political systems." [16]

Here, public health's problems and issues are explicitly political as the world's health bodies and organizations are supported by national governments - making their solutions equally as political as well. [17] [18] "If public health is the field that diagnoses and strives to cure social ills, then understanding political causes and cures for health problems should be an intrinsic part of the field." [19]

Concepts

Medical and health professionals as political agents

The delivery, planning, and research into health and healthcare, within the modern age of nation-states, is a highly state-orientated enterprise. The bureaucracy in its provision and regulation throughout countries across the world is often one of the most highly centralized activities of government and political actors. More than other areas in society, health politics intersects numerous socially, morally, and culturally crucial as well as sensitive issues that societies face that shape the health and well-being of everyone. [20] Because of this, medical and health professionals can be seen as political agents as a bridge between medical science and society. [21] How this agency takes place, through conformity or deviance (e.g. protesting against government policy), creates unique health politics landscapes and provides a perspective of looking at political power beyond the state. [22]

Political determinants of health

The political determinants of health (PDOH) are a conceptual framework that visualizes and frames the political factors that shape and control the health and wellbeing of people. [23] This places a sociological lens upon areas like medicine - treating it as a social science as much as an applied science to understand its political nature. [24]

Here, it is predominantly a critique of the social determinants of health in its perceived failure to incorporate political factors within its framework or its having a limited conceptualization of what politics can entail. [25] PDOH outlines that politics is not merely an institutional process, of government acting upon an individual. Rather, politics is a multifaceted contestation of social power (e.g. the ability to enact change upon someone else) that takes place throughout the social determinants of health. [26] Although government agencies and policy are important, seeing political contestation and politics as power operating across levels of analysis offers to seek out the cause of the causes. [27]

PDOH is set within the social determinants of health, but acknowledges that political processes and contestation over power form a unique social phenomenon that require a distinct conceptualization to appreciate their impact upon health and healthcare. [28] Rather than stopping at social determinants like sexual orientation, educational level, or food insecurity it encourages an explicit exploration of the causes of these determinants such as Neoliberal market failures, [24] homophobia, or poverty. [29] [11]

Perspectives

Comparative health politics

Comparative health politics takes influence from comparative politics, a major sub-field of politics. It focuses on the interactions of health politics within a country or comparing countries, as opposed to international health politics. [30] [31] This field of study explores how political culture, class relationships, to economic resources shape the implementation of health policy and wider social determinants of health, often taking the form of comparative case studies. [32]

Global health politics

Global health politics is interested in the statal and extra-statal space of politics in health that takes place on a global level. [33] It views the space of nation-states as increasingly being blurred, such as through processes like globalization, that makes the distinction of domestic and international health politics increasingly insensitive to shifting political contexts. [34]

LGBT health politics

LGBT or gender and sexual minorities (GSMs) [lower-alpha 1] , through a complex history and ongoing discriminations, have a distinct sub-field within health politics. From the Stonewall riots to the politics involved around HIV, [35] GSMs' health status has been deeply influenced by the politics of any given time and geopolitical location. [36] [37] [38]

Marxist health politics

Using theories generated by Karl Marx and Marxist scholars, a Marxist health politics centers on class conflict and the failures of capitalism and capitalistic processes and actors in the persistence of health inequalities and inequity. [39] [40]

"We have understanding only of inorganic capital and know nothing about human capital. In a wholly capitalist economy, where the loss of human life is considered only as a private loss for the family but as no economic loss for society, the economy of people becomes, of course, completely superfluous." [41]

Political epidemiology

This interdisciplinary field takes influence from epidemiology in creating a scientific study of the political factors that influence and shape the health of human populations. [42] It has a distinct leaning on natural science methodology through a positivist approach, involving methodology like statistical analysis or case studies. [43]

See also

Notes

  1. ↑ The terms used to describe the queer community are complex and has a politics of its own in terms of identity and recognition. Unless interacting with members of this community who can be asked what term is best, revert to using the most inclusive term.

Related Research Articles

A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.

Health has a variety of definitions, which have been used for different purposes over time. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep, and by reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors affecting health are due to individual choices, such as whether to engage in a high-risk behavior, while others are due to structural causes, such as whether the society is arranged in a way that makes it easier or harder for people to get necessary healthcare services. Still, other factors are beyond both individual and group choices, such as genetic disorders.

Interculturalism is a political movement that supports cross-cultural dialogue and challenging self-segregation tendencies within cultures. Interculturalism involves moving beyond mere passive acceptance of multiple cultures existing in a society and instead promotes dialogue and interaction between cultures. Interculturalism is often used to describe the set of relations between indigenous and western ideals, grounded in values of mutual respect.

Community health refers to simple health services that are delivered by laymen outside hospitals and clinics. Community health is also the subset of public health that is taught to and practiced by clinicians as part of their normal duties. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members.

Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions; by changing social attitudes or economic considerations; or by the development of new medications or treatments.

Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

<span class="mw-page-title-main">Kamran Abbasi</span> British physician and sports writer

Kamran Abbasi is the editor-in-chief of the British Medical Journal (BMJ), a physician, visiting professor at the Department of Primary Care and Public Health, Imperial College, London, editor of the Journal of the Royal Society of Medicine(JRSM), journalist, cricket writer and broadcaster, who contributed to the expansion of international editions of the BMJ and has argued that medicine cannot exist in a political void.

The social determinants of health are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk for a disease, or vulnerability to disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

<span class="mw-page-title-main">Social medicine</span> Understanding how culture and larger groups of people shape health procedures

Social medicine is an interdisciplinary field that focuses on the profound interplay between socio-economic factors and individual health outcomes. Rooted in the challenges of the Industrial Revolution, it seeks to:

  1. Understand how specific social, economic, and environmental conditions directly impact health, disease, and the delivery of medical care.
  2. Promote conditions and interventions that address these determinants, aiming for a healthier and more equitable society.
<span class="mw-page-title-main">Health policy</span> Policy area that deals with the health system of a country or other organization

Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.

<span class="mw-page-title-main">Rural health</span> Interdisciplinary study of health and health care delivery in rural environments

In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.

Frederick Wabwire-Mangen is a Ugandan physician, public health specialist and medical researcher. Currently he is Professor of Epidemiology and Head of Department of Epidemiology & Biostatistics at Makerere University School of Public Health. Wabwire-Mangen also serves as the Chairman of Council of Kampala International University and a founding member of Accordia Global Health Foundation’s Academic Alliance

The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.

Population health, a field which focuses on the improvement of the health outcomes for a group of individuals, has been described as consisting of three components: "health outcomes, patterns of health determinants, and policies and interventions". Policies and Interventions define the methods in which health outcomes and patterns of health determinants are implemented. Policies which are helpful "improve the conditions under which people live". Interventions encourage healthy behaviors for individuals or populations through "program elements or strategies designed to produce behavior changes or improve health status".

<span class="mw-page-title-main">Patrick Vallance</span> British medical doctor

Sir Patrick John Thompson Vallance is a British physician, scientist, and clinical pharmacologist who has worked in both academia and industry. He served as the Chief Scientific Adviser to the Government of the United Kingdom from 2018 to 2023. On stepping down, he became chair of the Natural History Museum in London.

<span class="mw-page-title-main">Tolullah Oni</span> Nigerian urban epidemiologist

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<span class="mw-page-title-main">Jocalyn Clark</span>

Jocalyn Clark is a Canadian Public Health Scientist and the International Editor of The BMJ, with responsibility for strategy and internationalising the journal's content, contributors and coverage. From 2016 to 2022, Jocalyn was an Executive Editor at The Lancet, where she led the Commentary section, coordinated peer review, and edited and delivered collections of articles and Commissions on topics such as maternal and child health, oral health, migration, end of life care and gender equity. She led the Lancet's project to advance women in science, medicine, and global health, #LancetWomen. She is also an Adjunct Professor of Medicine at the University of Toronto and an Honorary Associate Professor at the Institute for Global Health at UCL.

Irene Akua Agyepong is a Ghanaian public health physician with the Dodowa Health Research Center and member of the Faculty of Public Health of the Ghana College of Physicians and Surgeons. Agyepong led The Lancet commission on the future of healthcare in sub-Saharan Africa.

Asa Cristina Laurell is a Mexican sociologist who has had a long career in both research and government positions. She grew up in Sweden, but her education eventually brought her to Mexico. In Mexico, she was awarded two degrees and conducted research that focused on health policy, including ensuring access to health care for people in Mexico and various other Latin American countries. She is known for her role in helping to found the Latin American Association of Social Medicine (ALAMES), as well as the contributions she has made to widening access to health care for Mexicans during her time in government. This included serving as Undersecretary of Integration and Development at the Ministry of Health in Mexico.

<span class="mw-page-title-main">Mark Cullen (physician)</span>

Mark Richard Cullen is a physician, scholar, and population health scientist known for his work in occupational medicine. As a professor at Yale and later Stanford University, his research focused on the social, environmental, behavioral and bio-medical determinants of morbidity and mortality in adults, with special emphasis on the role of workplace’in such matters.

References

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