Health politics or politics of health is an interdisciplinary field of study concerned with the analysis of social and political power over the

health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...

status of individuals. Health politics, incorporating broad perspectives from

medical sociology Medical sociology is the sociological analysis of medical organizations and institutions; the production of knowledge and selection of methods, the actions and interactions of healthcare professionals, and the social or cultural (rather than cl ...

international relations International relations (IR), sometimes referred to as international studies and international affairs, is the scientific study of interactions between sovereign states. In a broader sense, it concerns all activities between states—such a ...

, 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.

Overview

Irish Famine Sculpture - Flickr - boulanger

Health politics is a joint discipline between

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

and

politics Politics (from , ) is the set of activities that are associated with making decisions in groups, or other forms of power relations among individuals, such as the distribution of resources or status. The branch of social science that stud ...

although, like many other interdisciplinary fields such as

sociology Sociology is a social science that focuses on society, human social behavior, patterns of social relationships, social interaction, and aspects of culture associated with everyday life. It uses various methods of empirical investigation an ...

, phenomenology or

public policy Public policy is an institutionalized proposal or a decided set of elements like laws, regulations, guidelines, and actions to solve or address relevant and real-world problems, guided by a conception and often implemented by programs. Public p ...

, often incorporates approaches and

methodologies In its most common sense, methodology is the study of research methods. However, the term can also refer to the methods themselves or to the philosophical discussion of associated background assumptions. A method is a structured procedure for bri ...

of other related fields of study such as

intersectionality Intersectionality is an analytical framework for understanding how aspects of a person's social and political identities combine to create different modes of discrimination and privilege. Intersectionality identifies multiple factors of adva ...

. It sits to realize the political nature of

healthcare Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...

, and the wider public health and medical contexts that sit within it. A

bibliometric Bibliometrics is the use of statistical methods to analyse books, articles and other publications, especially in regard with scientific contents. Bibliometric methods are frequently used in the field of library and information science. Biblio ...

search for 'politics of health' on

PubMed PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintain the ...

found the earliest entry to be Schmidt's 1977 article "National Blood Policy, 1977: a study in the politics of health" that was set within the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...

. Foucault, through his work in biopolitics, offers insight into health politics through his essay (English translation by Lynch, 2014) "The politics of health in the eighteenth century".

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. 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. By integrating analysis on

social power In social science and politics, power is the social production of an effect that determines the capacities, actions, beliefs, or conduct of actors. Power does not exclusively refer to the threat or use of force (coercion) by one actor against ...

and politics within health and healthcare systems, a better understanding of barriers in health inequality and inequity can be gained. It critiques

for professionalizing health and

healthcare systems Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profess ...

to an extent that it removes it from public engagement, depoliticizing it in the process. 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)'. Combining

political science Political science is the scientific study of politics. It is a social science dealing with systems of governance and power, and the analysis of political activities, political thought, political behavior, and associated constitutions and la ...

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. "Among professionals in public health, the

political system In political science, a political system means the type of political organization that can be recognized, observed or otherwise declared by a state. It defines the process for making official government decisions. It usually comprizes the govern ...

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". Here,

'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. "If public health is the field that diagnoses and strives to cure social ills, then understanding

political Politics (from , ) is the set of activities that are associated with making decisions in groups, or other forms of power relations among individuals, such as the distribution of resources or status. The branch of social science that studies ...

causes and cures for health problems should be an intrinsic part of the field".

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 centralised 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. Because of this, medical and health professionals can be seen as political agents as a bridge between medical science and society. 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.

Political determinants of health

The political determinants of health (PDOH) are a conceptual framework that visualises and frames the political factors that shape and control the health and wellbeing of people. This places a

sociological Sociology is a social science that focuses on society, human social behavior, patterns of social relationships, social interaction, and aspects of culture associated with everyday life. It uses various methods of empirical investigation and ...

lens upon areas like

medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

- treating it as a

social science Social science is one of the branches of science, devoted to the study of societies and the relationships among individuals within those societies. The term was formerly used to refer to the field of sociology, the original "science of soc ...

as much as an

applied science Applied science is the use of the scientific method and knowledge obtained via conclusions from the method to attain practical goals. It includes a broad range of disciplines such as engineering and medicine. Applied science is often contrasted ...

to understand its political nature. Here, it is predominantly a critique of the

social determinants of health The social determinants of health (SDOH) 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 (such as the d ...

in its perceived failure to incorporate political factors within its framework or its having a limited conceptualisation of what politics can entail. PDOH outlines that politics is not merely an institutional process, of government acting upon an individual. Rather, politics is a multifaceted contestation of

(e.g. the ability to enact change upon someone else) that takes place throughout the social determinants of health. 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. PDOH is set within the social determinants of health, but acknowledges that political processes and contestation over power form a unique

social phenomenon Social phenomena or social phenomenon (singular) are any behaviours, actions, or events that takes place because of social influence, including from contemporary as well as historical societal influences. They are often a result of multifaceted pr ...

that require a distinct conceptualisation to appreciate their impact upon health and healthcare. 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 Neoliberalism (also neo-liberalism) is a term used to signify the late 20th century political reappearance of 19th-century ideas associated with free-market capitalism after it fell into decline following the Second World War. A prominent fa ...

market failures, homophobia, or poverty.

Perspectives

Comparative health politics

Comparative health politics takes influence from

comparative politics Comparative politics is a field in political science characterized either by the use of the ''comparative method'' or other empirical methods to explore politics both within and between countries. Substantively, this can include questions relatin ...

, a major sub-field of

. It focuses on the interactions of health politics within a country or comparing countries, as opposed to international health politics. 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.

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. It views the space of nation-states as increasingly being blurred, such as through processes like

globalisation Globalization, or globalisation (Commonwealth English; see spelling differences), is the process of interaction and integration among people, companies, and governments worldwide. The term ''globalization'' first appeared in the early 20t ...

, that makes the distinction of domestic and international health politics increasingly insensitive to shifting political contexts.

LGBT health politics

LGBT ' is an initialism that stands for lesbian, gay, bisexual, and transgender. In use since the 1990s, the initialism, as well as some of its common variants, functions as an umbrella term for sexuality and gender identity. The LGBT term is a ...

or gender and sexual minorities (GSMs), through a complex history and ongoing discriminations, have a distinct sub-field within health politics. From the

stonewall riots The Stonewall riots (also known as the Stonewall uprising, Stonewall rebellion, or simply Stonewall) were a series of spontaneous protests by members of the gay community in response to a police raid that began in the early morning hours of Ju ...

to the politics involved around

HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...

, GSMs' health status has been deeply influenced by the politics of any given time and

geopolitical Geopolitics (from Greek γῆ ''gê'' "earth, land" and πολιτική ''politikḗ'' "politics") is the study of the effects of Earth's geography (human and physical) on politics and international relations. While geopolitics usually refers to ...

location.

Marxist health politics

Using theories generated by

Marx Karl Heinrich Marx (; 5 May 1818 – 14 March 1883) was a German philosopher, economist, historian, sociologist, political theorist, journalist, critic of political economy, and socialist revolutionary. His best-known titles are the 1848 p ...

and Marxist scholars, a Maxist health politics centres on

class conflict Class conflict, also referred to as class struggle and class warfare, is the political tension and economic antagonism that exists in society because of socio-economic competition among the social classes or between rich and poor. The forms ...

and the failures of capitalism and capitalistic processes and actors in the persistence of health inequalities and inequity. "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".

Political epidemiology

This interdisciplinary field takes influence from

epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evidenc ...

in creating a scientific study of the political factors that influence and shape the health of human populations. It has a distinct leaning on natural science methodology through a positivist approach, involving methodology like statistical analysis or case studies.

Notes

References

External links

Journal of Health Politics, Policy and Law

Journal of Policy, Politics, & Nursing Practice

Politics of Health Group
{{Public health Health and politics Health care Medical sociology Politics Public health