Health Politics
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Health politics or politics of health is an
interdisciplinary Interdisciplinarity or interdisciplinary studies involves the combination of multiple academic disciplines into one activity (e.g., a research project). It draws knowledge from several fields such as sociology, anthropology, psychology, economi ...
field of study concerned with the analysis of social and political power over the
health Health has a variety of definitions, which have been used for different purposes over time. In general, it refers to physical and emotional well-being, especially that associated with normal functioning of the human body, absent of disease, p ...
status of individuals. Health politics, incorporating broad perspectives from
medical sociology Medical sociology is the sociological analysis of health, Illness, differential access to medical resources, the social organization of medicine, Health Care Delivery, the production of medical knowledge, selection of methods, the study of action ...
to
international relations International relations (IR, and also referred to as international studies, international politics, or international affairs) is an academic discipline. In a broader sense, the study of IR, in addition to multilateral relations, concerns al ...
, is interested not only in the understanding of politics as government or 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 level. 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

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 de ...
and
politics Politics () is the set of activities that are associated with decision-making, making decisions in social group, groups, or other forms of power (social and political), power relations among individuals, such as the distribution of Social sta ...
. Like many other interdisciplinary fields such as
sociology Sociology is the scientific study of human society that focuses on society, human social behavior, patterns of Interpersonal ties, social relationships, social interaction, and aspects of culture associated with everyday life. The term sociol ...
,
phenomenology Phenomenology may refer to: Art * Phenomenology (architecture), based on the experience of building materials and their sensory properties Philosophy * Phenomenology (Peirce), a branch of philosophy according to Charles Sanders Peirce (1839â ...
or
public policy Public policy is an institutionalized proposal or a Group decision-making, decided set of elements like laws, regulations, guidelines, and actions to Problem solving, solve or address relevant and problematic social issues, guided by a conceptio ...
, health politics 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 groups' and individuals' social and political identities result in unique combinations of discrimination and privilege. Examples of these intersecting and overlapping factor ...
. It examines the political nature of
health Health has a variety of definitions, which have been used for different purposes over time. In general, it refers to physical and emotional well-being, especially that associated with normal functioning of the human body, absent of disease, p ...
and
healthcare Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...
within the wider public health and medical contexts. 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" which focused on policy in the
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
. Through his work in
biopolitics Biopolitics is a concept popularized by the French philosopher Michel Foucault in the mid-20th century. At its core, biopolitics explores how governmental power operates through the management and regulation of a population's bodies and lives. ...
, French philosopher
Michel Foucault Paul-Michel Foucault ( , ; ; 15 October 192625 June 1984) was a French History of ideas, historian of ideas and Philosophy, philosopher who was also an author, Literary criticism, literary critic, Activism, political activist, and teacher. Fo ...
also offered insight into health politics through his 1979 essay "The politics of health in the eighteenth century" (English translation by Lynch, 2014).


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 under-researched, with literature focusing on the social and cultural determinants of health at the lack of political ones. By integrating analysis on
social power In political science, power is the ability to influence or direct the actions, beliefs, or conduct of actors. Power does not exclusively refer to the threat or use of force (coercion) by one actor against another, but may also be exerted thro ...
and politics within health and healthcare systems, a better understanding of barriers in health inequality and
inequity Equity may refer to: Finance, accounting and ownership *Equity (finance), ownership of assets that have liabilities attached to them ** Stock, equity based on original contributions of cash or other value to a business ** Home equity, the diffe ...
can be gained. It critiques
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 de ...
for professionalizing health and healthcare systems 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 (social and political), power, and the analysis of political activities, political philosophy, political thought, polit ...
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 form of Political organisation, political organization that can be observed, recognised or otherwise declared by a society or state (polity), state. It defines the process for making official gov ...
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,
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 de ...
's problems and issues are explicitly political, as the world's health bodies and organizations are supported by national governments — making their solutions equally political as well. "If public health is the field that diagnoses and strives to cure social ills, then understanding
political Politics () is the set of activities that are associated with decision-making, making decisions in social group, groups, or other forms of power (social and political), power relations among individuals, such as the distribution of Social sta ...
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 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. 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) is a conceptual framework that visualizes and frames the political factors that shape and control the health and wellbeing of people. This places a
sociological Sociology is the scientific study of human society that focuses on society, human social behavior, patterns of social relationships, social interaction, and aspects of culture associated with everyday life. The term sociology was coined in ...
lens upon areas like
medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
— treating it as a
social science Social science (often rendered in the plural as the social sciences) is one of the branches of science, devoted to the study of societies and the relationships among members within those societies. The term was formerly used to refer to the ...
as much as an
applied science Applied science is the application of the scientific method and scientific knowledge to attain practical goals. It includes a broad range of disciplines, such as engineering and medicine. Applied science is often contrasted with basic science, ...
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 dist ...
in its perceived failure to incorporate political factors within its framework or its having a limited conceptualization 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
social power In political science, power is the ability to influence or direct the actions, beliefs, or conduct of actors. Power does not exclusively refer to the threat or use of force (coercion) by one actor against another, but may also be exerted thro ...
(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 pro ...
that require a distinct conceptualization 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 is a political and economic ideology that advocates for free-market capitalism, which became dominant in policy-making from the late 20th century onward. The term has multiple, competing definitions, and is most often used pej ...
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 relat ...
, a major sub-field of
politics Politics () is the set of activities that are associated with decision-making, making decisions in social group, groups, or other forms of power (social and political), power relations among individuals, such as the distribution of Social sta ...
. 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, and 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
globalization Globalization is the process of increasing interdependence and integration among the economies, markets, societies, and cultures of different countries worldwide. This is made possible by the reduction of barriers to international trade, th ...
, that makes the distinction of domestic and international health politics increasingly insensitive to shifting political contexts.


LGBTQ health politics

LGBTQ LGBTQ people are individuals who are lesbian, Gay men, gay, bisexual, transgender, queer, or questioning (sexuality and gender), questioning. Many variants of the initialism are used; LGBTQIA+ people incorporates intersex, Asexuality, asexual, ...
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, Stonewall revolution, or simply Stonewall) were a series of spontaneous riots and demonstrations against a police raid that took place in the early morning hours of ...
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 im ...
, GSMs' health status has been deeply influenced by the politics of any given time and
geopolitical Geopolitics () is the study of the effects of Earth's geography on politics and international relations. Geopolitics usually refers to countries and relations between them, it may also focus on two other kinds of states: ''de facto'' independen ...
location.


Marxist health politics

Using theories generated by
Karl Marx Karl Marx (; 5 May 1818 – 14 March 1883) was a German philosopher, political theorist, economist, journalist, and revolutionary socialist. He is best-known for the 1848 pamphlet '' The Communist Manifesto'' (written with Friedrich Engels) ...
and
Marxist Marxism is a political philosophy and method of socioeconomic analysis. It uses a dialectical and materialist interpretation of historical development, better known as historical materialism, to analyse class relations, social conflic ...
scholars, a Marxist health politics centers on
class conflict In political science, the term class conflict, class struggle, or class war refers to the economic antagonism and political tension that exist among social classes because of clashing interests, competition for limited resources, and inequali ...
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 Human capital or human assets is a concept used by economists to designate personal attributes considered useful in the production process. It encompasses employee knowledge, skills, know-how, good health, and education. Human capital has a subs ...
. 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 Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...
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.


See also

*
Health economics Health economics is a branch of economics concerned with issues related to Health care efficiency, efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. Health economics is important in dete ...
*
Human rights Human rights are universally recognized Morality, moral principles or Social norm, norms that establish standards of human behavior and are often protected by both Municipal law, national and international laws. These rights are considered ...
*
Medicalization 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 evi ...
* Medical-industrial complex *
Privatization Privatization (rendered privatisation in British English) can mean several different things, most commonly referring to moving something from the public sector into the private sector. It is also sometimes used as a synonym for deregulation w ...
*
Political science Political science is the scientific study of politics. It is a social science dealing with systems of governance and Power (social and political), power, and the analysis of political activities, political philosophy, political thought, polit ...
*
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 de ...
*
Political economy Political or comparative economy is a branch of political science and economics studying economic systems (e.g. Marketplace, markets and national economies) and their governance by political systems (e.g. law, institutions, and government). Wi ...
*
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...


Notes


References


Further reading

* Bekker P. M. Marleen and all (2018)
Public health and politics: how political science can help us move forward
* Carme Borrell, Albert Espelt, Maica Rodríguez‐Sanz and Vicente Navarro (2007)
Politics and health
* Clare Bambra, Debbie Fox and Alex Scott-Samuel (2006)
A politics of health glossary
* * Radhika Gore and Richard Parker (2019)
Analysing power and politics in health policies and systems


External links


Journal of Health Politics, Policy and Law
* Journal of
Policy, Politics, & Nursing Practice ''Policy, Politics, & Nursing Practice'' is a quarterly peer-reviewed nursing journal that covers the field of nursing and health policy. The editor-in-chief is Sally S. Cohen ( New York University College of Nursing). It was established in 2000 a ...

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