Political determinants of health
Health can be seen as a political choice. The social determinants of health are amenable to political interventions, and therefore they depend on political action – or inaction, most likely. Also, if considering the right to “a standard of living adequate for health and well-being” (as United Nations declared in 1948) as a human right, health or its absence is a result of political actions.1
In research literature empirical studies of political determinants of health have captured the impact of political traditions or parties and welfare state characteristics, on population health. A review of previous studies found two major research programs – welfare regimes and democracy – and two emerging programs – political tradition and globalization. The primary findings of the review included: (1) egalitarian political traditions on population health are the most salutary, consistent and substantial; (2) the health impacts of advanced and liberal democracies are also positive and large; (3) welfare regime studies, primarily conducted amongst wealthy countries, find that Social Democratic regimes tend to fare best with absolute health outcomes yet inconsistently in terms of relative health inequalities; and (4) globalization defined as dependency indicators such as trade, foreign investment and national debt is negatively associated with population health. 2
Sources:
- Bambra, C., Fox, D. & Scott-Samuel, A. 2005. Towards a New Politics of Health. Health promotion international. 20. 187-93. https://doi.org/10.1093/heapro/dah608
- Muntaner, C., Borrell, C., Ng, E. et al. 2012. Locating Politics in Social Epidemiology. In: O’Campo P., Dunn J. (eds) Rethinking Social Epidemiology. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2138-8_9
More:
Kickbusch, I. 2015. The political determinants of health–10 years on. BMJ (Clinical research ed.). 350. h81. https://doi.org/10.1136/bmj.h81
Commercial determinants of health
Initial definitions of commercial determinants of health emphasized profit-making as a determinant of health 1, but the definition has since evolved to the new definition by WHO.2 The commercial determinants of health now emphasize more generally private sectors activities that affect people’s health positively or negatively. Supply chains, labor conditions, product design and packaging, research funding and lobbying are examples of influences that private sector has through business actions and societal engagements.2
Commercial determinants can have impact on a wide range of health outcomes. These include, for example, obesity, cardiovascular health, diabetes, cancer, road traffic injuries and mental health. Unhealthy commodities may also worsen pre-existing economic, social and racial inequities.2
Sources:
- West R. & Marteau T. 2013. Commentary on Casswell: the commercial determinants of health. Addiction. 108(4):686-687. https://doi.org/10.1111/add.12118. PMID: 23496068.
- WHO 2021. Commercial determinants of health. Available from https://www.who.int/news-room/fact-sheets/detail/commercial-determinants-of-health
More:
de Lacy-Vawdon, C., Livingstone, C. 2020. Defining the commercial determinants of health: a systematic review. BMC Public Health 20, 1022. https://doi.org/10.1186/s12889-020-09126-1
Kickbusch, I., Allen, L., Franz, C. 2016. The commercial determinants of health. The Lancet Global Health, Volume 4, Issue 12, e895 – e896. https://doi.org/10.1016/S2214-109X(16)30217-0
Financialization and health
According to WHO (2013) there is a basic economic rationale for government interventions on the social determinants of health. Firstly, lack of efficiency can be observed as there is an obvious market failure, as the free market fails to allocate resources efficiently. Secondly, achieving the goal of equity is considered an important economic justification for public policy. The synergistic link between efficiency and equity has recently been identified in economic thinking. Neoclassical economics indicates that redistribution doesn’t come for free, but sometimes the price is worth paying.
There is a need to establish the value for money on social determinants of health interventions. Economic evaluation for the interventions can be indicated but isn’t always straightforward. For example, there are certain externalities in education that have non-economic benefits, such as crime fall and improvements in child rearing.
Even though there are very good economic arguments for both efficiency and equity perspective to invest in the areas of social determinants of health, more work for evidence to support investments is still needed.
Source: WHO 2013. The economics of the social determinants of health and health inequalities: a resource book. Available from https://apps.who.int/iris/bitstream/handle/10665/84213/9789241548625_eng.pdf