Mini Review Creative Commons, CC-BY
Understanding the Political Dimension of Health: A Global Perspective
*Corresponding author: Dr Tanya Tanu, Junior Resident, Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Received: May 02, 2023; Published: May 22, 2023
Apart from the three important dimensions of health, there are various other dimensions which need to be deftly understood. The political dimension of health has been vastly ignored and needs much attention. This dimension has various facets which have been described in this paper for better comprehension. The facets include resources, health education, health economy and healthcare. Politics and health don’t go hand in hand and hence there has always been a mutual disagreement between the two. Since both these entities have shared interests, a common ground needs to be achieved where both can mutually benefit from one another. By learning the art of compromise, issues of public interests can be looked after in a more efficient and productive way and major health gaps can be addressed. Finally, we must understand that health is very much a political entity and there’s an absolute need to develop a much better understanding of how this aspect affects health for the untrammeled progress of global healthcare.
When we talk about the various aspects that govern health, we basically consider its physical, mental, and social aspects while overlooking a particular aspect that is equally important, if not more. Health is so effortlessly classified into these three domains that we become easily oblivious to its political dimension; as a result, this aspect is frequently forgotten and misconstrued. So why has health been stripped of its political status, when in fact health is very much a political entity? To gain more perspective into the matter let’s dive deeper into the definitions of both health and politics. When defining health, we call it “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. More recently it has been modified to include the ability to lead an economically and socially productive life . Politics, on the other hand, is a set of activities that are associated with making decisions in groups, or other forms of power relations between individuals, such as distribution of resources or status. Politics, in its broad sense, is the activity through which people make, preserve, and amend the general rules under which they live . So, basically politics revolves around any entity that can either be considered as a resource or a status and health in its complete being is both.
Health is political because like any distributable resource, some groups of society receive more health benefits than the rest. The social aspects that govern health and the freedom with which certain groups can access healthcare are dependent in large part on the political framework and associated agendas in the defined area. Many a times, rather than preventing it, political parties promote inequitable distribution of health resources by focusing on a particular religious or social group while ignoring the rest  This paves way for further inequity.
Health education is another facet of health that is political in its entirety because its formulation and delivery to the community lies largely in the hands of the government. With proper health education, the community understands the importance of disease prevention along with its application. People also become aware of their health benefits and rights that they enjoy as citizens, with a better understanding of how to best avail them. In short, health education is the fuel to the fire that is health itself.
The political aspect of health is undeniable when we look at health as a basic human right. The right to the highest attainable standard of health is a human right recognized in international human rights law. The International Covenant on Economic, Social and Cultural Rights, widely considered as the central instrument of protection for the right to health, recognizes “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” In addition to that almost every country enshrines its citizens with the right to basic healthcare. When we discuss the rights of every “citizen”, it is pertinent to point out that citizenship sits on a political pedestal. The government of each country sets its own rules regarding who shall be conferred with the citizenship of that country. Citizenship is a law that recognizes a person as a member or belonging to that state. A citizen enjoys certain rights that a refugee or tourist does not, one of which is access to certain aspects of healthcare .
The only facet of health that has a political edge is ‘healthcare’ and in trying to politicize healthcare we have commodified it. This in turn has led to the surge of health insurance companies that cover medical and surgical expenses of an insured individual by reimbursing the expenses incurred due to illness or injury. The United States of America in 2010 passed the Patient Protection and Affordable Care Act signed into law by the then President Barrack Obama . The law regards healthcare as a commodity by giving the power to decide the cost and supply of healthcare in the hands of the market. It regards healthcare as a basic human right by giving the government the power to regulate care standards which might get compromised when insurance companies try to minimize its costs.
Citing heart wrenching examples from the Indian subcontinent which has exposed its crippled healthcare delivery system to the world, India saw the biggest surge in Covid-19 cases during the second wave of the pandemic. With a skewed doctor-patient ratio, inequitable distribution of health resources, mismatched logistics and supply, India can be revered as a classic example of the expression “don’t go biting off more than you can chew” . The extremely low %GDP India spends on its health sector reflects its improper planning and management and lack of the government preparedness for such health crises  Back in 2020, while most countries were preemptively partnering with vaccine companies to ensure an uninterrupted supply of the same, India was busy banging plates and shouting nationalistic slogans. Its rampant, morbid population explosion and lack of supplies to cater to the same was of little concern to the government. What followed was a catastrophic downfall of the government’s own diplomacy.
A third facet of health is the health economy. For the economic growth of a country, its population needs to stay healthy. Drawing example from the ongoing Covid-19 pandemic, as more and more healthcare and paramedical staff are falling prey to the virus, the manpower in healthcare setups has witnessed a decline which in turn has contributed to the decreased efficacy of healthcare delivery. Such events become issues of national security, making health a political agenda.
According to a study conducted by Dr Navarro on Politics and Health Outcomes, health policies (specifically dealing with social inequality and issues concerning the labor market) have a significant positive impact on health indicators, for instance the decline in infant mortality rate and surge in life expectancy at birth. This particular research focused on a set of countries belonging to the Organization for Economic Co-operation and Development (OECD) and was carried out whereby a number of political, economic, social and health variables were analyzed to understand how political ideologies of the ruling parties affect certain indicators of health in the population. The study identified a definite link between politics, policy, and health outcomes .
In the long list of reasons as to why health and politics don’t get along, one might be mutual suspicion, where public health personnel feel that politics does not allow scientific growth and politicians feel that the ideas of the medical community are far-fetched . Another reason might be the complexity of the relationship between politics, policy, and health; a clash of ideas exists between health and politics because both have different motives, each of which is widened by split interests. While public health is purely based on excavation and application of scientific evidence, politics on the other hand, is an art where socioeconomic as well as personal gains must be kept in mind. Public health advocates present their arguments in terms of scientific gain, without caring much about economic return and investment, which becomes disagreeable to the political parties as they find such ideas diffuse, abstract and impractical. Moreover, the goal of a ruling party is short-term; hence they endorse programs that will give finite results, preferably, during their term of office. Since health programs take decades to show an agreeable effect, ruling parties hesitate in giving such policies their unwavering support. All these reasons widen the gulf between health and politics .
It’s time we set aside mutual disagreements and safeguard health and political interests by striking a balance between the two as both disciplines have something unique to bring to the table . Without political support, a public health activist will never be able to reach out to the larger population; and without promoting health, no country will be able to sustain its economy, which will have direct repercussions on the government leading to the collapse of the ruling party. When both entities recognize, understand, and imbibe the aspects of mutual understanding, a constructive partnership will arise whereby each will look out for the interest of the other and newer arenas of public health shall be explored and taken care of. The community and media shall play a pivotal role in rebuilding this partnership. With the ongoing pandemic both the economy and healthcare system are nearing a collapse and hence, a lot of support is needed to pick the remaining pieces up and start afresh. By learning the art of compromise, issues of public interests can be looked after in a more efficient and productive way. A common ground of interest will bring forth a plethora of high-end advancements and collective growth shall follow .
In conclusion, health is political even if one refuses to acknowledge it. Feigning oblivion regarding this aspect will only halt progress in the health sector and the sooner we realize this, the quicker will healthy population reforms occur.
Conflict of Interest
TT and DK conceptualized the topic and did relevant literature search. TT and SNR wrote the paper. VS edited the manuscript and gave their useful inputs in improving the alignment and flow of the paper.
- Park K (2107) Park’s Textbook of Preventive and Social Medicine. (25th).
- Heywood A (1997) Politics. (5th). Red Globe Press.
- Aggarwal NK, Rowe M, Sernyak MA (2010) Is health care a right or a commodity? Implementing mental health reform in a recession. Psychiatr Serv 61(11): 1144-1145.
- Barbara C, Fox D, Samuel AS (2007) A Politics of Health Glossary. J Epidemiol Community Health 61(7): 571-574.
- Oliver TR (2006) The Politics of Public Health Policy. Annu Rev Public Health 27: 195-233.
- OECD (2022) Health spending (indicator).
- Navarro V, Muntaner C, Borrell C, Joan Benach, Agueda Quiroga, et al. (2006) Politics and Health Outcomes. Lancet 368(9540): 1033-1037.
- Hunter E (2016) Politics and Public Health-Engaging the third rail. J Public Health Manag Pract 22(5): 436-441.
- Farfard P, Cassola A (2020) Public Health and Political Science: Challenges and opportunities for a productive partnership. Public Health 186: 107-109.
- Mebane F, Blendon RJ (2001) Political strategy 101: how to make health policy and influence political people. J Child Neurol 16(7): 513-519.