Politics and Health

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Politics and health refers to 'political dimension of health and health inequalities' and an 'increasing acceptance' of the role of 'social determinants of health'. 'Key elements of politics like Government, Ideology, Power and Authority have an important impacts on the wide range of health Outcomes'(1). Political dimension starts from a perspective and extended to 'examine the complex interactions between 'political traditions, policies, and public health' and see how different political scenarios has been associated with systematic patterns in population health over time.(2) The present write up is a perspective based upon the references.

Policies:

The notion of Politics dates back to Rudolf Virchow’s work "Report on the typhus epidemic in Upper Silesia"(3)and his famous statement ‘‘Medicine is a social science, and politics nothing but medicine at a larger scale’’. Politics and Health have gained a new importance with Report of the Commission on Social Determinants of Health (4), The World health Report on Primary health care (5), and 8th Global Conference on Health Promotion discussing various approaches to 'Health in All Policies' (6, 7).

Public Health:

The 'Core Idea' of Politics and Health comes from Rudolph Virchow contribution which implies that 'whole populations can be sick, and that political action may be needed to cure them' and 'the notion that disease is an expression of normal life processes under abnormal circumstances'. He associated the typhus epidemic in upper Cecilia with hunger and war, and identified the deeper causes of the epidemic as social and ultimately political. The direct cause of the epidemic was the famine of the previous years, which in its turn was due to crop failures because of bad weather.

This was followed by Sir Geoffrey Rose work which emphasized that main requirement is to see populations as ‘‘systems’’ whose collective functioning (reproduction, growth, prosperity, etc.) can be impaired. Thus the need to study characteristics of populations, not characteristics of individuals (8).

The political action by various health professionals across time which made an impact or revolution though various means have been identified later, for eg. Semmelweis- Child bed fever/puerperal fever was transmitted by doctors’ dirty hands and later addition to it by the discovery of the microbial cause (9).

If we conceptualize politics as a struggle between conflicting ideologies and interests to reach the un-reached then, defining and understanding social class in health is more important. There has been a ‘neglect of power relations in social class research’ and need to ‘understand the difference in income, wealth or credentials if we use social class’ and to develop measures ‘to capture power relations’. (10)

There are many assumptions about category of population data of ‘those with the power to shape and accrue the data’ and ‘those who seek to use these data to illuminate and oppose social inequalities in health’. To understand the social class through epidemiological analyses social disparities in health have long been disparately interpreted as evidence of: (a) ‘‘innate’’ inferiority, (b) ‘‘cultural’’ inferiority or (c) embodied consequences of social inequity, (11)

Research results are presented by breaking down by sex, or sex is included as a variable for study and analysis broadly speaking refers to the agenda of 'health and gender'. Political support at higher end in Spain has resulted in setting up of observatory of women’s health, which has facilitated work to develop a series of guidelines for gender mainstreaming in the different stages of research. (12)

Political traditions:

The concept of health and welfare is related to expansion of welfare state which in turn reflects the degree to which societies take care of their citizens. The paper politics and health outcomes (2) reviewed and analyzed voters participation, time in government by political parties, Labour market data, data on welfare state policies, Income distribution (Gini coefficient), Social inequality (Theil index that have that policies aimed at reducing social inequalities, such as welfare state and labor market policies) with the health outcomes of infant mortality and life expectancy at birth for selected countries with in Organisation for Economic Co-operation and Development with data from 1972-996.

They identified four types of countries viz Social democratic countries; Christian Democratic countries; liberal countries; and the Ex dictatorship with assigned characteristic features. A hypothesis that socialist democratic countries are more committed to expansion welfare state have heavy emphasis on public provision of social services and redistribution through tax transfer system and high rate of women participation in labour force.

The specific mechanisms of how social democratic countries influence health and health inequalities was assumed to based on :

  • (a) presence of strong labour movements:
  • (b) Public benefits are high and are for everyone
  • (c) Full employment policies and a high percentage of women in the labour force
  • (d) Low socioeconomic and income inequalities

Infant mortality is the dependent health-related variables most commonly used as it is

  • (a) sensitive over a short period of time,
  • (b) it is sensitive to social development;
  • (c) it is sensitive to political and welfare state conditions. (2&13)

What can be done for Political action on health

There are various ways in which a person can participate and see what can be done ‘‘ladder of political activism’’(8) is proposed way across different stages

The first or lowest step: Information on health risks and opportunities for health improvement is exchanged within the health sector and informing politicians if asked (political passivism) . second Step: Active dissemination of relevant information among politicians, by drawing the attention of the media and by participating in advisory committees. third step: Actively disseminate relevant information among politicians, directly influence the political process, by lobbying and by actively engaging politicians of specific political parties. Highest or fourth Step: public health professionals become politicians themselves, directly influencing the political process, by lobbying and by actively engaging politicians of specific political parties.

References

  • 1.Bambra,C., Fox, D., Scott-Samuel,A., A politics of health glossary Journal of Epidemiology and Community Health 2007;61:571–574.
  • 2.Navarro,V., Muntaner,C., Borrell,C., Benach, J., Quiroga,A., Rodríguez-Sanz,M., Vergés,N., Pasarín,M., I., Politics and health outcomes The Lancet 2006; 368: 1033–37
  • 3.Report on the Typhus Epidemic in Upper Silesia
  • 4.Report of the Commission on Social Determinants of Health
  • 5.The World health Report on Primary health care
  • 6.-8th Global Conference on Health Promotion (8GCHP)
  • 7.Starfield, B, Politics, primary healthcare and health: was Virchow right?Journal of Epidemiology and Community Health 2011;65(8):653-55.
  • 8 Mackenbach JP, Politics is nothing but medicine at a larger scale: reflections on public health’s biggest idea, Journal of Epidemiology and Community Health 2009;63:181–184.
  • 9.Morabia A, Is epidemiology nothing but politics at a different level?Journal of Epidemiology and Community Health 2009;63(3)188-190.
  • 10.Muntaner, C, Power politics and Social class, Journal of Epidemiology and Community Health 2002;56:562
  • 11.Krieger N, Data, ‘‘race,’’ and politics: a commentary on the epidemiological significance of California’s Proposition 54- JJournal of Epidemiology and Community Health 2004; 58(8): 632–633.
  • 12 Revuelta,C., C., Peiro´-Pe´rez, R., Lo´pez- Rodrý´guez,R., M., Espiga-Lo´pez,I., Sa´iz-Martý´nez-Acitores,I., Soriano-Villarroel,I., Policies, politics and gender research, Journal of Epidemiology and Community Health 2007;61(Suppl II):ii2–ii3. doi:10.1136/jech.2007.066225
  • 13.Borrell,C., Espelt,A., Rodrý´guez-Sanz,M., Navarro, V., Politics and health, Journal of Epidemiology and Community Health.2007;61(8): 658–659.
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