Recognizing the Political Determinants of Health

By Vanessa P. Kenealy, JD, Public Health and Preparedness Programs Specialist

Policymakers and the medical community now widely acknowledge that the physical, economic, environmental, and social conditions in which people live have a significant impact on health outcomes. Yet, comprehensive initiatives to abate the health effects and disparities caused by social determinants have been slow to emerge. In order to make meaningful strides to address social determinants, Ranit Mishori, MD, professor of family medicine at Georgetown University School of Medicine, argues that it is essential to look upstream at the political choices and policies that influence, and in some cases prevent, these societal inequities (The Medical Care Blog, 2018).

The inextricable link between political decision making and health care will be explored at the 16th Annual Public Health Leadership Forum on October 24 at MMS Headquarters in Waltham. The forum will examine the nexus of politics, policy, and health care access in Massachusetts by focusing on three timely issues: immunization requirements, individuals without documentation, and incarcerated individuals. The forum will also explore the role of advocacy in supporting evidence-based policies and political decision making that improve health, access, and equity.

Politics and Women’s Access to Care

There are many instances when political decision making and governmental policy have considerable bearing on health and access to care. Most visible today is the contentious political debate related to reproductive health access. These politically driven decisions have a disproportionate effect on women since many of their health issue are related to reproduction. Moreover, their health care, including preventive care, is often delivered at reproductive health clinics and gynecological provider offices. Changes to, and reduction or elimination of, family planning programs, contraceptive coverage, and nondiscrimination protections are just some of the political decisions that have an impact on women’s health. Additionally, rollbacks of insurers’ and employers’ coverage of maternity care, birth control, and medical and family leave affect women’s health directly and have implications for the broader population because so many women are caregivers. As one might expect, women with lower incomes and those with disabilities are most at risk of having their access to care compromised.

The Positive Influence of Politics

Most physicians believe that individual decisions about a person’s health should be the sole province of the patient-physician relationship. Still, there are times when political influence and government involvement in health and health care is beneficial to, and even sought by, the medical community, health care advocates, and individuals. Government clearly has an important role in the regulation of hospitals and medical providers. Similarly, public health commonly includes governmental action to allocate funding, regulate pharmaceuticals, implement injury and disease prevention measures, such as smoking cessation, encourage vaccination and motor vehicle safety, and prevent gun violence.

Political choices and actions based on efforts to improve health outcomes and reduce costs are generally welcomed by the medical community. However, when these decisions are not evidence-based and subordinate health outcomes and access to societal, cultural, and religious objectives, concerns arise. Understanding how politics shapes health care, as well as the ability to address the social determinants of health, is necessary to effectuate policies and actions that advance health and reduce disparities.