Linking political exposures to child and maternal health outcomes: a realist review

Abstract

Background Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political tradition, democracy and globalisation – on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review. Methods The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories. Results Out of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to greater child and infant mortality and youth smoking rates in LMECs through greater influence of multinational corporations and neoliberal trade organisations. Conclusion We present a realist re-analysis of a large systematically identified body of evidence on how four key political exposures – the welfare state, democracy, political tradition and globalisation – relate to child and maternal health outcomes. Three final programme theories were supported.

Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice

“…40% ( n = 37) of the realist reviews cited use of an advisory group at some stage (as per the working definition for this study, notably other terminology was often reported) [14–17, 25–61]. 60% ( n = 56) did not mention the use of an advisory group [62–117]. Of those that did not mention an advisory group, seven reviews [62–64] did report participant involvement that did not fulfill the criteria of an advisory group, i.e., participants were used as data sources but did not advise on the review.…”

Political Ideology Direction of Policy Agendas and Maternal Mortality Outcomes in the U.S., 1915–2007

“…From a political epidemiologic perspective, we argue that the social determinants of health are largely affected by political forces (Barnish et al, 2018 , 2021 ; Rodriguez, 2019 ). We observe that there is no social determinant of health that is not preceded by a set of policies and programs prescribed by politicians and that is at least initially provisioned by and executed through the governmental apparatus.…”

The Political Economy of Health: Bringing Political Science In

“…Colonialism, too, has been identified as a source of adverse health outcomes and health inequalities that negatively affect (racialized) colonial and former colonial subjects and Indigenous peoples across the globe (Bashford 2003, Czyzewski 2011, Ramos et al 2022). An older line of research, but with recent additions relevant to a political economy understanding of health, concerns the adverse impact of dependency relations and globalization on health in the Global South, and on health inequities between populations in the Global North and South (Barnish et al 2021, Forster et al 2020, Labonté et al 2011. Neoliberal policies, policy paradigms, power relations, and ideas have also been identified as sources of health inequalities, both in a global context and within rich democracies (Friel et al 2021, Lynch 2020, Schrecker 2016, Sparke 2017.…”