Politics as an Explanation to the Health Divide in Different Settings: A Comparative Study of England and Ghana

Abstract

Informed by the theoretical perspective of the political economy of health and in the context of the recommendations of World Health Organization’s Commission on Social Determinants of Health, this article examines the political explanations of geographical health inequities in 2 extremely different settings: Ghana and England. Based on the “north-south health divide” in the 2 countries, the article finds that, while the drivers of health inequities in both countries are policy driven, historically situated contextual factors (colonialism in the case of Ghana and deindustrialization in the case of England) offer explanations for health inequities in both countries. We conclude by discussing the importance of paying attention to structural factors such as colonialism for understanding contemporary health inequities in formerly colonized countries such as Ghana.

Equity dimensions of the decline in under‐five mortality in Ghana: a joinpoint regression analysis

“…Regarding the other geographical dimension of inequity (regional), the evidence from our analysis suggests that some regions such as the Upper East region that had high levels of under‐five mortality in the late 1980s have made impressive improvements compared to the national average and are now among the best performers in the country, while regions such as the Ashanti, Brong‐Ahafo, Eastern and Volta regions had annual percentages of decline of less than 3%. Several historical factors such as colonialism, Structural Adjustment Policies (SAPs) and the evolution of the Ghanaian health system are important for understanding the regional variations in under‐five mortality [28]. That notwithstanding, regions such as the Upper East have made recent progress as seen in this analysis.…”

Where is the pain? A qualitative analysis of Ghana’s opioid (tramadol) ‘crisis’ and youth perspectives

“…Within a couple of weeks many young people were tweeting about bad roads, dumsor (power outages), water crises and other socioeconomic problems. The rise in tramadol use should be understood at least in part, as a reaction to economic realities created by decades of structural adjustment and neoliberal economic policies [9] that limit opportunities for decent work thus forcing young people to use drugs. These reactions merit structural intervention to improve the social determinants of health and to curb the potential dangers of addiction by youth.…”

“…Finally, I argue that a better way to understand tramadol use among young people in Ghana is to explore the pain that leads to consumption while moving away from the moralising discourses that have been the core approach of the government and other stakeholders. By paying particular attention to pain and themes of youth-and through a proposed framework -I show that tramadol is used as a coping mechanism for many young people who are struggling to find their place in the context of perpetual waithood and global neoliberal processes that shape young people's lives [9]. The reality of tramadol use requires improvement of young people's economic prospects and strengthening of mental health systems rather than victim blaming.…”