The Political Context of Social Inequalities and Health

Abstract

This analysis reflects on the importance of political parties, and the policies they implement when in government, in determining the level of equalities/inequalities in a society, the extent of the welfare state (including the level of health care coverage by the state), the employment/unemployment rate, and the level of population health. The study looks at the impact of the major political traditions in the advanced OECD countries during the golden years of capitalism (1945-1980)--social democratic, Christian democratic, liberal, and ex-fascist--in four areas: (1) the main determinants of income inequalities; (2) levels of public expenditures and health care benefits coverage; (3) public support of services to families; and (4) the level of population health as measured by infant mortality. The results indicate that political traditions more committed to redistributive policies (both economic and social) and full-employment policies, such as the social democratic parties, were generally more successful in improving the health of populations. The erroneous assumption of a conflict between social equity and economic efficiency is also discussed. The study aims at filling a void in the growing health and social inequalities literature, which rarely touches on the importance of political forces in influencing inequalities.

Implementation, Effectiveness and Political Context of Comprehensive Primary Health Care: Preliminary Findings of a Global Literature Review

“…This suggests that countries with broadly social democratic politics and openness to citizen engagement (including advocacy) are more likely to support a comprehensive PHC approach. This inference aligns with recent comparative studies of policies implemented in different types of highincome welfare states on public health funding and population health outcomes, showing that social democracies outperform liberal (market-oriented) democracies (Chung & Muntaner, 2006;Navarro & Shi, 2001). Whether initiated by NGOs or by governments, "political will" and commitments to equity were frequently referenced as contextual determinants of a more comprehensive PHC implementation.…”

Social determinants of tuberculosis in Europe: a prospective ecological study

“…However, despite the strong predictive associations between logged GDP, the Gini coefficient and the two TB outcomes, our models accounted for ,50% of the country-level variation in TB rates and it is plausible that unmeasured confounders may have biased our estimates. Further research is needed to identify these country-level predictors that account for the remaining variance, for example it has been proposed that characteristics of the welfare states, such as social benefits and generally high social expenditure, are related to improved population health [51] and this may be relevant to TB rates in the European and neighbouring countries, considered here. Finally, regardless of these uncertainties, the findings suggest that measures of wealth, inequality and the magnitude in their variation at regional and national level could be used to forecast changes in TB epidemics when facing socioeconomic changes at the European and global level.…”

Understanding responses to the political context of health inequalities in research and policy: Can post-structural theories of power help?

“…Muntaner and Lynch 1999;Navarro and Shi 2001;Navarro, Muntaner et al 2006;Navarro 2007;Schrecker and Bambra, 2015) and such approaches, as discussed, reflect a structural conceptualisation of power. It has not been the intention of this article to dismiss or critique this work but rather to take a different starting point to exploring this issue, by focusing on how a range of actors with an interest in health inequalities, involved in research, policy and the media, describe the political context of the UK (often labelled 'neoliberal') and the way in which they function within such a context.…”

“…Coburn 2004;Muntaner and Lynch 1999;Navarro and Shi 2001;Navarro, Muntaner et al 2006;Navarro 2007;Schrecker and Bambra, 2015). Whilst differing to some extent in their analyses, these authors all argue that policies in most countries are made in the interests of dominant, elite groups, rather than the majority of the population.…”