Extending the Political Determinants of Health framework with institutional theory for health system resilience analysis

This paper examines Health System Resilience (HSR) through a political science lens, arguing that the capacity of health systems to become resilient is shaped not only by technical capabilities but also by the Political Determinants of Health (PDoH). While both HSR and PDoH have gained prominence in health research, their integration remains limited, particularly within political science frameworks. This paper addresses this gap by extending the PDoH concept with institutional theory to analyse how power structures, governance arrangements, and historical institutional configurations influence the politics of resilience. Drawing on a scoping review of, the paper finds that political dimensions – such as governance, institutional path dependency, power dynamics, and civic engagement – are unevenly addressed in the literature. Most sources adopt a fragmented view of politics, rarely identifying PDoH systematically or analysing them through robust political theory. Consequently, resilience is often depoliticized and treated as a managerial issue, rather than a contested political process. The paper proposes a more integrated analytical framework, grounded in institutional and policy theories, to examine how HSR is shaped by the interplay of actors, ideas, and institutions. In doing so, the study contributes to developing a political science of health that strengthens interdisciplinary engagement. It calls on political scientists to proactively engage with public health scholarship to support more politically aware and effective resilience strategies.