Health, healthcare and health policy: Exploring the political determinants of health

Authors: Dr Jimena Vazquez Garcia, Dr Konstantinos Roussos, Professor Ewen Speed (all The University of Essex affiliates) A growing body of health and healthcare research across the social sciences and medical humanities explores the political dimensions of health, with significant attention given to social, political, commercial, and environmental determinants. However, political science and political theory have been slower to investigate and theorize the role of "the political" in health. “The political” here not to be understood as a synonym of politics or policy, but rather, as the underlying logic in how medical knowledge constructs disease, (by accentuating models of physical or biological aetiologies which simultaneously background social aetiologies), and how medical practice defines bodies, and shapes practices. The missing analytical focus on the political then allows for the embedding of specific types of responses, and these tend to be downstream interventions focussed on individual lifestyle and behaviour change models. In turn this creates a tautology where morbidity and mortality as seen as problems of individual bodies which require individual treatment, and actively mitigate against alternative, upstream explanations. This lack of attention from political science is also evident in healthcare policymaking, which is often framed as ‘evidence based’ (quotation marks because by underscoring the political, we bring to the fore a problematisation of what counts as evidence). These moves function to reassert the primacy of biological explanatory frames. On foot of these issues, this paper engages with a simple yet crucial question: How is health political? Drawing on Political Discourse Theory (PDT), we explore this question by examining the political framing that contemporary health policy discourses use to construct policy and ask whether these frames work to obscure issues of inequity and injustice within public and mainstream political narratives. Whilst there has been some attention paid to what we describe here as the political determinants of health, most, if not all, of this work has come from a (critical) public health or medical perspective. Where our approach differs is that in this paper political science is the dominant frame of reference. Focusing on two prominent policy areas—health disparities and food security—we analyse how dominant forms of policy-making reframes these issues in ways that function to actively depoliticize them. Specifically, we argue that such discourses expressly work to marginalize broader claims for social justice and health equity while promoting individualised models of resilience and personal responsibility (in line with atomistic models of medical aetiology). Through this analysis, we demonstrate the potential of PDT’s unique contribution to understanding the politics of health and its potential to uncover hidden dynamics of power and exclusion in health policy debates.