The Politicization of Health Care: A New Dataset on Party Positions, 1960–2024

Rising costs and aging populations have made health care an increasingly salient political issue. While most parties broadly support its provision and do not challenge its necessity, questions of inclusiveness, generosity, and cost are highly contested. Yet the extent and nature of partisan conflict over health care remain surprisingly understudied within the health politics literature, where attention has focused more strongly on policy outputs and institutional reforms than on political contestation and framing. The limited research that does address party competition in health politics is conducted predominantly on radical right parties, conceptualizes conflict mainly along an economic dimension, or treats health care primarily as a valence issue. Extending this research, we analyze how parties have politicized health care by drawing on nearly 2,000 party manifestos from 20 European countries between 1960 and 2024 and introduce a novel dataset on the politicization of health care. To construct this dataset, we leverage advances in supervised machine learning by fine-tuning an open-source large language model on hand-coded training data, resulting in a multilingual text classification model suitable for comparative health policy research. We classify health-related statements across the political spectrum not only along economic (state–market) lines, but also along two cultural dimensions that speak directly to contemporary debates on access, inclusion, and legitimacy in health systems. First, identity-related frames capture whether statements emphasize inclusion or exclusion of specific social groups, reflecting identity-based conflicts over belonging, minority rights, and stigmatization. Second, populist (distrust) frames assess whether statements express distrust toward political elites or institutions, or attribute responsibility for health-related problems to them. Our findings reveal a growing divergence in party rhetoric. Left parties predominantly employ economic–egalitarian frames, whereas radical right parties increasingly rely on identity-based and distrust narratives that link health care to migration and anti-establishment sentiment, thereby reshaping how health systems are publicly justified and contested. As a result, health care politics has become more polarized, though primarily at the symbolic rather than the policy level, helping to explain why policy stability often coexists with highly charged public debates. This study provides the first systematic analysis of both programmatic and symbolic dimensions of party competition over health care across several decades and a diverse set of European countries from a health politics perspective. It contributes to broader debates on the transformation of welfare state politics by demonstrating how health care is embedded in wider electoral realignments and multidimensional political conflict, structured not only along economic but, most importantly, along cultural lines that increasingly shape public attitudes toward health policy. Methodologically, the paper demonstrates the potential of fine-tuned open-source large language models for large-scale political text analysis in comparative health policy research.