Week Six: Politics are a Determinant of Health

The recent change of government in Ontario, and the sweeping changes that are already being made to the provincial healthcare system, are a clear indicator that the political environment is a major determinant of health. I think that this is mostly due to the change in healthcare related policies that a different political philosophy will implement, but there are assuredly wider systemic affects in other policy areas that will also impact population and personal health. It is likely that a government that cuts back directly on publicly-funded healthcare will also cut back on other social services, and vice versa. Although we have not discussed the politics of health all that much, as it turns out there is a substantial body of academic work on the subject. A recent review concluded that “The evidence was favourable about a positive association of population health with increased welfare state generosity, left-of-centre democratic political tradition and democracy, supported by over three-quarters of eligible studies.” Barnish et al (2018).

However, once I get past the first rush of confirmation bias, I have to caution myself that society is complex to begin with, and that the multiple determinants of health are interconnected in a complex network that makes a simple, linear understanding of cause-and-effect unlikely. I’d like to borrow a slide from a presentation that Dr. Oliver Mack made for Athabasca’s MBA program –

The only point that I’m trying to make is that even if there is evidence of a strong correlation between a certain political philosophy and desirable health outcomes, we should not rush to conclude that left-wing politics causes good health. Healthcare is a complex and uncertain environment, and I think that it is likely that there is more than one path to the same outcome. This is something that I was trying to get at earlier: even though (up ‘til now) Alberta and Ontario have had different approaches to provincial healthcare, according to CIHI data their overall health outcomes are not hugely different. Could it be that there is more than one right answer to healthcare politics?

Barnish, M., Tørnes, M., & Nelson-Horne, B. (2018). How much evidence is there that political factors are related to population health outcomes? An internationally comparative systematic review. BMJ open, 8(10), e020886.

Hunter, D. J. (2015). Role of politics in understanding complex, messy health systems: an essay by David J Hunter. Bmj, 350, h1214.

Kickbusch, I. (2015). The political determinants of health-10 years on. BMJ: British Medical Journal (Online), 350.

Martyn, C. (2004). Politics as a determinant of health. Bmj, 329(7480), 1423-1424.

Mack, O. (2019a). Dealing with Complexity (lecture). Athabasca University RSCM-689 In-residence week, Toronto. Presented March 13, 2019.

Mackenbach, J. P. (2014) Political determinants of health. European Journal of Public Health, 24(1), 2.

Navarro, V., Muntaner, C., Borrell, C., Benach, J., Quiroga, Á., Rodríguez-Sanz, M., ... & Pasarín, M. I. (2006). Politics and health outcomes. The Lancet, 368(9540), 1033-1037.