The Political Determinants of Health

In The Political Determinants of Health, author Daniel E. Dawes examines how policy and politics influence the social conditions that generate health outcomes. The following passage is an excerpt from the book.

Moving beyond Merely Nibbling at the Edges: Understanding, Managing, and Leveraging the Political Determinants of Health

Earlier, I mentioned that US citizens had added thirty years to their life expectancy, but only five of those years were attributed to better health care access and higher quality care. The other twenty-five years have been attributed to non–health care factors, including prevention and public health initiatives, affordable housing, education, employment, transportation, and other resources necessary to thrive in a society. Today, researchers have classified these as social determinants of health. According to Dr. Brian Smedley, a nationally distinguished expert, “recent bi-partisan interest in addressing the social determinants of health is an important development that hopefully will correct some of the imbalance in the United States’ investments in health—today, less than five cents of every federal health dollar is invested in prevention. But to make progress on some of our most deeply embedded health inequities, including racial, ethnic, and socioeconomic, improving the social determinants of health alone will not assure health equity.”

As we dig further into these social determinants to understand their interrelationships and how they have caused health inequities, we now recognize they rest on underlying political determinants undergirded by structural racism and other insidious forms of discrimination. These political determinants must be examined, understood, appropriately managed, and leveraged to address the structures and systems that have prevented the realization of health equity in America. Otherwise, we will continue to “merely nibble around the edges of the problem,” as Smedley declares. The United States, along with every other country, must seriously address the political determinants of health or else perpetuate the myth that existing inequities were purely socially derived or that inequities are so far removed from a political determinant that inequities can no longer be linked to a political determinant, thus severing any legal mechanisms to correct them. This will mean engaging in uncomfortable conversations on inequities stemming from race, ethnicity, place, and class; disrupting the fragmentation between systems; forging more thoughtful and effective partnerships; and expending the resources necessary to address these dynamics and achieve health equality.

As I mentioned in chapter 3, the political determinants of health involve the systematic processes of structuring relationships, distributing resources, and administering power, operating simultaneously in ways that mutually reinforce one another to shape opportunities that advance health equity or create, perpetuate, and exacerbate health inequities. These political determinants of health are the instigators of the causes of inequities, the determinants of the determinants, which have a cascading effect on our health and life. Over time, health inequities owing to political action or inaction have become so structurally entrenched that it has been difficult to identify their root causes. The failure to invest the time and resources necessary to understand, manage, and leverage political determinants of health is why it is difficult to stem the tide of inequities and achieve health equality. Fortunately, there have been successes in overturning precedent and setting new precedent; however, it has taken tremendous political will and capital to effect those changes.

Daniel E. Dawes is the director of the Satcher Health Leadership Institute at Morehouse School of Medicine who has been at the forefront of recent major federal health policy negotiations in the United States. The cofounder of the Health Equity Leadership and Exchange Network (HELEN), he is the author of The Political Determinants of Health and 150 Years of ObamaCare.

Order The Political Determinants of Health at the following link: https://jhupbooks.press.jhu.edu/title/political-determinants-health

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