Any Conversation about Healthcare is Political
politics pervades every aspect of how we prevent illness, deliver care, and pay for health services
Healthcare is often portrayed as a purely scientific or medical domain, separate from the contentious world of politics. However, this is a dangerous misconception. In reality, healthcare is deeply intertwined with political contexts and cannot be meaningfully discussed or improved without addressing its political dimensions. From the allocation of resources and the shaping of public policies to the very definitions of health rights and responsibilities, politics pervades every aspect of how we prevent illness, deliver care, and pay for health services.
The Political Nature of Health
Healthcare is political for several reasons:
Resource Distribution
Healthcare involves the distribution of scarce resources. No country can provide every possible treatment to every citizen at all times. Choices about what services to prioritize, how much to invest in prevention versus treatment, and how to balance individual needs with collective costs are deeply political. These decisions reflect societal values and priorities, influencing who gets access to care and who doesn't.
Social Determinants
Health outcomes are profoundly shaped by social, economic, and environmental conditions. Factors like income, education, housing, nutrition, and discrimination are powerful predictors of health, often outweighing individual behaviors or medical interventions. Addressing these "social determinants of health" requires political action to challenge entrenched interests and redistribute resources.
Health Inequities
Certain groups consistently experience worse health outcomes due to political decisions that concentrate health risks and barriers to care in marginalized communities. For example, people of color and low-income families in the U.S. bear disproportionate burdens of disease and mortality. The COVID-19 pandemic starkly exposed these inequities. Rectifying these injustices requires dismantling the political and economic systems that perpetuate racism, poverty, and exclusion.
Health Rights and Citizenship
Access to healthcare often depends on employment, income, and legal status. In many countries, including the U.S., healthcare is not guaranteed as a fundamental right, leading to large segments of the population being excluded from lifesaving care. The fight for universal healthcare is thus a political struggle over the meaning and boundaries of citizenship, aiming to define health as a public good rather than a commodity.
Ongoing Political Struggles
Even in countries with universal healthcare, political battles continue over the scope of services, cost distribution, and the role of private providers. Different political ideologies and interest groups vie to shape the healthcare system according to their values, whether emphasizing individual responsibility, market competition, social solidarity, or participatory democracy.
Implications for Health Policy and Advocacy
The inescapable politics of healthcare means that clinicians and public health professionals cannot be apolitical. They must engage in the political processes shaping health conditions. Efforts to improve healthcare access and quality must go hand in hand with broader movements for social, economic, and racial justice. The public must be empowered to participate in shaping health policies and priorities.
Acknowledging healthcare's political dimensions can foster more honest and accountable conversations about the values driving health decisions. It reveals that these decisions are fundamentally normative and political, requiring public deliberation and democratic oversight.
New Possibilities for Health Activism
Embracing the political nature of healthcare opens up new possibilities for health activism and social change. Alliances can be forged between health professionals and social movements, linking struggles for health justice with broader campaigns for economic equity, environmental sustainability, and human rights. Market-driven models of healthcare that prioritize profits over people can be challenged, advocating instead for systems centered on patients and communities.
Engaging the politics of healthcare is challenging, requiring coalition-building and sustained organizing. However, pretending healthcare can be divorced from politics is perilous. It leaves crucial health decisions to the market or the powerful, rather than to the needs and voices of the people. It perpetuates a narrow biomedical view of health that ignores social and structural determinants of well-being and undermines healthcare's mission to promote human flourishing and social equity.
Recognizing and engaging the inescapable politics of healthcare is imperative for advancing health as a human right and a public good. It calls for putting the "public" back in public health and acknowledging that the struggle for a healthier world is linked to the struggle for a more just and equitable one. By embracing this political lens, we can build a healthcare system and society that truly enable all people to thrive—not just as patients but as citizens and agents of change.
Further Reading
"You cannot practice public health without engaging in politics," BMJ Blogs
"Public health must engage in politics – here's why," Harvard T.H. Chan School of Public Health
"Patients and politics: What the AMA Code of Medical Ethics says," American Medical Association
"Healthcare Access in Rural Communities," Rural Health Information Hub
"Social determinants of health - World Health Organization (WHO)"