The Political Economy of Public Health

The field of public health is gradually broadening its conceptual and theoretical models to include non-individual level factors shaping the health outcomes of the population. This now includes macroeconomic policy as a powerful structural predictor. The interdisciplinary thrust of this movement has been mostly widely felt through the Place Matters initiative that links health disparities to socio-economic conditions that exist in one’s immediate neighborhood and community.

More recently, this has expanded to include political economic conditions that shape fiscal policies. One of the best examples of this work is represented by the research of David Stuckler and Sanjay Basu. In their book The Body Economic: Why Austerity Kills, the researchers demonstrate how nations respond to economic and financial crises can impact the life and death of their populations. More specifically, as the title suggests, when governments try to manage crises through austerity – the primary prescription of the neoliberal economic model – it has devastating effects on the health of the population as cutbacks in government spending sharply curtail the resources devoted to public health – physical and mental. Examples are provided from Greece, Britain, Spain, and the United States where suicides and HIV infections increased as a result of fiscal policy. A powerful counterexample is the case of Iceland which suffered a severe financial meltdown but it was managed, successfully, without sacrificing the health of the population. The authors note that if austerity had been subjected to a clinical trial, "It would have been discontinued. The evidence of its deadly side-effects – of the profound effects of economic choices on health – is overwhelming."

There is now evidence that similar misguided macroeconomic policies contributed to the severity of the Ebola outbreak. In this case the International Monetary Fund has played a major role in shaping the fiscal priorities of Guinea, Liberia, and Sierra Leone. As the researchers note:
Since 1990, the IMF has provided support to Guinea, Liberia, and Sierra Leone, for 21, 7, and 19 years, respectively, and at the time that Ebola emerged, all three countries were under IMF programmes. However, IMF lending comes with strings attached—so-called “conditionalities”—that require recipient governments to adopt policies that have been criticised for prioritising short-term economic objectives over investment in health and education. Indeed, it is not even clear that they have strengthened economic performance.

These developments in public health research are a welcome corrective to the “healthy choices” approach that assumes that individual health outcomes are solely the product of individual behaviors and lifestyles. The “structural turn” will have policy implications that will more successfully address the source of health disparities, rather than the symptoms.