Political Determinants of Health

At present, a growing literature base shows how people’s health is a consequence of the contexts in which they thrive. However, the view that health is an issue of personal choice and responsibility continues to predominate in the health professions. Partly for this reason, long-term, effective solutions for promoting health by addressing the social context have been elusive. For this session, papers will link population health to the political arena and/or the political economy. The assumption is that population health has much to do with how societies are organized, thus, more fundamental kinds of political and structural changes are needed. Tags: Economics, Health and Care, Policy, Politics

Organizer: Andrew Patterson, MacEwan University; Chair: Andrew Patterson, MacEwan University; Discussant: Andrew Patterson, MacEwan University

Presentations

Chungah Kim, York University; Gabriel John Dusing, York University; Antony Chum, York University

Does community political affiliation influence substance use and suicide-related crisis events across sexual orientations?

Lesbian, gay, and bisexual (LGB) individuals have higher risk of suicide-related behaviours (SRBs) and substance use crisis events compared to the general population. Although there is evidence on the sociopolitical factors which increase the risk of SRB and substance use crisis events in the general population, its influence across sexual orientations remains unknown. Political climate can contribute to experiences of structural stigma (i.e. minority stress) for LGB individuals, which in turn disproportionately impacts their health outcomes. Despite major shifts in support of LGB rights in Canada, such as the federal legalization of same-sex marriage in 2005, hot-button issues (e.g. Ontario’s sex-ed controversy in 2015) continues to incite political debate. LGB individuals in Ontario tend to vote in favour of socially progressive parties (Liberal and NDP), and living in ridings not aligned with their affiliations may be associated with increased stigma and minority stress. In order to gain a deeper understanding of how the socio-political context influences LGB substance use and SRB, our study uses population-based estimates of SRB and substance use events using hospital emergency department and voting-patterns’ data to answer the following question: how does political affiliation at the community-level influence disparities in SRB and substance-related outcomes across sexual orientations? We found that areas with higher support for conservative candidates had a larger disparity between heterosexual and sexual minority levels of SRB and substance use crisis events; however, effect sizes differed across gender, age, and specific outcomes. Understanding how community-level political affiliation can influence LGB health provides important evidence to support the implementation of culturally-sensitive care in affected communities. A focus on improving the knowledge and availability of LGB welcoming and affirming care should be a priority in communities with politically conservative ideologies.

Gabriel Lévesque, McGill University

Why is Coal Still Mined? Insights from Asbestos and the Political Structures of Risk Invisibilization

The recent resurgence of black lung among coal miners has reestablished coal as a prime occupational risk in the U.S. Given the protraction of the controversy around black lung and the inability of regulations to minimize risks, the lack of political traction for the end of coal mining may appear puzzling. In this presentation, I will ask why coal is still mined in the U.S. through a comparison with asbestos mining in Quebec, Canada, which ended in 2013 due to similar health concerns. Explanations based on the comparison of health hazards, economic concerns, or industry interference do account for some of the similarities between the two cases but fall short of explaining their divergent outcome. As an alternative to those explanations, I will outline a theory that emphasizes political structures as key enabling mechanisms of risk invisibilization. I will argue that three political structures specifically contribute to invisibilization in occupational health: repeated solvency of the controversy through technical means, a hierarchy of miner’s grievances that puts disease second to shorter-term concerns, and the local embeddedness of health hazards. Comparative analysis will suggest that while conflicts over asbestos and health eventually led to the breakdown of each of these political structures, such breakdown never occurred in the coal case. As a result, coal diseases remain invisible in the political arena, while asbestos diseases have increasingly been visible from the 1980s. This presentation contributes to the political sociology of health by highlighting how macro-level mechanisms lead to the protraction of controversies over occupational diseases.

Andrew Patterson, MacEwan University

Civil Service Organization: A Political Determinant of Health?

Much literature finds that a country’s politics can shape the health of its citizens. Democracies, for example, enjoy higher life expectancy and lower infant mortality rates than autocracies. Beyond democratization, however, few other studies explore the health implications of political-structural variables. The paper begins with a theoretical exposition of what these are: rules that define social-organizational relationships in political systems. The paper then discusses another variable that fits this criterion: recruitment of unelected staff positions in government based on the merits of a candidate’s credentials rather than nepotistic social ties. In the following, I propose that merit-based recruitment enhances population health, either partly or entirely by mitigating political corruption in societies. To test these presumptions, a series of regression models examines comparative data for 172 countries. Using path analysis, preliminary analysis finds that recruitment of unelected staff positions based on their credentials rather than nepotism may improve life expectancy and infant health, largely by way of reducing political corruption. However, robustness tests indicate that this pattern only applies to high-income countries, whereas meritocratic recruitment does not correlate with either health outcome for middle- or low-income countries. As with the larger literature on the political determinants of health, cross-national variation in economic development continues to be a powerful alternative explanation, but questions remain as to how in particular it should relate to these variables. Strengths, limitations and suggestions for future research in this area are discussed.

Manuel Vallee, University of Auckland

Tracing Disease to Political Context: The Case of Asthma in Auckland, New Zealand

Political economies play a major role in shaping how societies organize themselves, which then mediates health outcomes. A key site to examine these linkages is the housing sector. When governments treat housing as a commodity, as opposed to a human right, policy is tilted towards rewarding investors through favourable returns, which leads to speculation, inflates home prices and reduces access to safe and affordable housing. In turn, this reduced access leads to diminished health outcomes. In order to illustrate this dynamic this paper examines the relationship between political economy and asthma in Auckland, New Zealand. This paper endeavours to accomplish three things. First, guided by political ecology of health scholarship and informed by an analysis of relevant policy, the paper shows that, until recently, the New Zealand political apparatus primarily treated housing as a profit-generating vehicle for investors. Second, the paper shows how these policies contributed to rampant increases in home prices, with the cost of Auckland homes more than doubling between 2010 and 2020, which lowered home ownership amongst the middle and working classes, and forced a significant proportion of them to live in substandard housing. Third, the paper discusses how these housing problems led to an increase in health problems, with a particular focus on asthma. Auckland has one of the highest child asthma rates in the developed world, and this analysis will illuminate the ways the condition is tied to the larger political context.