The Political Determinants of Health
A determinant of health is defined as the range of personal, social, economic, and environmental factors that affect a wide range of health risks and outcomes. In his comprehensive discussion, The Political Determinants of Health, Daniel E. Dawes adds one more determinant of health — politics — which in the era of COVID-19, presents a persuasive answer to the current health-care inequities in our society. Not only does Dawes articulate structural failings from a historical perspective, but he endorses a new model for sending out “clear ripples of hope” to create tools for lawmakers moving forward.
Dawes presents that political policy reflects the values of its time and that discrimination is institutionalized in the very fabric of our society. It is as far back as 1790, early in our nation’s history, that Benjamin Franklin urged the U.S. Congress to advance health equity for all, including enslaved individuals. This became a lost opportunity when politicians bowed to political forces from slavery proponents. Dawes continues to follow U.S. history through to the Affordable Care Act, including efforts to dismantle it by the current administration, illuminating a series of expansions and retractions of the equity of our health-care policies, pushed and pulled by political forces. It is with this comprehensive historical retrospective of “wins and losses” and how discrimination is so ingrained in our institutions today, that the author articulates his political determinants of health model. Using successful lessons learned from our past, Dawes provides a roadmap for our current and future lawmakers, focusing on three major aspects of the political determinants: voting, government, and policy.
The discussion from behind the scenes, or “how the sausage gets made,” of the Affordable Care Act is of particular interest. Clearly illuminated is how influences from commerce, the military, the legislature, and the importance of the immense collective action by over 300 organizations, associations, and coalitions comprised of legal, social, and medical advocates — and even something as small as timing — came together, or were leveraged against each other, to enact the most comprehensive health equity-focused law in our nation’s history.
It is a startling statement that zip code, more than genetic code, predicts one’s health status and life expectancy in our country. This is a must-read for all those who advocate toward a “healthy, equitable, and inclusive society.”