Promoting Health Equity through Political Action

The relationship between health equity and the distribution of economic and social resources in a society is not well understood by the voting public in the English-speaking world. Yet, growing evidence shows that countries with a more equal distribution of resources such as income, housing, and health care among others have higher population health status and greater health equity compared to countries with higher inequalities. Even less well understood are the factors that can contribute to or hamper the achieving of health equity in a society, particularly the role of politics and political ideology. In this article I examine how political action can promote health equity. Specifically, I consider the role of politics in the development and implementation of public policies that promote health equity. These issues are examined from a political economy perspective which treats politics and economics as fundamentally related. Political economy is also concerned with the role of political ideology, the market, political power, and political ideology in shaping public policy decisions on health-related issues. Introduction The relationship between health equity and the distribution of economic and social resources in a society is not well understood by the voting public in the English-speaking world. Yet, growing evidence shows that countries with a more equal distribution of resources such as income, housing, and health care among others have higher population health status and greater health equity compared to countries with higher inequalities (Caiman 1997; Navarro 2002; Carr et al. 1999; OECD 2008). What seems to be less well understood are the factors that can contribute to or hamper the achieving of health equity in a society. For the purposes of this article, health equity refers to the achieving of equalities in health between groups (Braveman and Gruskin 2003). Inequalities in health outcomes are usually traceable to unequal distribution of income and other resources such as power or social and economic status in society. Existing political, economic and social structures consign groups in society to conditions of advantage or disadvantage on the basis of income-usually low income-but also, gender (female), race (populations of colour), disability, or sexual orientation, among others (Braveman and Gruskin 2003). These attributes become markers of difference leading to unequal conditions, and poor health outcomes for these groups. Equity is frequently equated with social justice and ensuring fairness for all individuals and groups, regardless of their gender, race, or other attributes. Governments intervene in the workings of the economy to ensure all members of a population have access to resources, social programs and services to meet their basic material needs such as housing, education, income support, and health care: the social determinants of health (SDOH). Access to these goods and services ensures health equity. The SDOH mediate between public policy and health equity. The creation of the welfare state in western political economies following the Second World War ensured that all citizens in a jurisdiction had access to public goods such as income support programs (for example, social assistance, unemployment insurance, pensions), health care, and other services (Teeple 2000). Inherent in countries with comprehensive welfare states is respect for human rights and specific protections to ensure the material security, health and well-being of citizens. The extent of the welfare state directly determines the extent of social and health inequalities and health equity in nations. In recent years, however, governments in some western countries, particularly Canada and United States, have reduced health and social spending (Teeple 2000). This has led to growing poverty and health and social inequalities in both countries. Indeed, the Organisation for Economic Cooperation and Development (OECD) identified Canada as having one of the largest increases in inequality among western developed nations (OECD 2008). …

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