Studying the political economy of health around the world advances the equity agenda in Canada and elsewhere

A stethoscope and patient chart
Dennis Raphael
Dennis Raphael

Dennis Raphael, a professor in the School of Health Policy & Management in the Faculty of Health at York University, believes there is a need for application of political economy concepts towards understanding the health of nations around the world, including Canada.

Raphael contends that theories that apply a political economy analysis – considering the role that politics and economics play in distributing resources – help make sense of health systems in widely divergent locations. In this light, Raphael frequently presents his graduate students in York’s graduate program in Health Policy and Equity with Kurt Lewin’s 1951 dictum: “There is nothing so practical as a good theory.”

Guided by this claim, Raphael and colleagues Professor Toba Bryant of Ontario Tech University and Morris Komakech, a PhD student in Health Policy and Equity at York, have published articles applying a political economy analysis to explore the health equity scenes in the Nordic nations and Rwanda.

Politics, policies, practices and outcomes: Despite Canada’s reputation, the Nordic nations are the leaders in health promotion,” which appears in the latest issue of Socialmedicinsk Tidskrift/Journal of Social Medicine, explores Nordic nations’ public policy approaches to ensuring economic and social security by providing what the World Health Organization (WHO) initially termed the prerequisites of health, now known as the social determinants of health.

Raphael and Bryant examine how Canada, traditionally seen as a leader in health promotion, ranks poorly compared to Nordic counterparts that provide leadership in implementing policies and practices consistent with WHO principles – policies that derive from the distinctive politics of the Nordic welfare state, and which are under threat from growing acceptance of neoliberal approaches to governance and anti-immigrant sentiment.

Morris Komakech
Morris Komakech

Conceptualizing and researching health equity in Africa through a political economy of health lens – Rwanda in perspective,” published in the September issue of World Development Perspectives journal, sees Raphael and Komakech using Rwanda, which generally has narrower health inequalities than other sub-Saharan African nations, as an example to demonstrate how concepts from the political economy of health literature are relevant for understanding health in Africa.

The authors explain how decommodification, stratification, class mobilization and the relative responsibility ascribed to the state, marketplace and family in defining the quality and distribution of economic and social resources, can inform research and policy action to promote health equity in Africa.

“It is rather remarkable how issues of power and influence and their impact on public policy that distributes the resources necessary for health can be applied to understanding the health of nations so diverse as Canada, the Nordic nations and countries in sub-Saharan Africa,” Raphael said.

He believes applying these concepts, as is being done in York’s graduate program in Health Policy and Equity, has the potential to move forward the health equity agenda in Canada and elsewhere by pointing out how the power and influence of particular societal sectors shapes health and identifying means of responding to these influences.