HLPR3001 - Module 2 (2022)
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This document discusses how politics relates to public health. It provides four key reasons why public health is inherently political: 1) Individual health actions can create externalities that affect others, requiring some level of political oversight. 2) There is debate around what basic health services governments should provide as "merit goods". 3) Moral views on public health issues require political support to enact policies. 4) Large public health problems could threaten national security if left unaddressed. The document explores these concepts through examples like infectious disease outbreaks and different countries' welfare systems.
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HLPR3001 - Module 2 (2022)
- 1. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J “Just because you do not take an interest in politics doesn’t mean politics won’t take an interest in you.” - Pericles
- 2. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Health Partnerships, Politics and Power ECONOMY OF HEALTH Louise Francis A POLITICAL
- 3. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Overview What is politics? What does it have to do with public health? • Externalities • Merit goods • Morality • National security
- 4. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Bambra et al. (2005) – Article in focus Reading critical review 1. Reflect on the readings/online materials for Module 2 2. Key messages/thoughts? What were the take away messages? 3. What content got you thinking? 4. How does the content presented relate to any of your previous units/studies?
- 5. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Bambra et al. (2005) – Article in focus Key messages/thoughts Any concepts you didn’t understand? Why is health political? Health as a commodity Health as an aspect of citizenship and a human right How do these concepts relate to political philosophy (neo-liberalism/capitalism & the welfare state)?
- 6. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Bambra et al. (2005) – Article in focus Key messages/thoughts Any concepts you didn’t understand? Why is health political? Health as a commodity Health as an aspect of citizenship and a human right How do these concepts relate to political philosophy (neo-liberalism/capitalism & the welfare state)? Why is health apolitical?
- 7. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J What is politics? 1. Politics as government – the art of government and the activities of the state. 2. Politics as public life – concerned with the conduct and management of community affairs. 3. Politics as conflict resolution – concerned with the expression and resolution of conflicts through compromise, conciliation, negotiation and other strategies. 4. Politics as power – the process through which desired outcomes are achieved in the production, distribution and use of scarce resources in all areas of social existence. Bambra, et al. (2005)
- 8. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Activity 2.1: Political Interpretations 1. What did Bambra et al (2005) mean when they referred to the first and last as a top down and a bottom up interpretation of politics? 2. According to Schrecker & Bambra (2015) what is the focus of a political economy approach to understanding health and how is it different to a biomedical approach to health?
- 9. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J EXPLORING THE CONNECTIONS HEALTH POLITICAL? WHY IS PUBLIC
- 10. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Some reasons… 1. Externalities and individual restrictions for the common good 2. Extent to which government is expected to provide bare necessities 3. Moral judgments about response to public health issues require political support to enact 4. Public health problems can affect national security if reaching a certain scale
- 11. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Health Partnerships, Politics and Power externalities… Individual + institutional actions often produce significant spillover effects (what economists call externalities). Some of these are beneficial and some are harmful. REASON #1
- 12. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J REASON #1
- 13. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J “The only purpose for which power can rightfully be exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.” - John Stuart Mill REASON #1
- 14. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J REASON #2 merit goods
- 15. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J In their own words: The Welfare State Video also available to view on Blackboard in Unit Materials – Module 2
- 16. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J In their own words: The Welfare State How do the MPs describe the role of welfare?
- 17. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Activity 2.2: Welfare States Reflect on the following with reference to the reading by Schrecker and Bambra (2015) in particular: What regime of welfare state is Australia and what are its key characteristics? Homework: Choose two countries identified in the article in Tables 1.1 and 1.2. With consideration to the political context discussed in the chapter, review the changes in health outcomes for the two selected countries and what may have contributed to the changes in health outcomes.
- 18. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J REASON #3 Senator Penny Wong and Senator Cory Bernardi take the oath in the Senate. Photo: Alex Ellinghausen
- 19. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J REASON #4 national security
- 20. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J COVID ‘Lived’ Case Study • Politics • Welfare State • Externalities • Merit Goods • National Security
- 21. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Key points Politics is central in determining how citizens and policy makers recognise and define problems with existing social conditions and policies, in facilitating certain kinds of public health interventions but not others, and in generating a variety of challenges in policy implementation. An understanding of politics helps public health practitioners to better anticipate both short term constraints and long term opportunities for change.
- 22. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Key concepts Politics Externalities Merit goods Morality
- 23. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Next week Tour of Western Australian Parliament – 9-11am Thursday Please arrive by 8.45am to avoid missing out. Masks should be worn along with professional attire. See Blackboard for more details on location and transport.
- 24. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Module 2: A Political Economy of Health Health Partnerships, Politics and Power Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Questions & comments
- 25. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J COMMONWEALTH OF AUSTRALIA Copyright Regulation 1969 WARNING This material has been copied and communicated to you by or on behalf of Curtin University of Technology pursuant to Part VB of the Copyright Act 1968 (the Act) The material in this communication may be subject to copyright under the Act. Any further copying or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice
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- An opportunity to explore one of the readings more explicitly
- This week’s reading discussed four definitions. Tell me about these definitions. Do any resonate more or less with you? Top down – separates politics from the community Bottom up - Politics is everything; it is a term that can be used to describe any ‘power-structured relationship’. - every issue is political and everyone can engage in a political act. (Millett, 1969) Not mutually exclusive and in this unit we will explore both the function and structure of the actual government but also how negotiate partnerships and use and challenge power to improve public health outcomes.
- This week’s reading discussed four definitions. Tell me about these definitions. Do any resonate more or less with you? Top down – separates politics from the community Bottom up - Politics is everything; it is a term that can be used to describe any ‘power-structured relationship’. - every issue is political and everyone can engage in a political act. (Millett, 1969) Not mutually exclusive and in this unit we will explore both the function and structure of the actual government but also how negotiate partnerships and use and challenge power to improve public health outcomes.
- This week’s reading discussed four definitions. Tell me about these definitions. Do any resonate more or less with you? Top down – separates politics from the community Bottom up - Politics is everything; it is a term that can be used to describe any ‘power-structured relationship’. - every issue is political and everyone can engage in a political act. (Millett, 1969) Not mutually exclusive and in this unit we will explore both the function and structure of the actual government but also how negotiate partnerships and use and challenge power to improve public health outcomes.
- This week’s reading discussed four definitions. Tell me about these definitions. Do any resonate more or less with you? Top down – separates politics from the community Bottom up - Politics is everything; it is a term that can be used to describe any ‘power-structured relationship’. - every issue is political and everyone can engage in a political act. (Millett, 1969) Not mutually exclusive and in this unit we will explore both the function and structure of the actual government but also how negotiate partnerships and use and challenge power to improve public health outcomes. The biomedical model focuses on possibilities for cure and views differences in health as differences among individuals; the behavioural approach focuses on what are widely referred to as lifestyle choices (smoking, alcohol consumption, healthy diets, seatbelt use) while normally neglecting the larger contextual influences (low incomes that make healthy diets unaffordable, intensive marketing of energy-dense convenience foods to children). The political economy approach, by contrast, focuses on ‘social, political and economic structures and relations’ that may be, and often are, outside the control of the individuals they affect: health is politically determined (Bambra et al., 2005). As epidemiologist Nancy Krieger describes the core of the political economy approach, patterns of health and disease are ‘produced, literally and metaphorically, by the structures, values and priorities of political and economic systems ... Health inequities are thus posited to arise from whatever is each society’s form of social inequality, defined in relation to power, property and privilege’ (Krieger, 2013). Another way of expressing this idea comes from work by Diderichsen and colleagues, who argued for explaining socially patterned disparities in health in terms of how social stratification (the unequal distribution of resources and opportunities) generates differences in exposures to risks of illness, vulnerabilities to those exposures and consequences of ill health. Further, they argued that explanations must venture upstream from the observed facts of stratification to consider ‘those central engines in society that generate and distribute power, wealth and risks’ (Diderichsen et al., 2001, p. 16). In 2014, the Lancet–University of Oslo Commission on Global Governance for Health took a further step by putting forward the concept of political determinants of health, insisting that ‘[c]onstruing socially and politically created health inequities as problems of technocratic or medical management depoliticises social and political ills’ (Ottersen et al., 2014, p. 636).
- So why is public health political? I’m going to give four reasons (but there are others). Politics is central in determining how citizens and policy makers recognise and define problems with existing social conditions and policies, in facilitating certain kinds of public health interventions but not others, and in generating a variety of challenges in policy implementation. Externalities and individual restrictions for the common good Extent to which government is expected to provide bare necessities Moral judgments about response to public health issues require political support to enact Public health problems can affect national security if reaching a certain scale
- In groups come up with a list of externalities for one of the following private actions: Smoking Driving while intoxicated Vaccination To compensate for externalities associated with private actions such as smoking, vaccination, driving while intoxicated, sexual practices, and the manufacture and sale of products requires political decisions about when and how to impose restraints on individual liberties or commercial interests. Emphasis is not on harms to self but the impact an action may have on others/environment.
- What is a recent policy that attempted to impose restraints on commercial interests because of an externality? Carbon price – costing pollution Plain packaging – limiting brand allegiance and promotion to reduce health harms
- This quote represents a common sentiment although it is not universal. What does this mean to you? How do we measure ‘potential harm to others’? Should we be concerned about individuals that chose to do risky or harmful things to themselves? In the eyes of John Stuart Mill, this would be the sole principle justifying public health policy: “The only purpose for which power can rightfully be exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.” Eg 1905 - landmark court decision of compulsory vaccination against smallpox in Massachusetts. What laws do we have in Australia that restrict individual liberties under the guise of the ‘common good’? List them on board Agree – disagree? We’ll explore this tension later in semester. There is a youtube video linked in the quote but depending on time don’t need to play it as the quote is sufficient to pose some considerations and it will be on BB after class: https://www.youtube.com/watch?v=R9IM3ZKNMCk
- The concept of a merit good introduced in economics by Richard Musgrave (1957, 1959) is a commodity which is judged that an individual or society should have on the basis of some concept of need, rather than ability and willingness to pay. Citizens look to government to identify and satisfy a variety of physical, economic and psychological needs that extend well beyond the means for survival. The public may support certain ‘merit goods’ that should be distributed to intended beneficiaries whether or not they have an ability to pay for those goods. Such merit goods include primary and secondary education, basic health care, and welfare payments as a social net for those in poverty and These require political decisions to define their scope and substance, eligibility to receive them, and the source of revenues to purchase them or provide them directly. We discussed in the first week that unlike the US we have universal health care and some of the benefits of this. You would have come across the term “welfare state” and just like the term “nanny state” is often used pejoratively. What services and support should be universally accessible by citizens and therefore provided by the government? Is there a limit to this provision? Is it necessary? What does it mean to be a citizen? What are our obligations and what should we expect in return? Different governments provide these things to different extents and can be classified according to different 'regimes' of welfare state as explored in the reading by Schrecker and Bambra (2015). In Australia, Medicare was introduced in 1975 to ensure universal healthcare provision to Australians. Norway has had universal healthcare since 1912 and New Zealand since 1938 while Greece, Spain and South Korea achieved it in the 1980s and the United States is still yet to (Obamacare made some small inroads). Australia provided free university education for a short period from 1974 to 1989 while countries such as Denmark, Finland, Iceland, Norway and Sweden continue to do so.
- Short discussion on what phrases and perspectives were present.
- Who can tell me about these two people? (Penny Wong – ALP, lesbian / Cory Bernardi – Originally Liberal, defected to Conservatives, no longer in parliament, campaigner against same-sex marriage) – might need some explanation as most won’t know who they are! What do you think the relationship might be between morality or moral judgement and public health that makes it political? Protecting public health involves moral judgements that require legitimacy through political debate and resolution. The appropriateness of offering clean needles to people who inject drugs, funding stem cell research, supporting medical uses for marijuana, ensuring access to contraception and abortion, and legalising physician-assisted suicide (euthanasia) are among the moral issues that are hotly contested in the political arena. In your groups Sex education in schools Needle exchange programs Decriminalisation or regulation of sex work Medical usage of marijuana How do we make decisions about controversial issues when there are different points of view? Considerations of evidence, equity and non-judgemental practice.
- A healthy population and workforce is vital to economic growth and social order. Threats from infectious disease or climate change are not only public health problems but also when they reach a certain scale, may become national security issues and thus a potential source of political instability.
- Consider the current context of COVID – what political aspects can you identify in the experience and response?
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