Introduction

Once upon a time all economics was political economy and economists accepted that the parameters within which markets work are determined by politics and history. (Conversely, the outcomes of market relations also shape political power and history.) For most of the 20th century mainstream economics chose to ignore the politics which shape markets, pre-occupied with the elegance of their quantitative modelling of economic relationships and economies. During this time political economy became closely identified with Marxism which maintained a focus on the political dimensions of economics. Nevertheless, the term is still used by non-Marxist, even neoliberal economists.

In trying to understand how the global economy works (and how it affects health) the discipline of political economy seeks to locate economic analyses within a political environment and seeks to understand the interplay between politics and economics.

Political economists recognise a range of different dynamics which drive the world economy. One of these dynamics may be described as 'growth through productivity'. This applies to situations where, through access to capital and technology, workers can produce more in the same time and (assuming they can access markets) they will earn more, some of which will lead to better health while some will be invested in increased productivity thereby maintaining the dynamic.

Working against this 'growth though productivity' is another dynamic which may be described as 'productivity overhang' or the crisis of overproduction. This applies to situations where increasing productivity jeopardises jobs (because fewer workers are needed to produce enough goods and services to satisfy the market) and jeopardises demand (because falling demand for labour reduces consumer demand) and economic activity.

The political economy of health refers to a body of analysis and a perspective on health policy which seeks to understand the conditions which shape population health and health service development within the wider macro economic and political context. However, the relationships between economic development and health development are complex and can be analysed in terms of a range of different linkages:

• economic growth leads to increased resources for health (improved living conditions and better health services); raising questions such as:

  • what is 'growth'? what are the political conditions for 'growth'? what are the political conditions for ecologically sustainable growth? 

  • under what political conditions does economic growth contribute to improved living conditions and better health care?

• health improvement contributes to economic growth (in particular, through improved labour productivity); raising questions such as: 
  • under what conditions does health improvement contribute to economic growth?
  • under what conditions is the contribution of health improvement to growth valued?
• people's health is exchanged for economic growth (mining 'accidents', unhealthy environments) and the 'disease burden' associated with these is the price of economic growth; raising questions such as:
  • whose health is valued because it contributes to labour productivity? whose health is consumed and transformed into wealth?
  • what are the political conditions which shape these dynamics?
• stagnation and austerity damage health (for example, where unemployment, perhaps through the 'productivity overhang', leads to negative health outcomes); leading to questions such as:
  • what are the causes of stagnation?  what are the political dynamics which cause stagnation? 
  • what are the conditions for protecting people's health in times of stagnation? 
• winners and losers (distributional effects where the competitive struggle for economic and political advantage enhances the prospects of some but diminishes the prospects for others)
  • what are the political conditions which determine these distributional effects?

Learning objectives

Participants will:

• develop the background knowledge and conceptual tools for analysing the political and economic structures and dynamics (at the local, national and global levels) which frame the social and environmental determinants of health and which frame health policy and funding directions;
• develop the analytical skills needed to apply such tools to the analysis of a particular set of health issues.

Contents

We will explore the political economy of health through a focus on the following sub-topics: 

• globalisation and health (looking at the interplay of growth through productivity and the crisis of overproduction and the implications for health of the various adaptations to looming overproduction), 
• trade and health (including the Uraguay Round, WTO, USTR, free trade or fair trade, special and differential treatment (SDT); South South trade); farming, food, hunger and poverty, 
• GATS and health systems (including the pressure towards privatisation and the effective irreversibility of GATS) 
• TRIPS and big pharma(and AIDS, TB and Doha). 
• Food 

Proposed IPOL on the Political Economy of Health

Acknowledgements

This topic has been developed by David Legge