Healthcare, politics, and public policies.

The relationship between health care and politics and the ills therein transcends the globe; Health and healthcare are fundamentally about relationships—between individuals and health professionals, between patients and their symptoms, between cultural beliefs and professionals, between community groups or organizations and the health system, between people and their governments and public institutions, and so on. Hence, the reason why the connection between healthcare and politics is rational, public policy and governmental activism both perpetuate and alleviate global inequalities and inequities in well-being.

Health is often described most simply as “absence of disease” and more broadly, as “a state of complete physical, mental, and social well-being.” The political coverage of health is equally broad: it is not just about the delivery and funding of clinical care but also about how health is created, maintained, and if lost, restored. Thus, political coverage of health includes public health issues, such as water and air pollution and sanitation. As part of this broad coverage of health, those who deliver the service, whether practitioners or institutions, are political participants. They see themselves as stakeholders, or as victims when policies or targets have an effect on their legitimately acquired interests.

While most of the traditional norms in many countries focus on the ethics of healthcare and the public role in providing care, research, and access to healthcare services, public choice theory presents an economic analysis of political decision-making. The public choice theory offers an alternative lens from which to consider and enact public policies, as well as understanding decisions made in the healthcare industry. Policy decisions in healthcare are not health-related decisions; rather, decisions made are through representatives or groups elected and subject to political constraints. Politics can often engage issues of scarcity, special interests, and personal freedom, resulting in financial constraints.

Governments have control over power and funding; citizens have the ability to participate, share their knowledge, and pressurize governments to deal with their concerns or affect the policies that they need. Although financial and resources may vary, enabling mechanisms for groups within all societies to secure political voice do exist potentially. Proponents of health as a human right tend to focus primarily on voice within political systems. It seems important then to expand current concepts of political voice to account for additional political factors that shape power relations in ever-increasing politically securitized governance arenas that currently influence questions of health.

All countries currently face the challenges of reorganizing, restructuring, or redesigning their healthcare systems. Health (care) is globally universal in that everyone gets ill at some point in time. It refers to a consuming good or service (care) and it deals with the most precious ‘commodity’ one can have: life. The nature of age, the gravity of the illness, the capacity to pay, the knowledge of contemporary standards of treatment, and the nature of healthcare systems (including what is funded from collective funds) differ considerably from one country to the other, depending on historical, economic, social, political, and cultural patterns. In all contexts, different societies, different healthcare systems, and different politicians face the ongoing challenge of balancing solidarity and subsidiarity and of trying to find innovative solutions concerning the question of ‘who pays’ and ‘how much’ in what way and toward which purpose. In essence, they try to answer the question as to what extent the private and the public sectors should control resources, should take care of patients, and should be involved in the process of treatment and care.