Week 6: Power and Politics of Health
Health Geography
2MINI-LECTURE 1
STARTS HERE
3- To what does the ‘power and politics of health’ refer?
- How do power and political structures influence health?
EXAMPLES
Health-related government policies
“New” geographies of health that explore less explicit/formal
ways in which power and politics shape health
- Human bodies as sites where power/politics are
exercised
- Politics of fertility
Lecture overview
4Health is profoundly political.
Politics, power, public policy and ideology influence
people’s health.
Social scientists often consider how human agency, or
the power an individual has to control a situation, is
constrained by structures of society.
Power and politics of Health
What does it mean to have power?
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7Politics as government: prevalent but restrictive
definition that limits who can engage in politics
(members of government /government agencies).
Politics as power-structured relationships: anyone and
everyone can engage in a political act.
What is politics?
8Health is political because :
- as with any resource or commodity, some people have more of it
than others;
- power is exercised over health via wider socio-economic and
political systems (i.e. political economy of health);
- its social determinants can be shaped/modified by socio-political
intervention;
- the right to a standard of living adequate for health and wellbeing
(including food, housing, medical and social services) is a universal
human right (Bambra 2005).
Power, Politics and Health
Take this quiz (you don’t need to share answers with
anyone; you can use a fake name)
 https://www.nhs.uk/oneyou/how-are-you-quiz/
 What are the main messages this quiz conveys to
you?
 What tensions do you see between these health
messages and a perspective that focuses on the
power/politics of health?.
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Examples of health geography studies in politics of health include:
• How has Africa’s refugee crisis affected emerging infectious disease?
(Kalipeni and Oppong 1998)
• How have historical, social, political, and economic processes
contributed to high levels of lead poisoning in parts of the US?
(Hanchette 2008)
• How have women been disadvantaged by Bangladesh’s arsenic-
contaminated water? (Sultana 2006)
• What are the impacts of AIDS in Africa on social and environmental
systems? (Barnett and Blaikie 1992)
• How does social, political marginalization increase vulnerability to
environmental hazards such as earthquakes and floods?
• Trade agreements and food access; tobacco industry etc.
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Powerful health
determinants are often
social, economic and
political:
socio-economic status,
gender, ethnicity,
migration status . . .
Power, Politics and Health Inequalities
Health Geography12
Indigenous Australians were hospitalised for potentially preventable
conditions nearly 4 times as often as non-Indigenous Australians
between July 2010 and June 2012.
Power, Politics and Health Inequalities
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Power, Politics and Health Inequalities
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Determinants of health
Human health and
well-being are
influenced by
social, economic
and environmental
factors (not only
biological, genetic).
But, as per this
figure, political
determinants are
often obscured?
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Power, Politics and Health Inequalities
HOW DO POWER AND POLITICS AFFECT
YOUR HEALTH (OR THE HEALTH OF
YOUR COMMUNITY, IF YOU WANT TO
BE LESS PERSONAL)?
16
- Health-related government policies
- “New” geographies of health explore less explicit
ways in which power and politics shape health
- Human bodies as sites where power/politics
are exercised
- Politics of fertility
EXAMPLES
17
Government policies regulate and influence human health, e.g.:
- by driving how healthcare is funded and administered,
- through public policy that affects housing, education, income,
access to food, and the environment in which we live in (social
determinants),
- promoting activities that support individual and community
health efforts,
- through regulating health-related behaviors,
- by regulating (or not) greenhouse gas emissions and thereby
climate change impacts for human health.
Can you think of examples of
how health is regulated and/or
shaped via government policy in
your country or community?
Political economy of health
 The political economy of health refers to a body of
analysis and a perspective which seeks to
understand the conditions which shape population
health and health service development within the
wider macro economic and political context.
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Health-related government policies: universal health coverage
Bambra warns,
“political attention
is directed towards
the variable that is
most amenable to
manipulation – the
healthcare system”
(2005: 190)
The politics of
health is sidelined;
becomes about
access to
healthcare.
Comparison of Indian state of Kerala (communist govt. since 1956) & All India
Kerala All-India
Death Rate/1000 (1998) 6.4 9.0
Rural Birth Rate(1998) 18.3 28.0
IMR(1998) 16 72
Life Expectancy (1993) 66.5 61.5
Literacy Rate (1991) 90.59 52.11
Female Literacy Rate(1991) 86.17 19.43
Mean age at marriage(F) 22.3 19.3
Per capita Income(1995-96) 8324 11649
Doctor-Population Ratio 1:7213 1:2148
Multi-sectoral government policies also affect health
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MINI-LECTURE 2
STARTS HERE
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Power differentials characterize everyday
interactions related to health.
New Geographies of Health and Power
Key fields of research in critical geographies of health include:
• Segregation and health: How certain groups of people, such as the
infectious, the mentally ill, or the homeless, are systematically
marginalized from society.
• Medicalisation, surveillance and public health: How biomedicine is
increasingly intervening in the lives of not only the ill, but also the
well, in surveying and regulating behavior (medical dominance)
• Power and the body: How struggles for power occur at the scale of
the body.
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- “New” geographies of health explore less explicit
ways in which power and politics shape health
- Power/politics and marginalization as a
determinant of health and health-care access
(e.g. two extra readings)
- Medicalisation
- Power at the scale of the body
EXAMPLES
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Power and politics as determinants of
HIV
Hunter (2007) considers HIV/AIDS in informal settlements in South
Africa and the impact of poverty and money/sex exchanges.
While HIV/AIDS is linked to histories of colonialism and apartheid,
other trends - such as women’s migration into informal urban
settlements, high unemployment and consequence engagement in
sexual economy – are also critical determinants.
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Access to medicine
Farmer (2001) considers access to medicine among poor people with
multi-drug resistant tuberculosis.
Globally, most patients with drug resistant TB are young or middle-
aged adults; few receive effective therapy. MDRTB widely regarded as
too expensive to treat in “resource poor” settings. Richer populations
have access to effective interventions; the poor are left out. This is a
global injustice.
“The argument that treatment is not cost effective is largely a means of
ending unwelcome discussions about the destitute sick” (2001: 210)
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- “New” geographies of health explore less explicit
ways in which power and politics shape health
- Power/politics and marginalization as a
determinant of health and health-care access
(e.g. two extra readings)
- Medicalisation
- Power at the scale of the body
EXAMPLES
27
Medicalisation is the process of defining (and creating) problems
as medical problems.
What is medicalisation?
• social anxiety • mood swings • impotence •
concentration • shyness • body size • breast
size/shape • aging • over-eating • under-eating •
gambling • infertility • PMS • childlessness •
childhood • childbirth • menopause • child abuse •
pedophilia • male chauvinism • alcoholism • drug
addiction • intelligence (or lack thereof) • PTSD
Who is healthy? Somebody who hasn’t had enough diagnostic tests.
 Caesarean section rates are rising around the world
Medicalisation of birth
Rise in caesarean sections in Australia
There’s a pill for that
 https://aeon.co/videos/watching-the-hidden-
world-of-dissolving-meds-is-its-own-chill-pill
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Medicalisation refers to transfer of
power/responsibility for health from individuals to
medical profession and pharmaceutical companies.
Doctors as providers; patients as recipients.
Power dynamics characterize the relationship
between patient and doctor.
“Medicalisation” as a transfer of power
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“Western modernity, along with its conceptions of sovereignty and biopolitics, is
unthinkable without a ‘political culture of danger’, without the permanent endangerment
of the normal, without imaginary invasions of constant, everyday threats such as illness,
filth, sexuality, criminality or the fear of ‘racial’ impurity, which must be immunized against
in various ways” Isabell Lorey
SUGGESTED RADIO DOCUMENTARY
The medicalisation of normality (BBC radio
documentary) (30 mins)
http://www.bbc.co.uk/programmes/b00jcjc5
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- “New” geographies of health explore less explicit
ways in which power and politics shape health
- Power/politics and marginalization as a
determinant of health and health-care access
(e.g. two extra readings)
- Medicalisation
- Power at the scale of the body
EXAMPLES
35
We can see in the body a symbol of society; the powers
and dangers credited to social structures reproduced in
small on the human body.
Mary Douglas
Death (death with dignity, euthanasia)
Birth (abortion, foetal rights, caesarean)
Reproduction (surrogate, genes, screening)
Ideal bodies (weight, appearance, skin color)
Healing (organ harvesting, GM foods, access to drugs)
Warfare (biometrics, asylum policies, borders and bodies)
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Fertility policy is a common way in which
governments intervene in individual health decisions.
Governments may have social or economic reasons
to implement anti-natalist (discouraging fertility) or
pro-natalist (encouraging fertility) policies.
Fertility policy
Why might a government wish to adopt
either a pro-natalist or anti-natalist policy?
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Fertility policy can be examined from a power
perspective.
A key distinction is often made between policies that
promote contraceptive technologies in order to
empower people to control their own fertility, and
others that seek to control the fertility of certain groups
within a society.
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China has experimented with some of the most aggressive
family planning policies.
One-child policy was introduced in 1979 and began to be
formally phased out in 2015.
China’s fertility policies may have prevented 250-400
million births (Zhengming 2000).
Family Planning in China
http://www.bbc.com/ne
ws/world-asia-china-
38714949
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China’s policies have focused on:
1) delaying marriage and childbearing,
2) birth spacing,
3) fertility limitation.
Preferential treatment in education and health has been
provided for only children, while penalties for non-
compliance have included large fines.
Stringent social and administrative control in China has
enabled the implementation of these policies.
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Compliance with and acceptance
of family planning policies varies
considerably across China.
Source: Attané (2002).
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A population pyramid can shed insight into population
policies. The large base of the pyramid, indicating a high
birth rate, clearly shows why China was interested in
maintaining its anti-natalist policies in 1990.
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The impacts of China’s fertility policies are
clearly visible in the narrowing base of this
population pyramid from 2009.
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China’s fertility policies may pose problems in the future as China’s
working population shrinks. This pyramid, showing China’s projected
population structure for 2050, illustrates how a large elderly
population must be supported by a shrinking working population.
Data source: US Census (2009)
Health Geography
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https://aeon.co/videos/how-the-
one-child-policy-created-a-
chinese-underclass-of-13-
million-people-with-no-rights
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Conclusion
Health and healthcare decisions are infused with power.
Whether at the scale of international debates regarding
fertility, national decisions over smoking policy, or an
individual’s discussions with her doctor, investigating the
impact of power relations is critical.