Summary
Politics determine one’s world view, priorities, and funding. Politics and health are intertwined. The health of the U.S. public has always been political. Therefore, we who care about health and quality of life should be talking about politics.
Politics Matters
Contrary to some who say that we should never talk about religion, politics, and money, I am committed (more than ever) to talk about these topics! You see, these topics, especially politics and money, determine a person’s health status. The health of the U.S. public has always been political. Because of this, we should be talking more about these things.
Here are just a few examples of how politics influence health: The quality of our water. Political. The quality of our air. Political. The safety of the food we eat. Political. The safety of the products that we use at work or at home. Political. The safety of our roads. Political. The safety of our vehicles and the gas mileage that they receive. Political. The quality of our neighborhoods, homes, and schools. Political. Assuring adequate public health infrastructure. Political. Preparing for and responding to emergencies. Political. Access to reliable childcare and transportation. Political. Protecting our children and grandchildren from mass shootings. Political. Health insurance coverage. Political. Access to health care. Political. Having adequate employment. Political.
It is difficult to think of an area of health that is NOT influenced by politics.
Public Health is Important
Public health keeps Americans safe and healthy via prevention, preparedness, and surveillance. Such programs serve as the first line of defense against epidemics and pandemics. Moreover, increased spending on public health programs is associated with a decrease in deaths from preventable diseases.
An investment of just $10 per person per year in evidence-based, community health programs yields an incredible return! Such a minor investment would save the U.S. more than $16 billion annually. That is a potential savings of $5.60 for every $1 invested. Wow!
No Longer Bipartisan Support for Health
Even though federal funding for U.S. agencies charged with protecting the nation’s health has historically enjoyed broad, bipartisan support, it no longer does so. The COVID-19 pandemic changed all that. One political party ensured that the pandemic and associated research, science, public health, and medicine became politicized. Many on that side of the political aisle also demonized those who worked tirelessly to keep us safe. Thus, a 2021 study of the public health workforce by the Centers for Disease Control and Prevention reported that 40% of the public health workforce intended to leave their job within the next five years!
Your Personal Politics Influences Your Health
Politicians and their followers’ responses to the COVID-19 pandemic created a stark contrast between red and blue areas in the U.S. Previous published research indicated that Republicans were less likely to get the COVID vaccine than Democrats. This led to counties that voted primarily for Republicans having approximately 73 more deaths per 100,000 people than Democratic areas.
A more recent research study done by researchers at Yale University reported a connection between COVID deaths and partisanship on a personal level. The investigators looked at more than half a million death records from Ohio and Florida that were logged between January 2018 and December 2021. Then the investigators matched each death record to a 2017 voter file to determine the individual’s party affiliation. The researchers specifically looked at excess death rate (i.e., deaths recorded during the pandemic relative to deaths that would have occurred in pre- pandemic times and conditions.) What do you think they found?
Researchers found that people who were registered as Republicans in Florida and Ohio had higher excess death rates than people registered as Democrats. They found that the introduction of COVID-19 vaccines, which occurred roughly a year into the pandemic’s existence, played a large part in supercharging the divide. Before the vaccines’ rollout, the average excess death rate was 76% higher among Republicans than Democrats. That gap continued to widen after the vaccines became widely available in the spring and summer of 2021, with Republicans seeing a 153% higher average excess death rate than Democrats.
Do your personal politics impact your health? Yup!
Politics Determines Priorities and Funding
Even though the health of the public is the responsibility of most every part of government, we have allowed our public health system to atrophy over time. How? By denying it the funding and attention that it deserves. For example, we entered the COVID-19 pandemic facing a massive deficit in our nation’s public health needs. Of the $4 trillion spent on healthcare in the U.S., less than 3% was invested in public health and prevention. Yet, rather than strengthen and increase our public health spending, especially during times of emergencies, we often see it reduced.
Many people (including me) have been critical of the Centers for Disease Control and Prevention poor messaging to the U.S. public during the pandemic. But maybe some of their weaknesses were related to budget and politics? Let’s take a look. The CDC’s budget for public health preparedness and response programs, when adjusted for inflation, has been halved since 2003. This happened during a period of time that included the COVID-19 pandemic; outbreaks of Ebola and Zika; the opioid epidemic; Hurricanes Katrina, Sandy, and Harvey; and the unprecedented California wildfires and massive floodings in other states. Did this lack of funding help or hurt?
Furthermore, a Select Subcommittee on the Coronavirus Crisis, detailed efforts by the Trump Administration to compromise the scientific integrity of the Centers for Disease Control and Prevention’s (CDC) coronavirus response in an attempt to serve the former President’s political goals. It turns out the former POTUS interfered often with the CDC’s response to the coronavirus pandemic.
Not talk about politics? Quite the contrary! I say that we should talk more about them.
The Political Determinants of Health
There is no debate that politics determine priorities and funding. We need to realize that structural and institutional barriers to health equity are political. Once we understand that, we have the opportunity to disrupt the status quo and emphasize the true drivers of health disparities – the political determinants of health.
According to a book written by Daniel Dawes (2020), the political determinants of health involve the systematic process of structuring relationships, distributing resources, and administering power, operating simultaneously in ways that mutually reinforce or influence one another and shape factors that either improve health equity or make health inequities worse.
The political determinants of health create the social drivers for health including environmental conditions, neighborhoods, schools, transportation, childcare, employment, and access to healthy food options – all things that affect health and quality of life.
As you can see, the health status of Americans is indeed political.
Join the 1795 Group in Helping Stimulate Needed Changes
The 1795 Group aims to make a difference. Will you join us?
The changes needed will require new thinking, new approaches to many things, and a significant investment of time, energy, and money. Generations of inequities will require generations of work. We will not be able to turn things around in weeks, months, or years.
We must engage with communities most affected by racism and inequity by using a grass roots approach. We must ensure that public health departments, academia, and academic medicine reflect the communities they serve. The perspectives of people who have lived the experience of inequity are the most important. They are the true experts. They must be at the table helping make decisions.
The good news is that Americans clearly see the need for a stronger public health system. According to a national poll by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, nearly three of four Americans believed that public health programs were vital to the nation’s health. Most Americans also reported that they supported substantial increases in federal funding to help health departments and agencies carry out their missions.
Will you join us to make a difference?
