The Causes of the Causes: A Systematic Review of Reviews of the Impact of Political Economy on Population Health
29 Pages Posted: 10 Sep 2018More...
Background: The relationship between political economy and population health is only partially understood with no systematic review of research available. Our systematic review of reviews explores the conclusions, extent, quality, and research gaps concerning political economy and health outcomes within and between populations over time.
Methods: We undertook a systematic review of reviews. The exposure of interest was any aspect of political economy defined as a difference or change in: policy, law or rules; economic conditions; institutions or social structures, including; politics, power or conflict. Relevant outcomes were any overall measure of population health, but not specific health conditions, diseases or causes of death. Research databases and the grey literature were searched, included studies critically appraised and synthesised narratively.
Results: A total of 4,912 citations were identified of which 58 reviews were identified as relevant. Only 10 were assessed as high or very high quality, with marked variation in the quality of the underlying primary studies. Many reviews assessed similar questions relating to the impact of economic recession, income inequality, welfare state type, some aspects of employment policy, urban regeneration, housing, healthcare policy and trade. Social democratic welfare states and states with greater public spending seem to have better overall population health, whilst neoliberal restructuring seems to be associated with increased health inequalities. Greater income inequality is associated with lower self-rated health and higher mortality. Fair trade policies, extensions to compulsory education provision, microfinance initiatives in low income countries, health and safety policy, improved access to healthcare, and high quality affordable housing are all found to have positive impacts on population health.
Conclusion: Political economy and public policy are important influences on population health. Generally, countries with social democratic institutional arrangements, higher public spending, lower income inequalities and policy to ensure safe workplaces and access to education and housing have populations with better health. Providing a nuanced and contextualised understanding of these factors for policymakers and the public could have marked beneficial health impacts through improved public policy making.
Funding Statement: This work was funded by NHS Health Scotland through part payment of PhD fees for GM by NHS Health Scotland. FP is funded by the Medical Research Council UK and the Chief Scientist’s Office Scottish Government (MC_UU_12017/13 and SPHSU13). The funders had no part in interpreting the findings. No other specific funding was received for this work.
Declaration of Interests: The authors declare they have no competing interests.
Keywords: Political Economy, Politics, Economics, State, Market, Governance, Policy, Health, Inequality, Neoliberalism
Suggested Citation: Suggested Citation