Politics and health: a neglected area of research.

One of the more surprising features of the literature on public health and on health policy research in Europe and North America is the scarcity of references on the impact of political variables on health policy and on health outcomes. One can find in this literature a growing number of articles that focus on the social and cultural determinants of health, but very few indeed on the political determinants of health. This is remarkable, because one would have thought that in societies claiming to be democratic, public-health scholars and public-health analysts would study how the various instruments (such as political parties) through which people express their wants and needs shape public policies that affect the health of populations. There have been studies on the impact of health policy on health, but very few on the impact of politics on health policy and/or on health outcomes. This silence on the relationship between politics and health is particularly surprising for a profession in which one of its founders, Rudolf Virchow, wrote that 'Medicine is a social science and politics nothing but medicine on a grand scale'. 1 The awareness that health depends on political as well as social, economic and cultural forces is well-established in the public-health tradition. Thus it is paradoxical that the scholarly literature on public health has such a limited number of references on this subject. Why is this so? The answer is a complex one. One explanation is that the public-health field is dominated by professionals trained in medicine and biology rather than in the social sciences. Epidemiologists and statisti-cians tend to dominate the field of public-health research. To them, politics seems to be very shaky and risky ground, something to be avoided. Political science is frequently seen as more politics than science. In my early years as a junior faculty member in one of the leading schools of public health in the United States, The Johns Hopkins University School of Public Health, politics was a forbidden subject, a 'dirty area', to be avoided by anyone with academic ambitions and hoping to climb the promotional ladder. However, there is another reason for the deficit of studies on the impact of political variables on health. And it is related to how most public-health research is funded. In Europe, most of the funding agencies receive their money from public sources accountable to political forces. They are unlikely to fund any …