A More Political Epidemiology: Historical Institutionalism & Population Health

• In Event: Comparative Politics of Health: Popular Demands, Institutional Legacies

Abstract

While it is widely recognized that upstream social and environmental factors are crucial determinants of health, this paper argues that our current understanding of how political factors and health interact is underdeveloped. In short, where political determinants and political factors are included in analyses of population health, they tend to be reduced to simplified concepts and measures – levels of corruption, the strength of particular (often democratic) institutions, the existence of political leadership, or simply having the “right” policies. This paper demonstrates that such measures are insufficient and often misleading and argues for the importance of a historical institutionalist approach to understanding the relationship between political factors and population health. Historical institutionalism allows us to see government policies as an intermediary variable, re-centering our attention on how those institutions were formed, the assumptions they carry, and the unspoken factors – about race, gender, etc. – that influence when and how they respond to disease. Drawing on interviews with stakeholders in South Africa and Uganda conducted in 2011-2013, this paper highlights the ways in which political history, context, and institutions shaped the environment in which policy decisions were made in response to HIV/AIDS.

Author

• Mark Daku, Texas Christian University