(iPoster) Comparing Political Economy and National Health: Process Model and Case Study

• In Event: Poster Session: Democracy and Autocracy II & Health Politics and Health Policy
  In Poster Session: Poster Session: Health Politics and Health Policy

Abstract

Introduction
System-level non-medical drivers of health influence the distribution of health and well-being across nations, but theory and evidence illuminating the relationship are missing. A macro systems comparative approach provides evidence about how the political and economic institutional attributes relate to health and well-being measured as national health status. Recent commentary in the field of comparative effectiveness research in health services research calls for an extension of the micro-level individual focus on healthcare to the broader macro-level focus on population health, including non-medical drivers of health. The approach at the level of national political economy captures the health and economic policy that influence the non-medical drivers of health that may have downstream causal effects. Theories from comparative capitalism and health services research come together to build and test a configuration model for the links between political economic organization and national health.

Methods
Process tracing methods and qualitative comparative analysis (qca) were used to develop a framework and collect evidence for how economic organization at the national level flows through causal pathways to affect national health status. Evidence for health status at the national level plus the attributes of political economy were collected for 26 countries using indicators from several publicly available economic and health datasets. The necessary and sufficient conditions for having comparative better national health were identified. Further, in-depth, comparative case studies of high-performing nations, including Australia, illuminated important steps in the process tracing method for model building.

Results
The results from the qualitative comparative analysis show that configurations of mixed liberal and coordinated economies result in variation in national health status. Comparative case studies of the best-performing nations examine detailed evidence of the causal pathways, including national prosperity, material inequality, the public provision of goods, social trust, and bio-stressors.

Both the comparative case studies and the qualitative comparative analysis provide evidence that the representation of worker interests and job security are important to having comparatively high national health status. Further, high-performing nations all have well-developed economies and healthcare coverage for their entire population.

Conclusions
When political economies are organized in a way that systematically externalizes transaction costs to their workers, without any beneficial constraint, there is evidence of a societal cost that manifests in comparatively worse health and well-being of their populations. This may be especially true during a time of crisis like the global financial crisis in 2008. Australia, as a comparative case study, serves as a natural experiment in how it changed the orientation of its mixed capitalist attributes of political economy from more liberal to more coordinated in response to the 2008 crisis. Combined with its consistent superannuation and national health system, those changes in the orientation of the configuration of its political economy may have preceded its trajectory from being considered a low-performing nation to a high-performing nation in terms of national health status a decade later.

Mixed capitalist attributes of a nation, especially configurations that limit externalizing transaction costs to workers, might be the beneficial constraint that allows comparatively low-performing nations to close the gap and thus improve their national health status to something closer to that of their high-performing counterparts, especially during times of crisis.

Author

• Jessica Nicole Wise, McGovern Medical School UTHealth Houston