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What Are Political Determinants of Health & Do They Differ from SDOH?

If social determinants of health are the social factors impacting our health, political determinants of health are the policy choices that led to those SDOH in the first place.

Social determinants of health have become almost something of a catchall term when it comes to the non-clinical factors that impact overall well-being. But drilling that concept down further, some healthcare industry leaders are starting to embrace the term “political determinants of health.”

Brought into the limelight in a 2020 book by Daniel E. Dawes, JD, director of the Satcher Health Leadership Institute at Morehouse School of Medicine, the political determinants of health look at the forces that have led to social determinants of health.

“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 to shape opportunities that either advance health equity or exacerbate health inequities,” Dawes wrote in the book.

In an industry that often talks about upstream and downstream factors of health, political determinants of health can explain how someone ended up in a certain part of that stream.

“So these are the political determinants of health essentially,” Dawes said during a 2020 roundtable hosted by the American Medical Association. “Somewhere upstream, decisions were made to divert the river to benefit certain people and harm others, and decisions were made to place certain types of people on specific banks of the river while placing others elsewhere.”

Take, for example, housing security and quality. Having a safe and clean home to live in is a social determinant of health; the political determinant of health is the redlining practice that led to Black and Brown people living in more disenfranchised neighborhoods.

The three political determinants of health

Political determinants of health can be split into three categories: voting, government, and policy.

For example, voters are who get individual policymakers into government, and therefore give those individuals the power to shape policy. In turn, those policies can impact overall well-being. That policy might be directly related to healthcare—the Affordable Care Act or the institution of Medicare—or they may have indirect consequences via social determinants of health.

Laws granting funds to revamp public transportation, for example, can impact health. If investment in public transportation is concentrated in affluent areas, it could exacerbate health disparities by perpetuating transportation barriers to healthcare.

How healthcare professionals can support political determinants

Solving political determinants may be largely dependent upon voting and then keeping policymakers accountable.

But in the exam room, healthcare professionals can take action on political determinants of health by practicing cultural responsiveness and unwinding their implicit biases, Dawes said during the AMA roundtable.

“And I do think it's important that folks understand that when they are working in certain communities, that they don't make the judgments that we've been making all along, that others have made about the people who live in these communities,” he said.

Although a clinician cannot change a certain political determinant of health (unless, perhaps, that clinician is also a policymaker), but clinicians can take into account the political determinants that lead to a patient’s lifestyle or situation. In doing so, that clinician can remove judgement from the encounter and work to promote health equity.

There is also an advocacy role clinicians can play, Dawes suggested in his book. While clinicians themselves do not write health policy, they can serve as advocates while they consult on health policy.

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