Political Determinants of Health
Dr Kris Naidu, Nadi
Health is a political choice and politics is a continuous struggle for power among competing interests. Looking at health through the lens of political determinants means analysing how different institutions, processes, interests and ideological positions affect health at different levels of governance.
Politics, for better or worse, plays a critical role in health affairs. Ultimately, health is shaped by factors such as the distribution of money, power and resources, all of which can be tackled only in sectors other than health.
Health has increasing relevance for political legitimacy and the economy and it is critical to fiscal policies and to the social state.
“Lack of political will” here in Fiji is often cited as the main reason for failing to deal with factors affecting health.
I must warn of romantic illusions in the face of messy problems.
Fiji has the highest death rate from diabetes in the world with 188 of 100,000 fatalities being attributed to the disease, the latest life expectancy world rankings show. And Indo Fijians were more likely to suffer from the disease, says the Ministry of Health and Medical Services, highlighting that one in three Fijian adults had diabetes.
This shocking data is undoubtedly a consequence of an ailing healthcare system along with poor lifestyle choices and lack of health consciousness.
As a result, I am loath to say that we as doctors are failing our patients and the subsequently failing the health of the nation. Health professionals and institutions alike need to become more politically astute to bring about change and end this healthcare nightmare.
The time is right to engage in a serious joint intellectual endeavour to further explore the political determinants of healthcare in this country.
Above all it requires a willingness to bring together a public health perspective reared on causality, evidence, determinants and interventions with a lens that deals with the nature of power, systems, wicked problems, uncertainty and complexity.