The conditions that shape a person’s health—where they live, work, and age—are widely understood to drive health outcomes. These factors, known as the determinants of health, extend far beyond individual behaviors or access to medical care. These daily conditions are systematically structured by governance and power, not naturally occurring. Understanding the impact of political decisions is necessary to truly address disparities in population health.
Defining Political Determinants of Health
Political Determinants of Health (PDOH) refer to the systems, processes, and structures that generate and maintain health inequities by shaping the distribution of power and resources. This concept moves beyond considering health as a purely biological or personal matter, arguing that it is deeply embedded within the political order. Political decisions, or the lack thereof, establish the societal ground rules that either advance health equity or exacerbate disparities.
These determinants operate at a foundational level, encompassing the mechanisms of governance, policy creation, and the administration of power. PDOH are the upstream factors that set the stage for all other health conditions, determining who gets what, when, and how. They include broad areas such as voting laws, legislative agendas, and the influence of lobbying and money in politics.
Distinguishing PDOH from Social Determinants of Health
The distinction between Political Determinants of Health (PDOH) and Social Determinants of Health (SDOH) is a matter of hierarchy and causation. SDOH are the non-medical conditions of daily life, such as housing quality, educational attainment, food security, and income level, which directly impact health. These are the factors most people recognize as affecting health outside of a clinic.
PDOH are the “causes of the causes,” acting as the foundational drivers that create and distribute the social conditions. To illustrate this relationship, imagine a river representing health outcomes. The SDOH, like poverty or lack of education, are the problems floating in the river that individuals must contend with.
The PDOH is the dam far upstream—the power structure and policy decisions—that controls the river’s flow, determining which communities receive clean water. For example, having a safe home is an SDOH. However, the political practice of redlining, which systematically denied mortgages in minority neighborhoods, is the PDOH that created the unequal housing condition. Focusing on PDOH means addressing the systemic political decisions that lead to unequal living conditions for marginalized groups.
How Political Structures Influence Health Outcomes
Political structures exert influence through tangible mechanisms that shape the environment and opportunities available to the public. The primary mechanism is the political process of resource allocation, where government budgets prioritize funding at all levels. Decisions to reduce funding for public health infrastructure directly limit access to preventative care and disproportionately affect vulnerable populations. Conversely, prioritizing investment in public transportation or affordable housing can dramatically improve community well-being.
Policymaking and regulation establish the standards and rules that govern various aspects of life with health implications. Legislative and judicial processes establish environmental laws, labor protections, and consumer safety rules. Weak environmental regulations, often influenced by political lobbying, can lead to increased air and water pollution, contributing to higher rates of respiratory illnesses in affected communities.
Civic engagement and the distribution of political power are also determinants of health. Voting rights, political advocacy, and lobbying shape the policy agenda and determine which issues receive legislative attention. States with more inclusive voting policies and higher levels of civic participation tend to show better health outcomes.
Policy Examples Shaping Health Equity
Specific political policies provide clear evidence of how governance directly acts as a determinant of health. Labor laws, such as setting the federal minimum wage, directly impact the economic stability of millions of workers. A political decision to keep the minimum wage stagnant can trap workers in poverty, limiting their ability to afford nutritious food, stable housing, and necessary healthcare. Research has shown that had minimum wage increases been enacted, infant mortality rates would have been significantly lower.
Zoning and housing policies are another area where political decisions have profound health consequences. Exclusionary zoning laws, which restrict the types of housing that can be built, often contribute to segregated neighborhoods and limit affordable housing options. This structure can confine marginalized communities to areas with poor access to healthy food, green spaces, and healthcare facilities, leading to higher rates of chronic illnesses. Policies like inclusionary zoning, which require developers to set aside units for affordable housing, are political actions that increase housing stability and improve community health.
Environmental regulations set by political bodies determine exposure to hazardous conditions. Decisions regarding clean air and water standards, or the enforcement of existing rules, can disproportionately affect communities living near industrial areas. Conversely, policies that increase funding for renewable energy infrastructure can mitigate pollution, leading to better respiratory health for the general population.
Healthcare access laws demonstrate the direct link between policy and individual health coverage. Political decisions regarding Medicaid expansion, as authorized by the Affordable Care Act, have extended health coverage to millions of low-income adults. This policy action has been associated with improved financial stability and better health behaviors for vulnerable populations, showing how legislative action can directly reduce health disparities.