Anna Mullany’s Award-Winning Essay

Our fifth winning essay comes from Anna Mullany of the School of Public Health at the University of Massachusetts, Amherst:

The Political Economy of Health Disparities

The Declaration of Alma Ata, the culminating statement at the 1978 International Conference on Primary Health Care, began with this assertion:

“The Conference strongly reaffirms that health, which is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.”

This affirmation of health as a fundamental human right explicitly recognizes that the underlying social and political determinants of illness must be concurrently addressed in order to eradicate the causes that give rise to preventable illness amongst the most vulnerable. Today in the United States, as the gap between rich and poor widens and with forthcoming cuts to healthcare, there is no better time to reflect on the Declaration of Alma Ata. In centering the principle of healthcare as a human right, this enables us to reenvision healthcare and also tirelessly work toward creative new ways to radically shift the political-economic system that determines these inequities.

The glaring pattern defining health disparities is that the poor disportionately suffer from ill health and preventable disease. From HIV-infection, to diabetes, to drug addiction and tuberculosis, the poor suffer the most. These disparities exist largely due to the mechanisms of capitalism and its neoliberal policies decimating the world’s poor.

Neoliberal policies, that are marked by deregulation, reduction of state intervention in the welfare of its citizens, and increased privatization, have huge ramifications globally on people’s health and the continued proliferation of poverty. The eradication of health disparities will not come about until a radical shift in the economic system and these policies. The very functioning of a capitalist economic system, marked by maximizing profit, produces gross inequality and sustained poverty. This system is a continued assault on the poor. Individual behavior is often ascribed to poor health rather than the larger social issues that are a consequence of this economic system that prioritizes profit over people. These Issues such as racism, subpar working conditions, sexism, unemployment, sanitation, lack of clean water, unviable healthcare systems, and poverty magnify inequities and result in intolerable living conditions with limited ways out and directly impacts health conditions.

The push toward a new system includes the rebuilding of public infrastructure, wrap-around resources available to the poor, and the transferring of wealth from private to the public in order stop the devastating cycles and entwinement of poverty and disease. When there is global recognition of healthcare as a human right and with a commitment to political change that creates this, then healthcare can no longer be commodified and people seen as consumers. Simultaneously, the progressive realization of the right to health can only happen when basic human needs, such as nutrition, food, housing, employment, and essential social support can be met and sustained.