Governance determinants of health: exploring the structural impact of politicalization, bureaucratization and medical standardization on health inequity

Abstract

PurposeUnequal social conditions that provide people with unequal opportunities to live healthy lives are considered unjust and associated with “health inequity”. Governing power is impacting people's lives through laws, policies and professional decisions, and can be used intentionally to combat health inequity by addressing and changing people's living- and working conditions. Little attention is paid to how these ways of exercising governing power unintentionally can structure further conditions for health inequity. In this paper, the authors coin the term “governance determinants of health” (GDHs). The authors' discussion of GDHs potential impact on health inequity can help avoid the implementation of governing strategies with an adverse impact on health equality. This paper aims to discuss the aforementioned objective.Design/methodology/approachThe authors identify Governance Determinants of Health, the GDHs. GDHs refer to governance strategies that structurally impact healthcare systems and health equality. The authors focus on the unintended, blind sides of GDHs that maintain or reinforce the effects of socioeconomic inequality on health.FindingsThe power to organize healthcare is manifested in distinct structural approaches such as juridification, politicalization, bureaucratization and medical standardization. The authors explore the links between different forms of governance and health inequalities.Research limitations/implicationsThe authors' discussion in this article is innovative as it seeks to develop a framework that targets power dynamics inherent in GHDs to help identify and avoid GDHs that may promote unequal access to healthcare and prompt health inequity. However, this framework has limitations as the real-world, blurred and intertwined aspects of governing instruments are simplified for analytical purposes. As such, it risks overestimating the boundaries between the separate instruments and reducing the complexity of how the GDHs work in practice. Consequently, this kind of theory-driven framework does not do justice to the myriad of peoples' complex empirical practices where GDHs may overlap and intertwine with each other. Nevertheless, this framework can still help assist governing authorities in imagining a direction for the impacts of GDHs on health equity, so they can take precautionary steps to avoid adverse impacts.Originality/valueThe authors develop and explore – and demonstrate – the relevance of a framework that can assist governing authorities in anticipating the impacts of GDHs on health inequity.