This post was written by Guest Contributor Dr. Nicole Loew. She has her PhD in nursing from the University of Iowa, and her research interests include understanding how women’s contexts impact their perspectives of sexual health and their sexual behavior.
Political Determinants of Health: The Policies Behind Our Health
When we talk about health, most people think about doctors, medications, or personal choices. But here’s the part we don’t talk about enough: health is shaped long before you ever walk into a clinic.
That’s where political determinants of health come in.
Political determinants of health are the laws, policies, and budget decisions that decide what resources are available, who gets access to care, and where barriers exist. Things like Medicaid expansion, telehealth rules, paid family leave, clean water protections, and whether preventive screenings are covered by insurance aren’t accidental. They’re political choices, and their inequities are by design.
You’ve probably heard of social determinants of health: housing, transportation, income, education, and food access. That framework was an important step because it helped move the conversation away from blaming individuals for their health outcomes.
But here’s the uncomfortable truth: focusing exclusively on social determinants can also become a sanitized way of avoiding accountability. They describe what conditions exist, without naming who has the power to change them – and how we got here in the first place.
Political determinants of health are the upstream force. They explain why those social conditions exist in the first place.
A law that covers mammograms with no cost. A policy that funds (or defunds) rural hospitals. A budget decision that limits transportation access. These aren’t abstract forces; they’re decisions made by elected leaders.
Politics sets the table. Health outcomes follow.
And once we name that, we can start having conversations that hold systems accountable, especially our political system.
