The Political Determinants of Health by Daniel E. Dawes provides a fresh take on a very familiar topic in healthcare—social determinants of health. Dawes takes the position that the social factors that we pinpoint as social determinants of health are often categorized as politically neutral items. Challenges such as poverty, homelessness, housing insecurity, or transportation inaccessibility are external factors that contribute to compromised access to healthcare, but in and of themselves aren’t political. Dawes contests this perspective by asserting that these factors are inherently developed political items in our politically charged society. And these factors have come about as a direct result of political movements and decisions.
From this point of view, Dawes provides a history of the quest for health equity in the United States reaching back to the early days of our country. He covers the eras of slavery, post-slavery, the civil rights movement, and continues through to the development of the Affordable Care Act.
While I'm well versed in the more recent aspects of this narrative, hearing the story of the development of the Affordable Care Act through the perspective of health equity was illuminating. I also found the acknowledgment that these factors contribute deeply to the health status of our population to be refreshing. To that end, social determinants of health are not inherent to life or society but are a result of political decisions that have been made regarding most aspects of our lives. This assessment was especially interesting to me given the current political climate as well as the importance of voting as a political determinant of health.
This book was well researched and intriguing in the presentation of Dawes’ argument. He is adept at using metaphors to help illustrate his points and uses this literary device to great effect in setting up his narrative as well as his alternative view of society. Throughout this work, the use of metaphor provides insight as to how unjust (and perhaps even unnecessary) some of the political decisions concerning inequality have been. These are a disservice, not just to the people who are disadvantaged by them, but also to society as a whole.
I would recommend this book to anyone interested in exploring social determinants of health, as well as those looking to see what steps we can take individually and collectively to reduce the disparities of healthcare. Everyone in this country deserves to have their potential fulfilled and everyone in this country deserves access to a life well-lived.