Political Determinants of Population Health

Abstract

There is growing awareness of the association of highly racialized political discourse with health behaviors and, ultimately, health outcomes. 1 In this context, the study by Gemmill and colleagues 2 finding a significant increase in preterm births among Latina women following the 2016 US presidential election adds novel information to our understanding of the health impact of political events. Using a conservative interrupted time series analysis, they reported that there were 3.2% to 3.6% more preterm infants born to Latina women after the presidential election than the number expected if the election had not occurred. Translated into a more tangible outcome, the results indicate an additional 2337 preterm infants were born in the 9 months after the election, after controlling for seasonal and temporal variation in preterm births as well as trends specific to Latina women. At a population level, the impact of a 3.2% to 3.6% increase in preterm births is not negligible. Putting aside the significant emotional and psychological effects related to the birth of a preterm infant on families, a recent study 3 estimated that each preterm infant accrues up to $78 000 in expenditures during their first year of life. Thus, the additional preterm infants born to Latina women following the 2016 election, as documented by Gemmill et al, 2 represent a substantial cost for families and society.Beyond quantification of numbers, an important contribution of this article is the authors' attempt to define the "critical periods" 2 of gestation as the periods when the 2016 election may have been associated with stress for pregnant Latina women. The article identifies a peak in preterm births among women whose conception and second trimester overlapped with the election. This intriguing finding raises the possibility that there are periods of high risk during gestation, which could be related to high levels of acute stress or other physiological insults. While further study is needed, the concept of vulnerable periods could identify novel opportunities for interventions to minimize the likelihood of adverse outcomes.However, the implications of the study extend beyond preterm birth. More globally, the authors' findings raise questions about the association between sociopolitical events and population health. Recent work on the "social determinants of health" 4 have deepened our understanding of how the health of an individual is shaped by their environment and society. This field of study has highlighted the effects of education, food, housing, and insurance on health outcomes. We have also begun to better understand the ways in which individual and institutional racism and discrimination affect biology and physiology. Furthermore, it is becoming increasingly apparent that such social determinants are associated with health disparities. 5 Gemmill and colleagues' work fits into this broader body of literature but goes one step further by highlighting political determinants of health as a core, but currently understudied, social deter...

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“…A related literature focuses on the consequences of political polarization for health behaviors (e.g., Iyengar et al 2019 andMontoya-Williams andFuentes-Afflick 2019). Party affiliation is correlated with physician recommendations on politicized health procedures, enrollment in government exchanges created under the Affordable Care Act, beliefs in the safety of vaccines, and hurricane evacuations (Hersh and Goldenberg 2016;Lerman et al 2017;Sances and Clinton 2019; controls for differential risk exposure or costs of social distancing (e.g., Economist 2020; Andersen 2020).…”

Polarization and Public Health: Partisan Differences in Social Distancing during the Coronavirus Pandemic

“…A related literature focuses on the consequences of political polarization for health behaviors (e.g., Iyengar et al 2019 andMontoya-Williams andFuentes-Afflick 2019). Party affiliation is correlated with physician recommendations on politicized health procedures, enrollment in government exchanges created under the Affordable Care Act, and beliefs in the safety of vaccines (Hersh and Goldenberg 2016;Lerman et al 2017;Sances and Clinton 2019;Trachtman 2019;Krupenkin 2018;Suryadevara et al 2019).…”

More Than Shelter: Housing for Urban Maternal and Infant Health

“…Analysis by the U.S. Centers for Disease Control found that much of the difference between U.S. and European infant mortality rates was associated with the higher prevalence of preterm birth in the United States [4]. Preterm birth is the most common contributor to infant mortality in highly industrialized nations and is causally linked with chronic and acute psychosocial stressors facing expectant mothers [5] and political determinants of health [6].…”