Martin McKee

The political economy of health: an exploration of the distribution of power in civil society, governments, corporations, and the implications for health

If we are to answer the question of why one person contracts a disease while another does not, we must confront complexity. Patterns of disease in a population are determined by factors acting at many levels, from the genetic to the societal. However, even when we have the evidence, our interpretation of it is also complex, shaped by a range of influences, some in our own minds and some externally. In this lecture I will address the distribution of power in society and how it influences both the determinants of disease and our responses to them. First, there is the power to define the narrative, influencing how we understand the causes of disease, such as the balance between the individual and the collective, the types of responses that are considered possible, and the cognitive biases that influence our interpretation of the evidence. Even when we have evidence pointing clearly to an effective policy, the dominant narrative may prevent us from implementing it. For example, even a decade ago, it would have been inconceivable that governments will impose standardised packaging of cigarettes. Now it is widely accepted. Second, there is the power to set the rules, defining global technical standards, as well as capturing regulatory and decision-making bodies. An example is the way that corporate interests seek to move decision-making from courts to secret tribunals. Third, there is the way in which powerful corporations can structure their operations in ways that undermine the actions of elected governments, for example by transfer payments and shell companies that reduce their tax liability to negligible levels. I will conclude by exploring the ways in which we can take advantage of new sources of data and advanced analytical techniques to tackle the abuse of power in global public health.