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Political Economy of Health and Health Policy (PEHHP)

Political Economy of Health and Health Policy (PEHHP)

Researching health at the interface of economics and politics

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About

Scholars from across the social sciences investigate the implications of industry activity and international trade on both population health and health policy making from the local to the global level.

Team

PEHHP researchers draw on disciplinary backgrounds and theoretical perspectives from political science, international political economy, sociology and social policy. 

About
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The Political Economy of Health and Health Policy (PEHHP) Group investigates the implications of economic production and trade on population health and the health policy process. 

Economic activity exerts enormous influence over the health and well being of populations across the globe. 

  • On the one hand, businesses play an important role in supporting population health through, for instance, the production of pharmaceuticals and other medical devices and technologies. Economic wealth is a key structural determinant of health and industry plays a key role in wealth creation and the generation of tax revenue, which can be spent on health services and public health programmes.
     
  • On the other hand, corporations in health-harming industries (tobacco, alcohol, processed food and sugary beverages) are key structural drivers of morbidity and mortality, particularly non-communicable diseases. As well as the health impact of their products, corporations pursue highly nuanced political strategies that seek to shape the regulatory context – often, in ways that conflict with public health and undermine evidence-based health policies. 

These issues and processes are now particularly relevant to low and middle-income settings as they experience an epidemiological transition and bear the dual burden of communicable and non-communicable diseases. This includes the impact of attempts by the tobacco and alcohol industry to oppose policies that jeopardise their profits, including through legal challenges under international trade and EU single market law.

Team
Team Block

Anna
Durrance-Bagale

Research Fellow

Ben
Hawkins

Associate Professor

Helen
Walls

Associate Professor

Cecile
Knai

Associate Professor

Preslava
Stoeva

Assistant Professor
Projects
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The political consequences of industry engagement in the Public Health England’s ‘Drink-Free Days’ campaign

In September 2018, Public Health England (PHE) and Drinkaware (the alcohol industry-funded body) ran a co-branded ‘Drink Free Days’ (DFD) campaign to target middle-aged drinking. This partnership created considerable political controversy within the public health community and PHE commissioned researchers at LSHTM to evaluate the campaign. We asked:

  • To what extent did the involvement of the industry funded body, Drinkaware, affect support from public health actors?
  • Did the partnership with a government agency offered commercial advantages to industry actors?

The Drink Free Days campaign aimed to:

  • alert increasing and higher risk drinkers, aged 40-64, to the health harms of alcohol
  • encourage them to reappraise their own drinking habits
  • motivate them to take several alcohol-free days each week.  

The campaign was released under PHE’s OneYou umbrella, an initiative that targets modifiable health risk factors through individual behaviour change – reducing an individual’s alcohol consumption for instance. The campaign’s radio and digital advertising was largely funded by Drinkaware, with additional digital and print materials available for download by local public health authorities and health organisations.

People

Addressing conflict of interest in pluralistic health systems: an interventional study in Pakistan

Pakistan has no organised system of primary healthcare in urban areas, and over 80% of the urban population uses for-profit private doctors as the first point of healthcare seeking. The professionalism of private doctors in Pakistan – which includes their technical knowledge and ethical practice – therefore determines the quality of care received. 

Funded by a UK Medical Research Council Research Grant, this three-year study (2020–2023):

  • identifies strategies for large scale improvement in the quality of healthcare provided by private doctors in Pakistan, paying attention to addressing conflicts of interest owing to profit generation motives
  • tests the effectiveness of an intervention developed through formative research to provide evidence for policy change

People

From Aga Khan University, Pakistan

  • Sadia Shakoor
  • Rumina Hasa
  • Wafa Aftab
  • Sameen Siddiqi
  • Rehana Siddiqui

Publications

Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries? Human Resources for Health. Feb 2020

Do Agricultural Input Subsidies on Staples Reduce Dietary Diversity?

There has been a resurgence of interest in agricultural input subsidy (AIS) programmes to boost agricultural productivity and food security. However there is considerable debate regarding the effectiveness and efficiency of AIS investments, including their impact on nutrition. AIS are almost always applied to production of staple crops and aim to increase their productivity and smallholder incomes, usually also with nutrition objectives. However, the overall impact on nutrition is unclear, not least because staples tend to be calorie-dense but low in other nutrients. AIS targeting maize, for example, may lead to increased concentration of production and consumption of maize and could reduce the intake of nutrient-rich foods. Alternatively, if the maize prices fall in real terms, this may enable consumers to purchase other goods including other food items. There is little evidence to determine the direction of impact.

The aim of this research is to examine the impact of Malawi’s AIS programme targeting mostly maize on overall food choices, by examining not just price and consumption of maize but crucially the effects of the AIS programme on consumption of other foods. It will also explore the wider context of food preferences and trade-offs, including by gender and socio-economic status. 

Approach

  • Mixed methods

Publications 

  • Walls HL, Johnston D, Mazalale J, Chirwa E. Why we are still failing to measure the nutrition transition. BMJ Global Health. 2018;3:e000657.
  • Others in progress.

People involved (staff as well as students)

  • Helen Walls (PI; LSHTM),
  • Deborah Johnston (SOAS University of London),
  • Ephraim Chirwa (University of Malawi),
  • Mirriam Matita (University of Malawi),
  • Jacob Mazalale (University of Malawi),
  • Tayamika Kamwanja (University of Malawi),
  • Richard Smith (University of Exeter)
  • Penelope Milson (RD Student; LSHTM)
  • Aloisia Katsande (RD Student; LSHTM)

Other outputs

Project status

  • Ongoing
Migration, gender and health system response in South Africa: A focus on the movement of healthcare users and workers

 

This project investigates the intersection of migration, population mobility, and gender with health systems through the application of a set of innovative qualitative and quantitative research methods, applying an intersectionality lens. The research is undertaken in South Africa, a country that has faced high levels of both historical and contemporary inward, outward, and internal migration and population mobility. The research focuses on the mobility of both healthcare users and healthcare workers within, into, and out of South Africa and their interactions with the public health system.  It will include piloting and evaluating an innovative method of tracking healthcare user and worker movement over time using social media (WhatsApp), which will generate new data on how movement by both healthcare users and healthcare workers within, into, and out of South Africa interacts with their experiences of the health system. This is paired with new quantitative analysis of existing data sets on the movements of both healthcare users and healthcare workers within, into and out of South Africa. Specifically, this quantitative analysis includes the Tourism South Africa Border Survey, and the first ever analysis of data from the National Department of Health regarding patients travelling into South Africa under regulated bilateral agreements between the government of RSA and 11 neighbouring countries, and others.

 

Key research questions 

  • How do migration and population mobility affect the South African health system?
  • How does the health system respond and adapt as a result of migration and population mobility?
  • How do these processes intersect with gender?

Objectives

  • To assess levels of migration by patients and health workers within, into and out of South Africa
  • To examine the health care experiences of both migrant and non-migrant patients and health workers.
  • To analyse how the South African health system adapts and responds in light of the population movements identified in Objective 1.
  • To examine how the experiences and responses garnered during objectives 1-3 are shaped by gender

Approach

  • Mixed methods

Publications

  • In progress

People involved (staff as well as students)

  • Johanna Hanefeld (PI; LSHTM), Helen Walls (LSHTM),
  • Jo Vearey (University of the Witwatersrand),
  • Moeketsi Modisenyane (South Africa Department of Health),
  • Sassy Molyneux (Oxford University and KEMRI Wellcome),
  • Lucy Gilson (LSHTM, University of Cape Town),
  • Jill Oliver (University of Cape Town),
  • Richard Smith (University of Exeter)
  • Penelope Milson (RD Student; LSHTM)
  • Aloisia Katsande (RD Student; LSHTM)

Other outputs

Project status

  • Ongoing

 

Completed Projects

Anti-Corruption Evidence (ACE)

 

ACE logo

Our work within the Anti-Corruption Evidence (ACE) research consortium brings together teams in Bangladesh, Nigeria, Tanzania and the United Kingdom to tackle corruption, one of the most difficult problems facing health policymakers in many countries. Our starting point is that corruption often arises in situations where health workers must make choices about how they balance the care they want to provide to their patients with the rewards that they obtain for their services. These tensions emerge where incentive structures are badly designed and where systems of governance, and particularly mechanisms for ensuring accountability and transparency, are weak. In these circumstances, traditional punitive measures do not work and can even be counter-productive. Instead, we are working with frontline health workers delivering healthcare and those to whom they are, in theory, accountable (including their informal networks) to:

  • understand the dilemmas they face
  • find ways to overcome dysfunctional managerial structures
  • develop politically feasible and acceptable measures

People

  • Dina Balabanova
  • Eleanor Hutchinson
  • Martin McKee
  • Obinna Onwujekwe
  • Prince Agwu
  • Aloysius Odii
  • Syed Masud Ahmed
  • Nahitun Naher
  • Mir Raihanul Islam
  • Peter Binyaruka
  • Masuma Mamdani
  • Blake Angell
  • Mushtaq Khan (ACE PI)
  • Pallavi Roy
  • Sonia Sezille

Publications

Abba-AjiI M, Balabanova D, Hutchinson E, McKee M. How Do Nigerian Newspapers Report Corruption in the Health System? Int J Health Policy Manag 2020 (published online).

Hutchinson E, Balabanova D, McKee M. We Need to Talk About Corruption in Health Systems. Int J Health Policy Manag. 2018;8(4):191-4.

Hutchinson E, McKee M. Balabanova D. What drives health workers to break the rules and use public resources for private gain? A review of the literature on sub-Saharan Africa, SOAS ACE Working paper 009, May 2019.

Onwujekwe O, Agwu P, Orjiakor C, McKee M, Hutchinson E, Mbachu C, Odii A, Ogbozor P, Obi U, Ichoku H, Balabanova D. Corruption in Anglophone West Africa health systems: a systematic review of its different variants and the factors that sustain them. Health Policy Plan. 2019 Sep 1;34(7):529-543.

Onwujekwe O, Agwu P, Orjiakor C, Mbachu C, Hutchinson E, Odii A, Obi U, Ogbozor A, Ichoku H, McKee M, Balabanova D. Corruption in the health sector in Anglophone West Africa: Common forms of corruption and mitigation strategies. 2018, SOAS-ACE Working Paper 005.

Naher N HM, Hoque R, Alamgir N, Ahmed SM. Irregularities, informal practices, and the motivation of frontline healthcare providers in Bangladesh: current scenario and future perspectives towards achieving universal health coverage by 2030. 2018, SOAS-ACE Working Paper 004.

Other outputs

Balabanova D, Hutchinson E, Mayhew S, McKee M. Health workers are vital to defeat COVID-19: but only if they are at work

Hutchinson E, Balabanova D, McKee M. Five reasons we aren’t talking about corruption in health systems – and why we need to start. 2018 

The health research within ACE consortium seeks to understand the structural and socio-political causes of corruption and to use those findings to support the adoption of new, feasible, high impact anti-corruption strategies in Bangladesh, Nigeria and Tanzania.

Funded by UK Aid. Learn more about ACE on the website and follow on Twitter and LinkedIn for updates.

Tobacco Companies, Public Policy & Global Health

This project analysed the corporate strategies of the global tobacco industry. In response to increasing regulation of its activities within the context of globalisation, the tobacco industry has developed innovative market and political strategies, including its use of international trade agreements to oppose new packaging requirement. 

Despite increasing regulation, tobacco companies remain highly profitable and smoking remains the single greatest avoidable cause of mortality. This project analysed the industry’s corporate and political strategies in order to strengthen tobacco control policies globally. Effective regulation of the tobacco industry at the national, regional and global levels requires a detailed and nuanced understanding of the structure and activities of the tobacco industry. 

Building on two previous phases of research, this project analysed how the tobacco industry has been affected by, and adapted to, developments in the global economy through corporate restructuring, operational rationalization, new product development, creation of new marketing modalities, entry into the e-cigarette market, opposition to ‘plain’ packaging and other strategies. 

We focused on four key themes:

  1. international trade and investment (i.e. the use of trade agreements to oppose tobacco control measures)
  2. illicit trade (i.e. smuggling and cotraband activities)
  3. the restructuring of the tobacco industry within a global economy (i.e. mergers, acquisitions and new product development such as e-cigarettes)
  4. tobacco control and global health governance (i.e. attempts to shape policies at the WHO, EU and other international organisations)

Team

Publications

A Corporate Veto on Health Policy? Global Constitutionalism and Investor–State Dispute Settlement. Journal of Health Politics, Policy Law. Oct 2016

A multi-level, multi-jurisdictional strategy: Transnational tobacco companies’ attempts to obstruct tobacco packaging restrictions. PubMed. Mar 2018

The Battle for Standardised Cigarette Packaging in Europe. Palgrave. 2019

European Union implementation of Article 5.3 of the Framework Convention on Tobacco ControlGlobal Health. Aug 2018

Law, market building and public health in the European UnionSage. Dec 2017

Reassessing Policy Paradigms: A Comparison of the Global Tobacco and Alcohol Industries. PubMed. Mar 2016

Transnational Tobacco Companies and New Nicotine Delivery SystemsAmerican Journal of Public Health. Feb 2019

UK: Tobacco industry and e-cigarettes - new issue, familiar tacticsTobacco Control. Nov 2013