Now, five years later, the notion that health is a preferred state of being, rather than a set of disconnected functions or services, is increasingly being embraced.

With this in mind, it becomes impossible to ignore a significant modern-day truism. Health is profoundly political. Why is this the case? For multiple reasons: Health is a collection of resources unequally distributed in society. Health’s “social determinants” such as housing, income, and employment, are critical to the accomplishment of individual, family, and community wellbeing and are themselves politically determined. Health is recognized by many throughout the world as a fundamental right, yet it is irreparably intertwined with our economic, social, and political systems. And growth in health, health care, and health systems requires political debate and political
consensus.2

For these reasons and more, it is entirely reasonable to acknowledge and attempt to structure in a purposeful manner the politics of health. To do so requires mention of some of the major forces shaping health worldwide. These include aging demographics, the growth of home-based caregivers, the dual burden of disease, the Internet, and consumer empowerment and activism.

In the United States, nearly 50 percent of all 60 year olds have a parent alive, and by 2050 there will be 1 million people over age 100.3 This means the three-generation family has been supplanted by the four- and five-generation family. Twenty-five percent of American homes have an elder caregiver in place, and 85 percent of them are volunteer family members. The vast majority of these caregivers are third generation women, managing parents and grandparents on the one hand and children and grandchildren on the other.4,5  In the United States, their focus is predominately on chronic diseases, seven of which cause 90 percent of the disability in senior populations.

In the developing world, the health focus remains primarily on infectious diseases, nutrition, and maternal and fetal issues, which are challenging the human and financial resources of these countries. But urbanization and the influx of tobacco and unhealthy foods are accelerating the onset of chronic diseases and creating a dual burden of disease.

And finally, consumer empowerment is being fueled by the Internet and supported by physicians, nurses and other caregivers. This has led to emancipation and engagement of an increasingly activist-oriented public.8 We desire education, behavioral modification, home-based care solutions, inclusion in the health care team, and financial incentives to reward wellness.

As these trends play out and the definition of health continues to evolve, we will see the seat of political power in health continue to shift. It will move away from paternalism toward partnership. It will move away from individual care models to team approaches. And it will move away from intervention toward prevention. It will embrace evidence-based clinical care but incorporate educational and social missions as well. It will move away from hospitals and outpatient care sites toward home settings. And it will move away from thought elites toward patients and their care teams.

Despite this shifting environment, there is a growing political disconnect between those who make health policy and those most affected by health policy. While the former continue to reinforce silos and the status quo, the latter seek broad, fundamental and comprehensive reform. Such reform might include expansion of insurance coverage, realignment of financial incentives toward prevention, increased reimbursement of physicians and nurses for team coordination that includes home health managers, support for early diagnosis and screening, and expansion of education and behavioral modification for individuals and families.

Due to its profound impact on the future of individuals, families, communities, and societies, the politics of health deserves broad debate, active public participation, and focused scholarly pursuit.