Political determinants of mental health
This editorial aims to focus on political determinants of mental health, which are linked with governmental policy, ideologies of the rulers and governance processes, and how and where power is held and administered.
Abstract
GeoPsychiatry as an emerging specially within psychiatry which aims to bring together sociology, anthropology, political sciences, psychiatry, medicine and other stakeholders in order to understand the impact of geo-political determinants on health including mental health. Disasters be these natural or manmade and their impact on mental health of individuals and populations including specific groups and communities who may need to migrate as a result, needs to be evaluated regularly. There is considerable evidence on the role social determinants play in the causation and perpetuation of psychiatric illnesses. Political determinants along with geographical, economic, cultural and commercial tend to trump social determinants of mental health. Although various social factors such as poverty, poor housing, unemployment, lack of green spaces, poor public transport and poor access to healthy food or good education have been identified as contributing to poor mental health, it is important to recognise that all of these are in turn strongly influenced by government, its ideology, policies and politics. It depends upon type of political system whether general population is invested and engaged in the government or not. People vote and the government elected on certain electoral promises and policies then carry out certain functions which may or may not be good for the population. In this editorial we aim to focus on political determinants of mental health. These are linked with governmental policy, ideologies of the rulers and governance processes. Dawes (2020) focuses on political determinants of health from a USA perspective but highlights lessons which can be emulated by others. The key principle when looking at mental health is equity between physical and mental health. He argues that political system does not value each group equally or realises or even recognises the long-term implications of various policies on citizens. This is particularly important for mental health as often policy makers do not consider the impact of their policies on health at all much less on mental health. We know that in many high-income countries high obesity rates, high maternal and infant mortality, gun violence (especially in the USA) depression, opioid addiction, substance use disorders and diabetes etc. are linked with political action or lack thereof (pp. 41–42) whereas similar lack of response to high rates of HIV/AIDS has been found in many countries in Africa. Eisenberg-Guyat and Prins (2022) have observed that in the USA between 2000 and 2017, rates of drug poisoning went up by 44%, of alcohol poisoning by 40% and suicide by 35%. They remind us that Marx (1990) had described capitalism as a socioeconomic system where the focus remains on means of production and the system is in private hands and the focus is on resulting profits. Thus, such an emphasis in which individuals work, live and play often tends to ignore individual welfare, working conditions and environment. All these factors then influence overall satisfaction and quality of life. Political determinants of health involve systematic processes of structuring relationships, distribution of resources and how and where power is held and administered. These then shape opportunities which may advance health equity or exacerbate health inequities (Dawes, 2020). Political ideology and their implementation are part of the social contract or social covenant between the rulers and the ruled. This social contract or covenant carries with it certain mutual expectations. These are associated with control of power and retention of privilege thereby creating power nexus which controls a number of factors which influence people’s working lives. It is inevitable that political determinants will influence social determinants in multiple ways. From poor health and poor safety controls in working and living conditions, poor housing and poor transport to unsafe neighbourhoods will influence health of communities and consequently that of individuals. All of these factors are affected by political ideologies which influence cultural values, opportunities in education, employment and conditions in which people work, play and age. Policies based on political ideologies influence funding for education, employment, social care, etc too. Health gap and health inequity are a direct result of political factors and determinants. Socio-political factors influence social circumstances including security, poverty, national wealth, income inequality, social integration and tensions affecting both population and individual health and wellbeing. Longitudinal impact of socio-political values and political ideologies deserves further detailed study (Yang & Mak, 2020). In a follow-up study Yang et al. Political determinants of mental health