Linking political exposures to child and maternal health outcomes: a realist review

Abstract Background Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political tradition, democracy and globalisation – on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review. Methods The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories. Results Out of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to greater child and infant mortality and youth smoking rates in LMECs through greater influence of multinational corporations and neoliberal trade organisations. Conclusion We present a realist re-analysis of a large systematically identified body of evidence on how four key political exposures – the welfare state, democracy, political tradition and globalisation – relate to child and maternal health outcomes. Three final programme theories were supported.

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P10 Realist review linking political exposures to child and maternal health outcomes

10.1136/jech-2021-ssmabstracts.100 ◽

2021 ◽

Author(s):

Maxwell Barnish ◽

Si Ying Tan ◽

Araz Taeihagh ◽

Michelle Tørnes ◽

Rebecca Nelson-Horne ◽

...

Keyword(s):

Maternal Health ◽

Health Outcomes ◽

Realist Review ◽

Maternal Health Outcomes ◽

Child And Maternal Health

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How much evidence is there that political factors are related to population health outcomes? An internationally comparative systematic review

BMJ Open ◽

10.1136/bmjopen-2017-020886 ◽

2018 ◽

Vol 8 (10) ◽

pp. e020886 ◽

Cited By ~ 9

Author(s):

Max Barnish ◽

Michelle Tørnes ◽

Becky Nelson-Horne

Keyword(s):

Systematic Review ◽

Welfare State ◽

Health Outcomes ◽

Population Health ◽

Positive Association ◽

Risk Of Bias ◽

Secondary Outcome ◽

Bibliographic Databases ◽

Previous Systematic Review ◽

Political Tradition

ObjectivesTo provide a 7-year update of the most recent systematic review about the relationships between political features and population health outcomes.SettingInternationally comparative scholarly literature.Data sourcesTen scholarly bibliographic databases plus supplementary searches in bibliographies and Google Scholar were used to update a previous systematic review. The final search was conducted in November 2017.Primary and secondary outcome measuresAny population health outcome measure, apart from healthcare spending.Results73 unique publications were identified from the previous systematic review. The database searches to update the literature identified 45 356 raw records with 35 207 remaining following de-duplication. 55 publications were identified from supplementary searches. In total, 258 publications proceeded to full-text review and 176 were included in narrative synthesis. 85 studies were assessed at low risk of bias, 89 at moderate risk of bias and none at high risk of bias. Assessment could not be conducted for two studies that had only book chapters. No meta-analysis was conducted. 102 studies assessed welfare state generosity and 79 found a positive association. Of the 17 studies that assessed political tradition, 15 were found to show a positive association with the left-of-centre tradition. 44 studies assessed democracy and 34 found a positive association. 28 studies assessed globalisation and 14 found a negative association, while seven were positive and seven inconclusive.ConclusionsThis review concludes that welfare state generosity, left-of-centre democratic political tradition and democracy are generally positively associated with population health. Globalisation may be negatively associated with population health, but the results are less conclusive. It is important for the academic public health community to engage with the political evidence base in its research as well as in stakeholder engagement, in order to facilitate positive outcomes for population health.

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