Penn on the World after COVID-19 Political Science and the Study of Health after COVID-19

Penn on the World after COVID-19 is a joint project of Penn Global and Perry World House. We've asked some of Penn's leading faculty, fellows, and scholars to imagine what the global pandemic will leave in its wake.

Julia Lynch is Associate Professor of Political Science and Senior Fellow at the Leonard David Institute of Health Economics at Penn. She also serves as an expert advisor to the World Health Organization’s European regional office .

COVID-19 will permanently change the study of health in American political science, and for the better. Despite health’s obvious political, policy, and normative importance, political science, unlike its sister social science disciplines, does not have a well-established subfield dedicated to the study of health. Political science research in health policy has, until quite recently, been limited to the study of policies governing the provision of medical care.

Yet, the current pandemic has made it clear the politics of health go far beyond access to medical care, and that political scientists should also consider how politics and policy outside of the medical care system are related to (unequal) health outcomes in society.  In the world after COVID-19, political science needs to start paying attention to health, as opposed to health care; and to how power in society and in politics gets translated into health.

There are exceptions to the rule of political science ignoring health, of course. But beyond a small handful of scholars in the United States and elsewhere, there has not been sustained, discipline-wide attention to health at the individual and population level: why it varies, what policies are causally related to it, how it functions as a political issue. COVID-19 is already changing that, and none too soon: political scientists need to pay closer attention to the insights generated by scholars working in other fields that have a longer history of scholarship on health and its determinants, to see where we can add the most value.

I’d like to highlight two areas that are especially urgent:

First, as we begin to work with health data, political scientists should be especially attentive as epidemiologists and demographers document the strengths and shortcoming of various measures of population health and disease. The work of scholars in these disciplines has made clear that we do not yet have data of sufficient quality to assess rigorously why COVID-19 outcomes vary so significantly between countries, cities, and regions. This is due to very significant differences across polities in how testing has been carried out, how deaths are recorded, and what kind of sociodemographic information is collected along with health and mortality information.

Of course, it will take years to sort the data out, and one lesson that we can take from scholarship in related disciplines that regularly deal with vital records data is that in all likelihood these data will never be fully comparable. Especially given the political sensitivity of allocating blame for potentially hundreds of thousands of lives lost, political scientists should be very cautious about making inferences based on the data available now.  But we can and should leverage our unique insights as political scientists to understand why vital records data are collected differently in different places and times, and what that tells us about the politics of health more broadly.

Second, many political scientists have been surprised by the enormous racial and ethnic disparities in death rates from COVID-19. They should not be. Social epidemiologists have been investigating the sources of inequalities in health for literally hundreds of years. A core insight of this literature is that inequalities in access to social determinants of health -- including both “upstream” determinants like political power, prestige, income, and education and “downstream” resources such as safe housing and access to affordable, healthy foods – are the primary drivers of inequalities in health outcomes across population groups.  Political science can add value to this established literature by bringing to bear our unique skills in analyzing how social inequalities translate into differences in political power, which in turn become translated into social determinants of health.

Political science insights can help us design more equitable health policy by pointing to the precise points of influence that result in existing health disparities.  As a discipline we can also help develop institutional frameworks for health policy-making that reduce inequalities and improve population health.  For example, soon after the COVID-19 pandemic hit the United States, I was asked to design a set of procedures for scarce resource allocation in a Veterans Administration hospital, precisely because as a political scientist I had specialized knowledge about how voting systems and institutional rules can shape representation and distributive outcomes. As we rebuild from COVID-19, we should be looking as a discipline for opportunities to share our deep understanding of how politics works – while remembering that other disciplines have a head start when it comes to understanding how health works.

The views expressed in Penn on the World after COVID-19 posts are solely the author’s and not those of Penn, Penn Global or Perry World House.