Roy Victor, Hamilton Darrick, Chokshi Dave A
National Clinician Scholars Program, Yale School of Medicine, New Haven, CT 06510-8088, United States.
The Department of Economics, The Institute on Race, Power and Political Economy, The Public and Urban Policy Program, The New School, New York, NY 10011, United States.
Health Aff Sch. 2024 May 6;2(5):qxae041. doi: 10.1093/haschl/qxae041. eCollection 2024 May.
The prevailing economic paradigm, characterized by free market thinking and individualistic cultural narratives, has deeply influenced contemporary society in recent decades, including health in the United States. This paradigm, far from being natural, is iteratively intertwined with politics, social group stratification, and norms, together shaping what is known as political economy. The consequences are starkly evident in health, with millions of lives prematurely lost annually in the United States. Drawing on economic re-thinking happening in fields like climate and law, we argue for a new "common sense" towards a health-focused political economy. Central to this proposed shift is action in 3 interconnected areas: capital, care, and culture. Re-orienting capital to prioritize longer-term investments, such as in public options for health care and baby bonds, can promote health and affirmatively include historically marginalized groups. Recognizing that caregiving is economically valuable and necessary for health, approaches like local cadres of community health workers across the United States would be part of building robust caregiving infrastructures. Advancing momentum in these directions, in turn, will require displacing dominant cultural narratives. As the health arena pursues change in the face of real obstacles, recent efforts reinvigorating industrial policy and addressing concentrated market power can serve as inspiration.
以自由市场思维和个人主义文化叙事为特征的主流经济范式,在近几十年里深刻影响了当代社会,包括美国的健康领域。这种范式远非自然形成,而是与政治、社会群体分层及规范反复交织在一起,共同塑造了所谓的政治经济。其后果在健康方面极为明显,美国每年有数百万人过早死亡。借鉴气候和法律等领域正在进行的经济反思,我们主张对以健康为重点的政治经济形成一种新的“常识”。这一拟议转变的核心在于在三个相互关联的领域采取行动:资本、照护和文化。将资本重新导向,优先进行长期投资,比如投资医疗保健的公共选项和婴儿债券,可以促进健康,并切实将历史上被边缘化的群体纳入其中。认识到照护在经济上具有价值且对健康至关重要,像美国各地社区卫生工作者的地方干部这样的举措,将成为构建强大照护基础设施的一部分。而朝着这些方向推进,反过来将需要取代占主导地位的文化叙事。鉴于健康领域在面对实际障碍时寻求变革,最近重振产业政策和应对市场权力集中的努力可资借鉴。