Day 2: The Political Economy of Health

Activity 5: Framing a political economy analysis

1 hour 30 minutes


To help us to:

  • Introduce a visual wall display of the South African political economy landscape 
  • Consolidate our definition of political economy
  • Understand different ‘lenses’ for economic analysis

Task 1
Reflecting on the Site Visits through a political economy lens

(30 minutes)

In plenary, we’ll begin the day by reflecting on how the site visit story telling as a political economy analysis tool felt for us. We will ask whether it has deepened and helped our understanding of political economy, and what remains confusing or unconvincing at this point. 

The facilitator will offer a brief crystalising of what political economy is, based on the reading below, as an introduction to our next task.

Task 2
Schools of thought on what political economy is and its usefulness as an activist tool

(1 hour)

In groups of three Fellows, you have 20 minutes to read through the school of thought (see below) allocated to you. A school of economic thought is a group of economic thinkers who share or shared a common perspective on the way an economy work. They generally share a common perspective on context, analysis and actions. We introduce five key and relevant schools of thought for deepening our understanding of the political economy:

  • Classic (mainstream) political economy 
  • Radical political economy
  • Black political economy
  • Feminist political economy
  • Political ecology approaches to political economy

Once you have read your section (and if your group finishes ahead of others, Google some supporting and/opposing views) come to the plenary ready to share your group’s perspectives:

  1. What speaks to you and what niggles you about the political economy school of thought you engaged with?
  2. In what ways does this particular school strengthen our tools of analysis?

The facilitator will crystalise the strengths and weaknesses of these schools and how we can use them in our social justice activism. 

Political economy and its evolution

Why political economy?

Health is not just about the well-being of an individual. Health is a social, economic, political and ecological issue. The same applies to health systems and outcomes. They are shaped by social, economic, political and ecological dynamics and factors. This is the basis for showing why the concept of political economy applies to health, health systems and health equity. 

Political economy as a tool of analysis 

A political economy analysis of health inequity enables us to understand the different social relations and power dynamics that affect health issues, systems and outcomes. And political economy can help us to develop critical perspectives on the workings of power in our socioeconomic landscape. It can, for example, explain how hidden power – the capacity of dominant actors to influence the agenda and outcomes from outside institutions – works in policy-making processes and choices. Understanding power will enable us to develop a deeper understanding of the root causes of inequality, poverty and exclusion.

When we use political economy as an analytical tool, we are able to develop complex and critical knowledge of the interconnections between the political and economic factors that shape our lived realities. By using political economy as an analytical tool, we can be able to distinguish between the theory of ‘free’ markets and how markets actually work, by examining the role of various interest groups including the state and private sector most critically. We should be able to develop a critical understanding of how and why political choices are made, how and why social and economic policies (or public policies) are made and are based on political choices made. 

In the case of the National Health Insurance (NHI), for example, which aims to give the poor greater access to public healthcare, there are concerns that the participatory process may have been captured by corporate interests in the health sector. Dr Louis Reynolds (a member of the People’s Health Movement of SA, for example, writes: 

Ordinary citizens are kept in the dark while those with vested interests are given the power to shape the process. Why is it that communities are frozen out of the structures? Does government not trust the experience of users? 

The questions asked by Reynolds are the kind of questions that a political economy analysis enables. In other words, a political economy analysis of the NHI can help explain the choices made in shaping its objectives, the interests it serves, who the key protagonists are, its scope and potential (or limits and deficiencies) in achieving health equity. 

Following from the definition of the concept of political economy and its evolution into different approaches, let us now consider how we may apply this concept as a tool for critical analysis (in particular of the interconnectedness of social, economic, political and ecological dimensions of power). The political economy tool takes seriously how power is produced, reproduced and exercised. 

Critical here is how a political economy analysis makes sensible the way in which social, political and economic power are shaped, practiced and contested. This starts with the capture of ecological resources, and then influence social relationships between gendered, raced and classed social groups. This is about how economies are organised and the political choices that are made about who owns, controls, benefits from and directs the resources of social production and reproduction. Most importantly, political economy is about action and collective struggle for social change. 

Defining political economy

The term political economy is best understood by breaking it down into the two parts it is made of and then reconnecting them: i.e., politics and the economy. 

A. Politics

Politics is often understood as being about government, parliament, laws, municipalities and political parties. Indeed, politics is about this. But it is about much more than that as it is actually about all aspects of life: 

The worst illiterate is the political illiterate. S/he hears nothing, sees nothing, takes no part in political life. S/he doesn’t seem to know that the cost of living, the price of beans, of flour, of rent, of medicines all depend[s] on political decisions. S/he even prides himself on his political ignorance, sticks out his chest and says s/he hates politics. S/he doesn’t know, the imbecile, that from her/his political non-participation comes the prostitute, the abandoned child, the robber and, worst of all, corrupt officials, the lackeys of exploitative multinational corporations. – Bertolt Brecht

Politics is about life beyond the ‘political sphere’

The above quote suggests a different approach to thinking about what politics is. In other words, it is best to think of politics in a way that connects it to lives of ordinary people and not just it being about the ‘political sphere’ of politicians (i.e., government, parliament, laws, municipalities and political parties). In other words, it is limiting to think of politics as just the contestations and processes limited to the ‘political sphere’ only. Rather, political processes (contestations for power and control) exist and manifest themselves right at home, in the community, in the taxi rank, at work, in NGOs, in the funding world, in how we sit at workshops, and other avenues of life where different interests compete over limited resources. This alternative thinking about politics is at the heart of the feminist adage that “the personal is political, the political is personal”. 

The above is best explained through the following step-by-step breakdown of how politics shapes and intersects with lives of ordinary people: 

In any given society, different interests arise out of the basic need for life and survival. These interests are shaped by the availability, and access to resources needed for life and survival. 

The given interests may lead to cooperation or competition as there are limited resources needed for life and survival. 

Out of either cooperation or competition there arises power over the limited resources, who has access to the resources, who owns and controls the resources, who benefits or is excluded from the resources, etc. These kinds of power contestations are the basis of shaping systems of social relations and economic production. Out of these systems of social relations and economic production arises systems and institutions of social control, rule, governance and hegemony.* 

In other words, politics is about the struggle between competing interests over the power to direct the distribution of resources – starting from the most basic unit of society (the household) and going all the way to the societal level as a whole. Because it is about power, when we think about politics, we have to look at the origins of power, where it is located and how it is used. When we do this, we also consider the history of power – how it has been constructed over time and the formal and informal institutions that power is exercised through. 

B. The economy (oikonomia) 

The term economy originates from two Greek concepts: oikos and nomos. Oikos means ‘about the well-being of the household’ and also refers to three distinct but interrelated concepts of the family, the family’s property, and the house. Nomos means management. The two words merged and developed a new meaning: oikonomia, the economy. 

Mainstream definitions of the economy define it as ‘the wealth and resources of a country or region, especially in terms of the production and consumption of goods and services’ (Oxford Dictionary). This approach emphasises the production, use and management of resources which then creates wealth. In this approach, economic agents can be individuals, businesses, organisations or governments. 

An alternative view defines an economy in relation to the basic resources such as food, water, shelter and clothing that are essential for sustaining life. An economy is therefore the way that a society decides upon and organises the production of goods and services needed for life and survival. In this alternative view, the economy is also about the way that resources, and the benefits and costs from production are distributed between members of society. 

In the alternative view, the following are critical questions: 

  1. How to live? What resources needed for life?
  2. How to organise society in order to sustain life? What social relations are required to produce goods and services required for life? Goods and services decided by who? 
  3. Resources owned by who? How they came to own them?
  4. Value produced by who? Conditions under which value is produced? 
  5. Ultimate beneficiaries from the value produced? Who accumulates? Distribution of the surplus from the value produced?
  6. Who benefits to society from the value produced? How are these benefits distributed and consumed? 
  7. How is the labour produced and reproduced? What about the uncounted goods and services in the sphere of social reproduction? 

Classic (mainstream) political economy 

Having broken down the meanings of politics and economics above, let us now fuse them into political economy. 

Investopedia tries to reconnect the two terms to define political economy as: 

The study of production and trade and their links with custom, government and law. It is the study and use of how economic theory and methods influence and develop different social and economic systems, such as capitalism, socialism and communism; it also analyses how public policy is created and implemented. Since various individuals and groups have different interests in how a country or economy is to develop, political economy as a discipline is a complex field, covering a broad array of potentially competing interests. (,1%EF%BB%BF)

Mosco defines political economy as:

… the interaction of economic, political and socio-cultural processes and practices that shape the distribution of socio-economic and cultural resources in a society

These definitions are consistent with what the literature refers to as classical political economy. 

Radical political economy

While mainstream definitions of political economy begin to point towards the connections between politics and economics, they do not account for processes and social relations often seen to be outside of what would be considered the formal economy. Mainstream definitions of political economy also fail to account for how the distribution of power and wealth between different groups and the processes that create, sustain and transform relationships between different groups over time. 

Given these shortcomings of mainstream approaches to political economy, radical political economy has extended the meaning and application of political economy to ask fundamental questions about who owns the resources required to produce goods and services, who does not own resources, who provides the labour to produce wealth, how is that labour exploited, and what system of social relations is required to enable production. Radical political economy analyses the relations between the owners of capital and the owners of labour, and how the struggle between these two social classes leads to changes in society, and who are the beneficiaries of the changes. Radical political economy, therefore, expands and connects our understanding of how political and economic processes interact, are structured, and contested in order to be changed. 

Put differently, radical political economy provides an analytical approach that integrates the economy, social relations and politics. It regards these three fields as interdependent structures that evolved historically. At the heart of radical political economy is the class struggle approach, involving the exploitation of labour by capital within the capitalist system. Capital owns the means of production, labour its labour power. To make profits and produce wealth, capital buys and exploits labour power.

Black political economy

The radical definition of political economy has also been criticised from the perspective of the enslavement and colonisation of black people, and the racist origins of these. This critique birthed black political economy which studies the way in which black people (as those who were oppressed, exploited, subjugated and exterminated by racism, white supremacy, slavery and colonialism) played a central role in the emergence of capitalism and the making of the global economy. The black political economy tradition has characterised the modern global economy as a system of racial capitalism which is centred on racism and the continued subjugation of black people. This approach engages with the economic and political processes that structure the lived reality and experience of exploitation and oppression of black people across social, economic and political spheres. 

Feminist political economy

Another approach to radical political economy that deepens the analysis of the links between political, economic and social factors is the feminist political economy tradition. This approach brings a gendered perspective into the analysis of political economy. It looks at the way in which the household, workplace and international economies are shaped by unequal gender relations. 

The major contribution from feminist political economy has been to emphasise more strongly the link between social reproduction and political economy. Social reproduction refers to the reproduction of social structures and systems, starting with the family and then extended to the maintenance and continuation of existing social relations. Social reproduction is about the daily activities undertaken by households, communities and society to reproduce society. Social reproduction is not merely biological; it has an economic logic to it. So at a poor or working class household level, for example, it includes cleaning, washing, ironing, cooking, which is mostly the unpaid labour of householders, mostly women and children. The extent to which the capitalist economy is dependent on activities in the household and community is at the heart of defining the concept of social reproduction. Feminist political economy has argued that social reproduction primarily rests on the hands, laps and backs of women: on women’s social reproduction labour of providing care, child rearing, food and other domestic labour which is largely unrecognised and unpaid. Under patriarchy, social reproduction has been organised to devalue the work of women, who have been assigned devalued labour as part of a mythical construction of women as ‘natural’ (and therefore undeserving of remuneration) caregivers.

Feminist political economy strives toward a feminist transformation of the economy as a basis for achieving gender equality. 

Political ecology approaches to political economy 

Another approach to radical political economy is that of political ecology which centres ecology by investigating the relationship between political, economic and social factors, on the one hand, and environmental changes and processes, on the other. Political ecology argues that life, the economy and politics are not possible without ecological resources and the processes that sustain the reproductive capacity of various ecologies: political, economic and social life is inseparable from ecological life. Life, the economy and politics are not possible without the foundation of ecological resources, ecosystems, the associated resource flows and sustaining their regenerative capacity. 

Ultimately, there are definite ecological boundaries to social, economic and political activities, choices and contestations. History has shown that the collapse of political institutions and systems is typically triggered by overstretching ecological boundaries. Political ecology therefore centres ecology into political economy. 

Political ecology differs from mainstream environmentalism by adopting and integrating an ecological approach in radical political economy. It applies a political economy lens to contemporary ecological crises.