Day 2: The Political Economy of Health

Activity 6: Case studies on political economy and health inequity

2 hours


To help us to:

  • Further understand ‘political economy’ and some of its key concepts
  • Deepen our ability to use a political economy frame of analysis 
  • Build our confidence when confronted with debates around economic issues and to feel encouraged to pursue ongoing study of political economy

Task 1
Snapshot of the key elements of political economy framing

(30 minutes)

In plenary, we will have a wall presentation and discussion on the key elements to consider when grappling with a political economy analysis. The map is reproduced on the page after the set of case studies below. 

Task 2
Group work: Case studies that consider the interactions across the social, political and economic spheres of political economy

(1 hour)

The following four case studies will help deepen our critical capacity to understand, engage and interface with the political economy of health.

Working in your assigned group, you have 40 minutes of which 10 minutes is reading and 30 minutes is analysis and discussion. Be ready to present your group’s answers to 3-5: 

  1. Read all of the case studies below (10 minutes maximum)
  2. Reread just the case study assigned to your group to analyse
  3. Identify who are the different actors in the social, political and economic spheres that should provide support to the protagonist(s) in your case study
  4. Now map the reality of the support that the protagonist can, in reality, receive from the different actors in your case study and their own responsibilities
  5. Reflect on whether your case study helps you think differently about the significance of a political economy analysis for understanding health equity?

Case Study 1

Nyiko is a 21-year-old, single, black man residing in an outside shack in a peri-urban area. Originally from a small, remote village, he lives by himself and migrated to the city to access income support for his younger siblings who are still in school and living with his Uncle after his parents passed away from HIV the previous year. Nyiko is unemployed but relocated to the city after he heard that there were more job opportunities there. Of late, Nyiko has been feeling overcome by feelings of helplessness and hopelessness. He worries that he is unable to get consistent work opportunities and relies on piece or hourly labour in the city. To get to the construction site, he has to walk three hours daily to a nearby construction company, where he hopes to get picked. He is tired and feeling less like waking up each day to access job opportunities. He has been unable to access any social grants as a young man. Furthermore, Nyiko is reluctant to get tested for HIV as he feels it will not better his circumstances to know his status. Nyiko earns roughly R2,500.00 each month from his work.

Case Study 2

Tshegofatso is a 30-year-old, young black woman residing in a one-bedroom apartment in the city. She is a single mother to three kids, one of whom has a disability. Tshego is considered lucky among her peers as she works as a receptionist in a large corporate and receives benefits with her salary that include medical aid. Despite these benefits, Tshego uses her salary to cover her household needs but also sends money home to her parents who are retired and rely on her income and the pension grant to make ends meet. Unable to afford full-time care, Tshego relies on the help of her neighbour to watch her children from 1 to 4 pm every afternoon after they are done with school. She worries that she is unable to provide her child with a disability, with the specialised care that she knows they need. 

Lately, Tshego has also noticed that her menstrual cycle is very heavy and runs for two weeks every month, and is accompanied by high levels of pain. On some occasions she has taken leave, but her boss has warned her that her frequent absences are bad for the company and she is dispensable. She wants to see a gynaecologist but her medical plan only pays 20% of the cost and she would need to pay a child-minder to watch her children so she can go to the gynaecologist after work. Tshego earns roughly R6,500.00 each month from her salary.

Case Study 3

Lindelani is a 30-year-old woman living in a township outside a small town with her partner, Lerato. The lesbian couple have decided recently that they would like to have children and have chosen to try in-vitro fertilisation (IVF). Lindelani and Lerato are anxious to explore this route as there is no nearby facility at which they can explore having a child. At Lindelani’s last visit to the clinic, the nurses berated her for being in a same-sex relationship and refused to assist her in accessing information about sexual and reproductive health. They also insisted that they should never adopt a child as the child will grow up confused. While both women are employed, they do not earn enough to go through with the adoption process and are hoping that IVF is more affordable and easier, given the stigma in their area surrounding same-sex relationships. A local non-profit organisation has advised them to seek medical support in the city for in-vitro fertilisation, if that is the route they choose to take. However, they worry about the costs of traveling to the nearest city (which is more than four hours away) for the treatment. Recently, the couple’s fears have been compounded by the threats of sexual violence they have received while walking in the street in their neighbourhood, where some local men have indicated that they want to teach them to be women. Both women are feeling anxious and considering setting aside their desires for a child altogether. Lindelani earns R12,000.00 per month.

Case Study 4

Tafadzwa is a 59-year-old domestic worker residing in the home of her employer in the city. She is a foreign migrant who is undocumented. She works to take care of two children and has been working for the family for eight years. She has no children of her own and is ostracised from her family following her decision not to get married and have children of her own. Prior to working for this family, Tafadzwa worked a street vendor with little or no savings for sustainable work. When she found employment with the family, she decided to stop renting the room she had in the township, and moved in full-time with the family. She seldom has time off, but when she does she visits a friend from her local church group and goes to church on Sundays. Recently, she heard on the news that the government has enacted lockdown restrictions following the Covid-19 pandemic. Following her last visit to the church group, Tafadzwa fell sick and started to exhibit symptoms associated with Covid-19. 

Her employer has advised her to go to the nearby public hospital where she has been quarantining. She was hopeful that she would return to work following the quarantine period, but her employer informed her that they prefer to quarantine as a nuclear family, and she can return to work following the lockdown period. They also advised her that since she will not be working, she will not receive a salary, and that they have not been able to pay in UIF contributions as Tafadzwa is an undocumented person in South Africa, so is not eligible for UIF. Tafadzwa is also worried about mounting hospital bills because she is undocumented, so will be charged. She earns R2,800.00 per month for full time work, which is below the minimum wage for domestic workers, that is currently set at R23.19 per hour for each ordinary hour worked (there is no monthly minimum in the law). This means that according to the minimum-wage legislation, Tafadzwa should earn at minimum R4,016.15 (for an eight-hour day, five days a week and 4.33 averaged weeks in a month). 

Task 3
Plenary: How useful are we finding political economy as a tool of analysis?

(30 minutes)

We will conclude this activity with a plenary engagement in which we’ll discuss your reflections on the following questions:

  1. To what extent is the concept of political economy helpful or necessary for grappling with health equity? (5 minutes) 
  2. What is the relationship between political economy and health equity? What is the political economy of health? (5 minutes)
  3. How are different social groupings affected by the political economy of health? (5 minutes)
  4. Thinking of political economy as a story-telling technique again, what is the plot being narrated? Who are the protagonists? What are the conflicts in the story? What is the climax? If the story can be resolved, how would it be resolved? (10 minutes)