Editorial

Abstract

Historical events and cultural practices, along with policymakers’ embrace of economic principles, all play formative roles in policy development, implementation, and success in addressing health outcomes in populations globally. In this issue of World Medical & Health Policy, our authors consider this complex interplay of factors from various angles. Petros, Abay, Desta, and O'Brien note the role of cultural factors in women's disempowerment, even in the face of intentional governmental and financial institution policy interventions. Women, particularly those living in poverty, are more likely than men to be exposed to adverse agricultural working conditions and consume compromised grains, burdening them with increased health risks on both counts. In order to reduce post-harvest loss in Ethiopia and improve population health broadly, the authors argue that impediments to women's empowerment must be meaningfully addressed. Despite the popularity of the adage “women and children first” it is more often the case that these groups suffer disproportionately in many categories of health and well-being. This is demonstrated in Petros et al.'s study of women and men farmers in Ethiopia, and in Mazecaite-Vaitilaviciene and Owens's service evaluation of the oral health of children with disabilities in post-Soviet Lithuania. Large-scale economic and political trends, even those that might be seen as politically positive, such as the restoration of the independent state of Lithuania, or the move toward a more market-based economy, can lead to disruptions that can compromise populations, particularly those with overlapping identities of marginalized groups. This study of oral health inequalities among children with disabilities in Lithuania points to what the authors convincingly characterize as an urgent need for policy reform. Even when it can be demonstrated that economic efficiencies are likely to accrue from certain categories of policy interventions, such as the provision of family planning in developing countries, historical and cultural factors hold sway in shaping such policies to a great extent. Harris examines how consideration of economic concepts such as efficiency, externalities, access to information and equity are also evident in policies providing for family planning in Uganda, Haiti, and the Philippines. She concludes that explicit consideration of economic policy concepts can complement rights-based policy rationales, to the benefit of nations applying such analysis. With regard to access to information, Patanavanich, Suriyawongpaisal, and Aekplakorn, note that the lack of a national database for malpractice claims in Thailand has hampered the ability of policymakers there to develop policy related to malpractice. Their findings with regard to the timing and location of wrongful death claims suggest the importance of such information in crafting meaningful policy. In addition to the policy importance of collecting pertinent information, Wiist points out that tax collection is critical to the provision of public health services and the funding of research to protect the public health. He identifies corporate income tax avoidance as one important cause of unrealized federal tax revenue that contributes to chronic fiscal and public health deficits. By defining the issue as a social determinant of health, he seeks to impel research and political interest in the issue to address its role in perpetuating inequality. Finally the review of Nora Kenworthy's Mistreated: The Political Consequences of the Fight Against AIDS in Lesotho by a physician with personal experience in the field, makes note of how closely intertwined political, social, and medical structures influence the design and implementation of HIV programs. Kaddis relates the book's coverage of factors ranging from disease stigma to misappropriation of funds from international aid organizations as being implicated in the country's flawed policy response to the public health crisis in its midst. These themes comport with World Medical & Health Policy's ongoing interest in advancing understanding of social determinants of health, most recently highlighted in an open access virtual issue available through June 2019 at https://onlinelibrary.wiley.com/doi/toc/10.1111/(ISSN)1948-4682.social-determinants-of-health