Politics and strategy in health inequalities discourses

Public health in the United States still exhibits anxieties about politics: it continues to construe politics to mean health care policy only. This resistance to explicitly acknowledging that political and class inequalities are reflected in, and generative of, health inequality beyond those differences explained by inequalities in access to care, that health is a social hieroglyphic of power relations, ignores the fundamental actors producing health inequality. It then bounds the potential for our research and strategies to eliminate inequalities. I critique these anxieties manifested both in public health research and popular health discourses. Recognizing that health inequalities persist in countries that have attained universal health care systems, I also suggest why this hesitation towards making the politicization of health explicit threatens longterm efforts to reduce health inequalities, why we must confront these anxieties now as we construct health action frameworks so that our set of demands is coherent in informing the trajectory of anti-inequalities strategy. Drawing upon the Latin American Social Medicine framework to interpret the context and production of health inequalities, I then discuss popular movements in the United States and elsewhere that have aimed to reduce health inequalities or social inequalities in domains seemingly tangential to health. Finally I suggest ways in which we can continue developing strategy frameworks for successful health action which build upon and transcend the current political climate in the United States and which center health as a model framework for reducing inequalities in other social domains such as education, labor and housing.