Health policy research tends to focus on medical care practices and disease prevention while the emphasis on political determinants of health is thin at best. Past performance can oft be used as a predictor for future political decisions. Politicians, the electorate and healthcare professionals stand to benefit from such analysis as it improves decision making for policy delivery, election outcomes and healthcare distribution. By expanding the research relating to the political determinants of health our understanding stands to improve. When thinking of health, who is in government and how the health policies might change because of the ideologies associated with that party in power is exceptionally pertinent. The motivation of this research for the health field is to uncover what populist radical right (PRR) parties do when they are in government with regards to health policy. The motivation for the political science realm is to uncover whether parties actually matter, specifically in areas (such as health) that lay far from their programmatic focus.
Populist Radical Right (PRR) parties are a relevant force in Western Europe as they enter governmental coalitions thereby having the ability to change policies; of which health policies, have escaped the keen eye of researchers. Being able to anticipate what these parties will do is fundamental not only to health and political science research, but also to countries’ on the verge of elections. This dissertation uses an in-depth case study approach to understand what the PRR in Austrian and Italian national and subnational governments actually accomplish with respect to health policies over time. Manifesto research is of little interest in this case, because the focus is on implementation, not promises.
Seeing as there is generally very little crossover between political science and health research, this research will add to the small literature available in the hopes of advancing the understanding of how PRR parties impact the development of a countries health systems thereby increasing the predictability of future policies and outcomes as well as generally inspiring more thought and action in this area. Who is in government matters immensely as the health policies parties implement, cut or change have serious consequences for the health of entire nations, especially given the current COVID-19 pandemic.
This dissertation argues that, when in government with a conservative coalition partner, PRR parties impact health in four distinct ways: 1) they implement welfare chauvinist policies implying that health policies for natives are expanded while those for non-natives are decreased. 2) they implement neoliberal policies. This suggests that they decrease the generosity of health policies across the board, but specifically for the non-native population. 3) They implement Conservative health policies. This would involve decreasing health sending and investment for all. 4) Finally, PRR parties in government tend to be anti-scientific in their decision making thereby going against expert opinions.
This research finds that on a national level all four of the above-mentioned arguments are valid, although dependent on the cooperation of the coalition partner, while on a subnational level, the impact is very country specific. In Austria, healthcare at a subnational level was of an area controlled by the Social Democrats and therefore difficult to influence. In Italy, on the other hand, the impact the PRR had on healthcare depended very much on the culture, geography and history of the region.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/169888/1/michfalk_1.pd
