The climate crisis, COVID-19 pandemic and geopolitical escalation are evidence that our ability to respond effectively to large-scale threats to population health and humanity is not limited by our technical know-how. Instead, our ability to navigate complex political terrain appears to be the main (and perpetual) stumbling block. Health policy and systems researchers are increasingly turning to political economy analysis (PEA) to gain greater insights into the political forces that undoubtedly shape our current realities and the futures we envision for health systems and population health. PEA entails building an understanding of the social, political and economic forces and power dynamics that shape a given context and, in turn, how context shapes decisions and the distribution of social wins and losses. This article will zoom in on PEA at the 7^th Global Symposium on Health Systems Research (HSR 2022) in Bogotá, Colombia – which all three of us attended.

Looking at the HSR 2022 conference programme, we could identify only four sessions/presentations that explicitly mentioned “political economy analysis” in the session title. Yet, we noticed that the topic was weaved like a “red thread” through the conference, at least implicitly; we attended many sessions that we thought included PEA without the term ‘political economy’ popping up in the session titles. We suspect that sessions/presentations with titles including the words “politics” (n=14), “power” (n=10) and “priority” (n=4) may have also included elements of political economy analysis, although that was challenging to judge from the session titles only. 

To give you an idea, below you find the overview of HSR sessions/presentations including “political economy analysis”, “politics”, “power” and “priority” in the session title: 

Political economy analysis

1. The political economy of financing primary health care in low- and middle-income countries (satellite)
2. How to integrate political economy into technical reform processes oriented towards Universal Health Coverage (organized session)
3. Political economy analysis of adolescent mental health and well-being – towards intersectoral collaboration and integrative governance (organized session)
4. Global political economy of adolescent mental health and well-being: unpacking a wicked problem (oral presentation)

Politics 

1. The politics and policies of health systems (plenary)
2. Researching (diverse) people and politics in complex systems (organized session)
3. Navigating the politics and policy challenges for strengthening climate resilience within health systems: Thematic Working Group on Climate Resilient and Sustainable Health Systems (organized session)
4. The politics and practices of participation in global mental health: learnings from Colombia, India, Afghanistan, Nepal and the United Kingdom (organized session)
5. Political accountability for Universal Health Coverage: a multistakeholder view on translating commitment into action (organized session)
6. Politics and political decision-making for health and health systems: who is making the call? (oral session)
7. Universal Health Coverage: balancing the technical with the political (oral session)
8. The politics of health system reform: Exploring the power of ideas and interests to constrain change through a case study of South Africa’s NHI policy (oral presentation)
9. Balancing the control-flexibility trade-off within political-managerial trade-off: How do decentralized countries in Africa ensure financing of health systems for effective service delivery? (oral presentation)
10. Politics and vaccine patent rights: a public arenas model of political responses to the COVID-19 pandemic shock (oral presentation)
11. How can we build back trust in global public health? The politics and policy challenges for post-pandemic health systems (oral presentation)
12. Politics and Public Health in the United States: What Does it Mean to be a Public Health Politician? (oral presentation)
13. The map is not the territory: Non-communicable diseases and the politics of Vanuatu’s sugar sweetened beverage taxation (oral presentation)
14. COVID-19 response in Bangladesh: Disentangling the influence of institutions, politics, organizations, and governance (oral presentation)

Power

1. The power of subnational measurement innovation to strengthen primary health care post-COVID: lessons from four countries (satellite)
2. Sustaining southern-led communities of scholarship and practice on health systems: reflections on people, processes, power and decoloniality (capacity strengthening)
3. A game of power and privilege in global health: can you walk the walk and talk the talk? Thematic Working Group Emerging Voices (organized session)
4. Increasing the voice of the unheard – south-south learning and sharing to address power imbalance and health inequity in marginalized populations (organized session) 
5. The power and politics of scaling-up a health systems intervention: lessons from Uganda, Ghana and Malawi (organized session)
6. “You want to deal with power while riding on power”: visualizing the social ecology of power in politics and policy in health systems (organized session)
7. Sites of struggles: the exercise of power in national health systems (virtual oral session)
8. Power and participation in health systems and health system research (oral session)
9. Power unpacked: How do power struggles impact on district health management teams responsiveness to public feedback? (oral presentation)
10. You want to deal with power while riding on power’: global perspectives on power in participatory health research (oral presentation)

Priority 

1. How to institutionalize explicit national health priority-setting and improve MOH budget execution: countries share promising practices from peer learning exchanges (satellite)
2. Priority-setting mechanisms to increase access in health services (virtual oral session)
3. Health system resourcing: who’s priorities? (oral session)
4. Applying a political priority framework to understand the policy and politics dynamics of COVID-19 vaccination in Ghana (oral presentation)

While attending HSR 2022, the lack of PEA, at least explicitly mentioned on the HSR programme, made us wonder about the blurred conceptual and methodological boundaries between PEA and other methods. Moreover, we find that, at HSR and beyond, the use of PEA is somehow “depoliticized”.

How to “re-politicize” PEA then? First, engage key stakeholders including policy-makers in the PEA process itself to co-create solutions to address implementation bottlenecks and structural changes. Second, incorporate practical, actionable solutions into research. The growing field of the commercial determinants of health has provided some good examples in this regard (see The public health playbook). Third, engage with networks of ‘policy changers’, such as the media and civil society organizations. During one of the HSR plenaries, Michael Reich provided a good example of a coalition between researchers and civil society who fought Coca Cola through a soda tax in Mexico. 

If the purpose of our research is to influence policy, we must engage in politics. Re-politicizing PEA and employing it as a tool for revealing power and examining interests, is a worthy first step in this direction. 

And let’s not wait till HSR 2024 in Nagasaki to do so.