Scoping review identifies growing use of political economy analysis to help design fairer and more effective health systems
A new review has found that understanding politics, power and institutions is essential for explaining why some health policies succeed while others fail, highlighting the growing role of political economy analysis in tackling complex health system challenges.
The study, published as part of the Health Policy and Planning supplement, reviewed 28 studies from around the world to examine how political economy analysis (PEA) is defined and used in health research. The findings show that while there is no single agreed definition or framework, researchers increasingly use political economy approaches to understand how power, interests, institutions and ideas influence health policies and their implementation.
The review found that political economy analysis has been applied to a wide range of health issues, including health financing, governance, workforce planning, service delivery and health information systems. It has been particularly valuable in helping researchers understand why reforms succeed in some settings but struggle in others, especially in countries experiencing health system reforms or political instability.
Across the 28 studies, researchers identified 31 different political economy frameworks and theories, drawing on disciplines including economics, political science and sociology. Rather than relying on a single approach, many studies combined multiple frameworks to capture the complexity of health systems and policy-making.
The review also found considerable variation in how political economy is defined. Only 11 of the included studies provided an explicit definition, although most described it as a way of examining how power, institutions, resources and competing interests shape health policies and outcomes. Despite these differences, a common theme emerged: political economy analysis provides a structured way to understand the political and institutional realities that influence health systems.
The authors argue that political economy analysis can help policymakers move beyond technical solutions by recognising the political, social and economic factors that influence whether policies can be successfully introduced and sustained. They suggest that wider use of these approaches could support more equitable, effective and context-specific health interventions.
Dr. Vineetha Karuveettil, Reader, Department of Public Health Dentistry, Amrita School of Dentistry, Kochi and first author of this review, said: “Understanding health systems requires understanding power. This review maps how political economy analysis helps uncover the institutions, interests, and ideas shaping health policies and outcomes.”
The authors conclude that although political economy analysis remains conceptually diverse, its growing use reflects an increasing recognition that improving health systems requires understanding not only what works, but also the political and institutional conditions that make change possible.
The paper, Political economy analysis of health: a scoping review of concepts, definitions, frameworks, outcomes, and applications, is part of a Health Policy and Planning supplement produced in collaboration with the Health Systems Global (HSG) community. The supplement explores how health policy and systems research can contribute to greater justice and sustainability in health systems.