Health is shaped long before anyone enters a clinic. It begins in the daily lives of people confronting systems built far from their realities. Picture a nurse in rural Peru during the height of COVID-19, forced to ration oxygen tanks because procurement budgets were cut and supply chains failed—watching families walk for hours seeking care that should never have depended on market prices or fiscal restrictions.
Or think of the parents in Flint, Michigan, who witnessed their children fall sick from contaminated water—a crisis born not of biology, but of political neglect and cost-cutting choices that placed savings above human safety.
Or imagine a garment worker in Bangladesh, breathing in toxic air and enduring exhausting hours in unsafe factories, her health shaped not by access to a doctor but by global supply chains, corporate interests, and the absence of protections for the people who fuel the world’s consumer economy.
These are not isolated stories; they are mirrors reflecting the deeper forces that determine who thrives and who is left behind.
Behind every price of medicine, every polluted neighbourhood, every overburdened hospital and every unaffordable essential good, decisions are being made—by governments, corporations, investors and lobbyists—often far from public scrutiny. And yet these forces, largely invisible in public debate, profoundly shape the wellbeing of entire populations.
As we approach 2026 and the 18th World Congress on Public Health in Cape Town, we are reminded of a truth communities have known for generations: health is political long before it becomes medical. The political economy of health challenges us to ask—with clarity and courage—who really shapes our wellbeing, and in whose interests?
Health in the Shadow of Markets
For decades, public health narratives have emphasised risk factors, behaviours, access to services and social determinants. While these frameworks have contributed enormously to understanding health, they often leave aside the deeper structures of power that shape everything from hospital budgets to pharmaceutical markets, from national regulations to global supply chains. Health does not exist outside the economy; it is woven into it. Every system of care reflects political choices, negotiations, and trade-offs that determine who benefits and who bears the cost.
The growing influence of market forces in health systems around the world has transformed the landscape of public health. In many countries, the logic of commercialisation has crept into the very core of health governance. Hospitals are encouraged to function like businesses, health becomes a commodity to be purchased, and services are evaluated through the lens of profitability rather than public benefit. In this environment, the boundaries between public good and private interest blur.
Pharmaceutical companies, medical device manufacturers, insurance firms and food and beverage conglomerates play increasingly influential roles in shaping how health is defined and delivered. Their influence is not necessarily malicious; in many cases, innovation and investment have brought incredible advances. Yet these actors operate within the logic of markets, where the incentives are not always aligned with population wellbeing. The development of new medicines, for example, often prioritises profitable markets over urgent global needs. Marketing budgets sometimes exceed research budgets, shaping public understanding of disease and treatment. In such a landscape, access, affordability and equitable distribution become secondary considerations.
The influence of markets goes far beyond the health sector itself. Financial speculation can affect commodity prices essential for nutrition. Trade agreements determine which medicines countries can produce locally. Intellectual property regimes shape the affordability of life-saving technologies. Advertising and media structures influence lifestyle behaviours, diet patterns and the consumption of harmful products. Market forces do not operate in isolation; they permeate every stage of the chain that leads to health outcomes.
The Hidden Architecture of Influence
Lobbying is one of the most powerful tools used to influence health policy, yet it remains one of the least understood. Corporations across industries—from food to pharmaceuticals, from alcohol to fossil fuels—invest heavily in shaping the regulations that govern their products. This influence may take the form of direct political lobbying, engagement in advisory groups, funding of research, or public relations campaigns designed to shape public perception.
Regulatory environments often reflect the success of these lobbying efforts. For instance, policies on sugar taxation, alcohol regulation, tobacco control, environmental emissions and food labelling are often shaped by intense negotiations between governments and corporate actors. The resulting frameworks may represent political compromise rather than optimal public health solutions. When industries shape the rules under which they operate, public health risks becoming secondary to economic interests.
Lobbying also shapes what is studied in the first place. Research agendas can be influenced by funding streams that prioritise commercially promising areas over neglected health burdens. Academic institutions, dependent on private or philanthropic funding, may find themselves navigating tensions between scientific independence and financial sustainability. The result is a landscape where knowledge production is partially shaped by those with the means to invest in it.
Globalisation and the Politics of Interdependence
Health has always been global, but modern globalisation has amplified interdependence in unprecedented ways. Supply chains for medicines, vaccines and medical equipment stretch across continents. Food systems are interconnected through trade and investment. Environmental degradation in one region affects disease patterns in another. Migration, conflict and climate change create transnational health challenges that cannot be contained within borders.
In this globalised environment, political and economic decisions made in one part of the world have ripple effects across others. Trade agreements influence how health systems operate, sometimes constraining governments’ ability to regulate harmful products or invest in public services. Global financial institutions shape national health budgets through structural adjustments, debt policies and fiscal recommendations that prioritise economic growth over social investment. Transnational corporations operate across jurisdictions, making national regulation more difficult.
At the same time, global health governance has shifted towards a complex landscape of public-private partnerships, philanthropic foundations and multi-stakeholder alliances. These actors have brought resources and innovation, but they have also introduced new forms of power and influence that often exclude less powerful actors as marginalised communities and low-income countries. Decision-making in global health is increasingly distributed across institutions that do not necessarily share accountability to the public. Understanding this reality demands a stronger focus on transparency, equity and democratic governance.
The Social Consequences of Economic Priorities
The political economy of health is not an abstract debate. It has profound consequences for how people live, suffer and thrive. When markets dominate health systems, inequalities widen: those with resources can access high-quality care, while populations in vulnerable situations depend on underfunded public systems. When governments prioritise austerity, essential services decline and communities bear the burden of preventable illness. When economic incentives trump public health in food systems, diet-related diseases rise. When industries controlling harmful products influence policy, the collective cost of chronic disease escalates.
Inequalities are not mainly the outcome of personal choices or biological factors; they are baked into the political and economic structures that shape society. They emerge when housing markets push families into unsafe environments, when labour policies fail to protect workers, when education systems reproduce disadvantage, and when environmental regulations allow pollution to harm the poorest communities. The political economy of health is visible in those who live near toxic waste plants, who work in precarious jobs, who have no access to green spaces and who are exposed to climate risks.
Ultimately, the political economy of health reveals how societies distribute risk and opportunity. It forces us to understand that health is deeply political—not in the partisan sense, but in the sense that it reflects collective choices about the distribution of wealth and power.
Democracy, Accountability and the Fight for Transparency
If market forces, corporate and financial interests shape health, then democratic institutions must play an essential counterbalancing role. Strong systems of accountability ensure that health policies reflect public interests rather than private gain. Transparent regulatory processes prevent undue influence. Robust public institutions protect marginalised communities. Independent media and civil society ensure that power is scrutinised and that health remains a public good.
Yet democratic institutions themselves face pressures. In many settings, political processes are influenced by corporate funding, polarisation, or short-term electoral cycles. Public health voices may struggle to compete with well-organised interest groups. Regulatory agencies may face resource constraints, limiting their ability to oversee powerful industries. In such contexts, reclaiming health as a public good requires revitalising democratic systems and strengthening civic participation.
Public health advocates have long demonstrated that change is possible when communities mobilise. The achievements of the HIV movement, tobacco control coalitions, environmental justice networks and disability rights campaigns show that determined advocacy can reshape policies and challenge corporate power. But sustaining this momentum requires building alliances, ensuring access to information and creating platforms for community leadership.
Reclaiming Agency in the Political Economy of Health
Public health professionals, researchers and practitioners often feel constrained by systems that seem too large to influence. Yet reclaiming agency starts with recognising that public health itself is a political act. Every effort to expand rights, strengthen primary care, regulate harmful products, promote equity, or increase transparency is a step toward reshaping the political economy of health.
Reclaiming agency means using evidence to challenge policies that undermine health, but also understanding that evidence alone is not enough. It means engaging with political processes—not as observers, but as participants. It means fostering dialogue between sectors, building coalitions, empowering communities and expanding public awareness. It requires learning from social movements that have successfully confronted power imbalances and holding global health institutions accountable for the equity commitments they profess.
Importantly, reclaiming agency also means reframing how we understand economic priorities. Health should not be treated as a cost to be contained, but as an investment in the wellbeing of societies. A healthy population is a prerequisite for economic stability, social cohesion and sustainable development. When societies place health at the centre of economic planning, the benefits extend beyond healthcare to education, productivity, environmental sustainability and democratic resilience.
Toward a New Social Contract for Health
The political economy of health calls for a new social contract—one that places wellbeing at the forefront of political and economic decision-making. Such a contract would require governments to regulate industries, in order to prevent the production of harmful products, invest in strong public systems, and protect health as a fundamental right. It would require corporations and investors to act with responsibility, transparency and respect for human wellbeing. It would require public health institutions to advocate boldly for equity and social justice.
As the world prepares for WCPH 2026, the opportunity to rethink health systems in this transformative way is within reach. The Congress offers a platform for researchers, practitioners, policymakers, civil society leaders and communities to explore how political and economic forces shape health—and how global public health can respond with courage, evidence and solidarity.
Reclaiming health from the forces that shape it invisibly is not a simple task. But history shows that public health thrives when people recognise their collective power to challenge systems, redefine priorities and rebuild structures in the public interest. The political economy of health reminds us that wellbeing is not merely the outcome of medical care—it is the product of choices about how societies organise themselves.
Public health must not stand at the margins of these choices. It must help lead them.