Global definitions of political determinants of health: A systematic review

Political Determinants of Health (PDoH) are increasingly recognised as crucial influences on health inequities, yet their definitions and conceptual frameworks remain inconsistent and underdeveloped. This systematic review aims to clarify the scope and thematic composition of PDoH and explore their relationship with other determinants of health.

A systematic search of peer-reviewed English-language literature was conducted across multiple databases. Studies explicitly or implicitly defining or conceptualising PDoH, their components, or relationships with other determinants were included. Data from 108 publications meeting inclusion criteria were analysed thematically to syntethise key dimensions and conceptualisations.

A total of 108 publications were included. Forty-eight provided explicit definitions of PDoH, yielding 51 distinct definitions. Analysis revealed substantial conceptual fragmentation, with definitions emphasising structural and procedural elements-particularly governance arrangements, decision-making processes, and power relations-were most consistently emphasised, while policy content, equity, political ideology, and mechanisms of protection were less consistently represented. Components of PDoH were reported in 101 publications. Initial coding extracted all components, which were grouped into 15 themes and aggregated into higher-order domains. The most commonly reported themes included democratic status, governance, political discourse, and power. Relationships with other determinants were discussed in 27 publications, showing PDoH as embedded within, upstream from, or interacting with social, commercial, legal, digital, and structural determinants. The majority of included publications originated from the USA and other major anglophone countries, indicating potential geographic and political bias in the literature.

This review highlights the conceptual fragmentation of PDoH in the literature, underscoring the need for clearer, more critical conceptualisations of PDoH that incorporate power dynamics and political contexts. It also highlights the importance of broadening research beyond Western-centric perspectives to encompass diverse political systems. Clarifying PDoH definitions and integrating them with other health determinants is vital to advance research and inform policies addressing the root causes of health inequities globally.