The problem
Health systems are among the largest and most redistributive institutions modern states operate, which makes them a principal arena of distributional conflict: who pays for care, who profits from its provision, and who bears the cost when access fails. This panel asks where authority over health now sits, through which institutions it is exercised, and with what consequences for the distribution of health and life chances.
Two connected processes are examined. Democratic erosion and executive aggrandisement shift entitlement and financing decisions from legislatures to executive discretion, reshaping who is protected and who pays without formal constitutional change. Corporate and platform actors, including the firms supplying the algorithmic infrastructure of care, acquire governing functions without assuming accountability: they set the terms of access, extract value from clinical data, and narrow the alternatives available to clinicians. Together these describe a relocation of authority rather than a decline in state capacity, a shift in who governs health and in whose interests.
The approach
The panel treats power as an analytical category to be measured and specified rather than invoked, exercised in visible decisions, in the setting of agendas, and in what never reaches the agenda at all. We welcome papers that identify mechanisms and trace the interests behind institutions to their distributive consequences. Comparative, quantitative, mixed-methods, historical and process-tracing designs are all welcome, as are single-country studies where the case establishes a mechanism of wider relevance.
Themes
Topics include democratic backsliding and retrenchment in health system governance; the commercial and platform determinants of health policy, including pharmaceutical and medical-technology pricing and the financialisation of care; the governance of health data and clinical artificial intelligence; the politics of cost containment and austerity; health labour and care work; and methodological contributions on causal inference and on the measurement of power itself.
Practicalities
The panel is convened by the editors of Health Politics, a peer-reviewed journal on the political determinants of health, in association with RC25. Contributions from early-career scholars and from under-represented regions are especially encouraged, and the panel will be composed with attention to regional and gender balance.
