South Africa’s National Health Insurance (NHI) reform was enacted in May 2024. It is the country’s most ambitious effort to achieve universal health coverage (UHC). South Africa has one of the most unequal healthcare systems globally. NHI debates are often framed in technical terms, focusing on cost and feasibility. This analysis shows that power relations and stakeholder interests fundamentally shape the reform’s design. This study draws on policy documents, parliamentary records, and stakeholder submissions from 2011 to 2024, with the political background from 2007 and legal documents to 2026. It applies Walt and Gilson’s policy triangle framework to examine how context, actors, and policy content interact. Key design provisions were embedded in the policy from its inception. These include the continuing voluntary role of medical schemes and accreditation frameworks for private healthcare providers. They reflect the private sector’s structural influence and fiscal constraints rooted in South Africa’s political economy. These are not concessions made during legislative passage. Public-interest civil society organizations were substantively engaged in the NHI process. These include health rights groups, trade unions, and rural health networks. Their influence was limited by restricted access to decision-making forums. The analysis draws lessons for policymakers pursuing UHC reform in contexts where the private health sector is powerful and governance is fragmented. Effective implementation requires governance capacity before or alongside financing. Sustained civil society engagement is an essential mechanism of accountability.

Drawing on our book Neoliberal Epidemics: How politics makes us sick (2nd edition, 2025), this article sets out how neoliberalism - the hegemonic political–economy of the last 50 years - has operated as a powerful upstream determinant of population health acting through four interlocking and mutually reinforcing pathways: widening socioeconomic inequality, chronic psychosocial stress, pervasive economic and social insecurity, and the growing power of the commercial determinants of health. Together, these pathways explain how political and economic choices translate into biologically embodied health outcomes over the life course. We illustrate our argument with a case study of austerity. Following Virchow’s insight that politics is medicine “on a large scale”, we conclude that under neoliberalism, health inequalities are inevitable. Addressing them therefore requires public health to confront the political and economic structures that systematically generate stress, insecurity, inequality and commercial harm, rather than relying on downstream or individual‑level interventions.

Citations

• Health Systems as Contested Ground
  Haejoo Chung, Carles Muntaner
  Health Politics.2026; 1(2): e006.     CrossRef

Background
The post–World War II institutional order that structured social protection and public health governance is under sustained strain, yet no coherent alternative has consolidated. Planetary, technological, and social transformations are simultaneously reshaping who lives, who receives care, and whose suffering is normalized. Political configurations are now more decisive for health and health equity than at any point in the postwar period.
Problem
Scholarship on health politics remains fragmented across disciplines, theoretically under-developed in its treatment of power relations, and methodologically limited in its capacity for causal inference. Existing journals either publish health politics research as a secondary concern within broader portfolios or lack the editorial infrastructure to integrate the theoretical and methodological traditions the field requires. No journal currently centres theories of power and institutions as applied to health.
Aim
To establish Health Politics as a dedicated, interdisciplinary journal for rigorous, policy-relevant research that explains how power, institutions, and political conflict shape health and health equity.
Approach
The journal bridges political science, political economy, political sociology, and public health. It is anchored in the political economy of health tradition while engaging theories of power, institutions, and political processes from across the social sciences. It combines methodological pluralism with a quantitative edge, emphasizing causal inference alongside qualitative depth and comparative analysis.
Illustrative cases
Four current examples demonstrate how politics shapes health under crisis conditions: the politicization of vaccination policy, war and humanitarian restrictions in Gaza, climate disaster response in Canada, and platform power and adolescent mental health in EU and United States. Each case reveals distinct political mechanisms through which power produces health consequences.
Contribution
A new scholarly home for power-aware, methodologically rigorous health research that fills a structural gap in the journal landscape and provides an interdisciplinary platform for the emerging field of health politics.

Citations

• Introducing Health Politics
  Haejoo Chung, Carles Muntaner
  Health Politics.2026; 1(1): e001.     CrossRef
• Mapping “Health Politics”: Two Conceptual Traditions, 1976–2025
  Haejoo Chung, Gunah Kim, Hyunbee Shim, Jaehyuck Byun, Kibeum Kwon, Yebin Ahn, Jaeho Gwak
  Health Politics.2026; 1(2): e008.     CrossRef
• Healthcare Politics in Japan: Differentiated Policy Dynamics across Multiple Arenas
  Ryozo Matsuda
  Health Politics.2026; 1(2): e011.     CrossRef