For researchers, funders, and global health practitioners, political will is not an abstract concept but a decisive force that determines whether equitable health outcomes are realized or obstructed. It shapes which policies are prioritized, whose voices influence decisions, and how power and resources are distributed. Daniel Dawes powerfully argues in his book, The Political Determinants of Health, that health inequities are rarely accidental—they are the result of intentional political choices.
Failing to interrogate political will means treating symptoms while leaving root causes intact. Advancing sustainable health equity therefore requires cultivating political accountability, engaging in strategic advocacy, and investing in transformative structural reforms. Without a clear understanding of political will, our health interventions remain vulnerable to inertia, short-termism, and systemic injustice.
As John Catford nicely puts it:
One of the reasons why progress has been less effective in the political arena is that we as health promoters have not placed as much attention on the process or method of policy making as we have on the content or shape of the policy.
Political will is a cornerstone of impact and health equity advancement. Defined as the committed support from decision-makers for specific policy solutions, it determines whether health evidence translates into policy and action. In contexts marked by widening inequities and shrinking development assistance, global health practitioners must grasp and engage with the concept of political will to achieve transformative outcomes.
Jeremy Shiffman has identified four factors that heighten the likelihood that an issue will rise to national-level attention: the existence of clear indicators showing that a problem exists; the presence of effective political entrepreneurs to push the cause; the organization of attention-generating focusing events that promote widespread concern for the issue; and the availability of politically palatable policy alternatives that enable national leaders to understand that the problem is surmountable.
The anatomy of political will involves the interplay of intent, capacity, leadership, and accountability. It reflects a government’s genuine commitment to prioritize and act on specific issues despite competing interests. Political will requires clear agendas, mobilized constituencies, and institutional readiness to implement change. For global health, it transforms evidence into action, ensuring sustained investment and reform. Without it, even the best policies and data fail to drive meaningful progress or equitable outcomes.
No Will, No Way
Failing to properly examine or invest in political will—whether by oversight or design—squanders valuable time, resources, and lives. Political will is not a passive backdrop; it is the engine of transformation. It decides which issues rise, which solutions are funded, and who benefits. Without it, even the most rigorous research or promising health interventions stall. Global health practitioners must recognize that overlooking the dynamics of political will undermines impact, reinforces inequities, and delays the change our systems desperately need. Ignoring political will is not neutral—it is costly.
Fostering Political Will
Seizing key policy windows—such as elections, crises, or reform moments—can accelerate action. Building broad coalitions across sectors and mobilizing civil society creates sustained pressure. Holding leaders accountable through advocacy and transparency ensures follow-through. Finally, legal frameworks can cement long-term commitments, transforming temporary pledges into lasting structural change.
According to Fran Baum and colleagues (2020):
Public health policy actors may create political will through: determining how path dependency that exacerbates health inequities can be broken, working with sympathetic political forces committed to fairness; framing policy options in a way that makes them more likely to be adopted, outlining factors to consider in challenging the interests of elites, and considering the extent to which civil society will work in favour of equitable policies.
What Next?
Health is inherently political, as the most important factors influencing it are independent of the health sector. Many of the things that cause people to be healthy or unhealthy start far beyond hospitals or clinics. This means that improving health isn’t just the job of health workers.
Political will is not accidental—it is nurtured through strategy, advocacy, and vision. Global health must stop assuming it exists, ignoring its existence, and proactively start cultivating it. With intentional efforts, we can move from evidence to equity, from policy ideas to implementation.
References
1. Catford J. Creating political will: moving from the science to the art of health promotion. Health Promotion International. 2006 Mar 1;21(1):1–4.
2. Shiffman J. Generating political will for safe motherhood in Indonesia. Social Science & Medicine. 2003 Mar 1;56(6):1197–207.
3. Dooris M. The politics of health promotion: channelling our anger and our hope for the wellbeing of people, place and planet. International Journal of Health Promotion and Education. 2023 Nov 2;61(6):332–40.
4. Baum F, Townsend B, Fisher M, Browne-Yung K, Freeman T, Ziersch A, et al. Creating Political Will for Action on Health Equity: Practical Lessons for Public Health Policy Actors. Int J Health Policy Manag. 2022 Jul 1;11(7):947–60.
