Lifestyle versus social determinants of health in Dutch parliament: A text mining analysis

Although public health scholars increasingly recognize the importance of the social determinants of health (SDOH), political discourse on health tends to emphasize downstream lifestyle factors instead. We use a text mining approach to analyse a decade of health debate in the Dutch house of representatives, testing three specific causes of the lack of attention for SDOH: political ideology, by which members of parliament (MPs) from some political orientations may prioritize lifestyle factors over SDOH; lifestyle drift, by which early attention for SDOH during problem analysis is replaced by a lifestyle focus in the development of solutions as the challenges in addressing SDOH become clear; and focusing events, by which one-off political or societal events bolster the lifestyle perspective on health. Our analysis shows that political ideology predicted the topics referred to by members of parliament, with left-leaning members referring more to SDOH and right-leaning members more to lifestyle. However, while some parliamentary periods start with an SDOH focus followed by a focus on lifestyle, the pattern is reversed in other parliamentary periods, yielding inconsistent evidence for and against lifestyle drift. Finally, while the ten-year peak in lifestyle-related language coincided with an important political moment around lifestyle (an anti-smoking initiative), the same was true for the SDOH peak (which coincided with a broader prevention program), and both these peaks were rendered relatively insignificant by the larger and more consistent attention for the health care system. This paper provides a first step toward automated analysis of policy debates at scale, opening up new avenues for the empirical study of health political discourse.