The Role of Health Systems in State Stability: A Scoping Review

Health systems constitute an essential function of the modern state and a central component of the relationship between public institutions and citizens. Beyond their clinical role, state capacity to ensure timely, equitable, and socially acceptable access to health care directly influences perceptions of political legitimacy, institutional trust, and social cohesion. In contexts of health crises, structural inequality, or institutional weakness, failures of health systems can acquire a political dimension, becoming drivers of social contestation, conflict, and political destabilization. Although a growing body of literature links health to human security, governance, and state stability, this research remains fragmented across multiple disciplinary fields, including public health, political science, security studies, and international relations. As a result, the mechanisms through which health systems contribute—directly or indirectly—to processes of state delegitimization, social unrest, or political instability have not been systematically synthesized. The objective of this study is to map and synthesize the academic literature examining the relationship between health systems and the social and political stability of states, identifying key concepts, theoretical approaches, causal mechanisms, and empirical contexts. Specifically, the review seeks to examine how structural failures in health systems, inequalities in access to care, the political management of health crises, processes of securitization, and governmental communication influence public trust, state legitimacy, and social conflict. To this end, a scoping review will be conducted, following methodological approaches widely used to map evidence in emerging and multidisciplinary fields. The review will include qualitative, quantitative, and mixed-methods empirical studies, as well as relevant theoretical reviews, that explicitly address the relationship between health, politics, and social stability. The synthesis will be narrative and analytical in nature, aiming to identify patterns, knowledge gaps, and priority areas for future research. This study seeks to contribute to a more integrated understanding of the role of health systems as determinants of political and social stability, providing evidence relevant both to academic debate and to the design of public policies in contexts of crisis, institutional fragility, and inequality.