The Politics of Public Health Policy

Abstract

Key Words agenda setting, incrementalism, health reform, policy entrepreneur, implementation ■ Abstract Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.

The Political Face of Public Health

“…John Stuart Mill's insistence that the State may abridge individual liberty only when harm to others is at issue, but not to constrain the choices of individuals "for their own good" resonates fi rmly in Western settings. 3 These concerns are especially salient in the US, which makes small government per se a point of national pride, but also extend well beyond the 50 states. Constraints on and disincentives for smoking, fi nes for failure to use seat belts while driving, and distribution of condoms to prevent unwanted pregnancies and the transmission of sexual diseases, for example, have all faced libertarian and/or moralistic objections.…”

“…A careful review of the literature on the politics of public health policy by Tom Oliver in 2006 found a sizable body of studies on health policy (which had of course expanded its scope enormously in the United States and elsewhere since Kaufman wrote in 1966), but rather limited offerings in the fi eld of the politics of public health per se. 3 Much of course depends on defi nitions. "Health" nowadays is everyone's affair, from individuals styling their lives to corporations abating their pollutants, so the weight of explication must fall on "public."…”

Provincial Elections and Timing of Cancer Drug Funding

“…Government action is necessary to produce outcomes that individuals cannot produce for themselves 10 . From the perspective of policymakers, "problems" are conditions that members of the public find unacceptable and for which change is desired 13 .…”

“…Translation of any health condition into a political problem occurs through the mobilization of individuals who recognize that their personal needs are shared by others and who subsequently demand action from public officials. Political action can be induced through public opinion, emergence of social movements, interest group mobilization, or voting 10 . Strategic policy agenda-setting and innovative seizing of opportunities by policy entrepreneurs will therefore continue to affect cancer drug funding.…”

“…Speculation has been raised concerning the effect of political forces on health policy decisions 10 . During pre-election campaigning, political parties often use various promises or incentives to win votes from the electorate, including the promise of funding for various resources.…”