The Political Face of Public Health
Public Health Reviews volume 32, pages 155–173 (2010)
Public health is politically paradoxical because its core conceptual components — the exercise of public authority and the promotion of population health — stand in practical tension that belies their theoretical promise. Across Western nations, public policymakers stand accused of failing properly to honor and support the crucial contributions that public health makes to the improvement of health outcomes and of overinvesting in acute medical care services, the need for which timely interventions in prevention and health promotion might have averted. The dramatic budgetary discrepancies in Western nations between the massive funds devoted to medical care and the minuscule sums allotted to public health are often taken as evidence that in such matters, political leaders are irrational (or perhaps uninformed, or captured by big-moneyed medical interests) and that good public policy would have epidemiologists and other public health experts running, or at least orchestrating, the show.
This paper explores the sources of this tension between population health and political power within the concept of public health and seeks to show why these strains prove to be so durable, indeed irresolvable. The argument and evidence draw largely on the United States, but the supposition — yway, the hope — is that the analysis will also throw light on the politics of public health in other nations.
Rilke MR. In Gadamer Hans-Georg, The enigma of health. Stanford (CA): Stanford University Press, 1996. p.75.
Kaufman H. The political ingredient of public health services: a neglected area of research. Milbank Mem Fund Q. 1966;44:13–44.
Oliver TR. The politics of public health policy. Annu Rev. Public Health. 2006;27:195–223.
Institute of Medicine. The future of the public health. Washington (DC): The National Academies Press; 1988. Available from URL: http://www.iom.edu/Reports/1988/The-Future-of-Public-Health.aspx (Accessed 20 May, 2010).
Tulchinsky TH, Varavikova EA. The new public health: an introduction to the 21st century. Second edition. San Diego: Elsevier Academic Press; 2008.
Institute of Medicine. The future of the public’s health in the 21st century. Washington (DC): The National Academies Press; 2002. Available from URL: http://books.nap.edu/html/assuring_health/reportbrief.pdf (Accessed 20 May, 2010).
Corburn J. Toward the healthy city: people, places, and the politics of urban planning. Cambridge (MA): MIT Press; 2009.
Brown L. Impermanent politics: the Hillsborough County Health Care Plan and community innovation for the uninsured. Health Aff. 2006;25:w162–72.
Brown LD, Stevens B. Market Watch: Charge of the right brigade? Communities, coverage, and care for the uninsured. Health Aff. 2006;25;w150–61.
McKeown T. The role of medicine: dream, mirage or nemesis. Second edition. Princeton: Princeton University Press; 1979.
Cutler DM. Your money or your life: strong medicine for America’s health care system. New York: Oxford University Press; 2004.
Fogel RW. The fourth great awakening and the future egalitarianism. Chicago: University of Chicago Press; 2000.
Kreig JP. Epidemics in the modern world. New York: Twayne Pub; 1992.
Fox DM. The determinants of policy for population health. Health Econ Policy Law. 2006;1:395–407.
Brown LD. Health determinants, policy indeterminacy? Health Econ Policy Law. 2006;1:409–14.
Nathanson CA. Disease prevention as social change: the state, society and public health in the United States, France, Great Britain, and Canada. New York: Russell Sage Foundation; 2007.
Leichter HM. Free to be foolish: politics and health promotion in the United States and Great Britain. Princeton (NJ): Princeton University Press; 1991.
Oliver JE. Fat politics: the real story behind America’s obesity epidemic. New York: Oxford University Press; 2006.
Nathanson CA. The contingent power of experts: public health policy in the United States, Britain and France. J Policy Hist. 2007;19:71–94.
Laugenson M. Personal communication.
Fassin D. Faire de la santé publique. 2e édition révisée. Rennes (France): EHESP; 2008.
Markowitz G, Rosner D. Building a toxic environment: historical controversies over the past and future of public health. In: Stevens RA, Rosenberg CE, Burns LR. (editors). History and health policy in the United States: putting the past back in. New Brunswick (NJ): Rutgers University Press; 2006. (p.130–50).
Proctor RN. Cancer wars: how politics shapes what we know and don’t know about cancer. New York: Basic Books; 1995.
Kingdon JW. Agendas, alternatives, and public policies, second edition. New York: Longman. 2002.
Lohr S. Watch the walk and prevent a fall. New York Times. 2009; November 7. Available from URL: http://www.nytimes.com/2009/11/08/business/08unboxed.html (Accessed 20 May, 2010).
Fee E, Brown TM. The unfulfilled promise of public health: déjà vu all over again. Health Aff. 2002;21:31–43.
Lalonde M. A new perspective on the health of Canadians: a working document. Ottawa: Government of Canada; 1974. Available from URL: http://www.hcsc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/1974-lalonde/lalonde-eng.pdf or (French) http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/1974-lalonde/lalonde-fra.pdf (Accessed 20 May, 2010).
Russell LB. Preventing chronic disease: an important investment, but don’t count on cost savings. Health Aff. 2009;28:42–5.
Russell LB. Is prevention better than cure? Washington (DC): Brookings Institution; 1986.
Brown LD, Kraft MK. Active living as an institutional challenge: lessons from the Robert Wood Johnson Foundation’s “Celebrate Fitness” program. J Health Polit Policy Law. 2008;33:497–523.
Compos P. The obesity myth: why America’s obsession with weight is hazardous to your health. New York: Gotham Books; 2004.
Morone JA. Hellfire nation: the politics of sin in American history. New Haven (CT): Yale University Press; 2003.
Kersh R. Morone J. The politics of obesity: seven steps to government action. Health Aff. 2002;21:142–53.
Thaler RH, Sunstein CR. Nudge: improving decisions about health, wealth and happiness. New Haven (CT): Yale University Press; 2008.
Marteau TM, Ashcroft R, Oliver A. Using financial incentives to achieve healthy behavior. BMJ. 2009;338:983–5.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Brown, L.D. The Political Face of Public Health. Public Health Rev 32, 155–173 (2010). https://doi.org/10.1007/BF03391596
- Public Health
- public policy
- political power
- health reform