Academic journal article Public Health Reviews; Rennes

The Political Face of Public Health

Academic journal article Public Health Reviews; Rennes

The Political Face of Public Health

Article excerpt


"Oh life, life, remaining always outside."

Rainer Maria Rilke1

In 1966, Herbert Kaufman, a political scientist then at Yale University, surveyed the literature on the politics of public health and bewailed the barren scene. The public health profession tended to view itself as an evidence-based calling that stood above and beyond politics, while political scientists were slow to see how public health agencies and programs illuminated central disciplinary preoccupations such as budget making, recruitment of personnel, and the infl uence of constituencies on the performance of public agencies. Not a single public health text that Kaufman reviewed "included anything more than a passing reference to politics, and most... did not contain even that." Conversely, the political science texts he surveyed contained "virtually no references to the politics of public programs." 2

More than 40 years later, both public health and political analysis have expanded their practical and theoretical reach, but their trajectories are mainly parallel, rarely convergent. The public health community seldom acknowledges that its work is pervasively political, much less explores in depth how that political saturation shapes its professional life. Public health is supposedly driven by science, whereas politics turns on tainted tasks such as raising campaign funds from special interests, pandering to voters, catering to constituents, and indulging ideologies. On the other side, even on the increasingly rare occasions when political scientists step away from formal modelling and inspect concrete public policies, public health programs rarely win their attention. 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." One can defi ne "public health" as the sum of interventions undertaken by the public sector in health affairs, but a formulation that indicates no conceptual distinction between, say, how public programs such as Medicare pay for healthcare and how local public health agencies mobilize to combat bioterrorism or the spread of swine fl u is too indiscriminate to sustain insights into the politics of policy subfi elds. This paper, therefore, with an eye more on utility than precision, takes "public health" to mean the arts and science which advisors to and agents of the State employ in exercising their (public) authority to identify and address threats that derive from sources in the environment for the health of populations (For CEA Winslow' famous defi nition.4(p.39)

Though crude, this formulat ion divides the fi eld of inquiry into traversable units. Health coverage policies (national health insurance or national health services) give people access to care. Policies that support research on, or the practice of, acute care medicine develop the capacity of medical innovators and physicians to cure ailments grounded in physiological and/ or biochemical processes. Public health policies aim to keep groups of people ("populations," and of course individuals within them) from getting sick. To study public health politically is to inquire how public institutions and actors (executives, legislatures, courts, bureaucracies, sub-national govern ments) and stakeholders in the private and voluntary sectors (interest groups, the media) shape the formulation and implementation of policies and programs the public health fi eld proposes and pursues.

Arguably new challenges to and priorities within public health may encourage fresh political responses; conversely, new confi gurations of political power may condition the prospects and progress of public health initiatives, older and newer. …

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