History and Health Policy in the United States: Putting the Past Back In

By Buck, Joy | Nursing History Review, January 1, 2008 | Go to article overview

History and Health Policy in the United States: Putting the Past Back In


Buck, Joy, Nursing History Review


History and Health Policy in the United States: Putting the Past Back In Edited by Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns (New Brunswick, NJ: Rutgers University Press, 2006) (364 pages; $24.95 paper)

Since its emergence in the early 1970s, the subfield of policy history has steadily gained a following. In the year 2000, historian Julian Zelizer wrote that "the future of policy history is unclear."1 History and Health Policy in the United States: Putting the Past Back In, substantiates Zelizer's 2005 proclamation that policy history is alive and well.2 In the book's introduction, Rosemary Stevens writes that the purpose of the book is threefold: to demonstrate the relevance of history in policy formation, to reconstruct contemporary health policy issues within the historical context in which they evolved, and to "confirm the place of history as a fundamental policy science" (p. 4). Stevens comments that policy analysts and historians have often worked in isolation but have much to learn from each other. By straddling these two underappreciated disciplines, the authors break down the artificial barriers between state and society to expose how and why tensions between competing social, political, and economic forces often create a misalignment between the issue(s) at hand and the policy solution.

History and Health Policy contains thirteen essays written by leading scholars from multiple disciplines, and is organized into four major parts. Part 1 is composed of three essays, by Stevens, Charles Rosenberg, and Lawrence Brown, that reveal the interplay between and among the public and private actors, the concealment of political ideology through the persistent use of evocative rhetoric, and the development of the modern medical marketplace. For example, as Stevens points out, rather than decisions being on an "inevitable trajectory" (p. 8), there is the potential for decisions to be made differently than they have been in the past. As Rosenberg points out, history contributes to the "fundamental sense of context and complexity, of the determined and the negotiated. The setting of policy is contingent, but it is structured contingency" (p. 28). Rosenberg persuasively argues that, in fact, this structured contingency renders policy and its consequences predictable, at least to some degree.

In part 2, "Rhetoric, Rights and Responsibilities," the authors explore how and why tensions between the competing forces of conflicting agendas and political expediency shaped interactions among industries, health care institutions, health professionals, and the public's health. Nancy Tomes provides a powerful analysis of the role of the consumer movement in remedying inherent power and information imbalances in health care by redefining patients as "health care consumers" and physicians as "health care providers." While she concludes that the movement ultimately failed to achieve lasting reforms, it did result in an increased public awareness of the necessity of patients' rights and autonomy in health care decision making. Gerald Markowitz and David Rosner raise critical questions about whose rights are given what sort of weight in policy decisions. They demonstrate that certain private industries have created environmental hazards that have profoundly impacted the public's health but have persistently refused to take responsibility for creating these toxic environments. As the authors point out, wealthy industries have funded studies that downplay the health consequences of pollution and have argued that "progress" was their most "important product' " (p. 146). While environmentalists and public health advocates have joined forces to call for unbiased research on the links between environmental toxins and disease, legislators and the private sector have been slow to respond. Much of policy is determined behind closed doors and, thus, hidden from the American public. Within this context, questions remain: what is the source of power in policy determination, how is this power used, and to what degree is responsibility for the consequences of these decisions-both corporate and legislative-factored into the decision-making process? …

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