Gostin argues, “A political community stresses a shared bond among members: organized society safeguards the common goods of health, welfare, and security, while members subordinate themselves to the welfare of the community as a whole. Public health commonly involves governmental action to produce outcomes-injury and disease prevention or health promotion-that individuals are unlikely or unable to produce by themselves. This understanding can help leaders to better anticipate both short-term constraints and long-term opportunities for change. It is essential that public health professionals understand the political dimensions of problems and proposed solutions, whether they hold positions in government, advocacy groups, research organizations, or the health care industry. Politics is central in determining how citizens and policy makers recognize and define problems with existing social conditions and policies, in facilitating certain kinds of public health interventions but not others, and in generating a variety of challenges in policy implementation. Politics, for better or worse, plays a critical role in health affairs. When we say that politics rather than analysis determines policy, we mean that policy is set by the various ways in which people exert control, influence, or power over each other” ( 104). Lindblom sets forth an important distinction: “When we say that policies are decided by analysis, we mean that an investigation of the merits of various possible actions has disclosed reasons for choosing one policy over others. Science can identify solutions to pressing public health problems, but only politics can turn most of those solutions into reality. Often an even greater struggle emerges when policy makers attempt to put that understanding to work, to translate knowledge into action for our collective well-being. The essence of public health, in the eyes of most researchers and practitioners, is a struggle to understand the causes and consequences of death, disease, and disability. 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. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. 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. 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. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. It begins by examining how health problems make it onto the policy agenda. 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. ▪ Abstract Politics, for better or worse, plays a critical role in health affairs.
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