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Abstract
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Among professionals in public health, the political system is commonly viewed as a subway's third rail: avoid touching it, lest you get burned. Yet it is this third rail that provides power to the train, and achieving public health goals depends on a sustained, constructive engagement between public health and political systems. This commentary outlines the importance of such engagement, and suggests ground rules that can help bridge the current divide.
Many of the top public health achievements have been achieved through such engagement, yet mutual suspicion and historically complex working relationships have led to immeasurable lost opportunities. Public health champions are quick to point to examples where “politics trumps science,” and politicians point to “overreach” by public health agencies and advocates.
Both sides would benefit from a new working relationship that puts suspicion and old habits in the past to generate opportunities to save lives and money...
Fundamental philosophical differences over the role of government provide an important backdrop to many public health policy debates. Many interventions employ the powers of government to ensure safety and improve health: these range across a continuum that spans the deployment of credible information, establishment of financial incentives, regulation of products or markets, and mandates or prohibitions of behaviors or commerce. However, for those favoring limited government, many interventions are viewed as government overreach—and therefore antithetical to personal or market-driven decision making...
Public health champions value the prevention of premature death and disability, and achievement of measurable improvements in health status and resulting quality of life. Consequently, public health training emphasizes these imperatives over other factors that impact public decision making. For example, public health officials may advocate interventions that demonstrate positive outcomes on mortality, but are less likely to assess the broader economic and social impacts of interventions.
Public health advocates also fear that the voice of public health scientists will be suppressed or discounted in the political process, particularly when evidence conflicts with positions that are grounded in nonscientific considerations. They also fear that the science will be discounted when businesses or other “special interests” influence the political process. They often view these interests as working against the public good...
To achieve success, political figures must often consider elements that go beyond the science—and to the disappointment of public health advocates, may sometimes value these factors over scientific considerations.
Scientific evidence is important, but decision making in the political arena also incorporates a complex set of economic, ideological, and personal factors. The art of politics involves tradeoffs across competing values and influences, and political figures may not always place a higher value on objective or scientific evidence than on other inputs. For example, elected officials have strong incentives to incorporate business and other perspectives in their decision making, and also respond to evidence on economic impact, relationships, maintaining coalitions beyond an immediate issue, and other factors in addition to public health evidence. Political decision makers are puzzled when advocates dismiss the role of these other factors in decision making, and resent being portrayed as ideologues or uninformed when they take positions outside a scientific consensus...
Language: en |