New Research on the Role of Politics in Effective Public Health Strategy

Columbia University study shows that funding public health is valuable but political capital might be priceless. 

Image of a StethoscopeA recent Governing article discussed the findings of a research cohort from Columbia University that looked at successful strategies for revitalizing local health departments facing workforce and communications challenges. Emergency funding from the pandemic created a rare opportunity to look at the adaptability of the current public health system to new problems, but also what progress can be made with an influx of cash. In short, they found that funding and workforce are important, but equally vital pieces to the puzzle were realized in public perception, messaging, and political relationship building.

With support from the Commonwealth Fund Commission on a National Public Health System, the research group traveled to five different states to examine whether meaningful progress was being made. And if not, what might there be to learn from the struggles. The article summarized:

Bottom line: they learned real-world change depends on more than funding. America’s public health system is complex and fragmented, with nearly 3,000 local health departments at its core. Dollars might be the lifeblood the system needs, but it takes political capital and bipartisan cooperation to put them to work.

While politics and science have certainly shared a tumultuous couple years in recent times, they are no strangers to this mutual strife. The intensity and concentration of strain brought on by the COVID-19 pandemic acted as an accelerant though, exposing challenges to an almost improbable degree but also lending itself to an equally notable hotwash. What were previously shrouded observances, were laid pretty bare. Generally, and not too surprisingly, what the study found from a messaging standpoint was that the grounding of health in science is an indispensible practice, but it’s application in society is necessarily more abstract and must lean on the political elements that support it.

The public health system requires local and somewhat independent authority to act with quick and decisive measures, but the breadth of resources to sustain that effort are established by and equal only to the value and interest of centralized policy makers. This siloed approach, and sometimes accompanying philosophical discrepancies, have stifled substantial collaboration between health experts and policy makers.

From the article:

For the most part, public health officials don’t talk to state legislators, county executives, city councilmembers or mayors. These are the people who make bureaucratic rules and approve funds and new positions, essential allies in lobbying for legislative changes. Bad or neglected relationships with them are a “pre-existing condition” that can affect public health systems.

Concluding remarks of the study found that the politics of public health requires a closer look at the role played by county commissioners, mayors, and other local elected officials. The full report was published in the Milbank Quarterly and explores the experience of the research teams in Kentucky, Indiana, New York, Washington, and Mississippi. The document details how cross-divisional relationships  in these areas were able to tip the scales for better or worse in establishing a public health system for the future.

Read the full Governing article.

Read the published report in the Milbank Quarterly.